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Sociologists have theorized about two ways in which neoliberal capitalist society manages its poorest members. First is the punitive mode, in which the police, courts, and other government offices punish the poor to keep them in line. The second is the paternalistic mode, in which public agencies and nonprofits treat the poor as wayward children who need to be told how to behave.
In a new paper, a young sociologist has formulated a third way, compatible with the first two, in which society manages the poor: palliative governance. Applying 15 months of ethnographic research at a van-based needle-exchange program in Los Angeles that offers clean supplies to drug users—many of whom are homeless—he gained insight into how government and nonprofits often try simply to keep poor people from dying, rather than actually solving any of their problems or addressing structural issues in the system.
The paper’s author, Anthony DiMario, a PhD candidate in sociology at the University of Southern California, spent more than a year volunteering at the Mobile Exchange of Los Angeles, observing how exchange workers interacted with clients. What he found was a program operating within a gossamer-web system of nonprofits and government initiatives, designed to keep clients from overdosing or contracting needle-borne diseases. What the program didn’t do, because it had neither the funding nor the mission to do so, was attempt to solve the other intractable problems that often coexist with poverty. Clients came to the needle exchange, received clean needles and anti-overdose medication, perhaps ate a doughnut, and went back, in many cases, to the streets.
Drawing on this research, DiMario describes palliative governance as a way of interacting with the poor in which the goal is to make sure that people don’t die—the bare minimum that can be done by “a state that has neither the means nor the will to care for people,” he says. In his paper, he set this against the two other established models of poverty governance, punitive and parental governance, and explains how the three work in concert to supervise and control the poor, without changing their lot or the structural deficiencies that keep them poor.
“This article theorizes palliative governance to describe forms of regulation that neither punish nor parent, but simply try to keep very poor subjects alive through a series of stopgap measures,” DiMario writes. “An analysis of palliative governance broadens our understanding of how institutions interact with subjects and each other, while revealing the paradoxical ways states both expose and protect bare life.”
DiMario became interested in the interaction of government forces and the lives of people in difficulties as he was growing up outside of Boston in the middle of a wave of heroin and opioid addiction, he recalls. During his undergraduate years at the University of Vermont, several hometown kids overdosed, while others went to prison for selling drugs. The experience gave him an opportunity to contrast “media representations of drug crises” with how things appear to people living through these problems.
In graduate school, where he studied drug policy, he worked with on-the-ground harm-reduction programs in Los Angeles. “I was interested in civilian emergency-response networks,” he says. “It’s not just overdoses; that’s a big factor, but the risks of being on the streets are so much more than that.” This paper came out of his master’s thesis.
What he found through his ethnographic work was that “hospice as a social policy” was taking root within the government agencies that oversaw social services for vulnerable populations such as the homeless and those addicted to drugs, as well as the nonprofits that do the outreach. The analog, he says, might be humanitarian interventions in the Global South, where overseas donors send medicine and funds to keep people alive. Rarely, though, do those interventions raise the standard of living of the recipients in any meaningful way or enable them to live with dignity.
“Palliative poverty governance represents a characteristically unique set of institutional behaviors with distinct motivations from those in previously articulated models,” says Lindsey Richardson, an associate professor of sociology at the University of British Columbia. “DiMario identifies relationships between punitive, paternalistic, and palliative modes of poverty governance to understand dynamics at play and the different types of institutional actions that fall into each category.”
The paper describes a third category of poverty governance, the “minimalistic interventions” of official agencies and nonprofit groups that seek to keep the poor barely surviving, she says.
“DiMario has advanced our understanding of institutional approaches to the ‘management’ and ‘mitigation’ of poverty in a way that is empirically justified, theoretically well-reasoned, and represents the articulation of an advance in the subfield,”
Richardson says.
Anthony DiMario, “To Punish, Parent, or Palliate: Governing Urban Poverty through Institutional Failure,” American Sociological Review, vol. 87, no. 5, 2022, pp. 860–88.
Read more stories by Chana R. Schoenberger.