Disability and the Normalization of Oppression
Author: Paul Dodenhoff : Contact: Disabled World (www.disabled-world.com)
Published: 2015-12-04 : (Rev. 2020-12-02)
Synopsis and Key Points:
Paul Dodenhoff writes on whether it is now the time to scrap the Work Capability Assessment (WCA).
The most blatant form of marginalization of disability is arguably the institutionalization of mental health and disability that we saw both in Britain and the US up until the early 1980's.
Unfortunately for disabled people within the UK, disability is often presented as the opposite of self-responsibility, independence and self-reliance.
Recently, a report by the University of Liverpool and University of Oxford in the Journal of Epidemiology and Community Health estimated that up to 590 disabled people may have committed suicide between 2010 to 2013 as a result of the Work Capability Assessment (WCA). The report found that 590 extra suicides, 279,000 extra cases of mental ill-health and 725,000 extra prescriptions for anti-depressants occurred in areas within the UK where people had work capability assessments (WCAs) in place. Of course, such evidence is naturally refuted by the UK's Department of Works and Pensions (DWP), this time for being 'wholly misleading' and 'failing' to establish cause and effect.
The Work Capability Assessment (WCA) is the test designed and used by the Department of Work and Pensions (DWP) in the United Kingdom to determine whether disabled welfare claimants are entitled to Employment and Support Allowance. Atos Healthcare, part of the multinational company Atos, conducted the assessments until 1 March 2015 when the American firm Maximus - trading as the Center for Health and Disability Assessments - took over. The test has been criticized for the high proportion of those tested being found 'fit for work'.
However, it is nigh impossible for any research to establish absolute cause and effect because all that any research is designed to do and can do is to illuminate correlations between different variables and therefore highlight a possible connection or problem. Cause and effect can never be 100% certain and nothing than be proved beyond absolute doubt - that is the main fallacy of the scientific method.
However, enough evidence existed before this report came out, presented from families of the deceased and from the Coroner's office to suggest a disturbing link between WCA's and the negative mental health impact of the process on sick and disabled people. And without being facetious, the only way that the DWP is going to be absolutely convinced of cause and effect between WCA's and the suicide of British citizens, is if hundreds of these victims come back as ghosts to haunt the parliamentary offices of Iain Duncan Smith himself.
Aim of the WCA
The aim of the WCA is to sort sickness or disabled benefit claimants into three groups:
- Fit for work
- Unfit for work, but fit for pre-employment training
- Fit for neither work nor training
However, it was designed to be a much tighter assessment than previous existing assessments, where eligibility for welfare benefits is not actually determined by a disability or a negative health condition itself, but rather by how ability to 'function' is affected. Thereby focusing on what somebody can do rather than focusing on what they cannot - while arguably also ignoring the pain or effort involved in actually attempting or completing a function in the first place.
It is also an assessment that is primarily intended to get most people back into work at some future date, despite ill-health, despite mental-health issues or disability, and even without an even basic acknowledgment of the impact of such problems on physical or mental 'functioning' within the 'real' world and within a real employment environment. This shift of focus also conveniently ignores and discounts the discriminatory practices of some employers towards mental health and disability, and the hostility, abuse and violence committed towards people with mental health or learning disability by fellow employees.
The ball of employment is therefore firmly tossed back towards the sick and disabled, where it is up to you to make yourself 'competitive' in the 'market place', and up to you to work through any pain and discomfort that work may generate because of sickness or disability. The WCA has therefore been amongst the most controversial and hated acts of British parliament in my lifetime, with many organizations and charities arguing since day one of its inception that the WCA is not only humiliating, unfair and unjust, but often also woefully inaccurate.
A parliamentary briefing paper released in 2012 also highlighted concerns over the inaccuracy of the assessment process:
"Concerns have been voiced about the new Work Capability Assessment and the number of people being deemed "fit for work" under the new test. The WCA is, in general, much tighter than the Personal Capability Assessment (PCA) for incapacity benefits and it was expected that more claimants would fail the new test, but statistics so far suggest higher rates of "dis-allowance" than anticipated".
"In March 2010 Citizens Advice, in association with the mental health charity Mind, published a report based on feedback from its advice bureaux about the impact of the new benefit regime. The report, 'Not working: CAB evidence on the ESA work capability assessment', which was endorsed by a range of charities and pressure groups, presented evidence suggesting that people with serious illnesses and disabilities who could not reasonably be expected to work were being found "fit to work" under the new test, and argued that a more sophisticated approach to assessment was needed. The main findings were:
- Seriously ill people were being inappropriately subjected to the WCA, since there are fewer exemptions than under the previous Personal Capability Assessment.
- The assessment was not measuring fitness for work effectively. Among other things, it was not taking sufficient account of variable symptoms or the seriousness of underlying conditions, or the context of the work environment.
- Application of the assessment was producing inappropriate outcomes"
Inappropriate outcomes indeed, and inappropriate outcomes often argued to have largely been caused by over-zealous target setting by government that pressurizes private companies involved in the WCA (i.e., formally Atos and now Maximus) into disallowing as many benefit claimants as possible from welfare.
