Claiming Disability Benefits as Contested Social
Citizenship
Michael J. Prince
Lansdowne Professor of Social Policy, Faculty of Human and Social Development, University of
Victoria, British Columbia, Canada V8W 2Y2 mprince@uvic.ca
______________________________________________________________________________
Abstract Examining a public disability insurance plan reveals how income support is a
place of contestation for persons with illnesses and disabilities. While established as
social insurance with entitlements to benefits, claiming income support from the Canada
Pension Plan Disability program involves layers of diagnoses or discursive practices that
regulate access and shape the experiences of individuals seeking to obtain benefits to
which they believe the qualify and are entitled. The multiple diagnoses include selfassessments, medical examinations, legal deliberations, rehabilitation evaluations,
income security, and actuarial considerations regarding the “financial health” of the
program itself. Even successful applicants for disability insurance experience stress in
claiming their benefits. An alternative conception of social policy emerges, one more
multi-dimensional than commonly presented. Social programs and agencies are seen as
containing elements of service provision, coercion/control, self-compliance, and
contestation, all forms of power dynamics. The result for many is a disjuncture between
the rhetoric of entitlement and the real experiences of people with this social program
with an outcome, for many Canadian men and women, of contested citizenship.
Illness and Social Citizenship
In her book, Illness as Metaphor, Susan Sontag calls illness “the night-side of life,
a more onerous citizenship.” Continuing the imagery, she adds: “Everyone who is born
holds dual citizenship in the kingdom of the well and in the kingdom of the sick.
Although we all prefer to use only the good passport, sooner or later each of us is
obliged, at least for a spell, to identify ourselves as citizens of that other place” (Sontag
1978: 3). This figure of speech resonates with prevailing beliefs regarding chronic
illnesses and a great many experiences in accessing disability benefits (Prince 2001 and
2002), and thus offers an obvious point of departure for understanding contestation. In
addition, the metaphor itself is a worthy object of contestation. Besides portraying health
and illness as a simple dichotomy, this passage pathologizes illness while pointing out
some biases that no doubt prevail in contemporary cultures about wellness and disability.
1
However, referring to citizenship as “the kingdom of the well” and “the good passport”
conveys the formal status and actual practice of citizenship as unproblematic, as
something that everyone holds and uses.
Experience, both historically and still today, reveals that citizenship is a contested
status for many individuals and social groups (Adamoski, Chunn & Menzies 2002; Prince
2004; White & Donohue 2003). Social citizenship, fully understood in practice, is not so
much a formal status of membership in a community or a firm solution to certain needs,
though it entails both of these, but is a field of possible actions and relations of power that
include action and resistance, participation and apathy, empowerment and exasperation
(Cruikshank 1999: 62; Foucault 1980: 41). In what ways are social policies spaces for
contestation, and how do individuals go about contesting questions regarding personal
experience, professional expertise and program eligibility?
In this paper, I examine how working age adults, participating in the formal
labour market and experiencing significant impairments, are governed by a public
program established to provide disability income security as an earned right. How does
social citizenship work? How is it constructed, and how do people and program officials
practise it? How do social security programs shape clients’ experiences in claiming
benefits and in realizing their rights? In what ways does power operate and circulate in
disability income programs? Through what procedures and mechanism is power
exercised, accepted, resisted or internalized?
For persons with mental or physical disabilities, claiming social insurance
benefits can be understood as an experience of contested illness as well as contested
citizenship. To explore this theme, I cover four topics. I first briefly explore the meaning
of contestation and how it relates to deliberative democracy, oppositional politics and
citizenship. I then examine disability as contested field of identity politics and social
policy. Next, I discuss social citizenship and diagnoses in action in relation to a public
disability insurance program. Finally, I explore the interactions between individuals and
officials as a multi-faceted series of power relations. This analysis is done in relation to
the Canada Pension Plan Disability (CCP-D) program. The paper concludes with
implications of these practices in claiming disability income security for our
understanding of citizenship, social policy and power.
