Tag: Nudge

IAPT is value-laden, non-prefigurative, non-dialogic, antidemocratic and reflects a political agenda

March 7, 2017April 30, 2019 · 30 Comments ·

Arnstein’s ladder of citizen participation and inclusion. It represents the redistribution of power that enables marginalised citizens, presently excluded from the political and economic processes, to be purposefully included in the future.

The government’s Work and Health Programme, due to be rolled out this autumn, involves a plan to integrate health and employment services, aligning the outcome frameworks of health services, Improving Access to Psychological Therapies (IAPT), Jobcentre Plus and the Work Programme.

But the government’s aim to prompt public services and commissioned providers to “speak with one voice” is founded on traditional Conservative prejudices about people who need support. This proposed multi-agency approach is reductive, rather than being about formulating expansive, coherent, comprehensive and importantly, responsive mental health provision.

What’s on offer is psychopolitics, not therapy. It’s about (re)defining the experience and reality of a marginalised social group to justify dismantling public services (especially welfare). In linking receipt of welfare with health services and state therapy, with the single politically intended outcome of employment, the government is purposefully conflating citizens’ widely varied needs with economic outcomes and diktats, which will isolate people from traditionally non-partisan networks of unconditional support, such as the health service, social services, community services and mental health services.

Services “speaking with one voice” will invariably make accessing support conditional, and further isolate marginalised social groups. It will damage trust between people needing support and professionals who are meant to deliver essential public services, rather than simply extending government dogma, prejudices and discrimination. And meeting ideologically designed targets.

As neoliberals, the Conservatives see the state as a means to reshape social institutions and social relationships hierarchically, based on a model of a competitive market place. This requires a highly invasive power and mechanisms of persuasion, manifested in an authoritarian turn. Public interests are conflated with narrow economic outcomes. Public behaviours are politically micromanaged and modified. Social groups that don’t conform to ideologically defined economic outcomes and politically defined norms are stigmatised and outgrouped.

Othering and outgrouping have become common political practices, it seems.

The Work and Health Programme is a welfare-to-work programme for people with disabilities, mental health problems and for long-term unemployed people, due to be rolled out in the autumn. In the recent Work, Health and Disability green paper, the government mentioned new mandatory “health and work conversations” in which work coaches will use “specially designed techniques” to “help” those people in the ESA Support Group – those assessed by their own doctors and the state as being unlikely to work in the near future – “identify their health and work goals, draw out their strengths, make realistic plans, and build resilience and motivation.”

Apparently these “conversations” were “co-designed” by the Behavioural Insights Team.

Democracy is based on a process of dialogue between the public and government, ensuring that the public are represented: that governments are responsive, shaping policies that address identified social needs.

However, policies increasingly reflect a behaviourist turn. They are no longer about reflecting citizens’ needs: they are increasingly about telling some citizens how to be. This has some profound implications for democracy.

Neoliberal policies increasingly extend behaviour modification techniques that aim to quantifiably change the perceptions and behaviours of citizens, aligning them with narrow neoliberal outcomes through rewards or “consequences.” Rewards, such as tax cuts, are aimed at the wealthiest, whereas the most vulnerable citizens who are the poorest are simply presented with imposed cuts to their lifeline support as an “incentive” to not be poor. Taking money from the poorest is apparently “for their own good”.

Defining human agency and rationality in terms of economic outcomes is extremely problematic. And dehumanising. Despite the alleged value-neutrality of behavioural economic theory and CBT, both have become invariably biased towards the status quo rather than progressive change and social justice.

Behavoural economics theory has permited policy-makers to indulge ideological impulses whilst presenting them as “objective science.” From a libertarian paternalist perspective, the problems of neoliberalism don’t lie in the market, or in growing inequality and poverty: neoliberalism isn’t flawed, nor are governments – we are. Governments and behavioural economists don’t make mistakes – only citizens do. No-one is nudging the nudgers. It’s assumed that their decision-making is infallible and they have no whopping cognitive biases of their own.

“There’s no reason to think that markets always drive people to what’s good for them.” Richard Thaler.

There’s no reason whatsoever to think that markets are good for people at all. Let’s not confuse economics with psychology, or competitive individualism and economic Darwinism with collectivism and mutual aid. Behavioural economics may offer us titbit theories explaining individual consumer’s decision making, but it’s been rather unreliable in explaining socioeconomic and political contexts and complex systems such as financial crises, and of course behavioual economists don’t feel the same pressing need to explore the decision making and “cognitive bias” of the handful of people who cause those.

It wasn’t those with mental health problems currently claiming social security. They do much less damage to the economy, in fact IAPT means vulture capitalist private companies like G4S and trusts like Southern Care can turn a profit offering “support”.

The current emphasis on quantitative methodology and standardisation has led to an overwhelming focus on measurement in IAPT settings. Mental health services are now dominated by IAPT, which focuses exclusively on “evidence-based” and short-term interventions for clients with particular diagnoses – mostly anxiety disorders and depression. Most workers in IAPT services offer CBT, often by minimally trained psychological wellbeing practitioners offering “low-intensity” interventions over few sessions.

Verificationism and standardisation leads to a focus on measurement in IAPT settings. CBT mutes the causes of distress, which do not reside “within” the individual: they are intersubjectively constructed, with cultural, socioeconomic and political dimensions. Furthermore, there is little room left for authentic dialogue – qualitative accounts of client’s experiences are not accommodated. In this context, CBT is authoritarian, rather than being prefigurative and genuinely dialogic.

Under the government’s plans, therapists from the IAPT programme are to support jobcentre staff to assess and treat claimants, who may be referred to online cognitive behavioural therapy (CBT) courses.

We must question the ethics of linking receipt of welfare with “state therapy,” which, upon closer scrutiny, is not therapy at all. Linked to such a narrow outcome – getting a job – it amounts to little more than a blunt behaviour modification programme. The fact that the Conservatives have planned to make receipt of benefits contingent on participation in “treatment” also worryingly takes away the fundamental right of consent.

CBT facilitates the identification of “negative thinking patterns” and associated “problematic behaviours” and “challenges” them. This approach is at first glance a problem-solving approach, however, it’s of course premised on the assumption that interpreting situations “negatively” is a bad thing, and that thinking positively about bad events is beneficial.

The onus is on the individual to adapt by perceiving their circumstances in a stoical and purely “rational” way.

So we need to ask what are the circumstances that we expect people to accept stoically. Socioeconomic inequality? Precarity? Absolute poverty? Sanctions? Work fare? Being forced to accept very poorly paid work, abysmal working conditions and no security? The loss of social support, public services and essential safety nets? Starvation and destitution?

It’s all very well challenging people’s thoughts but for whom is CBT being used. For what purpose? It seems to me that this is about coercing those people on the wrong side of draconian government policy to accommodate that; to mute negative responses to negative situations. CBT in this context is not based on a genuinely liberational approach, nor is it based on democratic dialogue. It’s about modifying and controlling behaviour, particularly when it’s aimed at such narrow, politically defined and specific economic outcomes, which extend and perpetuate inequality. In this context, CBT becomes state “therapy” used only as an ideological prop for neoliberalism.

CBT tends to generate oversimplifications of the causes human distress. It’s not about helping people make better choices, it’s about coercing people to make the choices that policymakers want them to make. Those “choices” are based on enforced conformity to the ideological commitments of policymakers.

It’s assumed that the causes of unemployment are personal and attitudinal rather than sociopolitical or because of health barriers, and that particular assumption authorises intrusive state interventions that encode a Conservative moral framework, which places responsibility on the individual, who is characterised as “faulty” in some way. The deeply flawed political/economic system that entrenches inequality isn’t challenged at all: its victims are discredited and stigmatised instead.

Yet historically (and empirically), it has been widely accepted that poverty significantly increases the risk of mental health problems and can be both a causal factor and a consequence of mental ill health. Mental health is shaped by the wide-ranging characteristics and circumstances (including inequalities) of the social, economic and physical environments in which people live. Successfully supporting the mental health and wellbeing of people living in poverty, and reducing the number of people with mental health problems experiencing poverty, requires engagement with this complexity.

There is also widely held assumption that working is good for mental health, and that being in employment indicates mental wellbeing. It’s well-established that poverty is strongly linked with a higher likelihood of being diagnosed with a mental illness. That does not mean working is therefore somehow “good” for mental health. Encouraging people to work should entail genuine support, it shouldn’t entail taking away their lifeline income as ~~punishment~~ “incentive” if they can’t work.

An adequate level of social security to meet people’s basic survival needs is not mutually exclusive from encouraging people to find a suitable job.

It’s worth noting that research indicates in countries with an adequate social safety net, poor employment (low pay, short-term contracts), rather than “worklessness”, has the biggest detrimental impact on mental health.

CBT does not address the socioeconomic and political context. It permits society to look the other way, whilst the government continue to present mental illness as an individual weakness or vulnerability, and a consequence of “worklessness” rather than a fairly predictable result of living a distressing, stigmatised, excluded existence and material deprivation in an increasingly unequal society.

Inequality and poverty arise because of ideology and policy-formulated socioeconomic circumstances, but the government have transformed established explanations into a project of constructing behavioural and cognitive problems as “medical diagnoses” for politically created socioeconomic problems. Austerity targets the poorest disproportionately for cuts to income and essential services, it’s one ideologically-driven political decision taken amongst alternative, effective and more humane choices.

Both nudge and CBT are being used to prop up austerity and reflect neoliberal managementspeak at its very worst. Neoliberal policies are causing profound damage, harm and distress to those they were never actually designed to “help”. Let’s not permit techniques of neutralisation: the use of rhetoric to obscure the real intention behind policies. It’s nothing less than political gaslighting.

The government’s profound antiwelfarist rhetoric indicates that there’s no genuine intention to support those people with mental health problems and others in need, despite their semantic thrifts and diversions.

Policies are expressed political intentions regarding how our society is organised and governed. They have calculated social and economic aims and consequences. In democratic societies, all citizen’s accounts of the impacts of policies ought to matter.

However, in the UK, the way that policies are justified is being increasingly detached from their aims and consequences, partly because democratic processes and basic human rights are being disassembled or side-stepped, partly because the government employs the widespread use of linguistic strategies and techniques of persuasion to intentionally divert us from the aims and consequences of their ideologically driven and increasingly dehumanising policies. Furthermore, policies have become increasingly detached from public interests and needs.

For people with mental health problems, policies are being formulated to act upon them as if they are objects, rather than autonomous human subjects. Such a dehumanising approach has contributed significantly to a wider process of social outgrouping, increasing stigmatisation and ultimately, to further socioeconomic and mental health inequalities.

It’s the government that need to change their behaviour.

It’s us that need to make a stand against hegemonic neoliberal discourse and injustice.

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This article was written for a zine to mark the protest at the 10th annual New Savoy conference on 15 March in London #newsavoy2017. You can read the zine, with other people’s excellent contributions, here.

Also, see: New Savoy Protest against psycho-compulsion of MH claimants – 15th March 2017.

You can read about the background to the Mental Wealth Alliance and the New Savoy demo and lobby here.

You can watch the video here from Let Me Look TV: Protest at the 10th Annual New Savoy Conference 15 March 2017.

Please share.

The importance of citizen’s qualitative accounts in democratic inclusion and political participation

A critique of the ‘Origins of Happiness’ study

A critique of Conservative notions of social research

Research finds damaging mental health discrimination ‘built into’ Work Capability Assessment. Again.

The Conservative approach to social research – that way madness lies

I don’t make any money from my work. I am disabled because of illness and have a very limited income. The budget didn’t do me any favours at all.

But you can help by making a donation to help me continue to research and write informative, insightful and independent articles, and to provide support to others. The smallest amount is much appreciated – thank you.

The still face paradigm, the just world fallacy, inequality and the decline of empathy

January 9, 2017November 11, 2022 · 25 Comments ·

r-wilkinson-spirit-level-lecture-november-2010-10-638

UNICEF’s reports have consistently put the UK at the bottom of the child well-being league table. See also: UNICEF criticises UK’s failure to tackle child inequality as gap grows.

pie-wealth Source: The Equality Trust

The still face paradigm and inequality

Before Christmas I read an excellent and insightful article by Michael Bader called The Decline of Empathy and the Appeal of Right-Wing Politics, which was about Edward Tronick’s Still Face experiment in part. Tronick is an American developmental psychologist at the University of Massachusetts, Boston. His studies illuminate the importance of trusting relationships and consistent human responses in children’s development and learning.

Tronick’s experimental design was very simple: mothers were asked to play as they usually would with their six-month-old infants. The mothers were then instructed to suddenly blank their face: to make their facial expression flat and neutral – completely “still” – and to do so for three minutes, regardless of her baby’s activity. Mothers were then told to resume normal play. The design came to be called the “still face paradigm.”

The study demonstrated that when the connection between an infant and caregiver is broken, the infant tries to re-engage the caregiver, and then, if there is no response, the infant withdraws – first physically and then emotionally. Recent studies have found that four-month-old infants, when re-exposed to the “Still Face” two weeks after the first time, show rapid physiological changes that were not present when they were exposed to it the first time.

Tronick said: “It speaks to the incredible emotional capacities [of] the infant — to pick up on the fact that the mother’s not reacting emotionally the way she normally does. The baby has not only this ability to process what’s [happening], but [also] the capacity to respond in a really appropriate way — that is, they try to get the mother’s attention, and then when they fail, they give up, with a sense of their own helplessness. They may be angry and then they become sad.”

Tronick also emphasised the impact of parenting practices embedded in the sociocultural and ecological environment of the infant.

Bader’s inspiring article draws on Tronick’s experimental findings, which he then applies to citizen’s life experiences in the US, in the face of dehumanising encounters with bureacracy, increasingly depopulated policies and a profoundly alienating sociopolitical system. He goes on to discuss how “the pain of the “still face” in American society is present all around us.”

He says: “People feel it while waiting for hours on the phone for technical support, or dealing with endless menus while on hold with the phone or cable company, or waiting to get through to their own personal physician. They feel it in schools with large class sizes and rote teaching aimed only at helping students pass tests.

They feel it when crumbling infrastructure makes commuting to work an endless claustrophobic nightmare. And, too often, they feel it when interacting with government agencies that hold sway over important areas of their lives, such as social services […] and city planning departments, or a Department of Motor Vehicles. Like Tronick’s babies, citizens who look to corporations and government for help, for a feeling of being recognized and important, are too often on a fool’s errand, seeking recognition and a reciprocity that is largely absent.

This problem is greatly exaggerated by the profoundly corrosive effects of social and economic inequality. Under condition of inequality, the vulnerability of those seeking empathy is dramatically ramped up, leading to various forms of physical and psychological breakdowns. In a classic epidemiological study [The Spirit Level] by Richard Wilkinson and Kate Pickett, researchers found a strong correlation between the degree of inequality in a country (or a state, for that matter) and such problems as rates of imprisonment, violence, teenage pregnancies, obesity rates, mental health problems such as anxiety, depression, and addiction, lower literacy scores, and a wide range of poor health outcomes, including reduced life expectancy.

Wilkinson and Pickett’s key finding is that it is the inequality itself, and not the overall wealth of a society that is the key factor in creating these various pathologies. Poorer places with more equality do better than wealthy ones marked by gross inequality.

Inequality makes people feel insecure, preoccupied with their relative status and standing, and vulnerable to the judgment of others, and it creates a greater degree of social distance between people that deprives them of opportunities for intimate and healing experiences of recognition and empathy.”

The still face of the neoliberal state

It’s impossible to fail to recognise the parallels with citizen’s experiences here in Britain. We have ideological and socioeconomic commonality with the US, especially as both the UK and US are neoliberal states. Neoliberalism is an ongoing, totalising ideological and political-economic project of a resurgent political right that gained ascendancy in the US under Ronald Reagan and in the UK under Margaret Thatcher in the 1980s. 

Bader says: “As a metaphor for adult life in contemporary society, the “still face” paradigm—the helplessness intrinsic to it and the breakdown of empathy that lies at its foundation—aptly describes the experience of many people as they interact with the most important institutions in their lives, including government.

And, as with Tronick’s babies and their mothers, when our social milieu is indifferent to our needs and inattentive to our suffering, widespread damage is done to our psyches, causing distress, anger, and hopelessness. Such inattention and neglect lead to anxiety about our status and value, and a breakdown of trust in others.”

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I agree that the growing inequalities we are witnessing in western neoliberal “democracies” create profound psychological trauma and ontological insecurity. Humans are fundamentally social beings. We thrive best when we have a social rationale which tends towards the promotion of cooperative and collective creativity. This was perhaps expressed best in our civilised, progressive institutions and civilising practices, facilitated by the social gains and economic organisation that arose from the post-war democratic settlement.

Those gains are now being systematically dismantled. Our culture has been saturated with conceptual schema that demand we remain committed to an socioeconomic Darwinism, a kind of economic enclosure: a neoliberal competitive individualist obsession with our private, inner experiences, the pursuit of economic self-interest, and ultimately, this embellishes our separability from other human beings. It alienates us.

Neoliberalism scripts social interactions that are founded on indifference to others, tending to be dehumanising, adversarial and hierarchical in nature, rather than social and cooperative. Neoliberalism is the antithesis of the responsive, animated human face; of collectivism, mutual support, universalism, cooperation and democracy. Neoliberalism has transformed our former liberal democracy into an authoritarian “still faced” state that values production, competition and profit above all else; including citizens’ lives, experiences, freedoms, well-being, democratic inclusion and social conditions that support all of this.

Citizens are seen and are being politically redefined in isolation from the broader political, economic, sociocultural and reciprocal contexts that invariably influence and shape individual experiences, meanings, motivations, behaviours and attitudes, causing a problematic duality between context and cognition. This also places responsibility on citizens for circumstances which lie outside of their control, such as the socioeconomic consequences of political decision-making, whilst at the same time, the state is steadily abdicating responsibility for the basic welfare of ordinary citizens.

Neoliberals see the state as a means to reshape social institutions and social relationships based on the model of a competitive market place. This requires a highly invasive power and mechanisms of persuasion, manifested in an authoritarian turn. Public interests are conflated with narrow economic outcomes. Public behaviours are ‘nudged’ – citizens are being politically micromanaged. Social groups that don’t conform to ideologically defined outcomes are stigmatised and outgrouped.

