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Mo Stewart (2016) Cash not care: The planned demolition of the UK welfare state
... While higher rates of mental health comorbidity relative to the general population have been reported among people with ELC and other long-term conditions (Daru 2023;Naylor et al 2012), debates have raged over the role that mental health, and psychosocial factors, should play in explanatory models, in particular in the case of 'medically unexplained symptoms' (see Lian and Robson 2017;Blease et al 2017). A concurrent trend to position ELC-most notably those lacking established biomarkers-as perpetuated by maladaptive psychology to be 'corrected' through positive mindset and increased activity (typically via cognitive-behavioural interventions) has been argued to be underpinned by a neoliberalableist project of welfare state demolition, privatisation of health and social services, and associated 'work cure' ideology (Frayne 2019;Hunt 2022aHunt , 2022bClifford 2020;Stewart 2016;Rutherford 2007). This project heavily implicates psy, having been traced to alliances between the state, disability insurance and rehabilitation industries, and psychiatry (Rutherford 2007;Hunt 2022cHunt , 2023bHunt , 2024. ...
... In UK social policy, medically contested ELC and prevalent mental health diagnoses have been further clustered as 'common health problems', a category that constitutes an ever-expanding group of alleged 'undeserving' disabled people (Hunt 2022a(Hunt , 2024. By positioning this group of disabled people as 'not really disabled' (Soldatic 2020), social protections such as a healthcare and welfare are limited or denied, pushing disabled people into the labour market whether or not they are capable of work (Clifford 2020;Stewart 2016;Hunt 2023bHunt , 2024. Such manifestations of what can reasonably be termed biopower and the government of disability (Tremain 2015) are facilitated by a neoliberal-ableist psy complex and overarching 'wellness industry' which invites or coerces individuals to work on themselves in pursuit of the idealised (productive, self-sufficient, self-regulating) citizen (Goodley 2014). ...
... In the wider disabled population, the above biopolitical logic, combined with a climate of increasing austerity and welfare conditionality, has been associated with distress, destitution, premature death and suicide within the wider disabled population (Stewart 2016;Clifford 2020). In the case of 'common health problems' (remembering this encompasses many ELC) such harms are compounded through systematic misrepresentation of moral character. ...
Despite sustained efforts among critically informed scholars to integrate thinking from disability studies into psychology, the psy disciplines continue to largely neglect the lived experience of disabled people and overlook disability as a form of social inequity and valued culture. In this article, I make a renewed case for integrating thinking from disability studies into psy, in particular within the psychotherapy professions and in the case of ‘energy limiting conditions’, a grass-roots concept that includes clinically and socially marginalised chronic illness such as Long COVID. Drawing on my experience as a disabled practitioner, and situating this within extant literature on disability and psy, I take an autoethnographic approach to exploring opportunities and challenges in bridging the interdisciplinary divide. I argue that unacknowledged institutional ableism within psy reproduces and is reinforced by physical and attitudinal barriers for disabled practitioners and service users, engendering under-representation of disability in psychotherapy professions and lacunae in disability-affirmative conceptual resources. Additionally, I propose that hermeneutical lacunae are bolstered by documented defensive clinical practices pertaining to disability. After discussing a wealth of opportunities for integration offered by disability studies, and noting the institutional failure within psy to embrace disability-related demographic and epistemic diversity, I question whether ongoing epistemic and social exclusions within the psy disciplines constitute a case of ‘willful epistemic ableism’. Drawing on theorising vis-à-vis epistemic injustice and epistemologies of ignorance, I signal a form of systematic, actively maintained and structurally incentivised (motivated) non-knowing that results in collective failure among dominant groups to recognise established hermeneutical resources of the disabled community and allies. I conclude with suggestions of how this form of epistemic injustice might be mitigated.
... It is reasonable to suggest that the construction of common health problems was primarily motivated by money. As documented elsewhere, UK welfare reform agendas (with which common health problems are inextricably bound) arose from alliances between the state and insurance industry (notably Unum), who shared complementary objectives of decreasing welfare expenditure on sickness benefits and curbing profit loss on income protection schemes, a matter ascribed to increasing claims by people with 'subjective' health complaints (Rutherford, 2007;Stewart, 2016Stewart, , 2018Stewart, , 2019Faulkner, 2016). Specifically, from the late 1970s through to the early 21st century, claims for Incapacity Benefit (and its predecessor Invalidity Benefit) increased over two-fold, resulting in various government strategies to counter this trend (Shakespeare et al., 2017;Rutherford, 2007Stewart, 2019. ...
... Contemporaneously, the income protection sector of the life and accident insurance industry was beset by increasing claims from people with health complaints lacking established biomarkers such as myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS), fibromyalgia, chronic Lyme disease and chronic pain (Rutherford, 2007). There was a burgeoning political need for a narrative positioning these conditions in such a way that welfare, private income protection and biomedical care could be restricted, whilst claiming to act in the best interests of people living with such conditions (Rutherford, 2007;Stewart, 2016Stewart, , 2018Stewart, , 2019 , the construct of common health problems was destined to be harnessed for biopolitical purposes. The Cardiff centre, for some time sponsored by US insurance company Unum, produced research that played a key role in UK welfare reforms. ...
... The Cardiff centre, for some time sponsored by US insurance company Unum, produced research that played a key role in UK welfare reforms. This research adopted a variant of a biopsychosocial model exploited by Unum for managing claims (Rutherford, 2007;Stewart, 2016Stewart, , 2018Stewart, , 2019 -also referred to as the Waddell-Aylward biopsychosocial model (Shakespeare et al., 2017) -whilst much of the centre's work was commissioned by the Department of Work and Pensions (DWP). Central to this project was Mansel Aylward, director of the Cardiff centre and former Medical Advisor, Medical Director and Chief Scientist at the DWP. ...