Using the CPP Disability program as a case study, I am interested in exploring
how this major public disability insurance program constitutes relations of power among
state officials, medical professionals, and individual applicants, and how contestation
figures in these networks of roles and relationships. The prime focus is not on the CPP D
as a form of income security as such, though this is an important backdrop to the inquiry,
but rather to view the CPP D as a place of power interactions over different meanings of
illnesses, diagnoses, and experiences. From this perspective, the politics of social policy
goes beyond conventional notions of financing programs to meet a range of needs or
adjusting old programs to meet new and shifting needs, to encompass the politics of
interpreting needs (Fraser 1987) and resisting definitions constructed and imposed by
others (Rice and Prince 2000; Schneider 2003).
2
Thinking about contestation
Contestation easily relates theoretically to conflict approaches to research inquiry,
and the belief that struggle is endemic to social experiences, structures and relations. As
an analytical perspective, contestation holds the promise of considering structural
contexts and the subjectivity of actors, at one and the same time.1 Mark Warren offers a
conception of politics quite useful for the purposes of this analysis that focuses on the
intersection of power and conflict. The domain of politics includes “contested relations of
power” that deal with social identities, material resources, and state-centred activities
(Warren 1999: 219). Along with these cultural, economic and state forms of manifest
conflict, Warren draws attention to “suppressed politics,” in which “routines and relations
of power [are] uncontested owing to vulnerability or hegemony.” In such circumstances,
though manifest conflict is not widely apparent, power is involved nonetheless, and any
resolution and decisions are “displaced onto civil society organizations” (Warren 1999:
225). Warren’s notion of suppressed politics, of uncontested relations of power, relates
to what I would call potential contestables. These are social goals, practices, beliefs and
outcomes which are taken for granted and considered ‘normal’ for the most part, but
which have the capacity in the future for being recognized as a political issue and thus
openly questioned and challenged. This is the stuff, of course, of political mobilization,
agenda setting and the work of social movements.
Contestation links to deliberative citizenship and democracy, concepts used lately
in political science, social policy, and critical and philosophical studies. Like
contestation, the notion of deliberation addresses political participation and shares an
interest in enhancing the voices of groups traditionally marginalized from public and
community spheres.2 Contestation differs from deliberation, though, as regards
understanding power relationships. Deliberation in public policy making is normatively
seen as “governed by norms of equality and symmetry; all have the same chances to
initiate speech acts, to question, to interrogate, and to open debate” with consensus
“freely reached, not coerced” (Benhabib 1996: 70). In contrast, contestation is commonly
imagined in terms of power imbalances and struggles against domination and oppression.
As a form of power, contestation implies controversy, resistance, strong dissent and
opposition to a dominant force, but other relationships and outcomes can occur.
Contestation has an internal subjective side, in which resistance is contemplated
and initiated as well as an external dimension of power as imposition and restriction.
More than this is involved though. Contestation is a relational phenomenon, a dynamic
interaction between individuals or groups and their immediate settings and larger
institutional contexts. Contestation is both ‘outside in’ and ‘inside out’ (Grosz 1994),
with the simultaneous experience and exercise of initiation and imposition. Contestation
plays out through multiple processes and can result in several power effects.
The notion of contestation is significant in challenging the construction of persons
with disabilities or chronic illnesses as passive victims living in the kingdom of the sick
or as deserving beneficiaries of readily available social rights. The notion is also
important in paying notice to the medical, bureaucratic, and financial discourses and
3
structures, among others, that construct and condition identities along with access to
welfare state social benefits and service (Prince 2004). As a process or phenomenon,
contestation thus offers a more dynamic and problematic image of citizenship rights than
is often presented in the social policy literature. The importance of claiming benefits
further lies not only in what it offers in financial support to individuals with disabilities
and family members, but in the process of involving members of a political community in
pursuing and thus exercising rights of citizenship. Contestation and citizenship, therefore,
are intertwined, played out together in formal public policy structures, concrete programs
and myriad local sites of interactions between individuals and officials.