Stigma is a political and cultural attack on people’s identities. It’s used to discredit, and as justification for excluding some groups from economic and political consideration, refusing them full democratic citizenship.

Stigma is being used politically to justify the systematic withdrawal of support and public services for the poorest – the casualties of a system founded on competition for allegedly scarce wealth and resources. Competition inevitably means there are winners and losers. Stigma is profoundly oppressive. It is used as a propaganda mechanism to draw the public into collaboration with the state, to justify punitive and discriminatory policies and to align citizen “interests” with rigid neoliberal outcomes. Inclusion, human rights, equality and democracy are not compatible with neoliberalism.

Othering and outgrouping have become common political practices, and are now culturally embedded.

This serves to desensitise the public to the circumstances of marginalised social groups. Outgroups serve to de-empathise society and dehumanise stigmatised others.

This political and cultural process legitimises neoliberal “small state” policies, such as the systematic withdrawal of state support for those adversely affected by neoliberalism, and it also justifies inequality. By stigmatising the poorest citizens, a “default setting” is established regarding how the public ought to perceive and behave towards politically demarcated outgroups. That default setting is indifference to the plight of others.

Authors of The Spirit Level, Richard Wilkinson and Kate Pickett, say “The truth is that human beings have deep-seated psychological responses to inequality and social hierarchy. The tendency to equate outward wealth with inner worth means that inequality colours our social perceptions. It invokes feelings of superiority and inferiority, dominance and subordination – which affect the way we relate to and treat each other.”

Neoliberalism and the myth of meritocracy

How does inequality and social injustice become acceptable? And why do we, as a society, permit the political construction of scapegoats and outgroups?

Neoliberalism is premised on the assumption that the market place can somehow replace the state as the ultimate arbiter of cultural logic and value. Relationships between people are mediated by the depersonalising market place.

It is fundamentally Hobbesian in character, neoliberalism privatises citizen’s experiences, who are valued for their economic productivity and are therefore only responsible for themselves.

Bader says: “The failure of our institutions to empathize with the plight of the middle and working classes, to recognize their sacrifice and reward their hard work is traumatic. It is the same type of trauma that children experience when their caretakers are preoccupied or rejecting. The trauma erodes trust. It overwhelms systems that people have developed to deal with stress and creates psychological suffering and illness.”

He goes on to tell us how our social brains seek a collective experience – of “we” rather than “I” – and often do so by creating a fantasy of an “us” versus “them” that we can devalue and fight.

Tribalism draws on our need for sociability and interconnectedness but it can also be used to pervert it. Rejected by government, employers and wider society, some citizens then go on to reject and demean others. It’s a coping strategy: they are trying to cope with the pain, powerlessness, and lack of empathy that they experience in their social lives. This serves to further divide citizens, undermining social solidarity further, and isolating vulnerable groups. The government and right wing press have ruthlessly exploited the social divisions and scapegoats they have meticulously crafted to uphold a dogma that is absolutely incompatible with democracy, human rights, human needs and any notion of equality.

We must recognise the play of hidden ideologies and the influence of dog whistle and wedge issue politicking. This is a state tactic which manipulates our fundamental human need for a sense of belonging. It’s about the creation of scapegoats and diversion from the real problem: neoliberalism, authoritarianism and the inequality and increasing precarity that this extends and perpetuates. Hierarchical thinking is embedded in neoliberal and authoritarian ideologies.

Neoliberalism also extends a myth that citizens are autonomous and free to make choices. However, this ignores the well-researched reality that those without resources have few or no choices.

Neoliberalism is an ideology that manufactures consent to inequalities by offering the myth of meritocracy: the false promise that everyone will eventually benefit by working hard to earn merit, status and wealth. However, it isn’t logically possible for equal opportunities to exist in a highly unequal society.

This myth undermines the principles of social and economic rights and discredits solidarity, collective responsibility and contravenes our human need for belonging. Success, according to the meritocrats, is shaped by your IQ and individual talents, hard work and personal effort. Yet at least a third of those touting this myth are millionaires who simply inherited their wealth.

The ideology of meritocracy conceals the fact that class privileges are institutionalised, and are reinforced through the education system, for example. The UNICEF report, Fairness for Children, emphasised the importance of a strong welfare system in reducing inequality – and carried a strong suggestion that the UK Government should reconsider its cuts to benefits. In June last year, following its investigation, the United Nations committee on the rights of the child called on ministers to act regarding austerity, the benefit cap and tax credit cuts, which are undermining children’s rights to an adequate standard of living. The government were also urged to do more to ensure children’s rights to adequate health, housing and education are met, too.

The government, however, have claimed that welfare cuts reduce poverty by “incentivising” people to work. Meanwhile, over half of those families queuing at food banks are in work, and nearly two thirds of children in poverty live in working families. “Making work pay” is nothing more than a Conservative euphemism for the incremental dismantling of the welfare state, which they intend to continue, regardless of the social consequences.

Neoliberalism is sustained by ideologues employed by governments, in think tanks, PR companies and as individual consultants, that invent technical justifications for small state neoliberal policies on the grounds of: “efficiencies”, savings, democracy, economic growth, and more recently “fairness” and “social justice.” The latter two especially are founded on the myth of meritocracy, in this context.

In any competitive system, there are invariably a few “winners” and many more “losers”. The system itself creates the conditions which mean that many people “lose”. It has nothing to do with the IQ, character or qualities of those people. Competition is adversarial – it’s defined as a situation in which two or more people or groups are fighting to get something which not everyone can have.

The Nudge Unit is one example of a technocratic think tank that promotes the myth of meritocracy, which is embedded in the Cabinet Office. The neoliberal Reform think tank and the Adam Smith Institution are others. There is a raft of contemporary academics who are also fueling ideological justifications of neoliberal policies – the likes of Adam Perkins, Richard Layard, Mansel Aylward and Simon Wessley, for example, each in their respective academic fields have each presented “studies” that endorse “small state” antiwelfarism and enforce notions of personal responsibility and competitive individualism. Public interests are steadily being aligned with economic outcomes, driven by private interests.

Status and rewards in society do not go “naturally” to those who are best “performers” or those who “earn” their privilege: the hierarchy of wealth and power is being purposefully shaped by the state.

Stigma and the just world fallacy

Sociologist Imogen Tyler at Lancaster University, says “[…] the centrality of stigma in producing economic and social inequalities has been obscured ‘because bodies of research pertaining to specific stigmatized statuses have generally developed in separate domains’ (Hatzenbuehler, 2013). In short, stigma is widely accepted to be a major factor in determining life chances, yet research on stigma is fragmented across academic disciplines.”

Tyler’s ongoing work – The Stigma Doctrine, is focused on “policy design and implementation, ‘The Stigma Doctrine’ aims to develop a new theoretical account of the ways in which neoliberal modes of government operate not only by capitalizing upon ‘shocks’ but through the production and mediation of stigma.”

Her explicit focus is on “stigmatization as a central dimension of neoliberal state-crafting.” The project is focussing in particular on welfare “reform”, the neoliberal de/recomposition of class, poverty, work and dis/abilities.

At a basic level, stigma is seen as a mark of disgrace associated with particular circumstances, qualities, or persons. However, it has a fundamental normative dimension, which is culturally and historically specific.

We tend to make assumptions about people, based on what their circumstances or characteristics are. Central to these assumptions lies a basic moral dichotomy founded on the binary notions of “deserving” and “undeserving”.

Everyone has heard “what goes around comes around” before, or maybe you’ve seen a person “get what was coming to them” and thought, “that’s karma for you.” These are all shades of the just world fallacy. But in reality, we don’t always “reap what we sow.”

In social psychology, the just world hypothesis is the tendency to attribute consequences to – or expect consequences as the result of – a universal force that restores moral balance. This belief generally implies the existence of destiny, cosmic justice, or divine providence.

It is very common in fiction for the villains to lose and the virtuous folk to win. It is a reflection of how we would like to see the world – just and fair. In psychology the tendency to believe that this is how the real world actually works is a known cognitive error: the just world is a fallacy.

Many people have a strong desire or need to believe that the world is an orderly, predictable, and fair place, where people simply get what they deserve. Such a belief plays an important role in our lives – in order to plan our lives or achieve our goals we need to assume that our actions will have predictable consequences.

Moreover, when we encounter evidence suggesting that the world is not just, we either act to restore justice by helping victims or we persuade ourselves that no injustice has occurred. We comfort ourselves with the idea that the person without a job is simply lazy, the homeless person is irresponsible, and the ill person made the “wrong” lifestyle choices. These attitudes are continually reinforced in the ubiquitous fairy tales, fables, popular fiction, comics, TV, the mainstream media, current political rhetoric and other morality tales of our culture, including the great myth of meritocracy, embedded in neoliberal narrative, in which “good” is always rewarded and “evil” punished. Only it isn’t.

Deep down, we all would probably like to believe hard work and virtue will lead to success, and laziness, evil and manipulation will lead to ruin, quite often we simply edit the world to match those expectations.

The normalisation of socioeconomic hierarchy: a nod to Milgram

Social psychologist, Melvin Lerner documents people’s eagerness to convince themselves that beneficiaries deserve their benefits and victims their suffering. In a 1965 study, Lerner reported that subjects who were told that a fellow student had won a cash prize in a lottery tended to believe that the student worked harder than another student who lost the lottery. Lerner observed that when one of two men was chosen at random to receive a reward for a task, that somehow caused him to be more favourably evaluated by observers, even when the observers had been informed that the recipient of the reward was chosen at random. (Lerner, M. J., & Miller, D. T. (1978). Just world research and the attribution process: Looking back and ahead. Psychological Bulletin, 85(5), 1030–1051).

Existing social psychological theories, including cognitive dissonance, do not fully explain these phenomena. In another study a year later, Lerner and a colleague recorded a simulated “learning” experiment in which it appeared that the “participants” were subjected to electric shocks. Lerner found that subjects who observed the videotapes tended to form much lower opinions of these “victimised” participants when there was no possibility of the victim finding relief from the ordeal, or when the victim took on the role of “martyr” by voluntarily remaining in the experiment despite the apparent unpleasantness of the experience.

Lerner concluded that “the sight of an innocent person suffering without possibility of reward or compensation motivated people to devalue the attractiveness of the victim in order to bring about a more appropriate fit between her fate and her character.”

If the belief in a just world simply resulted in humans feeling more comfortable with the universe, its uncertainties and our own precarity, it would not be a matter of great concern for human rights activists, ethicists or social scientists. But Lerner’s just world hypothesis, if correct, has significant social implications. The belief in a just world may well seriously undermine a commitment to social justice.

So, the just world fallacy is founded on a massive misconception: that we always get what we “deserve”. We like to think that people who are not doing well in their lives must have done something to deserve it. Yet we also know that the beneficiaries of good fortune often do nothing to earn it, and people doing harmful deeds often get away with their actions without consequences.

Lerner’s research extended, to some extent, on Stanley Milgram‘s research on social conformity and obedience. Lerner was curious as to how regimes that cause cruelty and suffering manage to maintain popular support, and how people come to accept social norms and laws that produce misery and suffering.

Lerner’s direction of inquiry was influenced by his frequent witnessing of the tendency of observers to blame victims for their suffering, particularly during his clinical training as a psychologist, when he observed treatment of mentally ill persons by the health care practitioners with whom he worked. Though he knew them to be basically kind, educated people, they often blamed patients for the patients’ own suffering. Lerner also describes his surprise at hearing his students derogate disadvantaged people, believing that poor people somehow caused their own poverty, whilst being seemingly oblivious to the social, political and economic (structural) forces that contribute significantly to poverty.

Zick Rubin of Harvard University and Letitia Anne Peplau of the UCLA conducted surveys to examine the characteristics of people with strong beliefs in a just world. They found that people who have a strong tendency to believe in a just world also tend to be more religious, more authoritarian, more Conservative, more likely to admire political leaders and existing social institutions, and more likely to have negative attitudes and and hold prejudices toward underprivileged groups. To a lesser but nonetheless significant degree, the believers in a just world tend to “feel less of a need to engage in activities to change society or to alleviate plight of social victims.”

It’s ironic that the belief in a just world may take the place of a genuine commitment to justice. For some people, it is simply easier to assume that forces beyond their control mete out justice. When that occurs, the result may be the abdication of personal responsibility, acquiescence in the face of suffering and misfortune, and indifference towards injustice

In the murky waters of real life, evil people often prosper whilst harming others, and quite often never face justice and retribution.

Social reality isn’t founded on some intrinsic and fair principle or quality of the universe. Social justice is something that we must construct and re-construct our selves. In the same way, democracy isn’t something we “have”, it is something we must do.

As a society, we make our own “karma”. We participate in, shape and distribute social justice. That affects those around us. We do need to think about what kind of world we live in, how we ought to live and how that affects our families, friends, neighbours and strangers. A measure of civilisation may be observed in how we behave towards those people we don’t know.

In our society, over the past 6 years, some (previously protected) social groups have become politically defined strangers and economic exiles. If you think that’s okay, it’s worth bearing in mind that sooner or later, someone you know well, perhaps one of your loved ones, will be affected by this ongoing process.

When one group are targeted with injustice and inequality, it affects everyone, and other groups soon follow. Historically, we learned that tyrants don’t stick with targeting and persecuting the group you don’t like. You don’t get a choice ultimately. Prejudice tends to multitask very well, and tyrants remain tyrants no matter who you are.

Wilkinson and Pickett’s research on the harmful effects of economic inequality is a challenge for us to ensure that redistribution is the main focus of our political programme. Their research very clearly shows us that if we work towards greater equality, we can ameliorate a wide range of human suffering. Because neoliberal ideology ultimately disconnects us from each other, we really must work hard to seek common ground with the people on the other side of what American sociologist, Arlie Hochschild, calls the “empathy wall” to reach out, communicate to them that “we not only feel their pain, but we share it, and that, in the end, we are all in this together.”

Hochschild’s work has often described the various ways in which we each becomes a “shock absorber” of larger social, economic and political forces. She explores the “deep story” of American citizens – a metaphorical expression of the emotions they live by. She recognised that the people she studied may not vote in favour of their economic self-interest, but they often voted for what they felt was their emotional self-interest as members of a group which feels marginalised, scorned and betrayed by the establishment. This sense of betrayal was utilised by the right, who readily draw on and manipulate the role of emotion in politics.

How much more of the current political-economic just world narrative will people permit to remain largely unchallenged before we all say “enough”?

In democracies, Government’s are elected to represent and serve the needs of the population. Democracy is not only about elections. It is also about distributive and social justice. The quality of the democratic process, including transparent and accountable Government and equality before the law, is crucial to social organisation, yet it seems the moment we become distracted, less attentive and permit inequality to fundamentally divide our society, the essential details and defining features of democracy seem to melt into air.

Government policies are expressed political intentions regarding how our society is organised and governed. They have calculated social and economic aims and consequences. In democratic societies, all citizen’s accounts of the impacts of policies ought to matter.

However, in the UK, the way that policies are justified is being increasingly detached from their aims and consequences, partly because democratic processes and basic human rights are being disassembled or side-stepped, and partly because the government employs the widespread use of linguistic strategies and techniques of persuasion to intentionally divert us from their aims and the consequences of their ideologically (rather than rationally) driven policies. Furthermore, policies have become increasingly depopulated; detached from public interests and needs.

Democracy is not something we have: it’s something we have to DO.

My hope for 2017 is that enough of us will recognise that democratic participation is essential, and that injustice directed against one is injustice ultimately directed against all.

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All the best for the new year.

In solidarity.

Who Believes in a Just World? – Zick Rubin and Letitia Anne Peplau

The Stigma Project – Imogen Tyler

The Spirit Level authors: why society is more unequal than ever – Richard Wilkinson and Kate Pickett

The importance of citizen’s qualitative accounts in democratic inclusion and political participation

I don’t make any money from my work. But you can make a donation if you wish and help me continue to research and write informative, insightful and independent articles, and to provide support to others. The smallest amount is much appreciated – thank you.

The government’s in-work sanctions are incompatible with ‘halving the disability employment gap’ (and other ideological problems)

December 5, 2016December 6, 2016 · 12 Comments ·

The government have introduced in-work sanctioning for low paid and part-time workers to “incentivise” them to “progress” in work. Historically, wages and employment conditions were raised, and hours were often negotiated by Trade Unions. Now those decisions are entirely down to the executive decisions of employers not employees. Sanctioning employees is grossly unfair, because they have very little negotiating and bargaining power (especially since the raft of Conservative anti-collectivist and anti-Trade Union legislation) to improve their lot.

There is also a significant growing body of empirical evidence that informs us sanctions do not work as the government claim.

It’s not as if employees’ behaviour is at fault or that they would ever actually want poor pay, fewer rights and adverse working conditions – that’s down to exploitative employers who are primarily profit driven. It’s hardly fair to punish workers for the motivations and behaviour of their employers.

There are profoundly conflicting differences in the interests of employers and employees. The former are generally strongly motivated to purposely keep wages as low as possible so they can generate profit and pay dividends to shareholders and the latter need their pay and working conditions to be such that they have a reasonable standard of living.

Clearly, the weight of favour in policy-making is heavily towards big business profiteering. Implying that the behaviours of workers are a problem in this context is simply another way justification is presented for the further erosion of state responsibility and support and ultimately, the long term plan is to remove such support completely.

Workplace disagreements about wages and conditions are now typically resolved neither by collective bargaining nor litigation but are left to management prerogative. This is because Conservative aspirations are clear. Much of the government’s discussion of legislation is preceded primarily with consideration of the value and benefit for big business and the labour market. They want a cheap labour force and low cost workers, unable to withdraw their labour, unprotected by either Trade Unions or employment rights and threatened with destitution via benefit sanction cuts if they refuse to accept low paid, low standard work. Similarly, desperation and the “deterrent” effect of the 1834 Poor Law Amendment Act – the principle of less eligibility – also served to drive down wages.

In the Conservative’s view, trade unions distort the free labour market which runs counter to New Right and neoliberal dogma. Since 2010, the decline in UK wage levels has been amongst the very worst in Europe. The fall in earnings under the Coalition is the biggest in any parliament since 1880, according to analysis by the House of Commons Library, and at a time when the cost of living has spiraled upwards.

