A Nan Goldin self-portrait, as seen in All the Beauty and the Bloodshed (TIFF)

So often New York appears with a vague rosy glow in documentaries centering on the 1970s and 1980s, no matter how gritty the subject matter: The city was livelier, more exciting, and the art more innovative back then, whether it’s the coke-fueled nights of Matt Tyrnauer’s Studio 54 or the downtown punk and creative scenes of Lydia Lunch: The War Is Never Over and Kenny Scharf: When Worlds Collide. Laura Poitras’s documentary biography of photographer and activist Nan Goldin effectively avoids that sentiment by fluidly connecting the past with the present. In fact, the past remains omnipresent: There are always causes to fight.

The director introduces Goldin on screen as a leader of P.A.I.N. (Prescription Addiction Intervention Now). At what was once called the Sackler Wing at the Metropolitan Museum in March 2018, the group holds a public protest against the august institution’s acceptance of millions from the Sackler family, owners of Purdue Pharma, the manufacturers and aggressive marketers of OxyContin and other opioids. It drew media attention and was the beginning of the movement to have art institutions refuse Sackler donations, or “blood money” in Goldin’s words, from the billions of dollars they reaped from the opioid epidemic. Throughout, Poitras intercuts P.A.I.N.’s actions at Harvard University, London’s National Portrait Gallery, and the Solomon R. Guggenheim Museum, where Goldin’s work is in the permanent collection.

Goldin became addicted to OxyContin after surgery in 2014. At one point, she was downing 18 pills a day and, for a better high, began snorting. (In a New York Times interview, she stated that in 2014 she was prescribed 40 milligrams a day because of tendinitis before she had surgery.)

Investigative reporter Patrick Radden Keefe, who wrote an exposé on the Sacklers for The New Yorker, which lead to the award-winning Empire of Pain: The Secret History of the Sackler Family, gives a CliffsNotes rundown of the billionaire Sacklers and Purdue-promoted opioids, with a clip from a 1996 commercial targeted to doctors that grossly denies the pills’ addictive qualities. However, this is not the purview of Poitras’s film. For a closer look of the opioid epidemic, Alex Gibney’s four-hour Crime of the Century covers the legal avenues that had been attempted to hold the Sackler family accountable.

In short order, Poitras delves into Goldin’s personal history, and it does seem like the artist reveals all before the camera—in more ways than one. In her voice-over, Goldin separates, as she will throughout, her “real memory” from the visual narrative within the barrage of photographic material, ranging from the family album to her prolific career output. Often there are two narratives flowing on screen, her recollections and an evocation of another era.

The director bookends her film with Goldin remembering her sister, Barbara, who committed suicide at age 18 in 1964. The sisters were raised in the “banality of suburbia. “Don’t let the neighbors know” was their mother’s admonition regarding the family friction centered around her rebellious older sibling. Just an adolescent on the day of Barbara’s death, Goldin overheard her mother tell her father that they would tell the rest of the family the suicide was an accident. Returning back to her teenage years toward the end, Goldin reveals more on why she lived with foster families, explaining further how her friendships became the most significant relationships in her life. They became the subject matter of her emerging artwork that began in Boston’s early-1970s gay scene: in situ color photos of partying, sex, and drugs.

After her halcyon days in mid-1970s Provincetown, Massachusetts, her center of action moved in 1978 to Manhattan’s Bowery, which she refers to as her “headquarters.” (The story of how she was able to bring a heavy crate of her artwork to a curator’s gallery is less than glamorous and more transactional than one might imagine.) For a while she lived on tips as a go-go dancer in New Jersey, where she legally couldn’t go topless. She also was a sex worker in a New York brothel to fund her photo supplies. When a friend complained to her about the inclusion of a photo of the said friend having sex, which was part of Goldin’s seminal slideshow exhibit, The Ballad of Sexual Dependency, Goldin began filming herself and her boyfriend in a series of unflinching NSFW photos. It’s one example of her motto: “I think the wrong things are kept private.”

The most heartfelt and riveting section, the documentary’s centerpiece, occurs after Goldin has returned from drug rehab to a New York art scene decimated by AIDS. Here is where the activism of ACT UP from the 1980s mirrors P.A.I.N.’s media-grabbing actions 30 years later against the Sackler family—Goldin fully acknowledges P.A.I.N. took its cues from ACT UP. That group confronted the federal government and pharmaceutical industry’s inaction in funding and finding treatment for AIDS, while calling out homophobia loud and clear.

In 1989, Goldin curated the exhibit Witnesses: Against Our Vanishing, which included work from dozens of artists, and asked David Wojnarowicz, an artist in several fields, to write the introduction for the catalog. The scathing result ignited a firestorm of a controversy and resulted in the National Endowment of the Arts withdrawing its funding for the show at its New York gallery, Artists Space. Decades later, Wojnarowicz’s indignation over the Reagan administration and the Catholic Church comes off like a blast of heat. For a closer look on the artist, the film Wojnarowicz: F**k You You F*ggot F**ker is a must-see. In comparison, Goldin, has a softer presence but is no less determined and unexpurgated in her views.

Energetically edited, All the Beauty and the Bloodshed touches upon each subject—her bio, her activism, her career—without succumbing to what could be a historical footnote. Certainly, it is among the strongest films about the 1980s New York art scene, especially for its expansive outlook. While it depicts a tale of triumph over a painful family history, an abusive relationship, and addiction, triumphalism is on mute; the last chapter returns to what happened to her sister Barbara and it points to the continuing death toll from opioid addiction. (It’s here where Goldin reveals the title’s rueful meaning.) If there is a sense of victory, then it has come at a tremendous cost.