Disability as a Contested Field
As a field of identity politics and social policy, disability has not the same public
intensity and controversy in contemporary Canada as, say, multiculturalism and the
politics of immigration, race and ethnicity; Quebec separatism or Western alienation and
the politics of national unity; or gender politics and the rights of gays, lesbians and
heterosexuals; or Aboriginal affairs and debates over treaty rights, reconciliation and selfgovernment. Nevertheless, individuals, advocates and groups in the disability field are
struggling to change outmoded attitudes held by the public and the mass media (Enns
1999), to remove barriers to participation, and to gain access to much needed supports
and services for everyday living. Tensions exist among disability groups, such as between
disease specific agencies and rights-based cross-disability organizations as to how to
frame disability and so what issues reforms to pursue. There is too, resistance if not
outright opposition by numerous public authorities (Crown corporations, health and
social service ministries and school districts) to claims by individuals and families or by
disability activists and groups for integration and services, for a seat at the table of policy
makers, in pursuit of equal participation and social justice (Boyce et al 2001; Puttee
2002).
Debates and disputes about disabilities, and thus people’s identities, with
eligibilities for and exclusions from public services, have characterized income security
programs from the beginnings of modern social provision. The politics of disability,
income maintenance and social citizenship were debated in the 1920s and 1930s, as they
were in later decades of the twentieth century and so today. A range of groups – injured
workers, wounded veterans, the blind, people with mental health conditions or physical
disabilities - have advanced political claims to gain state recognition of their status and a
meaningful response to their needs and interests. The contestation of illness and disability
are intertwined with the politics of need interpretation. Nancy Fraser (1987: 119) notes,
since “needs are irreducibly interpretive,” a politics of explaining and understanding
needs arise. The interpretation of social needs in welfare systems are in principle
contestable and thus subject to critique and struggle. As Fraser asserts, “the interpretation
of people’s needs is itself a political stake, indeed sometimes the political stake (1987:
104). A question to ask then is: whose interpretation of a person’s illness is
authoritative? On whose terms, does the welfare state deal with a person with a
disability?
4
Quite often, contestations are linked to the incompleteness, incoherence and thus
inequities among programs, laws, services of both a generic kind and those tailored for
persons living with impairments, chronic illnesses and disabilities. For instance, income
programs and support measures in Canada provide very different eligibility criteria and
level of assistance and possibly appeal and redress mechanisms. Consequently, whether a
person qualifies, and if so, for what and for how long, is often related to how and where
the injury or disability came about, and the nature and cause of the health condition
(Puttee 2003; Rioux and Crawford 1994). Eligibility can also be related to which
department or agency in the public service and which level of government is delivering
the program. Predictably, there are frustrations, clashes and tensions over navigating state
systems and gaining access to existing income programs and support measures (Bennett
2003; Doe & Kimpson 1999).
Contestations occur and may reoccur again and again around key life transitions,
for example from pre-school to school, from childhood to adolescence, school to work,
changing jobs, exiting the labour market or trying to re-turn to employment,
marriage/common law union, childbearing and rearing, care giving, retirement, and end
of life issues. Far too frequently, because supports and services are tied to specific
programs, budgets and agencies, they do not follow individuals through various stages
and transitions over their lives.
Public attitudes and practices certainly take part in the contested nature of
illnesses and disabilities for social policy. A 2004 public opinion poll of Canadians
revealed that many people “retain devaluing or exclusive ideas about who people with
disabilities are and how they participate in Canadian society.” This prompted Social
Development Canada, the federal department with lead responsibility for disability
issues, to concede: “There remain negative public attitudes about persons with disabilities
regarding the costs of inclusion and their potential contributions” (Kloosterman,
Rietschlin, Stienstra, Spector & Westmorland 2005: 14). People with disabilities struggle
against “paternalistic attitudes” and conceptions of disability that emphasize medical
conditions and that see impairments as personal abnormalities and thus personal
tragedies. The advocacy community also struggles for acceptance of the view that
disability is in large part a function of whether society recognizes and accommodates
impairments by adapting built environments, social beliefs and laws.