In-work conditionality enforces a lie and locates blame within individuals for structural problems – political, economic and social – created by those who hold power. Despite being a party that claims to support “hard-working families,” the Conservatives have nonetheless made several attempts to undermine the income security of a significant proportion of that group of citizens recently. Their proposed tax credit cuts, designed to creep through parliament in the form of secondary legislation, which tends to exempt it from meaningful debate and amendment in the Commons, was halted only because peers in the House of Lords have been paying attention to the game.

Sanctioning people in work flies in the face of the government’s previous “hard working families” mantra. But it also flies in the face of their aim to “help” disabled people into work. Many of disabled people would have to work part-time: reduced and flexible hours are also a reasonable adaptation, especially for people who are ill. Many of us also have to accommodate hospital appointments, often with a variety of specialists, as well as hospital based treatment regimes. All of which probably makes us much more likely to face in-work sanctioning in the future.

How does this address the “disability employment gap”?

The government propose tax cuts and other rewards for employers who employ disabled people in their recent consultation on work, health and disability. However, it is against the law to treat someone less favourably than someone else because of a personal characteristic, such as being disabled.

Furthermore, disabled people have a legal RIGHT to work and to be included in the economy, and I think in light of this, employers should be fined for not employing a quota of disabled people instead. “Disability Confident” is supposed to be about supporting disabled people, not providing publicly funded handouts to employers, whilst at the same time, financially punishing the very people that the policy is supposedly designed to “support.”

There was some very worrying discussion in the recent work health and disability green paper about new mandatory “health and work conversations” in which work coaches will use “specially designed techniques” to “help” disabled Employment and Support Allowance (ESA) claimants “identify their health and work goals, draw out their strengths, make realistic plans, and build resilience and motivation.” Apparently these conversations were “co-designed with disabled people’s organisations and occupational health professionals and practitioners and the Behavioural Insights Team – the controversial Nudge Unit, which is part-owned by the Cabinet Office and Nesta.

It’s very evident that “disabled people’s organisations” were not major contributors to the design. It’s especially telling that those people to be targeted by this “intervention” were completely excluded from the conversation. Sick and disabled people are reduced to objects of public policy, rather than being seen as citizens and democratic subjects capable of rational dialogue.

Systematically reducing social security, and increasing conditionality, particularly in the form of punitive benefit sanctions, doesn’t “incentivise” people to look for work. It simply means that people can no longer meet their basic physiological needs, as benefits are calculated to cover only the costs of food, fuel and shelter. In fact sanctioning people make it less likely that they will find work.

Food deprivation is closely correlated with both physical and mental health deterioration. Maslow explained very well that if we cannot meet basic physical needs, we are highly unlikely to be able to meet higher level psychosocial needs. The government proposal that welfare sanctions will somehow “incentivise” people to look for work is pseudopsychology at its very worst and most dangerous. State imposed sanctions on sick and disabled people are known to have very harmful consequences. In fact sanctions create significant difficulties and distress for everyone subjected to them. (See also An example of in-work conditionality: when work doesn’t pay).

In the UK, the government’s welfare “reforms” have further reduced social security support, originally calculated to meet only basic physiological needs, which has had an adverse impact on people who rely on what was once a social safety net. Poverty is linked with negative health outcomes, but it doesn’t follow that employment will alleviate poverty sufficiently to improve health outcomes.

In fact record numbers of working families are now in poverty, with two-thirds of people who found work in 2014 taking jobs for less than the living wage, according to the annual report from the Joseph Rowntree Foundation a year ago.

Essential supportive provision is being systematically reduced by increasing conditionally; by linking support to such a narrow outcome – getting a job – and this will ultimately reduce every service to nothing more than a state behaviour modification programme based on punishment, with a range of professionals being politically co-opted as state enforcers of an ideology which is perpetuating and accentuating socioeconomic problems in the first place.

Work is not a “health” outcome

The Government is intending to “signpost the importance of employment as a health outcome in mandates, outcomes frameworks, and interactions with Clinical Commissioning Groups.”

A Department for Work and Pensions research document published back in 2011 – Routes onto Employment and Support Allowance – said that if people believed that work was good for them, they were less likely to claim or stay on disability benefits.

It was decided that people should be “encouraged” to believe that work was “good” for health. There is no empirical basis for the belief, and the purpose of encouraging it is simply to cut the numbers of disabled people claiming ESA by “encouraging” them into work. Some people’s work is undoubtedly a source of wellbeing and provides a sense of purpose. That is not the same thing as being “good for health”.

For a government to use data regarding opinion rather than empirical evidence to claim that work is “good” for health indicates a ruthless mercenary approach to fulfill their broader aim of dismantling social security and to uphold their ideological commitment to s upply-side policy.

From the document: “The belief that work improves health also positively influenced work entry rates; as such, encouraging people in this belief may also play a role in promoting return to work.”

The aim of the research was to “examine the characteristics of ESA claimants and to explore their employment trajectories over a period of approximately 18 months in order to provide information about the flow of claimants onto and off ESA.”

The document also says: “Work entry rates were highest among claimants whose claim was closed or withdrawn suggesting that recovery from short-term health conditions is a key trigger to moving into employment among this group.”

“The highest employment entry rates were among people flowing onto ESA from non-manual occupations. In comparison, only nine per cent of people from non-work backgrounds who were allowed ESA had returned to work by the time of the follow-up survey. People least likely to have moved into employment were from non-work backgrounds with a fragmented longer-term work history. Avoiding long-term unemployment and inactivity, especially among younger age groups, should, therefore, be a policy priority. ”

“Given the importance of health status in influencing a return to work, measures to facilitate access to treatment, and prevent deterioration in health and the development of secondary conditions are likely to improve return to work rates”

The government made a political and a particularly partisan decision, rather than one that has any an evidence base, to promote the cost-cutting and unverified, irrational belief that work is a “health” outcome.

Furthermore, the research does conclude that health status itself is the greatest determinant in whether or not people return to work. That means that those not in work are not recovered and have longer term health problems that tend not to get better.

Work does not “cure” ill health. To mislead people in such a way is not only atrocious political expediency, it’s actually potentially downright harmful and dangerous.

The government’s Work and Health programme involves a plan to integrate health and employment services, aligning the outcome frameworks of health services, Improving Access To Psychological Therapies (IAPT), Jobcentre Plus and the Work programme.

2020health – Working Together is a report from 2012 that promotes the absurd notion of work as a health outcome. This is a central theme amongst the ideas that are driving the fit for work and the work and health and programme. Developing this idea further, Dame Carol Black and David Frost’s Health at Work – an independent review of sickness absence was aimed at reviewing ways of “reducing the cost of sickness to employers, ‘taxpayers’ and the economy.”

Seems that the central aim of the review wasn’t a genuine focus on sick and disabled people’s wellbeing and “health outcomes,” then. Black and Frost advocated changing sickness certification to further reduce the influence of GPs in “deciding entitlement to out-of-work sickness benefits.”

The subsequent “fit notes” that replaced GP sick notes (a semantic shift of Orwellian proportions) were designed to substantially limit the sick role and reduce recovery periods, and to “encourage” GPs to disclose what work-related tasks patients may still be able to perform. The idea that employers could provide reasonable adjustments that allowed people who are on sick leave to return to work earlier, however, hasn’t happened in reality.

The British Medical Association (BMA) has been highly critical of the language used by the government when describing the fit for work service. The association said it was “misleading” to claim that fit for work was offering “occupational health advice and support” when the emphasis was on sickness absence management and providing a focused return to work.

The idea that work is a “health” outcome is founded on an absurd and circular Conservative logic: it’s an incorrect inference based on the fact that people in work are healthier than those out of work. It’s true that they are, however, the government have yet again confused causes with effects. Work does not make people healthier: it’s simply that healthy people can work and do. People who have long term or chronic illnesses most often can’t work. It has been historically and empirically established that poverty is closely correlated with disproportionate levels of ill health, and it’s most probable that targeted austerity, leading to increasingly inadequate welfare provision, has made a significant contribution to poorer health outcomes, too.

The government’s main objection to sick leave and illness more generally, is that it costs businesses money. The government remain committed to a supply-side labour market model. However, as inconvenient as it may be, politically and economically, it isn’t ever going to be possible to cure people of serious illnesses by cruelly coercing them into work.The government’s aim to prompt public services to “speak with one voice” is founded on questionable ethics. This proposed multi-agency approach is reductive, rather than being about formulating expansive, coherent, comprehensive and importantly, responsive provision.

This is psychopolitics. It’s all about (re)defining the experience and reality of a social group to justify dismantling public services (especially welfare), and that is form of gaslighting intended to extend oppressive political control and micromanagement. In linking receipt of welfare with health services and “state therapy,” with the single intended outcome explicitly expressed as employment, the government is purposefully conflating citizen’s widely varied needs with economic outcomes and diktats, isolating people from traditionally non-partisan networks of relatively unconditional support, such as the health service, social services, community services and mental health services.

Public services “speaking with one voice” will invariably make accessing support conditional, and further isolate already marginalised social groups. It will damage trust between people needing support and professionals who are meant to deliver essential public services, rather than simply extending government dogma, prejudices and discrimination.

However, unsatisfactory employment – low-paid, insecure and unfulfiling work – can result in a decline in health and wellbeing, indicating that poverty and growing inequality, rather than unemployment, increases the risk of experiencing poor mental and physical health.

People are experiencing poverty both in work and out of work. Moreover, in countries with an adequate social safety net, poor employment (low pay, short-term contracts), rather than unemployment, has the biggest detrimental impact on mental health. There is ample medical evidence to challenge the current political dogma, and to support this account. (See the Minnesota semistarvation experiment, for example. The understanding that food deprivation in particular dramatically alters cognitive capacity, emotions, motivation, personality, and that malnutrition directly and predictably affects the mind as well as the body is one of the legacies of the experiment.)

Systematically reducing social security, and increasing conditionality, particularly in the form of punitive benefit sanctions, doesn’t “incentivise” people to look for work. It simply means that people can no longer meet their basic physiological needs, as benefits are calculated to cover only the costs of food, fuel and shelter.Food deprivation is closely correlated with both physical and mental health deterioration. Maslow explained very well that if we cannot meet basic physical needs, we are highly unlikely to be able to meet higher level psychosocial needs.

The government proposal that welfare sanctions will somehow “incentivise” people to look for work is pseudopsychology at its very worst and most dangerous.In the UK, the government’s welfare “reforms” have further reduced social security support, originally calculated to meet only basic physiological needs, which has had an adverse impact on people who rely on what was once a social safety net.

Poverty is linked with negative health outcomes, but it doesn’t follow that employment will alleviate poverty sufficiently to improve health outcomes.In fact record numbers of working families are now in poverty, with two-thirds of people who found work in 2014 taking jobs for less than the living wage, according to the annual report from the Joseph Rowntree Foundation a year ago.

Essential supportive provision is being reduced by conditionally; by linking it to such a narrow outcome – getting a job – and this will reduce every service to nothing more than a political semaphore and service provision to a behaviour modification programme based on punishment, with a range of professionals being politically co-opted as state enforcers.

I have pointed out previously that there has never been any research that demonstrates unemployment is a direct cause of ill health or that employment directly improves health, and the existing studies support the the idea that the assumed causality between unemployment and health may actually run in the opposite direction.It’s not that unemployment is causing higher ill health, but that ill health and discrimination are causing higher unemployment. If it were unemployment causing ill health, at a time when the government assures us that employment rates are currently “the highest on record,” why are more people becoming sick?

The answer is that inequality and poverty have increased, and these social conditions, created by government policies, have long been established by research as having a correlational relationship with increasing mental and physical health inequalities. For an excellent, clearly written and focused development of these points, the problem of “hidden” variables and political misinterpretation, see Jonathan Hulme’s Work won’t set us

I visit my doctor and not the government when I am unwell. There are very good reasons for this. I don’t believe anyone was ever cured by neoliberal ideology. Nor do I believe that work is a health outcome for ordinary people. Health is a health outcome. Work is just work. Being unemployed isn’t unhealthy. Below subsistence level social security is. Sanctions are. Poverty and massive inequality are also a major cause of poor health.

If work was a reliable health outcome, then the government wouldn’t need to address in-work poverty, although sanctioning low paid or part time workers for the employment conditions that profit driven employers are entirely responsible for won’t change the nature and incidence of in-work poverty. The problem isn’t one that is down to employee behaviours, it is a systemic one.

If the protestant work ethic is such an effective cure for disease, the Victorian era “trial” certainly didn’t provide any empirical evidence of that in the data collected concerning premature mortality rates. In fact both men and women were debilitated by the age of forty. Poor nutrition, long hours and premature full-time employment all contributed to a short life expectancy. Although life span slowly increased within the Victorian age, notably as treatment became more advanced, surgery more effective, and medical knowledge more extensive, the average life span in 1840, in the Whitechapel district of London, was 45 years for the upper class and 27 years for tradesman. Laborers and servants, who did the most work, lived only 22 years on average.

Heather Yoeli, a public health specialist from the Department of Public Health and Wellbeing at Northumbria University, says: “From a public health point of view, the main things which improved UK life expectancy between the Victorian era and the 1980s (at which point improvements tailed off) have been:

– near-universal access to clean water and indoor toilets

– childhood immunisation
– antibiotics
– access to education, and particularly, improving female literacy
– increasing social equality

Given that, as statistics sadly show, the health of the poorest in the UK is again declining despite the first four factors mainly still being accessible to even the UK’s very poorest, one can only point at the worsening inequalities and social injustices as a significant cause. The Marmot review pretty much concludes the same. “

Addressing these issues is not consistent with the ideological thrust of Conservative policies, unfortunately, since the government insist that social problems such as poverty and ill health (the biopsychosocial model, with an emphasis on the “psychosocial” elements) are due to individual “behaviours.” Their approach to date has been to level punitive policies with an embedded core of behaviour modification techniques which usually entails the punitive removal of lifeline income at the poorest citizens – casually called “incentivising” and “supporting” – whilst addressing the behaviours of the wealthy with a system of publicly funded financial reward. This simply recreates, deepens, perpetuates and accentuates existing inequalities.

Empirical research published two years ago demonstrated the high a cost the country paid in terms of health and wellbeing for the Thatcher administration’s neoliberal economic and social policies. The study, which examined at material from existing research and data from the Office for National Statistics, illustrates that Thatcherism resulted in the unnecessary and unjust premature deaths of British citizens, together with a substantial and continuing burden of suffering and a widespread degradation of wellbeing.

Co-author and researcher Professor Clare Bambra from the Wolfson Research Institute of Health and Wellbeing said that deaths from violence and suicide all increased substantially during the Thatcher era in comparison with other countries. Regional inequalities in life expectancy between north and south were also exacerbated, as were health inequalities between the richest and poorest in British society.

Professor Bambra also says that the welfare cuts implemented by Thatcher’s governments led to a rise in poverty rates from 6.7% in 1975 to 12% by 1985; poverty is well known to be one of the major causes of ill health and mortality. Income inequality also increased in the Thatcher period, as the richest 0.01% of society had 28 times the mean national average income in 1978 but 70 times the average by 1990. Other research (The Spirit Level) indicates that income inequality is internationally associated with higher mortality and morbidity.

Yet earlier this year, the welfare reform minister, Lord Freud, refused to monitor the number of people who take their own lives as a result of the £120-a-month cut planned for those people in the work related activity group (WRAG), claiming employment and support allowance from April 2017. Concerns were raised in the House of Lords, when Baroness Meacher, amongst others, warned that for the most vulnerable citizens, the cut was “terrifying” and bound to lead to increased debt.

Condemning the truly callous and terrible actions of the Treasury, she urged ministers to monitor the number of suicides in the year after the change comes in, adding: “I am certain there will be people who cannot face the debt and the loss of their home, who will take their lives.”

Many people have died as a consequence of the welfare “reforms.”

Not only have the government failed to carry out an impact assessment regarding the cuts, Lord Freud said that the impact, potential increase in deaths and suicides won’t be monitored, apart from “privately” because individual details can’t be shared and because that isn’t a “useful approach”.

He went on to say “We have recently produced a large analysis on this, which I will send to the noble Baroness. That analysis makes it absolutely clear that you cannot make these causal links between the likelihood of dying – however you die – and the fact that someone is claiming benefit.”

However, a political refusal to investigate an established correlation between the welfare “reforms” and an increase in the mortality statistics of those hit the hardest by the cuts – sick and disabled people – is not the same thing as there being no causal link. Often, correlation implies causality and therefore such established links require further investigation. It is not possible to disprove a causal link without further investigation.

Whilst the government continue to deny there is a “causal link” between their punitive welfare policies, austerity measures and an increase in premature deaths and suicides, they cannot deny there is a clear correlation , which warrants further research and political accountability.

We have a government that provides disproportionate and growing returns to the already wealthy, whilst imposing austerity cuts on the very poorest. How the government possibly claim that inequality is falling, when inequality is so fundamental a prop to their ideology and when social inequalities are extended and perpetuated by all of their policies? It seems an Orwellian re-writing of language about inequality is being used to mislead us into thinking that the economy is far more “inclusive’ than it is. The number of vulture private businesses payrolled by the government to deliver increasingly ideologically biased and punitive welfare, health and social care “services” has risen dramatically this past six years, all of which has cost the UK taxpayer billions.

Meanwhile, those people who need essential supportive public services are facing severe cuts to their lifeline provision. Many of the multinationals contracted by the government are paid to cut the costs of public services, but are costing the public far more than they save.far more than they save. This brand of neoliberal crony capitalist is an entrenched mindset that needs to radically change, because the only beneficiaries are big businesses, and at the expense of those people with the highest level of need. The government’s policies are harming our most vulnerable citizens.

It seems that for wealthy people, “incentives” are always financial rewards, and for poor people, “incentives” simply involve grossly unfair financial punishments, which have too often challenged people’s capacity to meet basic survival needs.

It’s time to challenge the class-based prejudice and blatant discrimination that is embedded in Conservative policies, which ultimately may only serve to deepen existing wealth and health inequality and increase social and economic division.

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An example of in-work conditionality: when work doesn’t pay

November 18, 2016November 18, 2016 · 14 Comments ·

Tory UK

Under in-work conditionality, those people claiming Universal Credit who are already working up to 35 hours a week – and who may never have been unemployed in their life – are forced to seek more work hours, higher pay, or an extra job as a condition of receiving low-wage top-ups and other benefits, or else face sanctions.

