In recent decades there has gradually developed a formalized global interest in helping the disabled to participate more fully in society. This interest has evolved into a complex multibillion-dollar network of organizations, programs for the disabled and professional experts. The phrase “work-for-the-disabled” designates this enterprise (see e.g. Abberley 2002, Butcher 2002, Drake 1999, Lindert 2004). Government-sponsored activities for integrating the disabled on the labour market are favoured by such international organizations as the International Labour Organization of the United Nations, the World Health Organization and the European Union. Likewise, single governments, lobby organizations and commercial industries in many countries sponsor programs for integrating and empowering the disabled in society through work.
In Sweden, a country that is often regarded a typical welfare state, several welfare programs for the so-called occupationally disabled are available through the National Employment Office (NEO), the government agency in Sweden responsible for the execution of public labour market policies. Government ordinance no. 2000:630 on “special measures for people with an occupational disability” states that an occupationally disabled person is an individual with particular needs due to his or her medically designated disorders, which impairs them from competing successfully with other people over the jobs offered. According to official statistics in 2006 by the Swedish Labour Market Board, almost 20% of Sweden's unemployed population is today occupationally disabled. The Swedish Labour Market Board has also recently reported that concomitant with the steep growth of unemployment during 1991–2004 in Sweden, the number of occupationally disabled persons recruited to work-for-the-disabled programs has risen with more than 350%. According to the yearly study “The Situation of the Disabled on the Labour Market” by Statistics Sweden, 20% of the Swedish work force considers them occupationally disabled.
Based on qualitative case study data, this paper reports on how the NEO creates the occupationally disabled as a result of its goal to integrate into the labour market people who are assumed to have particular difficulties in finding or keeping a job. The data consist of 20 open-ended interviews with staff at four branches of the NEO, all located in the Stockholm area. Each individual interviewed worked on a daily basis with helping disabled people to find a job. According to literature on “street-level bureaucrats” (see Evans & Harris 2004, Fineman 1998, Lipsky 1980, Meyers, Glaser & MacDonald 1998), the main activity of welfare organizations is to process prospective clients into manageable units that may entail the creation of certain “processable attributes” (Prottas 1978:290). In order to understand how staff at the NEO accomplishes organizing unemployed clients as occupationally disabled, questions were asked to the staff on how they (a) identified people for work-for-the-disabled programs; (b) on what formal grounds people were classified as occupationally disabled; and (c) how they tried to convince clients of their new social status. In addition internal documents of the NEO and related public organizations were used that highlight the NEO's efforts to integrate disabled persons on the labour market. The documents were chosen according to their relevance, based on information on the processing of occupationally disabled by the NEO. Other written sources consisted of official government studies and similar reports on the organization of the occupationally disabled in Sweden from 1970 to 2006. Interviews with staff at the NEO lasted between one and two hours, were all recorded and transcribed verbatim. Once themes began to emerge across interviews and documents, they were validated in subsequent interviews. The findings on how people were constructed as occupationally disabled emerged when confronting the empirical data with the relevant literature on the identification and classification of people in welfare organizations. Hence, I did not strictly follow the iterative process between data collection and the building of theoretical arguments recommended as a qualitative data analysis techniques (see Miles & Huberman 1994, Strauss & Corbin 1990). However, I iterated between the empirical material and my emerging theoretical themes to build my argument.
The Case Study
The NEO offers some of the unemployed the chance to gain access to the labour market through primarily two types of work-for-the-disabled programs: (a) wage allowances, which means that the Swedish state sponsors the lion's share of the employees’ wage if employed at a company or in any other professional organization; and (b) sheltered employment either at the state-owned business organization Samhall or in organizations run by the government or by local municipalities. Both programs imply that the job seeker is employed according to the same rules and laws as any employee in any organization, with one fundamental difference: they are all being classified as occupationally disabled. In the following I report how the NEO (a) selects people as occupationally disabled; (b) codifies them as such; and (c) encourages them to accept the label occupationally disabled. I end the empirical report on a section on occupational disability and labour market conditions that is important in order to fully understand the socially constructed character of this notion.
