Introduction: Real and imagined spaces

The hospital’s ambiguous relationship to everyday social space has long been a central theme of hospital ethnography. Often, hospitals are presented either as isolated “islands” defined by biomedical regulation of space (and time) or as continuations and reflections of everyday social space that are very much a part of the “mainland.” This polarization of the debate overlooks hospitals’ paradoxical capacity to be simultaneously bounded and permeable, both sites of social control and spaces where alternative and transgressive social orders emerge and are contested. We suggest that Foucault’s concept of heterotopia usefully captures the complex relationships between order and disorder, stability and instability that define the hospital as a modernist institution of knowledge, governance, and improvement. We expand Foucault’s focus on the disciplinary, heterotopic qualities of the hospital to explore the heterotopia as a space of multiple orderings. These orderings are not only biomedical. Rather, hospitals are notable for the intensity and heterogeneity of the ongoing spatial ordering processes, both biomedical and other, that produce them. We outline an approach to heterotopias that traces the contingent configuration of hospital space through relationships between the physical environment, technologies, and persons, while simultaneously considering the kinds of spatial imaginings, hopes for the future, and emotional responses that are rendered possible by those configurations. We provide three thematic frameworks through which the heterotopic and contingent qualities of hospital spaces might be explored: boundary work, generating scale, and layered space.