Redistribution and its Discontents: On the Prospects of Committed Work in Public Mental Health and Like Settings

Human Organization, Summer 2006 by Hopper, Kim

Refusal of services has long been treated as prima facie evidence of a disordered mind; this paper inquires instead into the tainted nature of the offer. I first sketch the conflicted nature of relief in the American welfare state-hedged so as to ensure only the truly needy will apply-and the way symbolic means are deployed to that end. I then go on to suggest that refusal to accept aid on those terms (even among the street-dwelling, psychiatrically disabled homeless) may be a last-resort exercise of self-respect. This dynamic has an ancient pedigree, whose mythic prototype is Philoctetes. Equally striking is the legacy of the outlaw hero of the story, apparent in the ways frontline workers today contrive to outwit the system's structural constraints. These anomalous forms of "committed work"-acts of resistance delivering both effort and benefit that cannot be bought-are my real concern. I review ethnographic work suggesting that such acts of common ministry are well-documented exceptions to the broad commodification of care and take their toll on the workers themselves. The paper closes, ruefully, with an acknowledgment of the contradictory valence of system-sustaining resistance that is so easily co-opted and integrated as compensation for "institutional bad faith" (Bourdieu).

Key words: resistance, emotional labor, homelessness, care work, recognition

So distribution should undo excess And each man have enough.

King Lear, Act IV, Scene I

Anthropologists have been busy chroniclers of orders of regard in societies at varying degrees of technological achievement, economic inequality, cultural diversity, and political rule. Whether yams or yachts, shells or shaker furniture, pigs or Proust, we attend to implicit codes, their studied display and decipherment, and all that betokens in turn. Material resources matter, but their symbolic freight so confounds the invoice of distinction that to ignore it is to leave the job half-done. Even the simplest inventory of possessions must tally meaning as well as number; scarcity and envy speak to larger questions of prestige, position, and control. Goods are "less objects of desire than threads in a veil that disguises social relations under it" (Douglas and Isherwood 1979:202).

This article will argue that the same logic applies to the unearned, hand-me-down offerings of the welfare state. Even here, in the domain of redistribution, where basic need not frivolous desire is the issue, considerations of regard condition the offer of assistance. The frontline ranks of relief turn out to be notable not only for their insufficiencies, but for the way that attitude intensifies them. More remarkable is the presence in this same system of workers whose tender labors manage to redeem the debased coin of poor relief and public care. I want to explore what those labors amount to.

Provocations

I can date with some precision when I first realized how vital the distribution mechanism might be to local economies of relief: January 27,1982. The day before, Rebecca Smith, a woman who lived in a cardboard box on the streets of Chelsea in New York City, had been found dead in her makeshift home. Ten days earlier, she had made news as the first person for whom the city was to go to court to obtain a 72-hour protective custody order, under a new law aimed at people found to be in immediate medical risk and unable to appreciate the consequences of their actions. For over a week, Ms. Smith had fended off a cavalry of would be interveners. Having exhausted outreach, city officials turned to coercion and filed the requisite court papers on the prior Friday afternoon. That ensured a weekend of inaction (when the courts are in recess) and that delay would, in turn, prove fatal. Commentators (myself among them) rushed to read her death as emblematic of something larger-that "something" usually construed either as mental illness abandoned (outreach workers had diagnosed her as schizophrenic) or, in more sweeping interpretations, homelessness recalcitrant.

In the event, Rebecca Smith went down in editorial history as the woman "who said no," but whose "no" was suspect because she "didn't have her wits about her" (New York Times, editorial, 29 January 1982). It seemed to me then, as it does today, that to accept that formulation is to miss the more troubling lesson of her life (and the way, incidentally, its closing may echo that of an earlier fictional refusenik-Dickens' character Betty Higden's unyielding determination "to die undegraded"1). In those final aid-resistant hours, it was as if she had chosen to make her stand, come what may, on the side of some kindred resolution. Put differently, it was as if she demanded-not justice at last-but injustice, consistently applied. No eleventh hour heroics, no last-minute salvage operation. Even the court calendar worked to her advantage.

What do such extreme instances of relief refused have to teach us about the terms that govern ordinary transactions of urgent aid? Set aside for the moment the exceptional circumstances of Ms. Smith's death (though hers was not the first, or last, such street death). I want to explore the possibility, arguably embodied in Rebecca Smith's unyielding "no," that some aboriginal sense of self-regard is at work in these acts of refusal, however self-destructive the consequences. To do so, it will be necessary to examine what it means to accept assistance on the state's terms.