With a view to doing no harm, all healthcare professionals, including psychotherapists, must familiarise themselves with oppressive socio-political landscapes imposed upon particular groups of chronically ill and disabled people, framed as 'undeserving' for biopolitical purposes. This article offers an account of the biopolitical backdrop to disavowed disability for practitioners, who are urged to ensure they do not unwittingly reproduce oppressive power relations within the therapeutic space.
... A DISCUSSION PAPER FROM CITIZEN NETWORK RESEARCH In writing this, I focus on the situation in the UK, and draw principally from the work of a number of disability activists and scholars (including Rutherford, 2007a;Jolly, 2012;Berger, 2014;Faulkner, 2016;Stewart, 2016Stewart, , 2018Stewart, , 2019aStewart, , 2019bShakespeare et al 2017). More recently, and after many years of trying, I have been able to add to the academic literature on structural injustice and abuse of power as it pertains to ME/CFS and Long-COVID (Hunt, 2022a(Hunt, , 2022b(Hunt, , 2022c(Hunt, , 2022d. ...
... As disability studies scholars and disabled people have highlighted, these interests are associated with the work of certain academics within a broader context of government welfare reforms and disability insurance industry profiteering (Rutherford 2007a;Jolly, 2012;Berger, 2014;Stewart, 2016). These reforms, as previously noted, can in turn be located within a global context, that of ableist, neoliberal politics and austerity management (structural adjustment) programmes across the OECD, of which disabled and chronically ill people have borne the brunt (OECD, 2009;Stewart, 2019b). ...
... In 2015, the media reported that more 80 people per month were dying after being told they were fit to work (Ryan, 2015;Butler, 2015; see also Stewart, 2019b). Mo Stewart, Independent Disability Studies Researcher, has written at length about how the WCA represents a BPS model of disability assessment adopted by US insurance giant Unum for assessing insurance claims (Stewart, 2016(Stewart, , 2018(Stewart, , 2019a(Stewart, , 2019b. Further, Personal Independent Payment (PIP), which gradually replaced Disability Living Allowance (DLA) from 2013, was discussed as being underpinned by 'the' BPS model in the now infamous Lord Freud contribution during the 2012 Welfare Reform debates (Freud, 2012). ...
Discussion paper for Citizen Network Research
Access at: https://citizen-network.org/library/biopsychosocial-model.html
The biopsychosocial model as it is applied to myalgic
encephalomyelitis/chronic fatigue syndrome (ME/CFS) and
so-called ‘medically unexplained symptoms’ has been robustly
critiqued for lack of evidential support, additionally being
implicated in harms experienced by chronically ill and disabled
people within the healthcare arena. However, the political
underbelly of this model as it dominates health and social policy in
the UK and beyond has received far less attention.
This paper, drawn from a series of the author’s blogposts on the
same topic, examines structural (here, socio-political) dimensions
of this variant of the biopsychosocial model. The first part of the
paper explores how biopsychosocial discourse, as it pertains to
‘medically unexplained symptoms’ and notably to ME/CFS, draws
from a politicised variant of the model that has been developed
to serve a neoliberal project of retrenchment across welfare and
healthcare sectors. This is followed, in the second section, by a
closer consideration of the features of this politicised model and
how it constitutes deserving and undeserving suffering, where
conditions such as ME/CFS are positioned as undeserving. The third section delves into the network of associations between certain academics and actors within the UK government and disability insurance industry, a network that has constructed and continues to reproduce this politicised variant of biopsychosocial discourse. Finally, the fourth section explores the human costs of structural injustices associated with this discourse.
Although focused on historical and current events in the UK,
the political and ideological context that has given rise to the
marginalisation of ME/CFS and other chronic illness bears relevance far beyond the UK. Importantly, and relatedly, there are indications that actors implicated in the politicised psychosocial framing and marginalisation of ME/CFS have now turned their attention to Long- COVID. The points raised in this paper should therefore be of interest to a wide readership.
... The welfare state including the NHS was arguably the UK's greatest asset when offering health care and financial support to those in greatest need, with the psychological security of the welfare state being available for anyone should they ever need it. This changed with Margaret Thatcher's time in office as Prime Minister (1979-90), as the adoption of neoliberal politics meant she was adamant that social policy reforms should include the eventual removal of the NHS (Cabinet, 1982) and a move to private income replacement health insurance (Sutcliffe-Braithwaite, 2013;Travis, 2012;Stewart 2016;2018b), despite her public declarations that the NHS was 'safe with us' (Travis, 2016). ...
... Seventy six years since the launch of the welfare state, neoliberal politics now dominates the UK and the western world (Monbiot, 2016;OECD, 2003). 'Cash Not Care' (Stewart, 2016) are the only priorities of the welfare state. Administered by the Department for Work and Pensions (DWP), there is a political emphasis to reduce the financial demands of the welfare state regardless of human consequences, which can be fatal for many of those in greatest need when claiming the Employment and Support Allowance (ESA) long-term disability benefit, which was introduced using a new assessment model in October 2008 by the Brown 'New Labour' administration . ...
... Some claimants were (Pring, 2020a), with no-one held to account, as social policy reforms were rapidly moving the UK towards becoming an authoritarian State for those in greatest need. Most recent social policy reforms, adopted since 2010 by the Cameron coalition administration, were introduced to covertly and successfully remove the past psychological security of the welfare state, and to move the UK towards the eventual adoption of income replacement health insurance for the majority of the British public (Stewart, 2016;2018b;2019a;. ...
