Regulation from Without

Abstract

Two preoccupations frame these remarks on the foregoing chapters: margins and managed care—specifically, the depletion of the first and the ascendancy of the second. I use the term managed care (a bit loosely, perhaps) to designate the growing practice of subjugating to the accountant’s ledger certain “medical” decisions about what constitutes appropriate or allowable care (cf. Schreter, 1993). In particular, I want to flag the constraints it is likely to impose on deviations from set norms. By margins, I mean those endangered spaces on the civic landscape that supplied forgiving accommodations to misfits of all sorts, at a cost conventionally figured in disgrace rather than dollars. Here, persons who failed to meet thresholds of acceptability elsewhere—by virtue of temperament, damage, pathology, or the rude wish to be left alone—could find a home. Precincts of “disreputable housing” (Groth, 1983), zones of discard (Schneider, 1986, p. 181), skid rows, and tenderloins—such places provided welcomed “anchors for people in a social and cultural limbo” (Groth, 1994, p. 130). Put simply, they made it possible for alternative livelihoods to make do, if not thrive. I do not want to romanticize the appointments or civilities of such spaces, which were meager and few, but neither do I want to discount the freedom they accorded those whom difference could make difficult. Above all, I want to stress the logic of accommodation implicit in their operation. It was the flexibility of habitat—literally, the room to move—and not some elaborate underworld code of conduct, that made it possible to hold trouble within tolerable limits.

... the world will have turned into one huge hospital where everyone is everybody else’s humane nurse.

Goethe, as cited in Rieff, 1968, p. 24n