As well, there are crucial ontological and epistemological foundations to
contestation. Questions of what is the nature of disability as a lived reality and how do we
know that reality, are not self-evident or simply answered. In her work on corporeal
feminism, scholar Elizabeth Grosz theorizes how the body is “the site of contestation, in a
series of economic, political, sexual and intellectual struggles” (Grosz 1994: 19). Andrew
Webster (2002: 144) writes of “the contested, socially constructed and variable
‘pathways’ of medical technologies” with many meanings and diverse needs vying for
resources. Understanding health as “inherently complex, multiple and dynamic,”
challenges assumptions of rationality in policy making that rely on “certainty,
predictability, [and] clear cause and effect relations” (Ontario Public Health Association
2003: 2).
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Matters of illness, disorders and disability contain assorted knowledge clashes,
discursive conflicts between expert professions and across academic disciplines as well
as among lay people and experts as regards definitions and the framing of experiences;
screening technologies, diagnostic scales and assessment tools; symptoms, prevalence
and incidence; causal relationships and the influence of other factors; the efficacy and
desirability of different treatments, interventions and controls. The more forms of
knowledge in play in a given policy field, the greater possibility of divergent perspectives
especially if information sources are aligned with different value systems and interests
endowed with authority (e.g. medicine, the legal process, private life insurance
companies, the state bureaucracy). In circumstances such as AIDS/HIV (Corbett 2004),
cancer care (Clow 2001), innovative health technologies (Plummer 2003; Webster 2002),
schizophrenia (Schneider 2003) and workers’ compensation (Duncan 2003), we see
conflicting perspectives that flourish, are quite noticeable and persist over extended
periods of time.
Disability policy advocates and government reports today routinely employ a
discourse of citizenship, participation and inclusion as the normative reference for
pursuing social reforms (Council of Canadians with Disabilities 1998; Enns 1999; Puttee
2002). A dilemma of this strategy is that citizenship is itself a contestable notion. For one
thing, there is a lack of clarity and agreement in the academic literature and among
practitioners as to the meaning of citizenship. Unresolved issues and ambiguities persist,
as White and Donohue (2003: 393) observe: “The dependence of ‘citizenship’ on myriad
forms of ‘participation’ and ‘community’ means that what it is must remain uncertain.”
Historical research exposes deeply contested visions of the Canadian citizen marked by
contradictory processes of exclusion, resistance, and stratification by age, gender, race
and ability among other differences (Adamoski, Chunn & Menzies 2000). And
contemporary research shows that persons with disabilities are making incremental gains
at best, attaining “citizenship by instalments” (Prince 2001) in a “hit-and-miss affair”
(Prince 2004).
Social Citizenship and Diagnoses in Action: The Canada Pension Plan Disability
Program
CPP Disability is the country’s largest public disability insurance program. 3
Established in the mid 1960s, the primary policy goal is (1) providing a degree of income
protection or financial security, that complements private insurance, personal savings and
employment benefit programs, by replacing a portion of the earnings of contributors who
cannot work because of a severe and prolonged mental or physical disability. This aim
reflects the social insurance nature of the program’s design. Other policy goals are: (2)
promoting a return to work by supporting at least some CPP disability beneficiaries to
undertake gainful employment; (3) ensuring program integrity and accountability so that
benefits are paid correctly, appeals heard fairly and promptly, and fraud and errors are
avoided; and (4) ensuring the financial sustainability and affordability of the CPP for
present and future generations.
6
In 2005-06, $3.3 billion will be paid to just over 380,000 people. Behind this
substantial expenditure, CPP Disability has a national vocational rehabilitation program
and other related return-to-work support services and incentives. There also is the
decision-making process on applications and a three-stage appeal system for adjudicating
benefit claims. Also, a series of information-sharing agreements exist with provincial
governments and comparable agreements with provincial workers’ compensation boards
along with reimbursement agreements with private sector insurers and international social
security agreements with numerous countries.