The 1982 Thatcher Cabinet minutes identified the intention to adopt ‘the politics of fear’ to coerce the British public to accept the need for private income replacement health insurance, to remove the financial burden of the National Health Service and the welfare state. Every administration since Margaret Thatcher adopted social policies to move towards this ultimate political ambition, which has bipartisan support. The difficulty was that the psychological security of the UK welfare state was embedded within the public psyche and removing it would take a long time. Forty years later, that ambition has now been achieved. Thatcher’s devotion to neoliberal politics, which is an ideology that supports free market competition with an emphasis on minimal State intervention, meant that the political ambition to reduce the financial burden of the welfare state would be relentlessly pursued by successive administrations. The breakthrough to justify introducing the ‘politics of fear’ followed the 2008 global financial crisis. The Brown ‘New Labour’ administration was obliged to fund a fifty billion pounds bank rescue package, which increased over time and significantly increased the national debt. Elected in 2010, the Coalition administration used the size of the national debt to justify the introduction of austerity measures, which were designed to reduce the costs of the welfare state and guaranteed that those in greatest need would endure preventable harm. This was the beginning of the end of the UK welfare state as funding was removed from essential public services, which generated human suffering on a vast scale.
... Their research paper (Aylward-LoCascio, 1995) supported testimony from the American health insurance industry, and argued that family doctors should not be expected to determine a patient's incapacity. Hence, the past authority and clinical opinion of GPs in support of their patients claiming long-term disability benefit would be curtailed by future social policy legislation, co-designed by corporate America (Stewart, 2016;. ...
... Hence, the introduction of the WCA in 2008 by the Labour administration, using the flawed Waddell-Aylward BPS model of assessment (Ravetz, 2006;Shakespeare et al., 2016), guaranteed that chronically ill and disabled ESA benefit claimants were destined to suffer given that the WCA is the adoption of the discredited Waddell-Aylward (2005, 2010 BPS 'non-medical functional assessment' (Stewart, 2016;; as all clinical opinion is disregarded by the WCA, and disregarding diagnosis and prognosis was guaranteed to create death, despair and preventable harm for many of those in greatest need (Stewart, 2020). Thousands of chronically ill and disabled ESA benefit claimants were destined to die, with their deaths linked to the WCA process after having been declared 'fit for work' by the flawed assessment (Butler, 2015;BBC News, 2015;DWP, 2015), which meant that, on average, 'nearly 90 people per month were dying after being declared fit for work' following a WCA (Butler, 2015). ...
... So, the justification for the adoption of austerity measures was unfounded and was used to successfully mislead the British public, and the UK parliament, to accept the adoption of severe austerity measures. This was the continuation of the political ambition to remove the past psychological security of the welfare state to make it easier to eventually remove, and replace with private health insurance; which is the long held political ambition that enjoys bipartisan support (Stewart, 2016). ...
As the world is preoccupied by the pandemic, and the British public are beginning to comprehend the full impact of Brexit, the predictable public mental health crisis created by the demolition of the UK social safety net has been disregarded by successive administrations. Few people realized that preventable harm was the inevitable creation of social policy reforms, gradually adopted by every administration since Thatcher, en route to her political ambition which was the demolition of the welfare state to be replaced by private health insurance. In order to demolish the welfare state it was first necessary to remove the past psychological security provided by the welfare state. This has been achieved, with disability denial created by significant social policy reforms since 2008. To justify the adoption of harsh and unnecessary austerity measures, which were introduced without ethical approval, the Coalition administration elected in 2010 vehemently challenged the integrity of the chronically ill and disabled community and routinely accused disability benefit claimants of fraud; whilst failing to produce evidence to support their claims. Their often hostile rhetoric encouraged a 213 percent increase in prosecuted disability hate crimes, and successive administrations disregarded the thousands of deaths directly linked to the Work Capability Assessment, which was adopted using a discredited and dangerous biopsychosocial model of assessment to restrict access to long-term disability benefit. Influenced by corporate America since 1992, the UK social policy reforms guaranteed that many of those in greatest need were destined to die when, covertly, killed by the State.
... These interactions can be understood as permeated with ableist and neoliberal ideology that can be discerned both in medicine and broader social practices (Cheshire et al. 2017;Hughes 2000). While neoliberalism can be understood as an economic policy model, prioritising the interests of private corporations and the market over respect for human rights in part via systematic retrenchment of health and welfare provision (Clifford 2020;Stewart 2016), it can also be understood as a biopolitical ideology. In this regard, neoliberalism is discernible in social practices and the collective consciousness through an emphasis on consumer-citizens, competition, free will and personal responsibility (Adams et al. 2019). ...
... This skill set (Metzl and Hansen 2014, 128) is further described as 'recognition of how economic, physical, and socio-political forces impact medical decisions' (Metzl and Hansen 2014, 128). In the context of long Covid, this would include clinicians acknowledging that clinical and societal discourse around poorly delineated health conditions and associated disability has been significantly influenced by sociopolitical agendas, for example, agendas associated with a particular application of the biopsychosocial model (Clifford 2020;Hunt 2021;Stewart 2016). Of particular note here is the argument, largely forwarded by disability scholars and activists, that biopsychosocial discourse around 'medically unexplained symptoms' has arisen from and is reinforced by sociopolitical interests coalescing around welfare reform policies in the UK and beyond (Jolly 2012;Berger 2014;Hunt 2022). ...
