'Gatekeepers' to benefits - Ben Goldacre

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Choccy's picture
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Nov 26 2008 14:42
'Gatekeepers' to benefits - Ben Goldacre

Bad Science's Ben Goldacre did a new documentary a week or two back - “Incapacitated” on Radio 4.
mp3 file

Goldacre discusses the problematic nature of doctors assuming the role of 'gatekeeper' to benefits. Luckily he avoids moralising about the unemployed, and rather focuses on the impact long-term unemployment has on people, and what role, if any, there should be for the medical profession.

There are 2.6 million people on incapacity benefit today, after all, the largest single group of workless people, and every practical aspect of their lives, their housing, their income, their social role, is founded in an ongoing belief in themselves as incapable people, sanctioned by doctors. We haven’t really researched what the consequences of that will be.
This is a contentious area, and although I don’t think we say anything very provocative, we will receive, undoubtedly, a deluge of angry complaints from people who accuse us of saying things we haven’t said, or think we are challenging their view of their own illness, which we’re plainly not. To be honest, our greatest crime, in what I suspect is not my most stimulating 27 minutes on radio, is that we don’t really say very much at all.

I don't know a lot about the historical relationship between doctors and the claims about 'encouraging' sickness but was pretty interesting.

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Nov 26 2008 15:00

i've been meaning to listent to this, cos goldacre's usually really good. is it about the idea of long-term sickness potentially having a pyschosomatic compontent legitimised by doctors? cos even if that's the case, work is really fucking shit like, so it's not necessarily an unhealthy response. don't know much about the topic though and haven't listened to it yet as i say.

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Nov 26 2008 18:18

Well the focus is on those on incapacity benefit (IB), rather just long-term unemployed (hope the OP wasn't misleading)

There's one part where a point is made about people on long term (+2yrs) IB being being more likely to retire or die than to go back to work. They've also higher rates of mental and chronic illnesses and die earlier. Seems like a tautology at first - sick people are more likely to be sick, yeh - but Goldacre's point is that the causality is difficult to pinpoint. So while 'sickness' means you're more likely to be on IB, being longterm IB means you're also less likely to see a change in the circumstances which caused the original illness or whatever.
The point he often makes, is about the medicalisation of social problems - turning what could be, as you say, a healthy response to the sheer monotony and alienation of work, into an 'illness'. So, while work is indeed shite and unfulfilling, and while time-off is much needed for everyone, not just the 'sick', doctors simply signing sicklines or ok-ing IB only helps to mask the real social reasons behind people suffering many conditions like stress etc.

be curious to know what the medical types on here think - refused, jenni ?

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Nov 26 2008 18:49

Isn't 2.6 million an inflated figure (representing the number of claimants rather than the number of people who actually get IB)?

Anyway, haven't got speakers on this computer, so I'll have to listen to the documentary later, but I'm suspicious of any suggestion that a return to work could be beneficial for many people on IB, even if their "sickness" is caused by social conditions, a return to work under capitalism is only going to make things much worse, surely? I'll come back to this when I've listened to the Goldacre thing.

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Nov 26 2008 19:20

Well the point isn't quite about getting them to return to work, well that's not the thrust I'm getting from it, but rather than medicalising legitimate reactions to social problems ignores the route causes and this means they're less likely to get sorted ever.

Not sure on the 2.6m figure either.

Caiman del Barrio
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Nov 26 2008 19:17

"...which is why we need an anarchist revolution" then? wink

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Nov 26 2008 19:22
revol68 wrote:
true but no doubt our caring conservative or nannying new labourite will twist this to implement more and more attacks on those on benefits all done under the name of promoting 'social inclusion' and breaking down 'isolation'.

oh I agree, that's why I said it's refreshing that he kinda refrains from those sorts of conclusions and avoids moralising about those on benefits

Boris Badenov
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Nov 26 2008 20:33
revol68 wrote:
xConorx wrote:
revol68 wrote:
true but no doubt our caring conservative or nannying new labourite will twist this to implement more and more attacks on those on benefits all done under the name of promoting 'social inclusion' and breaking down 'isolation'.

oh I agree, that's why I said it's refreshing that he kinda refrains from those sorts of conclusions and avoids moralising about those on benefits

yeah as far as I can see he's just interested in tackling the medicalisation of social problems which is spot on. Of course saying that things shouldn't be medicalised isn't to make them anyless real or serious as many people often interpret such criticisms as saying, I've noticed on Urban75 alot of people with depression really resent any attempt to suggest it isn't a medical illness. I suppouse that only highlights the power of the medical model and how deep rooted it is that unless something is categorised and explained through it, it's deemed to not really exist or considered petty and trivial.

Which is ironic because the mechanism behind this categorization is based on a contradiction. The way in which the accepted psychiatric model diagnoses illness is according to behaviour; the treatment however is biological; of course social factors don't even enter into the equation, unless it's some extreme case of isolation. To paraphrase Laing, there is no actual condition called "mental illness", but the label is a social fact and the social fact is a political event.

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Nov 26 2008 20:57

Well I'm not sure just how applicable that is.
I know my own undergrad psychology education had the notion of the 'biopsychosocial' model interowoven through all modules, particularly clinical/behavioural ones. Maybe we just got lucky and had a few slightly nuanced (though by no means radical) lecturers who decided to incorporate social factors into behaviour study.