Low-paid workers put through this process report “dehumanising” and “intimidating” experiences. Following years of government rhetoric about prizing “hardworking people”, suddenly many hard working people have found themselves subject to the same sanctions as out-of-work claimants.

A woman from Barrow described how she was given a benefit sanction after missing a job centre appointment because she took a last-minute offer of extra part-time work.

The punishment is one of three she has received, which she says have left her and her partner on the breadline for a year.

The couple were forced to use Barrow’s foodbank and town community kitchen so they didn’t starve, whilst living without heat or power on occasions when the high tariff pre-payment electricity meter at their rented home ran out of credit.

Hitting out at the unfair sanctions at the heart of the benefit system, the couple say this punitive approach is making them ill.

The woman, who is in her 20s, says she has applied for scores of jobs in a bid to secure full-time work, said: “I was given some extra hours on a Monday morning starting at 7am.

“My job centre appointment was at 9.30am and I didn’t have any credit on my phone. I took the work and called to explain about the appointment the next day but it was a sanction.

“I got another one for missing a workshop about Twitter. I know how to use Twitter but it didn’t make any difference. They’ll sanction you for anything.”

The sanctions have had such a detrimental effect that the couple faced homelessness when they could no longer afford the rent on their two-bedroom home.

They moved into a one-bedroom flat in the town after the landlord offered to accept a deferred deposit.

“We try our hardest,” she told the North West Evening Mail.

“I would love to have a full-time job but we’re really struggling. The stress has made me ill. These sanctions are not fair; they need to be stopped.”

The government claim that sanctions are a method of enforcing “cultural and behavioural change” of people claiming both in-work and out-of-work social security. This of course assumes that people’s behaviours are a problem in the first place. Sanctions don’t address the decision-making of employers – who are ultimately responsible for establishing rates of pay and the hours of work for employees – exploitation, structural problems, such as access to opportunity and resources and labour market constraints.

Barrow councillor and former job centre employee Michael Cassells said there needed to be more flexibility in the system to ensure sanctions were dished out fairly.

“There’s no doubt sanctions are cruel and causing real hardship and, unfortunately, in most cases, people are not told they can appeal against them, or how to do it.

“We need this system to be looked at so that people are treated with respect and empathy. Otherwise they simply feel they are trying their best but hitting a brick wall with nowhere to turn to for help.”

The government’s Universal Credit legislation has enshrined the principle that working people in receipt of in-work benefits may face benefits sanctions if they are deemed not to be trying hard enough to find higher-paid work. It’s not as if the Conservatives have ever valued legitimate collective wage bargaining. In fact their legislative track record consistently demonstrates that they despise it, prioritising the authority of the state above all else.

Workplace disagreements about wages and conditions are now typically resolved neither by collective bargaining nor litigation but are left to management prerogative. This is because Conservative aspirations are clear. Much of the government’s discussion of legislation is preceded with consideration of the value and benefit for business and the supply end of the labour market. They want a cheap, disciplined reserve army of labour and low cost workers, unable to withdraw their labour, unprotected by either trade unions or employment rights and threatened with destitution via benefit sanction cuts if they refuse to accept low paid, low standard work. Similarly, desperation and the “deterrent” effect of the 1834 Poor Law amendment served to drive down wages.

In-work conditionality enforces a lie and locates blame within individuals for structural problems – political, economic and social – created by those who hold power. Despite being a party that claims to support “hard-working families,” the Conservatives have nonetheless made several attempts to undermine the income security of a significant proportion of that group of citizens recently. Their proposed tax credit cuts, designed to creep through parliament in the form of secondary legislation, which tends to exempt it from meaningful debate and amendment in the Commons, was halted only because the House of Lords have been paying attention to the game.

Benefit sanctions are leaving people almost destitute, with some individuals being pushed toward “survival crime” in order to eat and children missing school because parents can’t pay the bus fare. These are the preliminary findings of a major study into increased restrictions on receiving benefits in the UK welfare system, published in full earlier this year.

The research, led by the University of York, also shows the controversial extension of benefit sanctions to working people on Universal Credit can produce disincentives to work.

The government clearly intends to continue formulating draconian policies which will punish sick and disabled people, unemployed people, the poorest paid, and part-time workers. Meanwhile, the collective bargaining traditionally afforded us by trade unions has been systematically undermined by successive Conservative governments, showing clearly how the social risks of the labour market are being personalised and redefined as being solely the economic responsibility of individuals rather than the government and profit-driven big business employers.

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Related

Man with diabetes had to have his leg amputated because of benefit sanctions

Nudging conformity and benefit sanctions: a state experiment in behaviour modification

Two key studies show that punitive benefit sanctions don’t ‘incentivise’ people to work, as claimed by the government

Welfare sanctions can’t possibly “incentivise” people to work. Here’s why

Exclusive: DWP Admit Using Fake Claimant’s Comments In Benefit Sanctions Leaflet

The politics of punishment and blame: in-work conditionality

Stigmatising unemployment: the government has redefined it as a psychological disorder

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‘Reforming’ ESA: the final frontier and the last moral boundary

November 15, 2016May 27, 2017 · 24 Comments ·

Context

Employment and Support Allowance (ESA) is a benefit for people who are assessed as being unable to work because of a health condition and/or disability. Despite this, ESA has also been politically defined as financial support for people having difficulty finding a job because of a long-term illness or disability, to “help them back to work” despite their illness or disability. This presents a problematic tension because in order to qualify for ESA at all, people must be found to be unable to work, by their own doctor, and by the “independent” Work Capability Assessment.

There’s a significant difference between being unable to work, and facing significant additional barriers to work. People who are assessed are most commonly described as having “limited capability for work” – a phrase which is not precise in its meaning, and which does not include or prompt any consideration of social, cultural, political and economic contexts that also present disabled people with significant barriers to employment.

The name of the allowance (“employment and support”) is also purposefully misleading, and betrays the original controversial political cost-cutting aims that prompted its inception. This re-branding of what was previously called “incapacity benefit” has been problematic. It implies that even those people placed in the Employment and Support Allowance Support Group, who are considered “unlikely” to be able to work in the foreseeable future, are nonetheless being “supported” into employment.

This blurring of definitions, categories and purposes has provided scope and political opportunity for discussion of introducing the mandatory requirement for pre-employment preparation, conditionality and sanctions to be applied to claimants with the most severe health conditions, in the Support Group. This has been casually suggested in the recent work, health and disability government consultation and green paper. Currently, anyone in the Support Group can voluntarily ask for pre-employment support, it isn’t compulsory.

A major assumption throughout the green paper is that disabled people claiming ESA are somehow mistaken in assuming they cannot work: “how can we improve a welfare system that leaves 1.5 million people – over 60% of people claiming Employment and Support Allowance – with the impression they cannot work and without any regular access to employment support, even when many others with the same conditions are flourishing in the labour market?

This group were assessed by doctors and the state (via the Work Capability Assessment) as being unable to work.

The aim behind the introduction of ESA was to actively reduce those previously eligible for Incapacity Benefit to a small group of people with severe disabilities (Support Group) and another moderately sized group who were to undergo fixed term pre-employment preparation and training (Work-Related Activity Group.) The latter group are deemed unable to work, but expected to recover sufficiently to work within two years of the assessment.

However, the controversial Work Capability Assessment (WCA) has been widely criticised, not least for its insensitivity and lack of capacity in differentiating between those people who “may” work, and those who cannot. Furthermore, the WCA does not identify the social, cultural, political and economic barriers that disabled people face in finding suitable employment, and so the focus is on individuals without a context and their perceived personal “deficits” caused through illness and disability. This means that any pre-employment “support” for those who may or who wish to work is by its design unlikely to address the structural barriers to suitable employment that disabled people face.

The architects

Much of the politics of welfare in the 1980s revolved around “cuts” and restrictions in public spending designed to allow tax cuts, particularly reductions in the rates of income tax. Blair’s new programme, the New Deal, was all about moving people from social security benefits into work, as were many of the measures in the 1998 Budget.

David Freud, a former vice-chairman of bulge bracket investment banking at UBS, was an advisor on out-of-work benefit reform in December 2006. Freud’s 2007 report – dubbed “the Freud report” but officially titled Reducing dependency, increasing opportunity: options for the future of welfare to work – called for the greater use of private sector companies who would be paid by results, for substantial “resources” to be made available to help people on Incapacity Benefit back into work, and for a single working-age benefit payment to replace individual benefits such as Housing Benefit and Jobseeker’s Allowance (the forerunner of Universal Credit). His central idea was that spending on “delivery” – such as schemes to get people back to work, like the work programme – would save money in the long run because there would be fewer people being paid money in the form of benefits.

Other contributions to the body of ideas behind ESA came from Frank Field, who was made Minister for Welfare Reform following the 1997 election, with Labour in power. Field felt that the state should have only a small role to play in the provision of welfare, and he viewed his task as “thinking the unthinkable” in terms of social security reform, but others report that Prime Minister Blair wanted some simpler vote-winning policy ideas. Blair writes that: “the problem was not so much that his thoughts were unthinkable as unfathomable”.

In January 2006, John Hutton published a White Paper outlining the government’s latest plans for welfare reform: the benefit that would replace Incapacity Benefit would be called Employment and Support Allowance and its “gateway” assessment would be transformed. Over the course of a decade, Hutton expected the number of people on Incapacity Benefit to fall by one million, saving £7billion a year.

In July 2008 a Green Paper was published, which James Purnell said was “inspired by the reforms proposed by David Freud”. The author announced that “between 2009 and 2013, all Incapacity Benefit claimants will be reassessed using a medical assessment called the Work Capability Assessment” that would divide them into three groups: fit for work; unfit for work but fit for work-related activity; or fit for neither. At the same time, Professor Paul Gregg was asked by the Department for work and Pensions (DWP) to conduct a feasibility study of conditionality and how it might be applied to people claiming sickness benefits. When responding to the Gregg Review, the DWP said that the study had recommended that conditionality be applied to “the vast majority of people in receipt of Employment and Support Allowance.”

In early 2011, under the Coalition government, the Incapacity Benefit reassessment programme was underway using a much more stringent version of the WCA. Atos were recontracted to carry out the work. Targets were written into Atos’s new contracts to reduce successful claims. Dr Steven Bick, a GP with 20 years’ experience, applied for a job as an assessor with Atos to carry out the WCA, and secretly filmed his training for Channel 4’s Dispatches programme, which was broadcasted on Monday 30 July. Undercover filming shows Bick being told by his trainer that he will be watched carefully over the number of applicants he “found eligible for the highest rate of disability payments.”

The documentary also highlighted the unease about the radically heightened eligibility criteria felt by some trainers employed by Atos to teach new recruits how to carry out the tests. It had become much more difficult for very severely disabled claimants to qualify for support. No matter how serious claimants problems are with their arms, for example, “as long as you’ve got one finger, and you can press a button,” they would be found fit for work, one trainer said. Bick said that assessors testing Incapacity Benefit claimants were told they should rate only about one in eight as needing to be placed in the Support Group. That’s regardless of the level of illness and disability they would be presented with, case by case.

In January 2016, the Conservative Welfare Secretary, Iain Duncan Smith, announced that ESA was “fundamentally flawed” and declared that a brand new policy, which would get nearly all ESA recipients back to work, would be unveiled within weeks. A hint of what that policy might be was given in a detailed report on ESA published the following month by Reform, the right-of-centre neoliberal think tank:

Effectively, ESA would be abolished: the amount of money paid each week to the claimant would be reduced to the level of Jobseekers Allowance
The WCA may be replaced by another assessment that set out to identify any barriers to work faced by the claimant, but which would play no role in determining eligibility to benefits
As a way to nudge claimants towards overcoming those barriers, extra money might be made available to fund a tailored programme of rehabilitation – although participation in this could be made a requirement of continued receipt of the benefit.

State diagnosis and treatment – a blunt instrument

The government say that according to previous research undertaken by the DWP, musculoskeletal conditions were the most common main condition of people claiming ESA. Mental health conditions have more recently overtaken this category of illnesses as the main condition that “triggers” an ESA claim.

In the recent work, health and disability green paper, the government also say: ““[..] how can we improve a welfare system that leaves 1.5 million people – over 60% of people claiming Employment and Support Allowance – with the impression they cannot work and without any regular access to employment support, even when many others with the same conditions are flourishing in the labour market?”

The research paper also says: “The belief that work improves health also positively influenced work entry rates; as such, encouraging people in this belief may also play a role in promoting return to work.”

The belief. Not evidenced fact.

That is a very dangerous idea. Many conditions are complex, unpredictable and difficult to diagnose. Some conditions have multiple symptoms affecting many different parts of the body. Musculoskeletal conditions, for example, are a category that includes conditions ranging from injuries to systemic and serious diseases. So “musculoskeletal conditions” include low back pain, injuries such as broken bones, torn or pulled ligaments and tendons, and slipped discs, wear and tear on joints, osteoarthritis, osteoporosis, and connective tissue diseases such as rheumatoid arthritis, lupus and scleroderma.

Connective tissue diseases are systemic illnesses that usually affect other parts of the body, such as major organs, as well as the widespread pain and damage in the musculoskeletal system. Most people with these illnesses don’t just contend with pain in their joints, tendons, ligaments and nerves; they usually feel very unwell, suffering from weight loss, profound fatigue, susceptibility to infections and general malaise. They may have serious lung, heart, kidney or blood disorders, neurological disorders, eye and ear problems, vascular problems and a wide range of other serious symptoms that can be caused through widespread inflammation throughout the body. Physiotherapy, splinting damaged joints, and other traditional measures for helping injury doesn’t help in the long term with connective tissue disease, because the damage is caused by a disease process: through autoimmune mediated widespread inflammation.

This is precisely why I see my doctor and not the government when I am ill. I want an objective and precise medical opinion, diagnosis and specialist treatment when needed, not an ideological diagnosis, dogma in soundbites and a prescription for hard labour, to “set me free.”

“[…]with the impression they cannot work and without any regular access to employment support, even when many others with the same conditions are flourishing in the labour market?”

Not all of the “same category” of conditions are the same. To assume they are is very dangerous. Furthermore, as previously stated, rehabilitation is unlikely to be helpful, since damage to the joints, tendons and ligaments isn’t caused through injury and it won’t heal. Medication is the only way to slow the damage that is caused by autoimmune complexes and inflammation. Connective tissue diseases are incurable.

However, many of the treatments for connective tissue disease are also very risky and experimental. They include methotrexate, which is a chemotherapy, and immune suppressants such as enbrel and rituximab, which leave people at risk of dying from overwhelming infection, as well as other serious side effects, which may also kill.

Having people believe that work is good for their health in order to reduce the numbers of people claiming ESA is authoritarian, disgracefully irresponsible and very dangerous.

On 22 December 2014 a bin lorry collided with pedestrians in the city centre of Glasgow, Scotland, killing six and injuring fifteen others. The driver of the council-owned vehicle, Harry Clarke, said he had passed out at the wheel. A similar blackout had happened to him in the driving seat of a bus, although he had not disclosed the incident on his heavy goods vehicle licence renewal application, despite such self-reporting being mandatory.

Having been admitted to the Western Infirmary after the crash, Clarke was discharged on 7 January 2015 He was eventually diagnosed as having suffered neurocardiogenic syncope, a fainting episode caused by drop in blood pressure. The inquiry also revealed that Clarke’s medical history contained episodes of dizziness and fainting dating from the 1970s and that he had previously suffered a blackout while at the wheel of a First Glasgow bus, which was in service but stationary at a bus stop.

It was stated that Clarke had been passed fit to return to work as a bus driver owing to failures by both the bus company’s doctor and Clarke’s own GP to spot that Clarke had changed his account of events, telling his GP that the episode had occurred in the canteen, which the GP then attributed to the hot conditions and deemed to be unlikely to be repeated. Clarke had a four-year history of episode-free driving after the 2010 incident, and First Glasgow’s occupational-health specialist had cleared him to drive after the 2010 incident and told him he need not notify the DVLA.

A good question to ask is this. In the event of injury or death to either the person coerced by the state into work, assured that work is good for health, or to their work colleagues, as a consequence of that person not being fit for work, who is ultimately responsible? Bearing in mind that to qualify for ESA, a person has already been assessed as unfit for work.

The shrinking category of illness and disability

ESA was originally calculated to include the acknowledged additional every day costs that disabled people face in their day to day living. There was also a recognition that disabled people who can’t work face the cumulative effects of poverty because of a low income over time, too. The ESA Support Group have the higher rate because they are anticipated to be highly unlikely to work in the longer term. That outcome is assessed via the state WCA. So the state has already acknowledged that those in the Support Group are unlikely to be able to work. Those in the Work-Related Activity Group (WRAG) are deemed unable to work, but “may” be capable of work in the future, more specifically, “within two years”.

Although PIP covers some additional costs that disabled people face, it’s designed to cover highly specific needs, with “components” for mobility, and a daily living component which is paid if you need personal care. Both the mobility and daily living allowance are narrowly task related, not cost related. There is no component, for example, that would cover extra heating, special diet and additional laundry requirements. Many special adaptations that people may need are not included, too.

Many people who were previously eligible for mobility support through the Disability Living Allowance (DLA) assessment are no longer eligible because of the much harsher eligibility criteria for PIP. This has meant many thousands of people have lost their specially adapted motability vehicles or motorised wheelchairs. This includes people who relied on their vehicles to get to and from work, since PIP and DLA are not means tested, it can be claimed by people in or out of work.

Earlier this year I wrote that a government advisor, who is a specialist in labour economics and econometrics, has proposed scrapping all ESA sickness and disability benefits. Matthew Oakley, a senior researcher at the Social Market Foundation, recently published a report entitled Closing the gap: creating a framework for tackling the disability employment gap in the UK, in which he proposes abolishing the ESA Support Group. To meet extra living costs because of disability, Oakley says that existing spending on PIP and the Support Group element of ESA should be brought together to finance a new extra costs benefit. Eligibility for this benefit should be determined on the basis of need, with an assessment replacing the WCA and PIP assessment.

Both ESA and PIP were introduced with the same claim: that eligibility should be determined on the basis of need. The category of disabled people that the government regard as “most in need” is shrinking as the political goalposts constantly shift. I think the word “need” is being conflated with politically defined neoliberal outcomes.

