آسیب شناسی فقر: اشکال جدید تشخیص، معلولیت و داغ ننگ ساختاری تحت اصلاحات رفاهی

In 1996 the U.S. severely restricted public support for low income people, ending “welfare as we know it.” This led to dramatic increases in medicalized forms of support for indigent people, who increasingly rely on disability benefits justified by psychiatric diagnoses of chronic mental illness. We present case studies drawn from ethnographic data involving daily participant-observation between 2005 and 2012 in public clinics and impoverished neighborhoods in New York City, to describe the subjective experience of structural stigma imposed by the increasing medicalization of public support for the poor through a diagnosis of permanent mental disability. In some cases, disability benefits enable recipients to fulfill important social roles (sustaining a vulnerable household and promoting stable parenting). The status of family members who receive a monthly disability check improves within their kin and neighborhood-based networks, counterbalancing the felt stigma of being identified by doctors as "crazy". When a diagnosis of mental pathology becomes a valuable survival strategy constituting the basis for fulfillment of household responsibilities, stigmatizing processes are structurally altered. Through the decades, the stigmatized labels applied to the poor have shifted: from being a symptom of racial weakness, to the culture of poverty, and now to permanent medical pathology. The neoliberal bureaucratic requirement that the poor must repeatedly prove their “disabled” status through therapy and psychotropic medication appears to be generating a national and policy-maker discourse condemning SSI malingerers, resurrecting the 16th century specter of the "unworthy poor".

The past two decades have witnessed dramatic changes in the structure of public aid for the poor in the United States. In 1996, President Clinton signed the Personal Responsibility and Work Opportunity Act, ending “welfare as we know it” and causing a sea change in poverty law – a redefinition and restriction of the basis of public support for our poorest citizens. The dismantling of traditional welfare transfer payments has shifted indigent populations to a form of financial support that is increasingly medicalized – requiring a medical or psychiatric diagnosis to qualify a patient for disability payments. This represents a new approach to the historically ambivalent public responsibility for poverty in the United States, altering it in ways that we must learn to understand and address at the level of public policy and clinical practice.