However, here are two very interesting facts for you. Firstly, almost half the people going through the WCA have a mental health problem as their main condition, a condition that may often be hidden from sight and not always displayed. In addition, the proportion of people with a mental health problem or behavioral problems claiming welfare benefits have grown in recent years compared to those with a physical condition. Secondly, there are nearly 1.5 million people with a diagnosed learning disability within the UK and only a small proportion of these are in employment - so all of these will also go through the WCA at some point.
As a consequence, there is a significant majority of people being pushed through the WCA process on a daily basis who would be described as highly vulnerable and unstable. People with fluctuating mental health conditions, functioning problems and disability that may be greatly affected by a process deemed to be extremely humiliating and traumatic. People with complex needs that may often be difficult to unravel and which may additionally be complicated by mental health issues, learning difficulties and in some cases addiction to, or some kind of dependence on drugs and/or alcohol.
Even if you are managed to be believed that an illness or disability makes you competently unfit for work or training, this is still something that will certainly be reviewed at any point in the near future and usually between 3 months to 3 years. Therefore as a consequence, any disability or condition has effectively been redefined to what you can do and not what you can't, which opens up many possible avenues to pressurize people into finding some kind of employment, where any illness, condition or disability is now never regarded as a permanent, automatic obstacle - no matter how serious.
Normality of Work and Oppression of Disability
I have been one of the few researchers within the last few years that have drawn a direct connection between the WCA and a shoring up of the ideology of the 'work ethic' - something that has often been argued by politicians of all colors as being in sharp decline. However, changes to Britain's benefit system is not a new thing and over the last 20 years there have been several major reforms, all aimed at making benefits harder to claim.
One of the key motivating factors involved for reform is the decline in traditional manufacturing jobs within the UK, which has caused concern over an increase in male unemployment and primarily because males are argued not to be taking up employment opportunities that they may view as not being traditional 'male' roles. A second key factor is the numbers of people claiming inability to work due to sickness or disability. It's a concern that centers upon welfare benefits being 'too' generous, something which encourages people to claim welfare rather than taking up jobs that they don't particularly want to do - thereby creating a system that only encourages laziness and dependency.
In more recent times, welfare reform has also been argued by politicians to be motivated primarily by a need to reduce unsustainable public spending after the 2008 global financial meltdown. However, if we take a close look at political speeches and parliamentary debates going back many, many years, we can easily find clues that highlight an underlying political ideology that views any form of employment as primarily the route to independence and self-responsibility, and any form of welfare or charity as the route to dependency and laziness. And an ideology that therefore aims to constantly reassert the 'normality' of work.
Disability, Difference and Dependency
Unfortunately for disabled people within the UK, disability is often presented as the opposite of self-responsibility, independence and self-reliance. Where having a disability not only tends to designate individuals who may differ from a measurable or visible 'norm' of some kind, but a norm that also views disabled people as dependent, unproductive and unreliable - particularly within the workplace. It's a social representation that is also continually at odds with the ideology of the 'work ethic'.
Moving the welfare 'goal posts' from a focus on sickness or disability itself and more towards 'functioning' or what people can still do, in essence fails to protect vulnerable people from state or employer abuse, nor combat the negative social stereotypes that surround disability on a daily basis. Employers will not employ people who are viewed primarily as unproductive and potentially problematic, even if research exists that often expose such perceptions as being cruelly inaccurate. But in order to make themselves more competitive in the marketplace, disabled people are now being 'encouraged' by our politicians to work for less than would be paid to an able-bodied worker, and with suggestions that disabled people should work for well below the national minimum wage. And that's a suggestion that applies to all disabilities, no matter how severe.
Social stereotypes can be extremely deep rooted within the UK and none so more than those surrounding disability and mental health. However, since 2008, another growing social stereotype has been circulating, one generated by right wing politicism and its associated media - that some disabled people are just fakes and scroungers. It's another aspect of the oppression that disabled people within the UK have suffered for a few hundred years now, and oppression that comes from a number of different angles. Including the medicalization of difference, the marginalization of disability, difference as a 'freak' of nature, and the widespread abuse, harassment and violence that disabled people may face for being designated as 'inferior', or indeed for being 'scroungers'.
- The Medicalization of 'Difference':
Science and medicine has produced a society that now measures and monitors physical and mental ability, practically from the day we are born. If we don't fit into the 'average' range of physical or mental characteristics then we get pigeon-holed and filed away with a label that effectively marks us for life as being 'defective' in some way. Which also introduces us to not only constant medical scrutiny, but interventions aimed at cure or at least controlling the disability. It is highly significant that the term 'invalid' had been used for many years within the UK to signify disability, a term that also means both 'defectiveness' and 'illegality. The concepts of 'defectiveness' and 'illegality' are concepts that we still see applied to disability today within the UK, and not just a physical and/or mental defectiveness, but a 'moral' defectiveness that surfaces in the 'scroungers' and 'layabout' rhetoric of our politicians and media. One longstanding and consistent 'concern' that the British ruling classes have had for hundreds of years, is that 'defective' and 'immoral' citizens are undermining our national interest by either draining national resources with a dependency on state help or charity, or not being able to be productive by being 'employed' nor able to 'fight' in armed conflicts. Arguments we still see raised in parliament today, particularly over benefit reform.