Oakley also suggests considering a “role that a form of privately run social insurance could play in both increasing benefit generosity and improving the support that individuals get to manage their conditions and move back to work.”

A toxic article from the Conservative and neoliberal Reform think tank suggests that “treatments” for some ESA claimants are made mandatory, subject to sanctions and so on.

And I can see that coming down the pipeline to the tune of an insane political mantra: “work is a health outcome.”

In Working welfare: a radically new approach to sickness and disability benefits, Reform have this to say:

“Those with mild or moderate health conditions that, with support, could be managed should be expected to take reasonable rehabilitative steps – some level of conditionality should therefore be applied. Employment advisers must be appropriately trained to support those claimants, and given a high degree of discretion in how they apply that conditionality.”

“Could be managed” by work coaches and state sponsored occupational therapists? That comment implies that sick and disabled people and our health service are somehow “failing” to “manage” sickness and disability. Seriously? The inference we are supposed to make is that people are sick and disabled because they can’t be bothered helping themselves. I think that tells you all you need to know about the attitude that informs what kind of “rehabilitation” will be on offer. It won’t be tailored to your medical condition, it will be tailored to you simply getting a job.

Another Reform article, Reforming ESA: the final frontier? says: “There is a risk, though, with making health support mandatory and asking health professionals to police this.”

Compulsory medical treatment is against the law. There are also human rights implications. That’s regardless of the government’s narrow aim of coercing people into work by using “health” interventions as a prop. A medical intervention without valid informed consent is a criminal offence and the offending health care professional can be charged with assault or battery. Examples of such situations include treatment against the patient’s will, different treatment than the one consented for and treatment after consenting when a person has been deliberately provided with wrong information.

There are very few exceptions, which include: patients with acute or permanent incapacity (i.e loss of consciousness after an accident or patients on mechanical ventilation) or chronic illness (i.e dementia), patients suffering from severe mental illness, (but if a patient has clearly given an advance directive while still competent, the treating physician is legally bound to respect this) and patients suffering from communicable diseases, such as tuberculosis (TB).

The four main principles of medical ethics are justice, non-malificence, autonomy and beneficence. Autonomy is the main ethical consideration underlying informed consent. The patients’ right to determine what investigations and treatment to undergo must be respected by all doctors.

For consent to be valid it must be informed consent. For this to be the case it must be:

Given voluntarily with no coercion or deceit. Sanctioning and the threat of sanctioning would constitute coercion.
Given by an individual who has capacity
Given by an individual who has been fully informed about the issue.

There are further implications regarding job coaches accessing medical records for patient confidentiality:

Breaching confidentiality fails to respect patient autonomy.
Violation of patient confidentiality is a form of betrayal.
Patients have a right to confidentiality that has frequently been demonstrated in common law and in some specific areas outlined in statute law.

The Reform think tank has also recently proposed entirely scrapping what is left of the disability benefit support system, in their report Working welfare: a radically new approach to sickness and disability benefits and has called for the government to set a single rate for all out of work benefits and reform the way sick and disabled people are assessed.

You see dangerous, circular and irrational justifications such as: “Nonetheless, international evidence does show that the rate at which sickness benefits are set can have behavioural effects – particularly on claim duration. ”

Well no. Those on the higher rates are assessed as unlikely to be able to work in the long term and thus the “behavioural effects” are simply that this group are too ill to work. That means they will be claiming for long periods. Yet this blunt, dangerous and backwards logic is being used to claim that higher disability rates serve as a “disincentive”for work.

The Reform think tank proposes that the government should cut the weekly support paid to 1.3 million sick and disabled people in the ESA Support Group from £131 to £73. This is the same amount that Jobseeker’s Allowance claimants receive. However, those people placed in the Support Group after assessment have been deemed by the state as unlikely to be able to work again. It would therefore be very difficult to justify this proposed cut, given the additional needs that disabled people have, which is historically recognised, and empirically verified by research.

Reform had also promoted the idea that the ESA WRAG should be paid the same as those claiming job seeker’s allowance. That happened of course. Now they are arguing that there should be NO disability premium at all for the Support Group, on the grounds that it serves as a “disincentive” to work. The government’s recent green paper clearly shows the idea has been taken on board in principle, given the discussion for introducing conditionality, work related activity and sanctions for the previously exempt group of very ill and disabled people, placed in that group originally because doctors and government contracted “independent” assessors deemed them too ill to work.

Yet the authors of the report doggedly insist that having a higher rate of weekly benefit for extremely sick and disabled people encourages them“to stay on sickness benefits rather than move into work.” People on sickness benefits don’t move into work because they are sick. Forcing them to work is outrageous. “Too ill to work” is simply that. It has nothing to do with “incentives”, and that patronising and dangerous claim is simply a politically expedient reinterpretation.

The government’s aim is to manage sickness and disability in the short term sufficiently enough to meet narrow neoliberal outcomes including fueling the supply side of the “labour market”.

But it’s a well known historical fact that a large reserve army of labour drives wages down. The other trend, over this last decade, has been the unprecedented growth of “flexible” or insecure contracts, which are considerably attractive to employers, who dispute many of the downsides that unions, workers and analysts have highlighted. (See: More than 7m Britons now in precarious employment). In this highly competitive context, it is highly unlikely that employers who have increasingly come to regard their employees as a disposable means of making profit are going to be “disability confident.” The fact that the government are proposing offering temporary financial “incentives” to employers that recruit disabled people tells us there is a major barrier there.

Further comment from Reform: “Reform call for a single rate of ‘income replacement’ for out of work claimants, whether disabled or not. This would mean a reduction for many ESA claimants. However, Reform ask why ESA is paid at a higher rate. If it is because there are extra costs associated with disability, then isn’t this what Personal Independence Payment (PIP) is for? If it is because ESA claimants are expected to take longer to find work, then doesn’t this also apply to some Jobseeker’s Allowance claimants and other groups?” From Reforming ESA: the final frontier?

PIP covers very only highly specific additional costs: those related to mobility and personal assistance, as I outlined earlier, and it is very difficult to fulfil the eligibility criteria, since this was another re-branded benefit designed to cut cost. Being sick and disabled does mean that at the very least, people may need recovery time, and meanwhile cannot meet even basic signing on conditionality, such as being available for work seven days a week. However, many in both ESA groups cannot work because they are chronically ill, or have degenerative conditions. Some people in the Support Group are terminally ill. This is very worryingly something that Reform have chosen to ignore.

The title of Reform’s paper – Reforming ESA: the final frontier? provides a glimpse of a wider political intention – ESA is the “last unexplored area” for welfare “reform.” “Thinking the unthinkable” is one of those trite things that ministers say when they expect something of a public backlash, but have nonetheless already made up their minds about cutting some public service or essential social support provision. Beforehand, think tanks and ministers periodically “kite fly” their proposals to test out public responses, using justification narratives: techniques of persuasion, usually reserved for the dodgy end of the advertising industry, and techniques of neutralisation to soothe and to sell their ideas about how things ought to be. And where our money should not be spent. The “public purse” is being “protected” from more and more of the public – ordinary citizens – and is now regarded as disposable income for the very wealthy and powerful. Austerity for us, tax gifts for the 1%

Six years ago it would have been unthinkable for a government to take away financial support from sick and disabled people, and to coerce them into work. It would have been unthinkable for a government to propose making any kind of medical treatment mandatory for a protected social group – sick and disabled people who need support to meet their basic needs. It would have been unthinkable that a UK government would systematically violate the human rights of disabled people. Yet they have.

That we have progressed to become a society that permits a so-called democratic government to do this indicates that the public’s moral and rational boundaries have been pushed, this has been an incremental process, permeated by a wide variety of deliberative practices which have added to the problem of recognising it for what it is.

There has been a process of gradual habituation of the public, to being governed by shock and surprise; to receiving decisions and policies deliberated and passed in secret; to being persuaded that the justification for such deeds and controversial policy was based on real evidence that the government parades as slogans propped up by glittering generalities and techniques of persuasion. It happens in stages. Many don’t notice the calculated step-by-step changes, but those that do – usually those affected – are often overwhelmed with the sheer volume of them.

“The final frontier” is the political garnering of sufficient levels of public indifference and complicity with state cruelty, coercion and the uncivilised systematic sanctioning and removal of support for those sick and disabled citizens that doctors and state assessors have already said are not able to work. This is a government that likes to get its own way.

Once the public’s rational and moral boundaries have been pushed sufficiently to accommodate this atrocity, it won’t be very difficult at all to argue a case for the complete dismantling of the welfare state.

That has always been the ultimate aim of the Conservatives.

If you think that’s okay, then perhaps it’s worth contemplating that illness can happen to anyone, and so can an accident. We have all paid into our social security system, as have our parents. It is ours; it’s there for if or when we need support. It reflects the collective best of us as a society, yet somehow this government have managed to attach shame and stigma to it. And as a society, we’ve allowed them to do that.

Disability can happen to any of us at any time. And when it does, you soon realise that it isn’t a “lifestyle choice” that you would ever have chosen to make.

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G4S are employing Cognitive Behavioural Therapists to deliver “get to work therapy”

The power of positive thinking is really political gaslighting

Nudging conformity and benefit sanctions: a state experiment in behaviour modification

The new Work and Health Programme: government plan social experiments to “nudge” sick and disabled people into work

GP practices to provide advice on job seeking in new pilot scheme

New return to work service goes live to help GPs, employees and employers across England

A critique of benefit sanctions: the Minnesota Starvation Experiment and Maslow’s Hierarchy of Needs

Let’s keep the job centre out of GP surgeries and the DWP out of our confidential medical records

The Psychological Impact of Austerity – Psychologists Against Austerity

A critique of Conservative notions of social research

Research finds strong correlation between Work Capability Assessment and suicide

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Initial thoughts on the work, health and disability green paper

November 6, 2016November 15, 2017 · 68 Comments ·

I’ve read the government’s Work, health and disability green paper: improving lives and consultation from end to end. It took me a while, because I am ill and not always able to work consistently, reliably and safely. It’s also a very long and waffling document. I am one of those people that the proposals outlined in this green paper is likely to affect. I read the document very carefully.

Here are a few of my initial thoughts on what I read. It’s organised as best I can manage, especially given the fact that despite being dismally unsurprised, I am scathing.

The context indicates the general intent

“The fact is that Ministers are looking for large savings at the expense of the poorest and most vulnerable. That was not made clear in the general election campaign; then, the Prime Minister said that disabled people would be protected.” – Helen Goodman, MP for Bishop Auckland, Official Report, Commons, 2/3/16; cols. 1052-58.

I always flinch when the government claim they are going to “help” sick and disabled people into work. That usually signals further cuts to lifeline support and essential services are on the way, and that the social security system is going to be ground down a little further, to become the dust of history and a distant memory of a once civilised society.

If the government genuinely wanted to “help” sick and disabled people into work, I’m certain they would not have cut the Independent Living Fund, which has had a hugely negative impact on those trying their best to lead independent and dignified lives, and the Access To Work funding has been severely cut, this is also a fund that helps people and employers to cover the extra living costs arising due to disabilities that might present barriers to work.

The government also made the eligibility criteria for Personal Independence Payment (PIP) – a non-means tested out-of- work and an in-work benefit – much more difficult to meet, in order to simply reduce successful claims and cut costs. This has also meant that thousands of people have lost their motability vehicles and support.

Earlier this year, it was estimated at least 14,000 disabled people have had their mobility vehicle confiscated after the changes to benefit assessment, which are carried out by private companies.

Under the PIP rules, thousands more people who rely on this support to keep their independence are set to lose their vehicles – specially adapted cars or powered wheelchairs. Many had been adapted to meet their owners’ needs and many campaigners warn that it will lead to a devastating loss of independence for disabled people.

A total of 45% or 13,900 people, were deemed as not needing the higher rate of PIP, and therefore lost their vehicles after reassessment. And out of the 31,200 people who were once on the highest rate of Disability Living Allowance (DLA) who have been reassessed, just 55%, or 17,300 – have kept their car.

In 2012, Esther McVey, then the Minister for people with disabilities, as good as admitted there are targets to reduce or remove eligibility for the new disability benefit PIP, which was to replace DLA. How else could she know in advance of people’s reassessment that “330,000 of claimants are expected to either lose their benefit altogether or see their payments reduced“ as she had informed the House of Commons.

This was a clear indication that the new assessment framework was designed to cut support for disabled people. A recent review led the government to conclude that PIP doesn’t currently fulfil the original policy intent, which was to cut costs and “target” the benefit to an ever-shrinking category of “those with the greatest need.”

The Government was twice defeated in the Lords over their proposals to cut Employment and Support Allowance (ESA) for sick and disabled people in the work related activity group (WRAG) from £103 to £73. However the £30 a week cut is to go ahead after bitterly disappointed and angry peers were left powerless to continue to oppose the Commons, which has overturned both defeats.

The government hammered through the cuts of £120 a month to the lifeline income of ill and disabled people by citing the “financial privilege” of the Commons, and after Priti Patel informing the Lords, with despotic relish, that they had “overstepped their mark” in opposing the cuts twice.

A coalition of 60 national disability charities condemned the government’s cuts to benefits as a “step backwards” for sick and disabled people and their families. The Disability Benefits Consortium said that the cuts, which will see people lose up to £1,500 a year, will leave disabled people feeling betrayed by the government and will have a damaging effect on their health, finances and ability to find work.

Research by the Consortium suggests the low level of benefit is already failing to meet disabled people’s needs. A survey of 500 people in the affected group found that 28 per cent of people had been unable to afford to eat while in receipt of the benefit. Around 38 per cent of respondents said they had been unable to heat their homes and 52 per cent struggled to stay healthy.

Watching the way the wind blows

Earlier this year I wrote that a government advisor, who is a specialist in labor economics and econometrics, has proposed scrapping all ESA sickness and disability benefits. Matthew Oakley, a senior researcher at the Social Market Foundation, recently published a report entitled Closing the gap: creating a framework for tackling the disability employment gap in the UK, in which he proposes abolishing the ESA Support Group.

To meet extra living costs because of disability, Oakley says that existing spending on PIP and the Support Group element of ESA should be brought together to finance a new extra costs benefit. Eligibility for this benefit should be determined on the basis of need, with an assessment replacing the WCA and PIP assessment.

I think the word “need” is being redefined to meet politically defined neoliberal economic outcomes.

Oakely also suggests considering a “role that a form of privately run social insurance could play in both increasing benefit generosity and improving the support that individuals get to manage their conditions and move back to work.”

I’m sure the rogue company Unum would jump at the opportunity. Steeped in controversy, with a wake of scandals that entailed the company denying people their disabilty insurance, in 2004, Unum entered into a regulatory settlement agreement (RSA) with insurance regulators in over 40 US states. The settlement related to Unum’s handling of disability claims and required the company “to make significant changes in corporate governance, implement revisions to claim procedures and provide for a full re-examination of both reassessed claims and disability insurance claim decisions.

The company is the top disability insurer in both the United States and United Kingdom. By coincidence, the company has been involved with the UK’s controversial Welfare Reform Bill, advising the government on how to cut spending, particularly on disability support. What could possibly go right?

It’s difficult to see how someone with a serious, chronic and progressive illness, (which most people in the ESA Support Group have) can actually “manage” their illness and “move back into work.” The use of the extremely misinformed, patronising and very misleading term manage implies that very ill people actually have some kind of choice in the matter.

For people with Parkinson’s disease, rheumatoid arthritis, lupus and multiple sclerosis, cancer and kidney failure, for example, mind over matter doesn’t fix those problems, positive thinking and sheer will power cannot cure these illnesses, sadly. Nor does refusing to acknowledge or permit people to take up a sick role, or imposing benefit conditionality and coercive policies to push chronically ill people into work by callous, insensitive and inept and often medically unqualified assessors, job advisors and ministers.

The Reform think tank has also recently proposed scrapping what is left of the disability benefit support system, in their report Working welfare: a radically new approach to sickness and disability benefits and has called for the government to set a single rate for all out of work benefits and reform the way sick and disabled people are assessed.

The Reform think tank proposes that the government should cut the weekly support paid to 1.3 million sick and disabled people in the ESA Support Group from £131 to £73. This is the same amount that Jobseeker’s Allowance claimants receive. It is claimed that the cut will somehow “incentivise” those people to find work, as if they simply lack motivation, rather than being ill and disabled. However, those people placed in the Support Group after assessment have been deemed by the state as unlikely to be able to work again in the near future, many won’t be able to work again. It would therefore be very difficult to justify this proposed cut, given the additional needs that disabled people have, which is historically recognised, and empirically verified by research.

Yet the authors of the report doggedly insist that having a higher rate of weekly benefit for extremely sick and disabled people encourages them “to stay on sickness benefits rather than move into work.” People on sickness benefits don’t move into work because they are sick. Forcing them to work is outrageous.

The report recommended savings which result from removing the disability-related additions to the standard allowance should be reinvested in support services and extra costs benefits – PIP. However, as outlined, the government have ensured that eligibility for that support is rapidly contracting, with the ever-shrinking political and economic re-interpretation of medically defined sickness and disability categories and a significant reduction in what the government deem to be a legitimate exemption from being “incentivised” into hard work.

The current United Nations investigation into the systematic and gross violations of the rights of disabled people in the UK because of the Conservative welfare “reforms” is a clear indication that there is no longer any political commitment to supporting disabled people in this country, with the Independent Living Fund being scrapped by this government, ESA for the work related activity group (WRAG) cut back, PIP is becoming increasingly very difficult to access, and now there are threats to the ESA Support Group. The Conservative’s actions have led to breaches in the CONVENTION on the RIGHTS of PERSONS with DISABILITIES – CRPD articles 4, 8, 9, 12, 13, 14, 15, 17, and especially 19, 20, 27 and 29 (at the very least.)

There are also probable violations of articles 22, 23, 25, 30, 31.

The investigation began before the latest round of cuts to ESA were announced. That tells us that the government is unconcerned their draconian policies violate the human rights of sick and disabled people.

And that, surely, tells us all we need to know about this government’s intentions.