... That is, the positioning of certain chronic illnesses as primarily psychosocial in origin has allowed a narrative to be constructed whereby 'disability' (here, understood as per the medical model) is amenable to psychosocial health interventions and thus to 'recovery', ushering disabled people back into the labour market whether or not they are capable of work (Rutherford 2007; Faulkner 2016). This facilitates a reduction in state (biomedical) healthcare and welfare expenditure while creating new markets for private profit, notably for the disability insurance industry (Rutherford 2007;Stewart 2016). Such discourse, which legitimises some patient groups while marginalising others, partly through policing the boundaries between 'deserving and undeserving disability' (see Soldatic 2020; Shakespeare, Watson, and Alghaib 2016), is likely associated with the well-documented epistemic injustice and broader harms sustained by chronically ill and disabled people (see Blease, Carel, and Geraghty 2017;Geraghty and Blease 2019). ...
While critically informed approaches to medical education are increasingly advocated in literature, discussion of the potential role of disability studies in informing pedagogy and practice is largely lacking. The emergence of long Covid, alongside the strong possibility of a wave of covid-related disability, underlines an urgent need for medicine to develop more contextualised, nuanced and structurally competent understandings of chronic illness and disability. This article argues that the integration of thinking from disability studies into medical curricula offers a pathway to such understanding, informing a more equitable, holistic and patient-centred approach to practice. Further, a structurally competent, antiableist approach positions clinicians and patients as allies, working together within a structural context that constrains both parties. Such positioning may mitigate tensions within the clinical encounter, tensions that are well documented in the realm of marginalised chronic illness and disability. While the possibilities arising from a partnership between disability studies and medicine are numerous, the foci here are the social relational model of disability and the concept of psycho-emotional disablism, within a broader framework of critical disability studies. It is argued that inadequate healthcare provision and policy in the realm of long Covid can be understood as a form of structural and psycho-emotional disablism, arising from and reinforcing an ableist psychosocial imaginary permeated with neoliberal assumptions, and carrying a risk of furthering both disability and impairment. After considering long Covid through these particular lenses, the article concludes with a discussion of how a partnership between disability studies and a structurally competent approach to medical education might translate into practice.
... 6,19 Following over ten years of ideologically motivated social policy "reforms" by right-leaning neoliberal governments, 20 unnecessary austerity measures which were adopted without ethical approval which devasted social care, 21 the excessive use of sanctions against disability benefit claimants, 22 hostile DWP letters that intimidate them, 23 and the introduction of the fatally flawed Waddell-Aylward biopsychosocial (BPS) assessment model adopted for the WCA, which disregards all clinical opinion and failed academic scrutiny; 24,25 the DWP remain oblivious to the human crisis they created for those in greatest need as emphasised by the content of the DWP Health and Disability Green Paper. 1 "Cash Not Care" 25 is demonstrated as being the political motivation driving the UK social policy reforms on route to the creation of what is described as "Thatcher's dark legacy", 12,20 which is identified as being the planned future demolition of the UK welfare state in favour of private income replacement health insurance. 12,20,25 As with most DWP reports, ambitious improvements in the benefit system are listed (p7) yet, if the past ten years have identified anything, it is that the DWP will only adopt social policies when guided by discredited policy-based DWP commissioned research, 24,25 whilst disregarding the volumes of published research papers identifying the preventable harm created by successive social policy "reforms" since 2010. 3,8,12,15,17,20,[22][23][24][25] This relentless DWP persecution of benefit claimants demonstrates an ideological resistance to detailed evidence that the social policies adopted since 2010 were guaranteed to cause death, despair and preventable harm to vast numbers of disabled people, by adopting a fiscal priority whilst disregarding health and wellbeing. ...
... 6,19 Following over ten years of ideologically motivated social policy "reforms" by right-leaning neoliberal governments, 20 unnecessary austerity measures which were adopted without ethical approval which devasted social care, 21 the excessive use of sanctions against disability benefit claimants, 22 hostile DWP letters that intimidate them, 23 and the introduction of the fatally flawed Waddell-Aylward biopsychosocial (BPS) assessment model adopted for the WCA, which disregards all clinical opinion and failed academic scrutiny; 24,25 the DWP remain oblivious to the human crisis they created for those in greatest need as emphasised by the content of the DWP Health and Disability Green Paper. 1 "Cash Not Care" 25 is demonstrated as being the political motivation driving the UK social policy reforms on route to the creation of what is described as "Thatcher's dark legacy", 12,20 which is identified as being the planned future demolition of the UK welfare state in favour of private income replacement health insurance. 12,20,25 As with most DWP reports, ambitious improvements in the benefit system are listed (p7) yet, if the past ten years have identified anything, it is that the DWP will only adopt social policies when guided by discredited policy-based DWP commissioned research, 24,25 whilst disregarding the volumes of published research papers identifying the preventable harm created by successive social policy "reforms" since 2010. 3,8,12,15,17,20,[22][23][24][25] This relentless DWP persecution of benefit claimants demonstrates an ideological resistance to detailed evidence that the social policies adopted since 2010 were guaranteed to cause death, despair and preventable harm to vast numbers of disabled people, by adopting a fiscal priority whilst disregarding health and wellbeing. ...