- The Marginalization of Disability:
The most blatant form of marginalization of disability is arguably the institutionalization of mental health and disability that we saw both in Britain and the US up until the early 1980's. However, Britain's disabled are still largely invisible within society today and we rarely see disabled people in public spaces, rarely see disabled people in 'visible' employment, rarely on TV and rarely in positions of power. So, marginalization is not just about locking people away within institutions, but about denying them access to opportunities such as employment, adequate housing, schools, universities and social services, as well as denying access to public spaces such as parks, shops and transport. Many disabled people report a lack of access to transport that virtually blocks their route not only to independence, but opportunity. Additionally, disabled people report abuse, harassment and violence that may occur in public spaces when they do indeed become 'visible' at any particular point, especially when traveling alone.
- Freaks of Nature:
Disability is certainly viewed by some within the UK as either being a personal liability that limits personal opportunity, or a national liability that is a drain on public resources. But it is also an area of great amusement to many Brits, where we like to laugh at and poke fun at people who look or behave 'different' from the crowd - and I am not just talking about the Victorian 'freak' shows of yesteryear. Undoubtedly, tied up in the 'freaks of nature' thinking are the notions of superiority, inferiority and domination. Nobody wants to be at the bottom of any kind of social hierarchy, but unfortunately Britain is a deeply divided and hierarchical nation where everybody is deemed as having a 'function' within society and where certain roles are deemed 'superior' to others. That is also the nature of the beast called 'employment', where at the very least we are usually subordinate to or dominant over others on a daily basis. While outside of work we may be less hierarchical on the surface, the underlying themes of inferiority and superiority, particularly 'moral' inferiority, regularly crop up in discussions and debates over gender, race, ethnicity, religion, sexuality and disability. While modern Brits like to imagine Britain as a classless society, unfortunately, the truth is that we find many ways to allocate each other into various groups and sub-groups. Disability being one, where one single characteristic of your identity may overrule every other aspect of your identity.
- Hate Crime:
Hate crime committed towards disability is currently a huge social problem within the UK, and undoubtedly this problem is interconnected with the three points outlined above. Disability is viewed as a medically defective state to be in, particularly if it limits function concerning employment. Being out of employment and on state welfare not only carries a 'moral' stigma but may also designate us to a level of 'inferiority' by casting us upon a lower rung on the social ladder. We live in an employment world were legitimate domination and oppression is something we see daily within the workplace, so it would be no surprise to see similar acts of domination and oppression committed outside the world of employment. Particular as disabled people tend to live on and be expected to live on, the margins of society. It is also interesting that those indulging in abuse, harassment and violence towards disability are often not just complete strangers to the victim, but friends, relatives, partners, neighbors and carers. Which speaks volumes about the widespread motivation underlying abuse, harassment and violence that disabled people face on a daily basis, and how it may have become a 'normative' aspect of society.
Oppression as 'Normality'
What the four points outlined above represent are aspects of oppression and domination that have become almost 'normalized' within British society. It is 'normal' to dominate others because of ones 'position' in society, so it is no surprise that some people view it as 'normal' to dominate and oppress those we may view as 'inferior' to ourselves. Especially, if we live in a world where political and media rhetoric works to demonize the sick, the weak and the vulnerable within society as being morally defective 'spongers' and 'fakes'.
The recent report by the University of Liverpool and University of Oxford again highlights that we have a massive problem with the work capability assessment process here within the UK. We are placing highly vulnerable people, often with fragile mental health issues or serious learning difficulties through stringent form-filling exercises, humiliating 'function' tests and traumatic interviewing from government funded assessors. While some within government view this as a valid step for protecting the principle of 'work', is the WCA not only an inappropriate way of dealing with vulnerable Brits, but one that is also a blatant recipe for disaster? And one that is certainly driving some vulnerable people to suicide.
- 1: Pakistan Will Fail To Reach Sustainable Development Goals Without Focus on Disability : Cynthia Sohail (2021/01/12)
- 2: The U.N.: Meddling in Britain's Affairs or Impartially Protecting Our Disabled? : Paul Dodenhoff (2015/09/07)
- 3: A Large Dollop of Fudge (A Letter from the DWP) : Paul Dodenhoff (2014/10/13)
- 4: Disability and the Normalization of Oppression : Paul Dodenhoff (2015/12/04)
- 5: Response to San Bernardino Terrorist Attack : Thomas C. Weiss (2015/12/06)
- 6: Medicalisation of Unemployment: Reprogramming Britain's Disabled and Unemployed : Paul Dodenhoff (2016/01/05)
- 7: Why is the Work Capability Assessment Costing Britain More Than it Saves? : Paul Dodenhoff (2016/01/18)
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