Coercing those deemed to ill to work into work. It’s not “nudge”: it’s psycho-compulsion

The casual discussion in the green paper about new mandatory “health and work conversations” in which work coaches will use “specially designed techniques” to “help” some ESA claimants “identify their health and work goals, draw out their strengths, make realistic plans, and build resilience and motivation” is also cause for some concern.

Apparently these conversations were “co-designed with disabled people’s organisations and occupational health professionals and practitioners and the Behavioural Insights Team – the controversial Nudge Unit, which is part-owned by the Cabinet Office and Nesta.

Most people who read my work regularly will know by now that I am one of the staunchest critics of nudge, which is being used as an antidemocratic, technocratic, pseudoscientific political tool to provide a prop and disguise for controversial neoliberal policies. It’s very evident that “disabled people’s organisations” were not major contributors to the design. It’s especially telling that those people to be targeted by this “intervention” were completely excluded from the conversation. Sick and disabled people are reduced to objects of public policy, rather than being seen as citizens and democratic subjects capable of rational dialogue.

John Pring at Disability News Service (DNS) adds: “Grassroots disabled people’s organisations (DPOs) have criticised the government’s decision to exclude them from an event held to launch its new work, health and disability green paper.

The event for “stakeholders” was hosted by the disability charity Scope at its London headquarters, and attended by Penny Mordaunt, the minister for disabled people.

The Department for Work and Pensions (DWP) said in its invitation – it turned down a request from Disability News Service to attend – that the event would “start the consultation period” on its green paper, Improving Lives.

It said that it was “launching a new conversation with disabled people and people with health conditions, their representatives, healthcare professionals and employers”.

But DWP has refused to say how many disabled people’s user-led organisations were invited to the event, and instead suggested that DNS submit a freedom of information request to find out.
But DNS has confirmed that some of the most prominent user-led organisations with the strongest links to disabled people were not invited to the launch, including Shaping Our Lives, Inclusion London, Equal Lives, People First (Self Advocacy) and Disabled People Against Cuts.”

For further discussion of the policy context leading up to the green paper, see The new Work and Health Programme: government plan social experiments to “nudge” sick and disabled people into work from October 2015.

Also see G4S are employing Cognitive Behavioural Therapists to deliver “get to work therapy” and Stephen Crabb’s obscurantist approach to cuts in disabled people’s support and also Let’s keep the job centre out of GP surgeries and the DWP out of our confidential medical records from earlier this year.

The dismal and incoherent contents of the green paper were entirely predictable.

The Conservatives claim work is a “health” outcome: crude behaviourism

It was then decided that people should be “encouraged” to believe that work was “good” for health. There is no empirical basis for the belief, and the purpose of encouraging it is simply to cut the numbers of disabled people claiming ESA by “encouraging” them into work. Some people’s work is undoubtedly a source of wellbeing and provides a sense of purpose. That is not the same thing as being “good for health”. For a government to use data regarding opinion rather than empirical evidence to claim that work is “good” for health indicates a ruthless mercenary approach to a broader aim of dismantling social security.

Rather than make a link between manual work, lack of reasonable adjustments in the work place and the impact this may have on longer term ill health, the government chose instead to promote the cost-cutting irrational belief that work is a “health” outcome. Furthermore, the research does conclude that health status itself is the greatest determinant in whether or not people return to work. That means that those not in work are not recovered and have longer term health problems that tend not to get better.

Work does not “cure” ill health. To mislead people in such a way is not only atrocious political expediency, it’s actually downright dangerous.

As neoliberals, the Conservatives see the state as a means to reshape social institutions and social relationships based on the model of a competitive market place. This requires a highly invasive power and mechanisms of persuasion, manifested in an authoritarian turn. Public interests are conflated with narrow economic outcomes. Public behaviours are politically micromanaged. Social groups that don’t conform to ideologically defined economic outcomes are stigmatised and outgrouped.

Othering and outgrouping have become common political practices, it seems.

It is used as a propaganda mechanism to draw the public into collaboration with the state, to justify punitive and discriminatory policies and to align citizen “interests” with rigid neoliberal outcomes. Inclusion, human rights, equality and democracy are not compatible with neoliberalism.

Earlier this year, I said: The Conservatives have come dangerously close to redefining unemployment as a psychological disorder, and employment is being redefined as a “health outcome.” The government’s Work and Health programme involves a plan to integrate health and employment services, aligning the outcome frameworks of health services, Improving Access To Psychological Therapies (IAPT), Jobcentre Plus and the Work Programme.

But the government’s aim to prompt public services to “speak with one voice” is founded on questionable ethics. This proposed multi-agency approach is reductive, rather than being about formulating expansive, coherent, comprehensive and importantly, responsive provision.

This is psychopolitics, not therapy. It’s all about (re)defining the experience and reality of a social group to justify dismantling public services (especially welfare), and that is form of gaslighting intended to extend oppressive political control and micromanagement. In linking receipt of welfare with health services and “state therapy,” with the single intended outcome explicitly expressed as employment, the government is purposefully conflating citizen’s widely varied needs with economic outcomes and diktats, isolating people from traditionally non-partisan networks of relatively unconditional support, such as the health service, social services, community services and mental health services.

Conservatives really seem to believe that the only indication of a person’s functional capacity, value and potential is their economic productivity, and the only indication of their moral worth is their capability and degree of willingness to work. But unsatisfactory employment – low-paid, insecure and unfulfiling work – can result in a decline in health and wellbeing, indicating that poverty and growing inequality, rather than unemployment, increases the risk of experiencing poor mental and physical health. People are experiencing poverty both in work and out of work.

Moreover, in countries with an adequate social safety net, poor employment (low pay, short-term contracts), rather than unemployment, has the biggest detrimental impact on mental health.

There is ample medical evidence (rather than the current raft of political dogma) to support this account. (See the Minnesota semistarvation experiment, for example. The understanding that food deprivation in particular dramatically alters cognitive capacity, emotions, motivation, personality, and that malnutrition directly and predictably affects the mind as well as the body is one of the legacies of the experiment.)

The Government is intending to “signpost the importance of employment as a health outcome in mandates, outcomes frameworks, and interactions with Clinical Commissioning Groups.”

I have pointed out previously that there has never been any research that demonstrates unemployment is a direct cause of ill health or that employment directly improves health, and the existing studies support the the idea that the assumed causality between unemployment and health may actually run in the opposite direction. It’s much more likely that inadequate social security support means that people cannot meet all of their basic survival needs (food, fuel and shelter), and that contributes significantly to poor health outcomes.

It’s not that unemployment is causing higher ill health, but that ill health and discrimination are causing higher unemployment. If it were unemployment causing ill health, at a time when the government assures us that employment rates are currently “the highest on record,” why are more people becoming sick?

For an excellent, clearly written and focused development of these points, the problem of “hidden” variables and political misinterpretation, see Jonathan Hulme’s Work won’t set us free.

Semantic thrifts: being Conservative with the truth

Prior to 2010, cutting support for sick and disabled people was unthinkable, but the “re-framing” strategy and media stigmatising campaigns have been used by the Conservatives to systematically cut welfare, push the public’s normative boundaries and to formulate moralistic justification narratives for their draconian policies. Those narratives betray the Conservative’s intentions.

Not enough people have questioned what it is that Conservatives actually mean when they use words like “help”, “support”, and “reform” in the context of government policies aimed at disabled people. Nor have they wondered where the evidence of “help” and “support” is hiding. If you sit on the surface of Conservative rhetoric and the repetitive buzzwords, it all sounds quite reasonable, though a little glib.

If you scrutinise a little, however, you soon begin to realise with horror that Orwellian-styled techniques of neutralisation are being deployed to lull you into a false sense of security: the ideologically directed intentions behind the policies and the outcomes and consequences are being hidden or “neutralised” by purposefully deceptive, misdirectional political rhetoric. It’s a kind of glittering generalities tokenism ; a superficial PR ritual of duplicitous linguistic detoxification, to obscure deeply held traditional Conservative prejudices and ill intent.

Rhetoric requires the existence of an audience and an intent or goal in the communication. Once you stand back a little, you may recognise the big glaring discrepancies between Conservative chatter, policies, socioeconomic reality and people’s lived experiences. At the very least, you begin to wonder when the conventional ideological interests of the Conservatives suddenly became so apparently rhetorically progressive, whilst their policies have actually become increasingly authoritarian, especially those directed at the most disadvantaged social groups.

The ministerial foreword from Damian Green, Secretary of State for Work and Pensions and Jeremy Hunt, Secretary of State for Health, is full of concern that despite the claim that “we have seen hundreds of thousands more disabled people in work in recent years”, there are simply too many sick and disabled people claiming ESA.

They say: “We must highlight, confront and challenge the attitudes, prejudices and misunderstandings that, after many years, have become engrained in many of the policies and minds of employers, within the welfare state, across the health service and in wider society. Change will come, not by tinkering at the margins, but through real, innovative action. This Green Paper marks the start of that action and a far-reaching national debate, asking: ‘What will it take to transform the employment prospects of disabled people and people with long-term health conditions?’”

I think mention of the “engrained attitudes, prejudices and misunderstandings within the welfare state and across the health service” is the real clue here about intent. What would have been a far more authentic and reassuring comment is “we have met with disabled people who have long-term health conditions and asked them if they feel they can work, and what they need to support them if they can.”

Instead, what we are being told via subtext is that we are wrong as a society to support people who are seriously ill and disabled by providing civilised health and social care, social security and exempting them from work because they are ill or injured.

Ministers say: “Making progress on the government’s manifesto ambition to halve the disability employment gap is central to our social reform agenda by building a country and economy that works for everyone, whether or not they have a long-term health condition or disability. It is fundamental to creating a society based on fairness [..] It will also support our health and economic policy objectives by contributing to the government’s full employment ambitions, enabling employers to access a wider pool of talent and skills, and improving health.”

I think that should read: “By building a country where everyone works for the [politically defined] economy.”

There’s patronising discussion of how disabled people should be “allowed to fulfil their potential”, and that those mythic meritocratic principles of talent determination and aspiration should be “what counts”, rather than sickness and disability. There are some pretty gaping holes in the logic being presented here. It is assumed that prejudice is the reason why sick and disabled people don’t work.

But it’s true that many of us cannot work because we are too ill, and the green paper fails to acknowledge this fundamental issue.

Instead “inequality” has been redefined strictly in terms of someone’s employment status, rather than as an unequal social distribution of wealth, resources, power and opportunities. All of the responsibility and burden of social exclusion and unemployment is placed on sick and disabled people, whilst it is proposed that businesses are financially rewarded for employing us.

Furthermore, it’s a little difficult to take all the loose talk seriously about the “injustice” of ill people not being in work, or about meritocratic principles and equal opportunities, when it’s not so long ago that more than one Conservative minister expressed the view that disabled people should work for less than the minimum wage. This government have made a virtue out of claiming they are giving something by taking something away. For example, the welfare cuts have been casually re-named reforms in Orwellian style. We have yet to see how cutting the lifeline benefits of the poorest people, and imposing harsh sanctioning can possibly be an improvement for them, or how it is helping them.

The Conservatives are neoliberal fundamentalists, and they have supplanted collective, public values with individualistic, private values of market rationality. They have successfully displaced established models of welfare provision and state regulation through policies of privatisation and de-regulation and have shifted public focus, instigating various changes in subjectivity, by normalising individualistic self-interest, entrepreneurial values, and crass consumerism. And increasing the social and material exclusion of growing numbers living in absolute poverty.

Basically, the Tories tell lies to change perceptions, divert attention from the growing wealth inequality manufactured by their own policies, by creating scapegoats.

Another major assumption throughout the paper is that disabled people claiming ESA are somehow mistaken in assuming they cannot work: “how can we improve a welfare system that leaves 1.5 million people – over 60% of people claiming Employment and Support Allowance – with the impression they cannot work and without any regular access to employment support, even when many others with the same conditions are flourishing in the labour market? How can we build a system where the financial support received does not negatively impact access to support to find a job? How can we offer a better user experience, improve system efficiency in sharing data, and achieve closer alignment of assessments?”

The government’s brand of armchair pseudo-psychology, propped up by the Nudge Unit, is used to justify increasingly irrational requirements being embedded in policy. The government intend to merge health and employment services, redefining work as a clinical health outcome. According to the government, the “cure” for unemployment due to illness and disability and sickness absence from work, is… work.

The new work and health programme, “support” for disabled people, is actually just another workfare programme. We know that workfare tends to decrease the likelihood of people finding work.

Work is the only politically prescribed “route out of poverty” for disabled people, including those with mental distress and illness, regardless of whether or not they are actually well enough to work. In fact the government implicitly equates mental health with economic productivity. Work will set us free. Yet paradoxically, disabled people haven’t been and won’t be included in the same economic system which is responsible for their exclusion in the first place.

Competitive market economies exclude marginalised groups, that’s something we ought to have learned from the industrial capitalism of the last couple of centuries. GPs inform us that employers are not prepared to make the necessary inclusive workplace adjustments sick and disabled people often need to work.

But in a dystopic Orwellian world where medical sick notes have been  politically redefined as ”fit notes”, sick and disabled people are no longer exempt from work, which is now held to be a magic “cure”. People are already being punished and coerced into taking any available job, regardless of its appropriateness, in an increasingly competitive and exclusive labor market.

The nitty gritty

You know the government are riding the fabled rubber bicycle when they calmly propose coercing the most disabled and ill citizens who are deemed unlikely to work by their doctors and the state (via the Work Capability Assessment) into performing mandatory work-related activities and finding jobs. Previously, only those assessed as possibly capable of some work in the future and placed in the Work Related Activity Group (WRAG) were expected to meet behavioural conditionality in return for their lifeline support.

However, the government have cut the WRAG component of Employment and Support Allowance (ESA) – another somewhat Orwellian name for a sickness and disability benefit – so that this group of people, previously considered to have additional needs because of their illness and disability, are no longer supported to meet the extra costs they face. The ESA WRAG rate of pay is now to be the same as Job Seeker’s Allowance.

If the government make work related activity mandatory for those people in the ESA Support Group, it will mean that very sick and disabled people will be sanctioned for being unable to comply and meet conditionality. This entails the loss of their lifeline support. The government have the cheek to claim that they will “protect and support” the most vulnerable citizens.

Hello, these ARE among our most vulnerable citizens. That’s why they were placed in the ESA support group in the first place.

Apparently, sick citizens are costing too much money. Our NHS is “overburdened” with ill people needing healthcare, our public services are “burdened” with people needing… public services. It is claimed that people are costing employers by taking time off work when they are ill. How very dare they.

Neoliberals argue that public services present moral hazards and perverse incentives. Providing lifeline support to meet basic survival requirements is seen as a barrier to the effort people put into searching for jobs. From this perspective, the social security system, which supports the inevitable casualties of neoliberal free markets, has somehow created those casualties. But we know that external, market competition-driven policies create a few “haves” and many “have-nots.” This is why the  welfare state came into being, after all – because when we allow such competitive economic dogmas to manifest without restraint, we must also concede that there are always ”winners and losers.”

Neoliberal economies organise societies into hierarchies.The UK currently ranks highly among the most unequal countries in the world.

Inequality and poverty are central features of neoliberalism and the causes of these sociopolitical problems therefore cannot be located within individuals.

The ESA Support Group includes people who are terminally ill, and those with degenerative illnesses, as well as serious mental health problems. It’s suggested that treating this group of people with computer based Cognitive Behaviour Therapy (cCBT), and addressing obesity, alcohol and drug dependence will “help” them into work.

Ministers claim that this group merely have a “perception” that they can’t work, and that they have been “parked” on benefits. It is also implied that illness arises mostly because of lifestyle choices.

Proposals include a punitive approach to sick and disabled people needing support, whilst advocating financial rewards for employers and businesses who employ sick and disabled people.

And apparently qualified doctors, the public and our entire health and welfare systems have ingrained “wrong” ideas about sickness and disability, especially doctors, who the government feels should not be responsible for issuing the Conservatives recent Orwellian “fit notes” any more, since they haven’t “worked” as intended and made every single citizen economically productive from their sick beds.

So, a new “independent” assessment and private company will most likely soon have a lucrative role to get the government “the right results”.

Meanwhile health and social care is going to be linked with one main outcome: work. People too ill to work will be healthier if they… work. Our public services will cease to provide public services: health and social care professionals will simply become co-opted authoritarian ideologues.

Apparently, the new inequality and social injustice have nothing to do with an unequal distribution of wealth, resources, power and opportunities. Apparently our society is unequal only because some people “won’t” work. I’m just wondering about all those working poor people currently queuing up at the food bank, maybe their poorly paid, insecure employment and zero hour contracts don’t count as working.

I’ve written as I read this Orwellian masterpiece of thinly disguised contempt and prejudice. I don’t think I have ever read anything as utterly dangerous and irrational in all my time analysing Conservative public policy and the potential and actual consequences of them. These utterly deluded and sneering authors are governing our country, shaping our life experiences, and those of our children.

The sick role and any recovery time from illness or accident that you may need has been abolished. Work will cure you.

Well, at least until you die.

Pictures courtesy of Robert Livingstone

The closing date for the consultation is 17 February 2017.
You can download the full consultation document from this link.
You can take part in the consultation from this link.

The Nudge Unit’s u-turn on benefit sanctions indicates the need for even more lucrative nudge interventions, say nudge theorists

October 20, 2016September 24, 2025 · 26 Comments ·

Some context: the new neuroliberalism and “behavioural insights”

The behaviourist turn in government administration – the use of targeted citizen behavioural conditionality in neoliberal policy making – has expanded globally and is linked to the growth of behavioural economics theory (“nudge”) and a New Right brand of “libertarian paternalism.”

Reconstructing citizenship as highly conditional stands in sharp contrast to democratic principles, rights-based policies and to those policies based on prior financial contribution, as underpinned in the social insurance and social security frameworks that arose from the post-war democratic settlement.

The fact that the poorest citizens are being targeted with behavioural theory-based interventions also indicates discriminatory policy, which reflects traditional Conservative class-based prejudices. It’s an authoritarian approach to poverty which simply strengthens existing power hierarchies, rather than addressing the unequal distribution of power and wealth in the UK.

Some of us have dubbed this trend neuroliberalism because it serves as a justification for enforcing politically defined neoliberal outcomes. A hierarchical socioeconomic organisation is being shaped by increasingly authoritarian policies, placing the responsibility for growing inequality and poverty on individuals, side-stepping the traditional (and very real) political/structural explanations of social and economic problems.