... 12,20,25 As with most DWP reports, ambitious improvements in the benefit system are listed (p7) yet, if the past ten years have identified anything, it is that the DWP will only adopt social policies when guided by discredited policy-based DWP commissioned research, 24,25 whilst disregarding the volumes of published research papers identifying the preventable harm created by successive social policy "reforms" since 2010. 3,8,12,15,17,20,[22][23][24][25] This relentless DWP persecution of benefit claimants demonstrates an ideological resistance to detailed evidence that the social policies adopted since 2010 were guaranteed to cause death, despair and preventable harm to vast numbers of disabled people, by adopting a fiscal priority whilst disregarding health and wellbeing. 3,8,15,17,20 DWP claims that 13 years since the initial introduction of the WCA, in 2008, there is still an ongoing need to "increase the quality and accuracy of decisions we make on benefit entitlement" (p7), and a need to improve "the information we use to make decisions (p7), demonstrates the ongoing human crisis the DWP have created, and the negative health impact of the WCA. ...
This is a briefing regarding the planned future social policy reforms in the UK.
... Detailed evidence in the Preventable Harm Project (the Project), that I led for ten years until December 2019, identified that a public mental health crisis within the disabled community was inevitable for disability benefit claimants, when considering successive social policy reforms of the past forty years; which exacerbated the recently identified mental health problems linked with the distress of the Covid-19 pandemic (Marshall et al, 2020). The adoption of neoliberal politics by the Thatcher administration(s) (1979)(1980)(1981)(1982)(1983)(1984)(1985)(1986)(1987)(1988)(1989)(1990) demanded that "Cash Not Care" (Stewart, 2016) became the only political priority for social policy funding. Human suffering was inevitable, and is demonstrated by the Project as being increased by the most recent social policy reforms, adopted since 2010, using an ongoing fiscal priority when disregarding health and wellbeing (Barr et al, 2016a;Dwyer, 2018;Stewart, 2019a). ...
... Thatcher stepped down as PM in November 1990, in a dramatic resignation following a challenge to her leadership (White, 2013). She was succeeded as the UK PM (1990PM ( -1997 by the Conservative Member of Parliament (MP) John Major, whose domestic agenda was to continue with Thatcher's social policy ambition by inviting corporate America to influence future UK social policy reforms (Rutherford, 2007;Stewart, 2016;2018a). ...
... In essence the recommendations of the Waddell-Aylward (2005) report, which would dominate the DWP Green Paper (2006) to demonstrate the need for significant social policy reforms, was exposed as being policy-based evidence; written to support the long-held political ambition to reduce welfare costs. This was another demonstration of major social policy reforms being adopted using a fiscal priority when disregarding health and wellbeing; and is another example of "Cash Not Care" (Stewart, 2016) being the priority of the UK government when disregarding the clinical needs of the disabled community who are unfit to work. ...
I am the research lead for the Preventable Harm Project, that I led for ten years. The research demonstrates the plan by successive administrations to eventually replace the UK welfare state with private health insurance, identified as being Thatcher's 'dark legacy'.
... Following in Thatcher's footsteps, in 1992 the John Major Conservative government invited the American corporate giant UnumProvident TM Insurance to consult, with reference to future welfare claims management (Stewart, 2016). By 1994, the company were appointed as official government advisers. ...
... The authors were sponsored at the Centre with £1.6 million by UnumProvident TM Insurance (Cover, 2004). The company fully expected to gain from the UK welfare reforms, and the planned future reduction of the numbers eligible for State funded welfare support for sickness and disability (Stewart, 2016;Rutherford, 2007). ...
... Of course, the medical model of assessment also acknowledged medical opinion, so it was time to change to using the BPS model of assessment, which disregards medical opinion in order to limit the possible number of future claimants. This was a replica of the BPS assessment model successfully introduced by UnumProvident TM Insurance in America to limit access to healthcare insurance claims, and to guarantee future profits (Stewart, 2016;Rutherford, 2007). ...
In the UK there are three words that identify the government enforced suffering of sick and disabled people, and they are: Work Capability Assessment (WCA). This report identifies the influence of a corporate healthcare insurance giant with successive UK governments since 1992, the influence of a former government Chief Medical Officer and the use of the WCA, conducted by the private sector, as the government permit state crime by proxy when justified as welfare reform.
... Zemiology is the study of social harm. Eight years after the introduction of the WCA, when using the totally discredited Aylward (2005, 2010) BPS model of assessment (Shakespeare et al 2016), the preventable social harm created by the introduction of the WCA has been identified by independent research (Stewart 2015, Barr et al 2015, Baumberg et al 2015, Shakespeare et al 2016, Garthwaite 2016, Stewart 2016b, which continues to be disregarded by DWP Ministers. Instead, Ministers prefer to reference DWP commissioned policy based reports, or publications from a right-wing think-tank, whose research exclusively references DWP commissioned policy based research and demonstrates that the claimed 'independent' research is ideologically motivated (Robertson, 2012). ...
... This one statement demonstrates the danger of right-wing think-tanks whose research demonstrates that costs, not need, are the priority of the welfare reforms when presuming that people in the Support Group, allocated because they are considered by the DWP to be too ill to work, yet 'independent researchers' continue to suggest that there is a problem because these often very, very ill people haven't yet made any effort to find work. One more example of the danger of commissioned academics considering cash not care, when totally disregarding diagnosis and prognosis in any welfare setting (Stewart 2016b). ...
... Recovery is not possible for many very ill people, and totally disregarding diagnosis and prognosis is dangerous as is the constant psychological pressure that welfare benefit for a permanent diagnosis is no longer guaranteed (Stewart 2015), and those in greatest need are intimidated by the DWP who have '...guaranteed human suffering of the least able on a vast scale.' (Stewart 2017) What was once the psychological security of the welfare state has been totally destroyed by neoliberal politics, when enthusiastically supported by the national press (Stewart 2017). The market is the dominant force, costs are the only priority, and all evidence of care, concern and compassion has been successfully removed when using academic research that lacks credibility and totally fails scrutiny (Shakespeare et al 2016, Stewart 2016b. ...
