After Welfare: The Culture of Postindustrial Social Policy

By Sanford F. Schram | Go to book overview

3 In the Clinic
The Medicalization of Welfare

Many features of contemporary welfare reform make it as selfdefeating as it is self-legitimating. Welfare reform is busy recreating the problems it attacks while simultaneously rationalizing how it allegedly solves those problems. Prominent among these self-defeating features is its self-legitimating focus on “welfare dependency,” which represents a return in social policy to older concerns at the expense of attacking poverty. The country has moved away from the “war on poverty” initiated the 1960s to the “war on welfare” that has become ascendent in the 1990s.1 It is again assumed—as before the sixties—that reliance on public assistance for anything other than a very short period of time is unquestionably wrong. For people like Newt Gingrich the country's failed welfare policies are a sure sign that a “sick society” is encouraging sickness.2 Welfare receipt has been transformed from use to abuse, from an active exercise of the legal right to an income to a passive dependency on government. Welfare dependency has returned to its pre-1960s state as a universal deficiency that almost no one can actively support, while poverty is no longer considered a public problem that must be attacked. Unfortunately, the way welfare reform has articulated treatment for welfare dependency in the late 1990s ensures that poverty will persist and intensify.3

In what follows, I want to suggest that there is more to this story. While recent changes reflect a return to the focus on welfare dependency, a “new paternalism” is changing welfare administration so that welfare dependency is itself increasingly being transformed from an economic problem to a medicalized one.4 This medicalization goes further than individualization. The latter locates the problem in the individual; the former likens it to an illness that afflicts the individual. The welfare reform law of 1996 has helped accelerate the tendency to construct welfare dependency as an illness, thereby transforming welfare into a set of therapeutic interventions designed to cure people of that malady. In the process, welfare itself is

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