Such a behavioural approach to poverty also adds a dimension of cognitive prejudice which serves to reinforce and established power relations and inequality. It is assumed that those with power and wealth have cognitive competence and know which specific behaviours and decisions are best for poor citizens, who are assumed to lack cognitive competence (because they are poor and therefore make “the wrong decisions”). Apparently the theories and insights of cognitive bias don’t apply to the theorists applying them to increasingly marginalised social groups. Policy has increasingly extended a neoliberal cognitive competence and decision-making hierarchy.

It’s very interesting that the Behavioural Insights Team now claim the state using the threat of benefit sanctions may be “counterproductive”. The idea of increasing welfare conditionality, enlarging the scope of its’ application and increasing the frequency of benefit sanctions originated from the behavioural economics theories of the Nudge Unit in the first place.

The increased use and rising severity of benefit sanctions became an integrated part of welfare conditionality in the Conservative’s Welfare “reform” Act, 2012. The current sanction regime is based on a principle borrowed from behavioural economics theory – an alleged cognitive bias we have called loss aversion.

It refers to the idea that people’s tendency is to strongly prefer avoiding losses to acquiring gains. The idea is embedded in the use of sanctions to “nudge” people towards compliance with welfare rules of conditionality, by using a threat of punitive financial loss, since the longstanding, underpinning Conservative assumption is that people are unemployed because of alleged behavioural deficits and poor decision-making. Hence the need for policies that “rectify” behaviour.

I’ve argued elsewhere, however, that benefit sanctions are more closely aligned with operant conditioning (behaviourism) than libertarian paternalism, since sanctions are a severe punishment intended to modify behaviour and restrict choices to that of compliance and conformity or destitution. At the very least this approach indicates a slippery slope from “arranging choice architecture” in order to support the “right” decisions that are felt to benefit people, to downright punitive and coercive policies that entail psycho-compulsion, such as sanctioning and mandatory workfare.

Psychology is being misused by the government to explain unemployment (it’s claimed to happen because people have the “wrong attitude” for work) and as a means to achieve the “right” attitude for job readiness. Psycho-compulsion is the imposition of often pseudo-psychological explanations of unemployment and justifications of mandatory activities which are aimed at changing presumed beliefs, attitudes and dispositions. The Behavioural Insights Team have previously propped up this approach.

Welfare conditionality and its experimental approach to behavioural change doesn’t operate within an ethical framework, citizens cannot withdraw from behavioural experiments, nor is this framework based on informed consent. The impact of state directed psycho-compulsion and potential harm that it may cause citizens is not being monitored.

The Behavioural Insights Team (BIT) is composed of mostly behavioural economists, who also claim the title of libertarian paternalists (and who have a clear and distinct ideological premise for their behavioural theories, while attempting to claim “objectivity”.)

They claim that while it is legitimate for government, private and public institutions to affect behaviour the aims should be to ensure that “people should be free to opt out of specified arrangements if they choose to do so.” Apparently, that proviso doesn’t apply to poor citizens.

The nudges favoured by libertarian paternalists are also supposed to be “unobtrusive.” That clearly is not the case with the application of extremely coercive and punitive Conservative welfare sanctions.

When it comes to technocratic fads like nudge, it’s worth bearing in mind that truth and ethics quite often have an inversely proportional relationship with the profit motive. It’s a cognitive bias, if you will.

And when one nudge theory fails, there are always lucrative and political opportunities to generate more.

Of course Dr Kizzy Gandy, a leading researcher at the policy unit says: “We are optimistic that behavioural science can help government departments to better design policies to help those who are ‘just managing’ in order to prevent and overcome poverty.”

In a new report released today from the Behavioural Insights Team, the authors say: “There is evidence that welfare conditionality in the UK – mandatory behavior requirements such as attending meetings with work coaches or providing repeated evidence of disability in order to receive benefits – is associated with anxiety and feelings of disempowerment.”

“However, as far as we know no one has examined whether welfare conditionality has cognitive depleting effects.”

It’s particularly worrying that there is a proposal in the report for further experimental pseudo-psychological approaches to policies aimed at the poorest citizens. The researchers call on the Department for Work and Pensions to conduct experiments into whether welfare conditionality actually had any positive effects and suggested that “self-set” and “enforced goals” might be a better way of “helping people into work.” Although this allows for a little tokenist self-determination and permits a little autonomy, it is still an approach ultimately based on coercion and enforcement.

There is a clear distinction to be made between “behavioural science” – which is almost entirely about economic outcomes; what is politically deemed “best” for citizens and social conformity, and mainstream psychology – which embraces a much broader and deeper perspective of the complexities of human potential and wellbeing.

For anyone curious as to how such tyrannical behaviour modification techniques like benefit sanctions arose from the bland language, inane, managementspeak acronyms and pseudo-scientific framework of “paternal libertarianism” – nudge – here is an interesting read: Employing BELIEF: Applying behavioural economics to welfare to work, which is focused almost exclusively on New Right small state obsessions.

(Update 27/10/17 – the link to the original document no longer works. But I found a copy with the same page layout here, luckily: – https://www2.learningandwork.org.uk/sites/default/files/publications/CESI_employing_BELIEF.pdf).

Pay particular attention to the part about the alleged cognitive bias called loss aversion, on page 7.

And this on page 18: “The most obvious policy implication arising from loss aversion is that if policy-makers can clearly convey the losses that certain behaviour will incur, it may encourage people not to do it,” and page 46: “Given that, for most people, losses are more important than comparable gains, it is important that potential losses are defined and made explicit to jobseekers (e.g.the sanctions regime).”

The recommendation on that page: “We believe the regime is currently too complex and, despite people’s tendency towards loss aversion, the lack of clarity around the sanctions regime can make it ineffective. Complexity prevents claimants from fully appreciating the financial losses they face if they do not comply with the conditions of their benefit.”

The Conservatives duly “simplified” sanctions by extending them in terms of severity and increasing the frequency of use. Sanctions have also been extended to include previously protected social groups, such as lone parents, sick and disabled people.

The paper was written in November 2010, prior to the Coalition policy of increased “conditionality” and the extended sanctions element of the Tory-led welfare “reforms” in 2012. I wrote about this at length earlier this year, here: Nudging conformity and benefit sanctions: a state experiment in behaviour modification.

The Behavioural Insights Team, (otherwise known as the Nudge Unit) was set up by David Cameron in 2010. In their most recent report called Poverty and decision-making: How behavioural science can improve opportunity in the UK, the nudge researchers now say that burdening unemployed people with responsibilities, using the threat of sanctions might actually be making it harder for them to get jobs.

According to the behavioural economist theorists authoring this highly jargonised report, government policies designed to help people are reducing and impairing people’s so-called cognitive scope and abilities.

However, it’s difficult to imagine how punitive sanctioning, which entails the removal of people’s lifeline income, originally calculated to meet the costs of only basic survival needs, such as for food, fuel and shelter, could ever be seen as “helping people.”

I don’t believe that Orwellian semantic shifts (or ‘thrifts’, in this case) can ever provide a genuine and effective solution to poverty and inequality.

Some major inconsistencies and incoherences in the report

In the latest BIT report, loss aversion is mentioned again: “People dislike losses more than they like equivalent gains. Babcock, Congdon, Katz, and Mullainathan (2012) hypothesise that people may experience loss aversion if they consider taking a job paying below past earnings. Therefore, they may stay on unemployment benefits longer than they should. Unrealistic wage expectations may be reinforced when the social status and personal identities of workers are strongly tied to their previous job.” [My emphasis]

Note the phrase “unrealistic wage expectations” and later incoherent comments in the report about in-work poverty, which I will highlight.

The summary report states in the introduction: “A third of the UK population spent at least one year in relative income poverty between 2011 and 2014.

Traditionally policymakers and anti-poverty organisations such as the Joseph Rowntree Foundation (JRF) have focused on boosting people’s economic capital (e.g., income) and human capital (e.g., educational attainment) to reduce poverty. While investments in these areas have led to important gains in opportunity for many Britons, emerging research from behavioural science shows that other less tangible resources, which derive from psychological, social and cultural processes, significantly influence people’s ability to overcome disadvantage.

BIT was commissioned by JRF to examine the role of individual decisions in shaping people’s experiences of poverty in the UK and to identify the drivers of these decisions. This reflects JRF’s interest in looking beyond traditional, structural drivers of poverty. Our findings, based on a review of the published literature, are presented in a new report, launched today.”

Let’s cut to the chase. The entire document is framed by the use of a distinct and established narrative; it’s composed of a pre-loaded ideological language, references and signposts, using comments and phrases like “[…] we explain some of the ways that cognitive, character and social capital influence social mobility, via decision-making.”

And a sub-heading: “Character capital: Self-efficacy and responsive parenting.” Apparently, “home visits by health workers have had positive effects in preventing intergenerational poverty.” That’s quite a remarkable claim, given that the document acknowledges poverty is actually increasing in the UK.

The whole concept of character capital is itself founded on the notion that people with an “internal locus of control” tend to perform tasks better than those with an “external locus of control.” This is about where people place the responsibility for what they achieve – either “inside” individuals, based solely on notions of merit, specific skills and talents, or external to individuals – “outside” of them, based on environmental conditions such as competition, chance, opportunities, socioeconomic, employment market context and so on. However, the cited evidence to support this theory was later contradicted in the report.

One of the key features of poverty is loss of choice and a steady erosion of control over one’s decisions, of course.

It’s also worrying that it is implied those who believe that achievement is linked with structural conditions are “under-performers.” It reads a little like a Samuel Smiles Victorian treatise on “thrift, character and self-help.”

It’s also an almost subliminal method of dismissing the impact of structural constraints on the opportunities available to individuals. It serves to make invisible what was once a key consideration in public discussions about poverty: the unequal distribution of power, wealth, resources and opportunity.

Also of note: “low levels of financial literacy” was conflated with notions of “human capital”, which “potentially exacerbate the effects of depleted cognitive capital among low income groups when choosing between credit options.” Nothing to see here, then, regarding the behaviour of lenders. I mean whoever heard of a bank offering an overdraft to people who actually need one. Still, thank goodness there are generous companies like Wonga, always ready to step up to the mark, with eye-watering interest rates to offer those on low incomes.

The research authors seem to think that the only human potential worth recognising is that of our economic decision-making. Yet when people are materially poor, budgeting and decision-making are invariably constrained – that’s intrinsic to the very nature of poverty.

Limited decision-making and reduced available choices don’t cause poverty: they are the subsequent exclusion effects of poverty.

It’s telling that none of the recommendations made in this document actually address the structural and political causes of material poverty and growing inequality in the UK.

There is a substantial incoherence in some of the claims made, too. For example: “The world of work is possibly the single most important policy area for maximising individual and household resources to prevent and overcome poverty.”

Yet: “Just under half of those in poverty in the UK live in a workless household (Joseph Rowntree Foundation, 2014)”. So work clearly doesn’t pay for over half of those people in poverty.

In fairness, it is later acknowledged that: “However, simply being in work is not sufficient to prevent or overcome poverty. Nearly two-thirds of children in poverty live in working families.”

This heavily jargonised rhetoric is, on the whole, about looking for cheap individualist “solutions” to poverty that disregard the need for improving people’s material and financial situations, by extending on an existing neoliberal narrative of alleged individual fault, character deficits, cognitive bias and decision-making flaws.

None of this will raise the profile of crucial issues such as the conditions imposed by austerity and neoliberal policies, socioeconomic organisation and political decision-making, that are having a profound impact on growing inequality and increasing poverty in the UK. The persistent use of the word “workless” rather than “unemployed” is another linguistic signpost for neoliberal competitive individualism, too.

Geographer David Harvey describes neoliberalism as a process of accumulation by dispossession: predatory policies are used to centralise wealth and power in the hands of a few by dispossessing the public of their wealth and assets. The report does not refer to the mode of political-economic organisation of which growing inequality and poverty are an intrinsic and inevitable feature.

Proposed solutions: more of the same

Summary of recommendations:

MINIMISING COSTS

Consumer credit

1 Make it easier to access low cost credit through extending access to interest-free Budgeting Advances; assisting credit unions to expand online services; and providing tax relief to individuals taking out payroll loans.

2 Further restrict practices by high cost credit providers that play on consumer biases, and test remedies that will improve consumer credit decision-making.

3 Continue to evaluate financial capability programmes through initiatives like the Money Advice Service What Works Fund.

(Access to credit does not alleviate poverty in the long-term.)

Savings

1 Test ways of automating rainy day savings through employer enrolment, default savings accounts with banks, and Universal Credit payments.

2 Evaluate the effectiveness of financial apps for helping people save.

3 Optimise the Help to Save matching scheme, through testing auto-enrolment and prizes for regular saving, to encourage low-income groups to save.

(Poor citizens do not have sufficient funds to make savings. And research shows that absolute poverty is growing in the UK, which means that many people often don’t have sufficient funds for meeting even fundamental survival needs, such as for food and fuel.)

MAXIMISING RESOURCES

Work

1 Use identity-building activities in Jobcentres to cultivate intrinsic motivation for work in order to improve the quality and sustainability of jobs that people find.

2 Collect longer-term and more holistic outcome measures of labour market interventions to understand their full impact on poverty.

3 Develop a simple tool for Jobcentres to identify capital deficits in order to match interventions to individual job seeker needs.

Entitlements

1 Develop a common “cognitive load stress test” that measures how easy it is for eligible groups to access government entitlements.

2 Use annual entitlement summaries to prompt existing welfare recipients to apply for other assistance they may be eligible for, and to help them budget.

3 Experiment with the design of welfare conditionality to boost cognitive capacity and self-efficacy, such as having claimants set their own payment conditions.

PREVENTING INTERGENERATIONAL POVERTY

Parenting

1 Provide families in or near poverty with free access to evidence-based online parenting programmes.

2 Develop community to strengthen social ties between parents from different backgrounds.

3 Conduct research into whether small and inexpensive adjustments to housing conditions can reduce cognitive load and improve parental decision-making.

Post secondary education

1 Make the application process for post-secondary education as simple as possible, for example, by pre-populating application forms.

2 Use personalised assistance and prompts to encourage students and parents to apply to post-secondary education.

3 Link formal information about returns to post-secondary education with informal information (from peers) about what post-secondary education will be like.

Every single intervention recommendation fails to address the structural causes of poverty, which lie outside of the control of people experiencing poverty. Yet most of these recommendations are aimed at prompting the state to act upon individuals.

Proposals such as providing access to parenting programmes, “identity-building activities in Jobcentres to cultivate intrinsic motivation for work”, “rainy day savings”, and to “develop a simple tool for Jobcentres to identify capital deficits in order to match interventions to individual job seeker needs” all sound like a New Right blame-storming exercise. Again, the problem of poverty is regarded as being intrinsic to the individual, rather than one that is about material deprivation which arises in a wider political, economic, cultural and social context.

Post secondary education costs money and isn’t supported by the state. The Education Maintenance Award (EMA) was withdrawn by the Conservatives, and the cost of a university education is now far too much for many young people from poorer backgrounds because of the tripling of fees and reduction in maintenance support. It’s the government that need a nudge, here. This is a good example of how opportunities and choices are being limited for poorer citizens by cuts and constraints imposed by the neoliberal ideologues in office.

The government never question the decision-making of the powerful and wealthy, yet it certainly wasn’t the poorest citizens that caused the global recession in 2007, nor was it the poorest citizens that imposed damaging austerity policies. The poorest people are burdened with a disproportionate weight of austerity cuts to their income and support. The wealthiest citizens have meanwhile been gifted with substantial tax cuts.

Nudge is a state prop for neoliberalism, inequality and social control

Neoliberalism organises societies into hierarchies. Inequality is therefore an inevitable feature of the UK’s current mode of socioeconomic organisation.

The UK currently ranks highly among the most unequal countries in the world.

Inequality and poverty are central features of neoliberalism and the causes therefore cannot be located within individuals.

Neoliberals see the state as a means to reshape social institutions and social relationships based on the model of a competitive market place. This requires a highly invasive power and mechanisms of persuasion, manifested in an authoritarian turn. Public interests are conflated with narrow economic outcomes. Public behaviours are politically micromanaged. Social groups that don’t conform to ideologically defined outcomes are stigmatised, and outgrouped.

Shamefully, in a so-called first world, wealthy liberal democracy, othering and outgrouping have become common political practices.

Replacing spent micro-managementspeak with more micro-managementspeak

The Nudge Unit, which was part-privatised in 2014, have now warned that some Government policies were reducing so-called “cognitive bandwidth” or “headspace” of the people they were designed to help. So more theoretical psychobabble to overwrite the previous psychobabble which didn’t work when applied via policy.

This is bland neoliberal managementspeak at its very worst. The policies are causing profound damage, harm and distress to those they were never actually designed to “help”. Let’s not permit an evading of accountability and techniques of neutralisation: the use of rhetoric to obscure the real intention behind policies, as well as the consequences of them. It’s nothing less than political gaslighting.

Of course the report attempts to apply “the latest findings from behavioural science to improve government services.” In a neoliberal framework, there are many lucrative opportunities for private companies to experiment in the psychological management of populations who have become the casualties of political decision-making, for political ends. The ethical relativity, moral entrepreneurship and sheer financial opportunism on display here certainly reflect some fundamental neoliberal values and principles. The main one being profit over human need.

Dr Kizzy Gandy proposes that cost-effective “simple tweaks” to services could help improve the way services worked. “Government policies should help people to have less on their mind, not more,” she added.

However, I propose that government policies in democratic societies should also be designed to meet the public’s needs, including alleviating poverty, rather than being about impoverishing targeted social groups and then undemocratically acting upon individuals, without their consent, directing them how to behave in order to accommodate government ideology and meet politically defined neoliberal outcomes.

Material poverty steals aspiration and motivation from any and every person that is reduced to struggling for basic survival. Abraham Maslow (a real social psychologist) explained that when people struggle to meet their basic physical needs, they cannot be “incentivised” to fulfil higher level psychosocial needs – that includes job seeking.

Further criticism

Labour Shadow Work and Pensions Secretary, Debbie Abrahams, said: “Even the government’s own Behavioural Insights Team now recognise the mountains of evidence that the widespread use of sanctions is not leading to better outcomes for people seeking work. Indeed, this government team’s report suggests that sanctions may be operating as a barrier to finding a job.

