Saturday, March 30, 2013

The Construction of Disability

Everyone should all listen to this latest This American Life episode on what the reporter of the piece, Chana Joffe-Walt, calls the "disability industrial complex."  The simple factoid with which it begins?  The rise in the number of people all over America on disability.  Joffe-Walt starts with this and starts to burrow in deeper.  She finds that disability is a slippery concept: how does it get defined in practice?  When she meets the doctor in Hale County, Alabama where 1 out of every 4 people is on disability (and he's responsible for many of these diagnoses), he tells her some of the criteria he uses.  One among them is education level.  Why, she wonders, is education level a criterion for disability?  The answer is, of course, that he's trying to think about the kinds of jobs they will be working in, and if he estimates that they can't work those jobs successfully, well, then for all practical purposes, they are disabled. (See transcript.)

But Joffe-Walt doesn't stop there.  She wants to explore this whole ecosystem of disability.  So she looks at lawyers.  What role have lawyers played in getting people on disability?  (And lawyers here come off surprisingly well, I think--crass, yes, money-minded, definitely, but also fulfilling a deep need.)  The answer: a lot.  And what of the political economy?  Aside from the problem of inequality--that the number of good jobs that don't require college degrees is steadily decreasing--she also points to federal and state regulations.  States, she finds, have an active interest in moving off people from their welfare rolls onto the federally funded disability program.  This work, naturally, is done by consultants who charge a fee for every successful transfer. 

It's all deeply fascinating stuff that moves fluidly on a number of different levels.  Sometimes Joffe-Walt is down on the ground, talking to people, seeking their opinions, wondering what they think.  At other times, she is taking an eagle-eyed view of the scene, talking to economists, and regulators.  [The web-site has a number of interesting graphs that are worth checking out.]  


Anonymous said...

The NPR Story has been quite controversial, and a number of experts and advocates have been quite critical. One example is here which focuses on claims about who is on disability and where the growth in disability comes from.

Chris O'Connell said...

Great article! One has to wonder how long such programs are sustainable...