The Promise of Social Insurance: Modernizing Provision
Social insurance programs are regarded as pivotal to the development of modern
welfare states. Here is a typical expression: “After centuries of reliance on the medieval
poor law, the advent of social insurance was one of the great watersheds in income
support policy” (Heidenheimer, Heclo & Adams 1975: 193). Another policy scholar
explains that social insurance was a crucial departure from traditional public last-resort
poor relief, “in that, for the first time, beneficiaries were being required to contribute
towards their own security in relation to (predictable) times of need … and that, when
they did call for such assistance, they could do so as a matter of right not as a question of
charity” (Jones 1985: 70). “Compulsory social insurance,” elaborates no less an authority
than T. H. Marshall, “was a novelty in three respects. It involved a new kind of
interference in the affairs of industry, a new type of relationship between the citizens and
government, and new problems of finance and administration” (Marshall 1975: 53).
In thinking of contestation, social insurance promises several features that would
alleviate such disputes. Social insurance as a program technique treats human needs as
social circumstances rather than personal conditions with benefits a matter of right due to
a record of employment and contributions paid by applicants. These elements provide a
social insurance program with the legitimacy of market liberalism and, it is expected, the
avoidance of stigma associated with more intrusive and punitive welfare relief.
In administrative term, with highly formalized means for calculating eligibility,
social insurance programs is thought to have the advantage of automatic decisions on
eligibility with uniform rules, thus minimizing contact between applicants and program
officials and curtailing discretion by officials (Heidenheimer, Heclo & Adams 1975:
193). By providing coverage of significant risks to a wide population group, social
insurance is believed to enjoy mainstream political support to maintain if not expand
benefits and defend such programs against the threat of retrenchment.4
The Practice of Social Insurance: Discursive Rules and Diagnoses
Is the promise of social insurance in mitigating contentious provision realized in
practice? In what ways do people with disabilities, as applicant for benefits, experience
the CPP D program?
7
A ‘right’ to CPP disability benefits is a claim for financial resources by
individuals based on certain criteria and duties, as well as mediated through a number of
discursive systems. Eric Gorham reminds us that “society and the state do not simply
give them [rights] to citizens gratis; citizens must subject themselves to the procedures
and institutions necessary to ensure that the state can continue to provide rights” (Gorham
1995: 29). In the case of CPP disability, applicants are subjected to disciplinary
procedures, knowledge systems and rules from administrative, medical, vocational
rehabilitation, actuarial/financial, income security, and judicial discourses. These
discursive practices regulate access and shape the experiences of individuals seeking to
obtain benefits to which they believe they qualify and are entitled. The multiple
diagnoses include self-assessments, medical examinations, legal deliberations,
rehabilitation evaluations, and even actuarial considerations regarding the “financial
health” of the program itself. This multiplicity of discourses and associated diagnoses are
integral to the nature of contestation in claiming their benefits. Even successful applicants
for disability insurance who become beneficiaries experience tensions and stresses.
For many working Canadians with disabilities, the experience of seeking this
social right of income support is one of rejection and denial of benefits. The ‘earned
right’ of CPP disability, even though based on contributions and work force participation,
does not guarantee the automatic provision of benefits. While labour force attachment is a
prerequisite for entitlement to the CPP Disability, as a work-related insurance plan, it is
not a sufficient condition for eligibility. Further conditions must be satisfied for a worker
with a disability to actually qualify and obtain financial support from the program. In
addition to having sufficient valid contributions to the CPP, these conditions are that the
individual is found to have a severe mental or physical disability that is prolonged.
This is a crucial point: the CPP D insures against a specific category of disability
– severe in condition and prolonged in duration, preventing a person, it is assumed from
being able to pursue any gainful employment. A related point is that CPP D does not
provide partial benefits; a person either qualifies for the full benefit or gets nothing at all
from the program. To determine if the person has a severe and prolonged disability,
information is complied from the applicant, their physician, and employer to produce a
profile of the applicant, which is then used to determine medical eligibility for the income
benefit. And while the issue of determining employability “is often treated as a technical
matter, it is impossible to separate the issue of employability from considerations of who
is or is not deserving” (Boychuk 1998: 18). Labour market considerations, too, enter into
decisions, informed by the relative strength of the economy and the extent of employment
opportunities in a local area that may match the skills or background of an applicant.