In the UK there are three words that identify the government enforced suffering of sick and disabled people, and they are: Work Capability Assessment (WCA). This report identifies the influence of an American healthcare insurance giant with successive UK governments since 1992, the influence of a former government Chief Medical Officer and the use of the WCA, conducted by the private sector, as the government permit state crime by proxy when justified as welfare reform.
... Long before the introduction of the Work Capability Assessment (WCA) in 2008, the Thatcher government had held Cabinet discussions in 1982 regarding the possibility that the welfare state could be dismantled (Travis 2012), and that possibility has been pursued by all subsequent governments whilst masquerading as welfare 'reforms' (Stewart 2016). ...
... With specific relation to social security policies, and the introduction of sanctions and conditionality for compliance to access income replacement benefits, chronically sick and disabled people are viewed as an addition to the unemployment figures, which must be reduced regardless of human consequences. Successive UK governments disregarded all independent research that confirmed that the WCA is a dangerous assessment model (Barr et al 2015), influenced by an American healthcare insurance giant, with deaths linked to the WCA totalling in excess of 91,000 people between January 2011 and February 2014 (Stewart 2016). The DWP disregards all evidence concluding that the WCA should be replaced, even when delivered by the Work and Pensions Select Committee (WPSC 2014), demonstrating that all evidence identifying preventable harm will be dismissed. ...
... Whilst the biopsychosocial model is typically associated in healthcare discourse and practice with the work of Engel (1977), disability activists and scholars have argued that the model as dominates UK health and social policy has been heavily informed by political agendas coalescing around UK welfare reform (Jolly, 2012;Stewart, 2016Stewart, , 2019. It has been contended that alliances between UK government officials, academicclinicians (predominantly within psychiatry) and social actors within the disability insurance industry -a so-called 'academic-state-corporate nexus' (Rutherford, 2007a) -have drawn on a particular interpretation of the biopsychosocial model to further a neoliberal project of health and welfare sector retrenchment (Rutherford, 2007b). ...
... That is, disability scholars and disabled activists have argued that successive welfare reforms in the UK and beyond are associated with a neoliberal capitalist agenda to prioritise market forces and the interests of private corporations over respect for human rights, in part via a shrinking of the welfare state and creation of opportunities for private profit within the welfare arena (Clifford, 2020;Stewart, 2016). Such global structural adjustment programmes preceded, but were accelerated by, the 2008 global financial crisis and subsequent austerity measures (Sakellariou and Rotarou, 2017;Clifford, 2020). ...
Whilst parallels have been drawn between Long Covid and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), there is a well-documented history of negative stereotyping and marginalisation of patients with ME/CFS. A socio-politically oriented comparison of scientific, clinical and societal responses to Long Covid and ME/CFS is thus important to prevent similar harms arising among Long Covid patients. We identify four reasons for injustices in the treatment of ME/CFS patients, and discuss the risk of Long Covid following a similar trajectory. We conclude with policy and practice recommendations to help prevent such injustices arising again, including consideration of critical reflexivity in medical education.
... Like Rosie, I also encounter obstructive systems and practices which prevent people with disabilities from accessing services and/or equipment which would have immense impacts on our mobility and quality of life. Nonetheless, the light of Rosie's joy in an otherwise horrendous context is a brutal indictment of the quality of life and services for people with disabilities in 21st-century Britain (see : Pring, 2011;Quarmby, 2012;Stewart, 2017). Rosie's poem, then, provides a stark and poignant view of the wider context of disabled people cycling which I may well have overlooked in a conventional thematic analysis. ...
In this article, I present three I-poems from a larger research project in which I explore the health, identity and social impacts of cycling for people with physical disabilities. I used I-poems as a means of kick-starting an in-depth, multi-perspective engagement with my interview transcripts after struggling to formulate insightful and productive thematic analysis. For me, this research project is something of a departure from my normal research processes and practices as it is taking place in partnership with a voluntary organisation. This organisation facilitated the recruitment of the research participants and had specific inputs into the research questions as well as maintaining ongoing interests in the research findings. My usual research tends to be much less structured and much more exploratory and messy than this. And yet, for me, this messiness facilitates insight and creative engagement which is intensely productive in terms of both findings and outputs – often via the use of creative methods. Therefore, as much as I have enjoyed conducting the research for this project and liaising with the organisation and meeting the participants, I struggled to find my ‘researcher mojo’ when working with the transcripts. In this context, I-poems became a creative stimulant for productive engagement with the transcripts and deepening my critical and reflective insights into the data.
... 12 Another crucial area of work in the resistance struggle has been the production of research to highlight the harm to disabled people caused by recent policy agendas. From the beginning, DPAC has placed a high value on both academic and non-academic research, drawing upon work by disabled researchers such as Mo Stewart among many others (Stewart, 2016). DPAC's own research and reports include four papers and ten reports on a variety of subjects, including a substantial focus on DPAC's evidence to the United Nations (UN) Committee of Inquiry into the application of Convention on the Rights of Persons with Disabilities (CRPD). ...
