In this paper we examine how clinicians at a community mental health center
are responding to the beginnings of changes in the health care delivery sy
stem, changes that are designated under the rubric of ``managed care.'' We
describe how clinicians' attitudes about good mental health care are embodi
ed in what sociologist Pierre Bourdieu calls their habitus, i.e., their pro
fessional habits and sense of good practice. Viewed in this light, their mo
ral outrage and sense of threat, as well as their strategic attempts to res
ist or subvert the dictates of managed care agencies, become a function of
what Bourdieu terms the hysteresis effect. The paper is based on ethnograph
ic fieldwork conducted by a team of researchers at the mental health and su
bstance abuse service of a hospital-affiliated, storefront clinic which ser
ves residents of several neighborhoods in a large northeastern city. Data c
onsist primarily of observations of meetings and interviews with staff memb
ers. We describe four aspects of the clinicians' professional habitus: a fo
cus on cases as narratives of character and relationship, an imperative of
authenticity, a distinctive orientation towards time, and an ethic of ambig
uity. We then chronicle practices that have emerged in response to the limi
ts on care imposed by managed care protocols, which are experienced by clin
icians as violating the integrity of their work. These are discussed in rel
ation to the concept of hysteresis.