The interplay of these eligibility requirements as presented, interpreted, at times
negotiated and challenged, affects a person’s ability to receive benefits. Accessing
benefits is certainly not free of numerous kinds of interventions into the personal lives of
individuals. And both the literature and the record of the CPP show that medical
judgments and administrative decisions on eligibility are shaped not just by professional
knowledge and expertise but also by economic factors, political calculations, service
traditions, and bureaucratic constraints (Biklen 1988; Clow 2001; Prince 2002; Torjman
8
2002). With detailed investigations, reviews and various encounters with complex
organizations, for many people this social insurance program can feel a lot like a social
assistance program.
The CPP is part of what Pierre Bourdrieu calls “the left hand of the state,” located
in Social Development Canada, a spending department, with traces “of the social
struggles of the past,” in contrast to “the right hand of the state, the technocrats of the
Ministry of Finance” and private sector interest (Bourdrieu 1998: 2). Over the 35-year
history of the CPP both hands of the state have influenced and continue to shape the
scope and direction of disability policy. This bureaucratic dialectic inside the state,
reflecting larger ideological interests and differences, is an important part of the contested
terrain (Prince 2002; Rice and Prince 2000).
Individual-Official Interactions
Turning to consider ways in which people engage in claiming social rights, I
situate contestation within interactions between applicants for disability insurance and
officials charged with diagnosing applicants and with determining their eligibility income
protection. How do people experience social policies in their daily lives? What
interpretations, responses and social identities are produced? These questions deal with
prime experiential aspects of citizenship for people as individuals and as members of
families, workplaces, communities (Neysmith, Bezanson & O’Connell 2005), with what
has been called “intimate citizenship” and the intersection of public and private decisions
(Plummer 2003).
Following Max Weber, we can view the state as a mechanism of coercion and
bureaucratic administration; and, at the same time, following Michel Foucault, see the
state as a mechanism of compliance and self-regulation. This connects analytically to
what Mitchell Dean calls practices of governmental self-formation and practices of
ethical self-formation. While recognizing that these are not absolute distinctions, Dean
defines practices of governmental self-formation as “the ways in which various
authorities and agencies seek to shape the conduct and capacities of specified political
and social categories, to enlist them in particular strategies and to seek definable goals.”
Practices of ethical self-formation involve “techniques and rationalities concerning the
regulation of the self by the self, and by means of which individuals seek to question,
form, know, decipher and act on themselves” (Dean 1995: 563).
Notably, Dean describes social security programs as “governmental-ethical
practices” suggesting these income support programs have a hybrid nature combining
practices of governmental and ethical self-formation. On the governmental side, are goals
of income protection, perhaps the alleviation of poverty, and labour market participation
and on the ethical side, practices shaping “the attributes, capacities, orientations and
moral conduct of individuals” with defining “their rights, obligations and statuses” (Dean
1995: 567). This perspective fits agreeably for the CPP Disability program. The practices
and relations of power in this disability insurance scheme are simultaneously coercive
9
(social control) and chosen (self-compliance) as well as accepted (service provision) and
resisted (contestation).
Along with medical constructions and organizational processing, contested
illnesses are linked through and through with self-descriptions, presentations of personal
experiences and lived realties to various institutional agencies. To establish eligibility,
individuals engage in self-presentations to construct and negotiate their identities in
exchanges with professionals and administrators (Schneider 2003) and the multiple
discourses within human service organizations (Spencer 2001).
Interactions between clients and experts are not all experienced as an overt
struggle. Many interactions over seeking the provision of services or benefits are mostly
helpful, encouraging and productive, giving clients a sense of satisfaction and well-being.
Other interactions generate a sense of quiet unease or anxiety with “the wish to suggest
other issues for attention other than those given priority by the professional” (Leonard
1997: 170). In still other situations, the “interaction will be experienced more negatively
as one of monitoring, surveillance and control” of individuals by experts (Leonard 1997:
170; Bennett 2003). Depending on how serious the controls and constraints, the client
may feel a sense of mistrust, crisis or panic. This might provoke strong resistance by
clients, individually or collectively through informal or formal associations, to challenge
the “knowledge claims of experts” and to seek a more equitable relationship by
advancing the legitimacy of their own accounts. In the case of the CPP Disability
program, many applicants seek out the help and support of co-workers, their employer or
union, legal advocates and their Member of Parliament.