The case studies that will be presented in this book illustrate the extent to which a ‘punitive turn’ across a number of policy domains is a prominent and pervasive feature of neoliberalism in the UK. However, before we turn to these examples of policy implementation, this first chapter will outline a broader understanding of this phenomenon and its implications for activist strategy. Consequently, the chapter has two main aims. The first is to locate these punitive tendencies as a feature of the ‘integral’ state under contemporary neoliberalism, which utilises increasingly draconian and divisive means to maintain a degree of legitimacy for this system. These threats to consent-making processes are an effect of neoliberal reconfigurations of the interrelated spheres of production and social reproduction that underpin harmful and detrimental processes such as work intensification in the former and crises of care provision in the latter. However, neoliberal reforms have also resulted in demographic shifts both within labour markets and across society more widely that are engendering new patterns of contestation and resistance. Our second major aim in the chapter is, therefore, to explore the strategic implications of these shifting contexts and demographics for strategies of resistance and the development of oppositional currents and coalitions. In particular, and building on our analysis of these shifts, we propose a framework for activist strategy which we call the ‘integrative transitional’ approach (ITA). ITA takes account of these wider changes in social conditions by incorporating political demands that span productive and reproductive concerns and in so doing, we argue, has the potential to enhance activist efforts to build and strengthen diverse and broad-based alliances of resistance to punitive state-corporate policy agendas.
... 12 Another crucial area of work in the resistance struggle has been the production of research to highlight the harm to disabled people caused by recent policy agendas. From the beginning, DPAC has placed a high value on both academic and non-academic research, drawing upon work by disabled researchers such as Mo Stewart among many others (Stewart, 2016). DPAC's own research and reports include four papers and ten reports on a variety of subjects, including a substantial focus on DPAC's evidence to the United Nations (UN) Committee of Inquiry into the application of Convention on the Rights of Persons with Disabilities (CRPD). ...
To examine government policy and state practice on housing, welfare, mental health, disability, prisons or immigration is to come face-to-face with the harsh realities of the 'punitive state'. But state violence and corporate harm always meet with resistance. With contributions from a wide range of activists and scholars, Resist the Punitive State highlights and theorises the front line of resistance movements actively opposing the state-corporate nexus. The chapters engage with different strategies of resistance in a variety of movements and campaigns. In doing so the book considers what we can learn from involvement in grassroots struggles, and contributes to contemporary debates around the role and significance of subversive knowledge and engaged scholarship in activism. Aimed at activists and campaigners plus students, researchers and educators in criminology, social policy, sociology, social work and the social sciences more broadly, Resist the Punitive State not only presents critiques of a range of harmful state-corporate policy agendas but situates these in the context of social movement struggles for political transformation and alternative futures.
... Dismantling of the UK welfare state was first suggested by Margaret Thatcher in 1982, and wide spread speculation at the time claimed that the suggested removal of the welfare state was due to her very close bond with 2 the American President Ronald Reagan . In my view, Thatcher's legacy continues to this day as successive Prime Ministers engage with her ultimate goal which, I have argued elsewhere, is the eventual removal of the welfare state and the adoption of private healthcare insurance in its place (Stewart 2016). ...
The ongoing reluctance of the British government to accept overwhelming evidence that the assessment used to limit access to disability benefits is compromised and many chronically ill and disabled claimants are suffering, often with fatal consequences, as the UK welfare state is systematically demolished as planned since 1982.
Outsourced to unaccountable private contractors, and influenced by the healthcare insurance industry, the most vulnerable in the UK now live in fear of the Department for Work and Pensions.
... Unless and until the government acknowledge the preventable harm created by the adoption of welfare reforms copied from 1996 American Social Security policies (Stewart, 2016b), and begin to accept the detailed evidence provided by mainstream academic research, I suspect that the increase in the numbers of people suffering from a mental health problem will continue to rise as the most vulnerable people in society plunge into anxiety and despair, and disabled veterans are exposed to the fact that the British government fails to uphold the armed forces covenant. ...
Purpose
No civilian has any comprehension of life in British military forces, or the impact of the removal of that life when unexpectedly returned to “Civvy Street” following the onset of a permanent illness or profound disability, with the gradual realisation that support in the civilian world means that a disabled veteran is just one of a crowd. The paper aims to discuss this issue.
Design/methodology/approach
Participant observation.
Findings
Welfare reforms together with austerity measures introduced by the British government are causing preventable harm to the most vulnerable in society.
Research limitations/implications
This paper was written by invitation and is limited by word length.
Practical implications
Older working-age disabled veterans are being abandoned by the state and suffer due to a change in government social policy.
Social implications
Disregarding the suffering and preventable harm created in society by the ongoing welfare reforms will have consequences that will need to be addressed as a matter of urgency, as the often tragic consequences are eventually alerted to the public.
Originality/value
A demonstration that the older working-age disabled veterans are being harmed by welfare reforms and the armed forces covenant has been breached.
There exist problematic attitudes and beliefs about dwarfism that have rarely been challenged, but continue to construct people with dwarfism as an inferior group within society. This book introduces the critical term ‘midgetism’, which the author has coined, to demonstrate that the socio-cultural discrimination people with dwarfism experience is influenced by both heightism and disablism.
As a result, it unpacks and challenges the problematic social assumptions that reinforce midgetism within society, including the acceptability of ‘midget entertainment’ and ‘non-normate space’, to demonstrate how particular spaces can either aid in reinforcing or challenge midgetism.
Drawing on the tripartite model of disability, this book demonstrates how midget entertainment is framed as a non-normative positivism, which makes it an acceptable form of employment. Using autocritical discourse analysis, the book exposes, examines and responds to excuses that are used to reinforce midgetism, thus critiquing the numerous beliefs influenced by cultural representations of dwarfism, such as people with dwarfism being acceptable figures of entertainment.
It will be of interest to all scholars and students of disability studies, social history, sociology and cultural geography.