“This government should be ashamed of their persistent failure to act on this issue over many years, after I, and other campaigners, have provided evidence of the devastating impacts of their sanctions policy. I have committed to putting an end to Tories’ cruel and unnecessary sanctions regime, as part of our work to transform the social security system.”

In fairness to the BIT, the report does say on page nine, among the listed areas of proposed future research: “A significant portion of behavioural science research focuses on improving the decisions of end-users – in this case people in poverty. But what about the decisions of service providers and policymakers? How can we improve the quality of their decisions to support people [to] escape poverty? And how can we build their empathy with those whose opportunities are at stake?”

But who is nudging the nudgers? I would think nudgers are “incentivised” by those providing the contracts that pay their salaries, on the whole. The government part-own the nudge unit.

Researchers from a variety of universities across the UK, using qualitative longitudinal interviews with nine groups of welfare service users from across England and Scotland, aim at determining longer-term effects of sanctions. The first wave findings from this collaborative ongoing study regarding the effects and ethics of welfare conditionality were released last year

It was found that linking continued receipt of benefit and services to mandatory behavioural requirements has created widespread anxiety and feelings of disempowerment. The impacts of benefit sanctions are universally reported by service users as profoundly negative, having severely detrimental financial, material, emotional, psychological and health impacts. Some individuals disengaged from services, some were even pushed toward “survival crime”.

The most surprising thing about these findings was the general lack of surprise they raised.

A recurring theme is that sanctions are grossly out of proportion to “offences”, such as being a few minutes late for an appointment. Many reported being sanctioned following administrative mistakes. The Claimant Commitment was criticised for not taking sufficient account of individuals’ capabilities, wider responsibilities and vulnerabilities. Many saw job centres as being primarily concerned with monitoring compliance, imposing discipline and enforcement, rather than providing any meaningful support.

Power relations, class and economic organisation have now completely disappeared from public conversations about poverty. Neoliberal anti-welfarism, amplified by a corporate media, has aimed at reconstruction of society’s “common sense” assumptions, values and beliefs. Class, disability and race narratives in particular, associated with traditional prejudices and categories from the right wing, have been used to nudge the UK to re-imagine citizenship, human rights and democratic inclusion as highly conditional. 

This is not just about shifting public rational and moral boundaries to de-empathise the electorate to the circumstances of politically defined others. It also obscures the consequences more generally of increasingly non-inclusive, anti-democratic, prejudiced and extremely punitive policies.

The bottom line is that government policies are expressed political intentions regarding how our society is organised and governed. They have calculated social and economic aims and consequences. In democratic societies, citizens’ accounts of the impacts of policies ought to matter.

However, in the UK, the way that policies are justified is being increasingly detached from their aims and consequences, partly because democratic processes and basic human rights are being disassembled or side-stepped, and partly because the government employs the widespread use of linguistic strategies: euphemisms, superficial glittering generalities and techniques of persuasion to intentionally divert us from aims and consequences of ideologically (rather than rationally) driven policies. Furthermore, policies have become increasingly detached from public interests and needs.

For example, the state has depoliticised disadvantage, making it the private responsibility of citizens, whilst at the same time, justifying a psychopolitical approach that encodes a punitive Conservative moral framework.

According to the behavioural economist theorists, in their highly jargonised and fairly meaningless report, government policies are reducing so-called “cognitive bandwidth” or “headspace” of the people they were designed to help.

That the government imposes additional “cognitive costs”, as well as material and financial ones, on low-income groups, is hardly a groundbreaking revelation.

I can put it much more plainly, and strip it of neoliberal psychobabbling: imposing sanctions on people who already have very limited resources is not only irrational, it is absurdly unjust, damaging, distressing and spectacularly cruel.

Dr. Robert J. Lifton’s Eight Criteria for Thought Reform, Cult Thinking and how they relate to Neoliberalism

October 4, 2016September 24, 2020 · 6 Comments ·

behavchange
Dr Robert J. Lifton is a psychologist who studied and identified the techniques of mass persuasion and groupthink used in propaganda and in cults (from political to religious). I found his interesting article about the eight criteria for “thought reform” on the International Cultic Studies Association (ICSA) site.

What struck me immediately about Lifton’s criteria is how easily they may be applied to neoliberalism – a totalising, authoritarian New Right ideology, imposed by an elite of very financially secure and powerful oppressors. Neoliberalism is incompatible with democracy, values of equality and human rights. It also requires narratives of othering in order for governments to justify the inequality that neoliberalism is designed to cause.

Over the last few years, much of the population in the UK have experienced growing inequality and increasingly precarious socioeconomic circumstances, exacerbated by class-contingent neoliberal austerity and ‘small state’ policies.

The neoliberal approach to public policy has become naturalised. Political theorist Francis Fukuyama announced in 1992 that the great ideological battles between “east and west” were over, and that ‘western [neo]liberal democracy’ had triumphed. He was dubbed the “court philosopher of [post-industrial] global capitalism” by John Gray.

In his book The End of History and the Last Man, Fukuyama wrote:

“At the end of history, it is not necessary that all societies become successful liberal societies, merely that they end their ideological pretensions of representing different and higher forms of human society…..What we are witnessing, is not just the end of the cold war, or a passing of a particular period of postwar history, but the end of history as such: that is, the end point of mankind’s ideological evolution and the universalisation of western liberal democracy as the final form of human government.”

I always saw Fukuyama as an ardent champion of ultra-neoliberalism, he disguised his conservatism behind apparently benign virtue words and phrases (as part of a propaganda technique called Glittering Generalities), such as “Man’s universal right to freedom.”

He meant the same sort of self-interested “freedom” as Ayn Rand: “a free mind and a free market are corollaries.” He meant the same kind of implicit social Darwinist notions long held by Conservatives like Herbert Spencer – where the conditions of the market rather than evolution decides who is “free,” who survives, and as we know, the market is rigged by the invisible hand of government.

Fukuyama’s ideas have been absorbed culturally, and serve to normalise the dominance of the right, and stifle the rationale for critical debate. Additionally a political context has been created to pathologize the left.

Fukuyama’s work is a celebration of neoliberal hegemony. It’s an important work to discuss simply because it has been so widely and tacitly accepted, and because of that, some of the implicit, taken-for-granted assumptions and ramifications need to be made explicit.

Neoliberalism requires an authoritarian approach to public administration. Rather than an elected government recognising and meeting public needs, instead, we now have a government manipulating citizens to adapt their views, behaviours and circumstances to meet the politically defined needs of the state, in the form of ‘nudging’ and behavioural economics.

This turns democracy on its head. It is also presents us with a political framework that is incompatible with the UK’s international human rights obligations and equality legislation.

Government policies have become increasingly irrational. We have a government that has decided work is a health outcome, for example. In an absurd world where medical sick notes have been politically redefined as fit notes, sick and disabled people are apparently no longer exempt from work, which is now held to be a magic “cure”. The only way out of the politically imposed punitive and increasing poverty for those who cannot work is… to work. (See: Let’s keep the job centre out of GP surgeries and the DWP out of our confidential medical records.)

Neoliberalism has become a doxa in the Western world. Here in the UK, citizen behaviours are being aligned with politically defined neoliberal outcomes, via policies that extend behaviour modification techniques, based on methodological behaviourism. Policies that “incentivise” have become the norm. This is a psychocratic approach to administration: the government are delivering public policies that have an expressed design and aim to act upon individuals, with an implicit set of instructions that inform citizens how they should be.

Aversives and punishment protocols are most commonly used. Coercive welfare policies are one example of this. The recent eugenics by stealth policy entailing the restricting of welfare support to two children only is another. Both were introduced with the explicitly stated political intention of “changing behaviours” of poorer citizens. Those that cannot or will not conform are politically stigmatised and outgrouped, as well as being being further “disciplined” by state-imposed economic sanctions.

Another particularly successful way of neutralising opposition to an ideology is to ensure that only those ideas that are consistent with that ideology saturate the media and are presented as orthodoxy. Every Conservative campaign has been a thoroughly dispiriting and ruthless masterclass in media control.

Communication in the media is geared towards establishing a dominant paradigm and maintaining an illusion of a consensus. This ultimately serves to reduce democratic choices. Such tactics are nothing less than a political micro-management of your beliefs and are ultimately aimed at nudging your voting decisions and maintaining a profoundly unbalanced, pathological status quo. (See also: Inverted totalitarianism and neoliberalism.)

As a frame of analysis, Lifton’s criteria are very useful in highlighting parallels between cult thinking and how political dogma may gain an illusion of consensus; how it becomes a dominant paradigm and is accepted as everyday “common sense.”

Kitty.

Lifton’s criteria for “thought reform” are:

Milieu Control. This involves the control of information and communication both within the environment and, ultimately, within the individual, resulting in a significant degree of isolation from society at large.
Mystical Manipulation. There is manipulation of experiences that appear spontaneous but in fact were planned and orchestrated by the group or its leaders in order to demonstrate divine authority, spiritual advancement or some special gift or talent, such as claims of having a high IQ, that will then allow the leader to reinterpret events, scripture, and experiences as he or she wishes. (This can include “natural order” ideas and political doxa.)
Demand for Purity. The world is viewed as black and white and the members are constantly exhorted to conform to the ideology of the group and strive for perfection. The induction of guilt and/or shame is a powerful control device used here. (Stigma and political outgrouping is used to deter and exile non-conformists.)
Confession. Sins, as defined by the group, are to be confessed either to a personal monitor or publicly to the group. There is no confidentiality; members’ “sins,” “attitudes,” and “faults” are discussed and exploited by the leaders. (Mainstream media have bombarded us with “confessions” of “scroungers”, for example. The lives and experiences of those out of work have become public moral “property.”)
Sacred Science. The group’s doctrine or ideology is considered to be the ultimate Truth, beyond all questioning or dispute. Truth is not to be found outside the group. The leader, as the spokesperson for God or for all humanity, is likewise above criticism. (Ties in with Conservative notions of a “natural social order.” But also, pseudoscience may be used to justify controversial policies.)
Loading the Language. The group interprets or uses words and phrases in new ways so that often the outside world does not understand. This jargon consists of thought-terminating cliches; slogans which serve to alter members’ thought processes to conform to the group’s way of thinking. (See Glittering Generalities and The Conservatives are colonising progressive rhetoric.)
Doctrine over person. Member’s personal experiences are subordinated to the sacred science and any contrary experiences must be denied or reinterpreted to fit the ideology of the group.
Dispensing of existence. The group has the prerogative to decide who has the right to exist and who does not. This is usually not literal but means that those in the outside world are not saved, unenlightened, unconscious and they must be converted to the group’s ideology. If they do not join the group or are critical of the group, then they must be rejected by the members. Thus, the outside world loses all credibility. In conjunction, should any member leave the group, he or she must be rejected also. (Lifton, 1989)

*Italics in blue added by me.

The new Work and Health Programme: government plan social experiments to “nudge” sick and disabled people into work

Cameron’s Nudge that knocked democracy down: mind the Mindspace.

Link: The Government Communication Service guide to communications and behaviour change gcs-guide-to-communications-and-behaviour-change1

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A Naiad Cortege I

August 31, 2016January 8, 2019 · Leave a comment ·

Penelope and her suitors

A guest post written by HUBERT HUZZAH·

Sometimes Science reveals something we would prefer not to know. For Medieval Popes, who could control the World by deciding the date of Easter, Natural Science revealing that Aristotlean Wisdom was flawed was one of those things. Giordano Bruno was dressed in yellow and burned at the stake. Galileo Galilei was forced to write a retraction of experimental findings. Natural Science showed that Venus had phases which may seem obscure. However, when the only consistent explanation of those phases is that Venus is orbiting the Sun the Papacy is challenged. The knowledge, that the Earth orbited the Sun, was not something Galileo originated. The big offence of Galileo was that he proved the thesis: that the Earth is not the Centre of Creation.

The date of Easter is an important illustration of Papal Power. The Computus was the process by which Easter was calculated and, once determined, the Computus fixed all of the significant dates of the calendar for the entire year. Fixing the date of Easter was not simply about deciding a single date. The Computus was as the centre of determining the way the World would work. Not only fixing Easter but also significant moveable feasts which were non-working days and even Quarter Days, when rents, tithes and obligations were due. Controlling Easter was a proof of mysterious power and a very worldly power.

Science proved something far more significant than Heliocentricity: it proved no mysterious power was needed to know things. It proved that the Papacy, the Computus and all of the moveable feasts were constructed by society, not ordained, and this could be proven without any need to ask for permission. Natural Science demonstrated that the Aristotlean Method has distinct limitations and that those limitations can be overcome by a Socratic Method.

According to Aristotlean Method, Scientific Knowledge is the Knowledge of Causes. For Aristotle, a demonstration is a deduction in which the premises are true, primary, immediate , better known than the conclusion, prior to the conclusion and causes of the conclusion. In other words, Scientific Knowledge is a sequence of causes back to the mists of existence. Science is not merely a body of knowledge but a body of Authoritative Knowledge. Socrates may have written nothing: an appropriate mystery for someone whose Method consists of asking questions that banish belief but clarify what is known.

The Socratic Method has parallels in Crowdsourcing while the Aristotlean Method tends to be about Expertise. Both have a relevant role to play in Science.

There are infant simulator programmes seeking to prevent teenage pregnancy. These are used in high, middle and low countries. Despite policy popularity published evidence of their long-term effects are rare. The Lancet has recently published a randomised control trial investigating the Virtual Infant Parenting (VIP) programme’s effects on sexual health. This study is registered as an international, randomised controlled trial, (ISRCTN24952438). The aims of registration suggest the Socratic approach of discovering knowledge, yet the outcome of the study suggests the Aristotlean approach of dispensing knowledge.

After statistical analysis, the Lancet Authors concludes:

“The infant simulator-based VIP programme did not achieve its aim of reducing teenage pregnancy. Girls in the intervention group were more likely to experience a birth or an induced abortion than those in the control group before they reached 20 years of age.”

which suggests that, just possibly, infant simulator programmes do not prevent pregnancy and, indeed, might even demystify childcare to such an extent that young women can make a more informed choice about getting pregnant. This would be a reasonable hypothesis to investigate. Young women might well, in Socratic fashion engage in critical thinking and determine that having a child younger is a better prospect as Virtual Infant Programme has demonstrated the challenges of childcare. Programme and Policy creators, in Aristotlean fashion, persist in the idea that the Policy is correct but requires adjustment.

Which leaves Science in the same situation as Giordano Bruno: too badly connected to the political, economic and social infrastructure of society to be merely told off. Science, and Scientists, are dressed in metaphoric yellow and burned at the allegorical stake. The Socratic Revolution of 1615 embraced empirical observation along with socratic questioning and began the slow overturn of Aristotlean Science. Four hundred years later, Science policy has, largely, reestablished Aristotlean Science. Science by fiat.

One of the huge gaps in the narrative around the infant simulator approach is that it fails to acknowledge that the programme seeks behavioural change. The infant simulator is a nudge towards “better” life choices. Yet, the life choices being made are exactly the opposite of those intended. In the intervention group – the group being nudged – 8% got pregnant; in the control – un-nudged group – 4% got pregnant. Instead of engaging with the empirical evidence – that the intervention is associated with higher pregnancy rates – Programme Designers lock themselves into an Aristotlean Behavioral Change Stairway Model whereby the intervention will be redesigned.

What Programme Designers rarely do is question if the underlying assumption – reducing pregnancy rates – is actually realistic. Evolution has reinforced the human behaviour of having children. When parents – particularly women – see a child they are rewarded with the hormone Oxytocin. The same hormone is involved in social recognition, orgasm, childbirth and stress. Designing a programme with the potential to promote oxytocin secretion is designing a programme with the potential to promote childbirth. Evolution trumps Policy. Regardless of Policy Objectives.

Which is a fundamental problem with Nudge. Ultimately, as observed by Sue Jones in her excellent Politics and Insights Blog, Nudge is about the exercise of power. As with a lot of Aristotlean Science of the past, the exercise of power requires control of social construction. The Computus must be a mystery controlled by a Papacy. Anything else leaves open the possibility of transformative change through Socratic Method. Critical Thinking as it is known.

Persuading young women to delay childbirth has an awful lot to recommend it in a society where childbirth is a personal Easter that determines a range of future events. Controlling female fertility need not be about improving opportunities in life by nudging young women to delay conception. There is evidence that particular nudge fails in some situations. In those situations, Policy remains resolutely Aristotlean: it does not change.

The huge truth of the Galilean Revolution is not that Galileo did something new and revolutionary but that between the trial of Bruno in 1593 and the trial of Galileo in 1633 the same thing resulted in two different results. The Papacy ceased to be able to define the social construction of reality as Aristotlean Science failed. Yet, here we are, four centuries later, with Aristolean Policy in a Socratic World.

References:

Lancet Article: “Efficacy of infant simulator programmes to prevent teenage pregnancy: a school-based cluster randomised controlled trial in Western Australia”, Brinkman, et al.

Oxytocin Review: “The orgasmic history of oxytocin: Love, lust, and labor”, Magon & Kalra Trial Registration: ISTRN Registry Entry ISRCTN24952438

Politics and Insights: The benefit cap, phrenology and the new Conservative Character Divination.

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The still face paradigm and inequality

The still face of the neoliberal state

Neoliberalism and the myth of meritocracy

Stigma and the just world fallacy

The normalisation of socioeconomic hierarchy: a nod to Milgram

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Work is not a “health” outcome

Neoliberalism and inequality are strongly correlated with increasing ill health

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Context

The architects

State diagnosis and treatment – a blunt instrument

The shrinking category of illness and disability

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The context indicates the general intent

Watching the way the wind blows

Coercing those deemed to ill to work into work. It’s not “nudge”: it’s psycho-compulsion

The Conservatives claim work is a “health” outcome: crude behaviourism

Semantic thrifts: being Conservative with the truth

The nitty gritty

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Some context: the new neuroliberalism and “behavioural insights”

Some major inconsistencies and incoherences in the report

Proposed solutions: more of the same

Nudge is a state prop for neoliberalism, inequality and social control

Replacing spent micro-managementspeak with more micro-managementspeak

Further criticism

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