Significant numbers of people each year do not exercise their legal right to appeal
an initial negative decision on their application for public disability insurance benefits
(Bennett 2003). Reasons are no doubt several and shed light on the constraints and
context of contestation.
People decline contesting a negative decision on eligibility for disability benefits
because of poor personal health; concern that they may lose some other supports they
currently receive if they do appeal; or conversely, they lack important supports, such as
accessible transportation, to enable attending appeal hearings; family members or friends
discourage them from contesting; the family physician tells them they do not meet the
eligibility criteria; information about rights of redress are not easily accessible and so
they are unaware of the review and appeal mechanisms; and, previous negative
experiences with bureaucrats may convince them they have little or no chance of winning
against the government. This list contains explanations rooted in personal factors and
organizational processes, plus a cultural frame of beliefs and assumptions about medical
science, state authority and individual responsibility. We see in action here a mix of
governmental and ethical practices of self-formation.
Disability Insurance as a Network of Power Relations
10
In carrying out the official policy goals of income protection, return to work,
program integrity and financial affordability, the CPP Disability administration enlists the
participation of clients in several ways (Bennett 2003). These techniques comprise
placing the responsibility on clients for compiling documentation and completing detailed
applications forms as well as for paying for copies medical records required to be
completed by a physician; and if they appeal a denial of benefits, clients must pay for any
legal assistance or representation they have along with other possible costs such as travel
expenses to attend hearings. Further techniques include a specified labour force
attachment requirement for eligibility purposes; making compulsory the payment of
contributions or premiums from regular paycheques to the program’s fund; recipients of a
benefit being responsible for reporting to program officials a favourable change in their
condition; allowing recipients to undertake some paid work, take courses or do volunteer
activities without jeopardizing their benefits; and offering, on a voluntary basis,
vocational rehabilitations services for beneficiaries. These later methods give clients
opportunities and incentives to invest in their own conduct.
Other techniques include program officials doing periodic reviews of files and
issuing guidelines and interpretive directives to officials in field offices and to physicians
and other medical practitioners across the country. Surveillance of specific cases and the
overall caseload is justified by authorities by a quality assurance discourse of ‘ensuring
program integrity and accountability’ so that fraud and errors are avoided and benefits are
paid to those properly eligible (Bennett 2003).
In turn, applicants marshal support from members in their households and
extended families, their physicians, lawyers, advocates and sympathetic others in
compiling the necessary information for claiming disability insurance. And when faced
with an initial negative decision of their claim, lots of applicants request a departmental
reconsideration and, if after that are still not satisfied, file a formal appeal to a review
tribunal and possibly after that stage to a court for final resolution (Prince 2002). Even
with state constructions of disability and regulations of eligibility, clients are capable of
an array of decisions, actions on their own behalf, responses and end results in this
network of power relations. Through these practices and methods then, power circulates
through this disability insurance program.
Consider the story of Sandy, and her struggles through self-regulation and formal
application to qualify for CPP disability insurance. In her own words:
I have Fibromyalgia, Chronic Fatigue Syndrome, Myofascial Pain Syndrome, and
many other known illnesses that fall under the umbrella of the “Invisible
Illnesses”…. I applied for CPP Disability only after I had tried everything
imaginable to cope with and/or improve my life in living with these illnesses. … I
gave up all social activities, changed my lifestyle dramatically by down-sizing the
home I lived in, curtailed all hobbies that I enjoyed (gardening, reading, visiting),
and had to quit a job that I loved dearly because I was just unable to do it any
longer. … My application has been in the “process” now for almost 2 years and
there is no need for this to go on that long. .. Their failure to acknowledge our
11
illnesses (request repeat letters, request further tests, paper us to death with
routine form letters), and not treat us individually, only intensifies our feelings
that we are being treated like liars, thieves, and cheats (Bennett 2003: 34-35).