The psychosomatic approach to medically unexplained symptoms, myalgic encephalomyelitis and chronic fatigue syndrome (MUS/ME/CFS) is critically reviewed using scientific criteria. Based on the 'Biopsychosocial Model', the psychosomatic theory proposes that patients' dysfunctional beliefs, deconditioning and attentional biases cause or make illness worse, disrupt therapies, and lead to preventable deaths. The evidence reviewed suggests that none of these psychosomatic hypotheses is empirically supported. The lack of robust supportive evidence together with the use of fal-lacious causal assumptions, inappropriate and harmful therapies, broken scientific principles, repeated methodological flaws and an unwillingness to share data all give the appearance of cargo cult science. The psychosomatic approach needs to be replaced by a scientific, biologically grounded approach to MUS/ME/CFS that can be expected to provide patients with appropriate care and treatments. Patients with MUS/ME/CFS and their families have not been treated with the dignity, respect and care that is their human right. Patients with MUS/ME/CFS and their families could consider a class action legal case against the injuring parties.
WHILST THE WORLD is distracted by the global pandemic, and the United Kingdom (UK) is adjusting to the reality of Brexit, there is an ongoing public health crisis created by social policy reforms and austerity measures which is being totally disregarded by successive administrations.
At the beginning I stated that the purpose of this book was to critically assess the social policies of inclusion for persons living with an intellectual disability. I have assessed the contemporary paradigm through an analysis of the philosophical values arising from neoliberalism that dominates the allocation of resources by governments in western nations. Neoliberalism is the dominant paradigm and it also exercises control over the structures used by service providers to deliver the funded services. This has a significant impact on how persons employed to work with persons living with an intellectual disability engage with such persons, since the emphasis for the former is more concerned with employment practices and organizational outcomes rather than on personal-planning (e.g., Clement & Bigby, 2008, 2010). The interrelationship between the social and economic policies was highlighted through a focus on culture and how social policies of inclusion have failed, in the majority, to impact the personal lives of persons living with an intellectual disability.
The focus of this chapter is persons living with an intellectual disability as they continue to remain socially excluded from their communities in western societies. A possible explanation for this phenomenon occurs when persons living without an intellectual disability encounter persons who live with an intellectual disability and how the former’s personal, latent, preconceived notions dominate their ability to act freely. The term ostracized other: social pariah other is, I propose, a more accurate way of describing persons living circumstances in western societies. Carling-Jenkins (2014) presents a four-category critique which positions “[persons living with an intellectual] disability as other” across domains such as citizenship, segregation within institutions, living on the margins and the disabled body (p. 4). The author notes that this risks understanding disability “in binary terms” (p. 4) although it has the advantage of understanding how persons living with an intellectual disability actually live their lives and how policies and society form to shape, positively and negatively, the personal lives of persons living with an intellectual disability. Carling-Jones’ (2014) argument presents how Australians living with an intellectual disability are positioned in roles that reinforce disability as a negative characteristic and which fail to use contemporary knowledge to create spaces inclusively. DeJong (1979) has explored the independent living movement in the United States and compared it to five other social movements: civil rights, consumerism, self-help, de-medicalization and deinstitutionalization. This notion of a person being defined by his/her limitations is by no means new; for example, Adrianne Asch argues that disability is not part of her “lived experience”, rather it is the basis on which she is judged as a person (1976, p. 28). There are, however, two domains that are not addressed in this typology, the first could be termed economically excluded: emphasizing disability and the second ostracized other: social pariah other. These aspects of persons living with an intellectual disability lives are presented in the Sects. 3.4 and 3.5 in this chapter.
The model presented in Chap. 1, Critique—Praxis—Emancipation, will now be used to explore the dominant philosophical values that stand behind the economic and social paradigms that influence and control the lives of persons living with an intellectual disability in western nations. For our purposes here, praxis will present the features of the dominant economic discourse used to administer, fund and regulate service provision to persons living with an intellectual disability. The social sciences rely and, indeed, use each other’s knowledge to develop theses or to substantiate their own arguments. For instance, the neoliberal theories in economics take learnings from psychology about the motives of human behaviour and then aggregate these motives into a model of how persons will behave in a market economy. There is, then, an incline within the social sciences; they are interconnected through economic and social values. Western nations accept These philosophical assumptions and try to integrate them with social justice initiatives such as the Convention of the Rights of Persons with Disabilities (CRPD). Therefore, the philosophical values inherent in neoliberalism and the CRPD have currency with those found in western nations. Praxis will also include a discussion on the often-overlooked role the characteristics of an institution play in the personal lives of persons living with an intellectual disability. The Australian National Disability Insurance Scheme (NDIS) will be used as a critique to assess how neoliberalism’s philosophical values serve persons living with an intellectual disability in a western nation state.
In this paper I argue that sociology is intricately related to social justice. To paraphrase Mills (The sociological imagination, Oxford University Press, Oxford, 2002), by revealing the ways in which experiences which are normatively framed as “private troubles” are in fact “public” or social issues, sociologists expose the structures of power which shape individual lives. These structures are not only evident in easily identifiable material, social and environmental inequalities but also in what appear to be individual “health” experiences such as mental distress and self-injury. I draw on qualitative research to explore a social justice perspective of self-injury via the intersections of social class, gender and sexuality and the oppressions and injustices inherent to them. Next, I turn my attention to social justice responses to self-injury, and I explore the importance of user-led interventions for developing social justice oriented responses to both mental distress and self-injury, and the ways in which these have been marginalised in medical and sociological perspectives. Finally, I argue that with the urgency of social justice interventions never more apparent, sociologists and social researchers should be working as allies with rights movements both within “mental health” and beyond.
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