But yeah, I mean, I've never suffered any sort of clinical depression, well, not that I'm aware of wink but I'd find it in no way trivialising for someone to say it was because I was working too hard, or had a relationship breakup, therby situating it in social/interpersonal sphere rather than an individualised/medical one.

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Nov 26 2008 21:14
revol68 wrote:
yeah as far as I can see he's just interested in tackling the medicalisation of social problems which is spot on. Of course saying that things shouldn't be medicalised isn't to make them anyless real or serious as many people often interpret such criticisms as saying, I've noticed on Urban75 alot of people with depression really resent any attempt to suggest it isn't a medical illness. I suppouse that only highlights the power of the medical model and how deep rooted it is that unless something is categorised and explained through it, it's deemed to not really exist or considered petty and trivial.

I think that especially counts with depression because of the idea of 'pulling yourself together' medicalising it removes the blame, after all there are lots of people who live in the same conditions but don't have the same problems (no one uses this logic for other diseases).

Did they mention the fact that IB was used to get people off the unemployment lists? adds a bit of a twist to it. Otherwise healthy people stuck on these lists because there's no work then ten years later once they're medicalised into a state where they can't work they are targetted as benefit scammers.

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Nov 26 2008 21:38
jef costello wrote:
Did they mention the fact that IB was used to get people off the unemployment lists? adds a bit of a twist to it. Otherwise healthy people stuck on these lists because there's no work then ten years later once they're medicalised into a state where they can't work they are targetted as benefit scammers.

yeah the list was mentioned

Wellclose Square
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Nov 26 2008 23:30

Noticed in today's Mirror that the government is planning to replace Sick Notes with 'fit notes', whereby GPs will tell employers what duties their employees could perform, rather than automatically signing them off. Health Secretary Alan Johnson wants to encourage ill people to return to work 'as soon as possible', believing it's not just an economic imperative, but 'a moral and social one too'. If there's a 'debate' about the long-term sick being 'written off' from the world of work, its one whose terms of reference have been determined by those who want to wield the axe on benefits. As if that wasn't enough they want to put the screws even further on workers taking sickies - it's the only chance I get to have a decent amount of time off!

Jason Cortez
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Nov 27 2008 23:11
Jef wrote:
I think that especially counts with depression because of the idea of 'pulling yourself together' medicalising it removes the blame, after all there are lots of people who live in the same conditions but don't have the same problems (no one uses this logic for other diseases).

I am not sure what you mean here. Are you suggesting that people who suffer from depression should take responsibility for their depression and if so, in what way?

Depression is considered to be caused by a wide spectrum of interactions, social, psychological, biological.

Jason Cortez
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Nov 27 2008 23:19

As of Feb 2008 there was 2, 389,720 people claiming IB in Britain.

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Nov 28 2008 00:10
Jason Cortez wrote:
Jef wrote:
I think that especially counts with depression because of the idea of 'pulling yourself together' medicalising it removes the blame, after all there are lots of people who live in the same conditions but don't have the same problems (no one uses this logic for other diseases).

I am not sure what you mean here. Are you suggesting that people who suffer from depression should take responsibility for their depression and if so, in what way?

Depression is considered to be caused by a wide spectrum of interactions, social, psychological, biological.

Exactly the opposite. I'm saying that depression is often seen as a form of weakness and that medicalising it can make sufferers (for want of a beter word) feel better about it. Like the example I tried to give; with other diseasesno one would say to a cancer suffferer, for example, that someone else had the same environment and doesn't have the problem.

Jason Cortez
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Nov 28 2008 19:59

Ar, right i got the wrong end of the stick and read it saying medicalising depression remove the blame and this was a problem. Doh. embarrassed

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Nov 29 2008 14:54

bit late coming to this thread but never mind.

xConorx wrote:
So, while work is indeed shite and unfulfilling, and while time-off is much needed for everyone, not just the 'sick', doctors simply signing sicklines or ok-ing IB only helps to mask the real social reasons behind people suffering many conditions like stress etc.

this is very true and it's almost impossible to know what's best sometimes. it certainly is medicalising a social problem, but since doctors aren't in a position to change or improve the social circumstances that cause/exacerbate their patients' conditions they're left with two options really - writing sick notes and eventually okaying incapacity benefit, or treating them medically and encouraging them to stick at it with work. and the latter is often just completely moronic sounding when either a) it's obvious that their illness is too severe for them to work without it being unbearable, or b) the work they could find/go back to would be so awful and boring in itself that it'd take a doctor with a pretty defunct sense of humanity to NOT sign something that lets them escape it for a bit longer. the point about whether this is more damaging in the long run is a difficult one. maybe it is the case. i certainly think the idea of it being psychologically damaging to be labelled as 'incapable' is valid. but at the end of the day i would find it more worrying if doctors became bigger barriers to people getting IB: i think it's worse for the balance to be tipped towards people being denied it when they do need it (be that based on physical or mental reasons) than towards people getting it when it's questionable whether they're really 'sick'. it is not a doctor's job to decide who is and isn't appropriate to be subjected to work in all its alienating, depressing, exploitative glory. nobody is. i think it's more important for patients to see their doctors as 'on their side' and thus trustworthy when it comes to whether or not they'll have to do work they don't want to do/return to when they're not well, than for them to know doctors aren't "contributing to a social problem". (which would be impossible to know anyway - sign the damn things and they're worsening the problem of the long term risks of being on IB, don't sign and they're sentencing people to work and all the health/social problems that go with it.)