This brief account powerfully discloses the politics of contested illnesses, of individuals
morally coping through practices of self-regulation, and somewhat of the mechanisms of
governmental control in a rights-based social program. In such circumstances, which are
not scarce, people endure public disability insurance programs as profound frustration
and disappointment to be sure, but also as domination in which they are in a subordinate
role with state officials holding considerable power over and within them.
Conclusions
Canada’s foremost disability insurance program is a site of power with contested
relationships among state officials, medical professionals, and individual applicants over
the diagnoses of disablements. Processes of application, assessment, administration and
adjudication are relations of authority interwoven with other relationships in families,
support networks and work places, in which power relations are active. Besides overt
contestation against coercive measures, other power dynamics are present, of course.
Four arenas of forms of power circulate in social programs, particularly major
expenditure programs with elaborate administrative structures and regulatory procedures.
In addition to contestation, forms of power include service provision, coercion/control,
and self-compliance. To properly understand contestation, these other forms must be
considered. The politics of social policy is a multi-dimensional phenomenon with
different, shifting, though interacting contours of power relations that includes the
authority and inertia of state agencies, the prestige and expertise of medical professionals,
and the agency of individuals in diverse local milieus.
With compulsory contributions and labour force attachment requirements, social
insurance programs are said to be “earned rights” to income benefits, important elements
of social citizenship in modern welfare states. The analysis here shows these rights are
not so automatic or free from struggle to obtain. In comparison to classic means-tested
welfare programs, social insurance policies like the CPP are claimed to have a far less
“intrusive and individualised form of disciplinary relationship between the state and the
applicant for benefit” because the state administers aggregate factor for the working
population as a whole, with actuarial principles of “averages and the application of the
laws of probability” (Squires 1990: 138 and 130). However, in social insurance
programs that address risks of illness, injury, and disability (workers’ compensation,
sickness benefits, compassionate care benefits, and public disability insurance), the state
intervenes in every case, examining and verifying the information submitted by each
applicant, and accepting or rejecting that information for the purposes of eligibility.
Social insurance is not the twin of means-tested programs, but they are relatives;
differences between the two social policy techniques as systems of discipline are not as
great as commonly claimed in the literature.
12
Welfare state policies carry several discourses, ranging from the medical, through
actuarial and bureaucratic-legal, to the personal/self and rehabilitation. Each is a complex
of ideas, practices, forms of knowledge, and relations of power. Striking a balance among
multiple discourses is an interesting belief that liberal politics and administrative
bureaucrats are fond of expressing. Although various discourses interact and interlock,
they do not comprise a coherent pattern and stable arrangement. Each contains certain
core principles and preoccupations over others, and promotes particular aims and
relationships over others.
In view of these struggles and contested experiences, obtaining a disability
pension is as much a personal accomplishment as it is a formal entitlement. Clients are
not totally autonomous agents but neither simple creatures of state bureaucracies or
medical experts. Seeing the receipt of social benefits as personal accomplishments
underscores the role of individual’s own actions and their interactions with others
(including their supporters) in immediate settings and larger contexts. Whatever its
structure, social provision is a disciplinary and political occasion.
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Endnotes
1
Contestation suggests a way of thinking about the world that at its core is critical and social constructivist.
Realities such as medical diagnoses, judicial rulings or administrative decisions are socially constructed
and subject to multiple interpretations expressed in numerous formats, sites and narratives. Such realities
are shaped by various power relations, interest and ideas, and interacting in local specific milieus and
mediated by larger external settings. Outcomes then are often contingent and accompanied by unintended
consequences.
2
Governance is another popular concept which, like deliberation, implies a new way of doing politics and
policy with a new relationship between the state and civil society, one that is more participatory and open
and less hierarchical and conflictual. This notion of governance is not to be confused with Foucault’s
concept of governmentality (Foucault 1980).
3
The province of Quebec has a distinct program, the Régime de rentes du Quebec, with fairly comparable
features in retirement pensions and disability and survivor benefits. For details, see Torjman (2002).
4
Space limitations do not permit me to examine this later point about the political resiliency of social
insurance programs. For some discussion of this in general, see Brodie (1995) and Rice and Prince (2000)
and as regards the CPP specifically, see Bennett (2003), and Prince (2001 and 2002).
16