Selection of Jobseekers as Occupationally Disabled
Staff at the NEO are educated and trained to match job applicants with jobs available in the labour market, and base their judgment of potential occupational disability on the same criterion as they use for other job applicants, i.e. the applicant's capacity for work. In reaching the conclusion that an applicant is unable to hold down a job in the open labour market and would be best suited for a vocational program for the occupationally disabled, they examine a number of factors connected with the applicant's conduct, such as repeated, lengthy but unsuccessful efforts to find work themselves or with the help of NEO staff, problems in holding down a job, deviant behaviour during meetings with the NEO, difficulties in reading information from the NEO or in understanding information given verbally, physical abnormalities, problems in completing a written job application and/or in using the computer when searching for job opportunities at the NEO, difficulties in communicating in Swedish, etc. These and other forms of ‘problematic behaviour’ on the part of the job applicant can indicate for the NEO that a person has or can be expected to have difficulties in finding work in the regular fashion. It can also be assumed that the applicant has or will have difficulties in functioning “normally” in a typical workplace – that he or she in effect has one or several occupational disabilities. To assume that a person has a problem which makes the person occupationally disabled in relation to others who clearly have not failed to succeed in getting and keeping a job, is not only a reasonable but also a necessary conclusion for the NEO to reach.
The empirical world for both the administrative official at the NEO and for the job applicant is typically ambiguous and uncertain to a degree and the case is considered on the basis of a problematic and confused situation, which justifies an assessment process. Without a problem on which to proceed, the administrative official at the NEO is groping in the dark – the initial formulation of the problem thus has implications for the structure of the process that follows, which is adapted to the problem that the administrative official encounters from the outset. The social deviation in the form of unemployment, especially lengthy unemployment, implies that the person concerned has some personal problems, where the normal is defined as the ability to find and keep a job. Identification of the problem therefore influences the questions that will be asked by the administrative official, which parts of the job applicant's conduct the administrative official will note and which will be ignored, as well as which of the statements made by the applicant will be regarded as relevant or irrelevant.
In determining the applicant's status, the administrative official must possess an ability to organize and sort, on the basis of certain implicit theories as to what the problem consists of, among the stream of experience that each interaction with the job applicant involves. In other words, the administrative official needs to know what to look out for in order to reach the right diagnosis according to the organization's rules and routines for selecting jobseekers. Fundamental to the ideas about occupational disability is the fact that the person applying for work has a number of personal problems that are termed functional disorders: “A person is occupationally disabled if a functional disorder impairs or prevents participation in working life”, as it is expressed in a government report (Riksrevisionsverket 1999:18, 17). If, for instance, a person has problems with sight or hearing, if he or she has lost one leg or both, or arms and hands, has hydrocephalus or suffer from other physical or mental impairments, or if he or she behaves in a manner that the NEO recognizes as “ADHD”, “suffering from cerebral palsy” or similar “typical cases”, as one officer put it, there is no reason for the administrative official not to assume that the person is occupationally disabled. These “traditional obvious cases”, as an administrative official called them, consist of persons who are regarded as “objectively impaired”. They can many times submit written documentation supporting their problem such as statements from a doctor, where a medical expert has experienced them as disabled in roughly the same way as the administrative official is now doing. In many cases, there is therefore no doubt that such a jobseeker will be difficult to place on the labour market based on the experiences of the NEO as these are interpreted by their officials.
There are also a number of cases, grey zone cases as they are called within the organization, which are more ambiguous. One of the administrative officials defined the grey zone cases as “complex cases, psychologically deviant personalities, hidden addiction, odd customers in general terms”, and another official emphasized that they are “persons that you cannot point out as having anything physically or mentally wrong, but there is still some kind of impairment at the basis of their behaviour”. Another administrative official implied that for this group “one cannot say they have a disability. There are other causes and reasons. We all have our own different personalities; one can be odd in different ways. One can have deficiencies in one's social ability, creating difficulties on the labour market resulting in long-term unemployment”.
The regular method for the NEO to obtain confirmation of the difficulties of a “grey-zone case” is an in-depth investigation. “If you [the administrative official] are uncertain of the extent of the disorder, you should call in an expert, for example a doctor, a psychologist or counsellor”, as stated in the NEO's training materials1. Thus, some of the problematic job applicants are passed on internally to special units for the occupationally disabled. In contrast to the service provided by the ordinary offices of the NEO, the special units have a more all-round competence in inquiry issues, which are considered to be especially important for persons suspected of having an occupational disability. An administrative official at a special unit explained that difficult cases that the ordinary NEOs are not able to handle “are referred to us, so-called grey zone areas, cases for investigation”. Another official at a special unit pointed out that they had “very good resources for identifying, mapping and analysing” the personal qualities of the jobseeker as an explanation of his or her problem on the labour market. But even “clear problem cases”, as one officer called them, are normally referred to the special units: “As soon as they [ordinary NEOs] have an applicant that they discover has an occupational disability the case is transferred here”.
During a number of weeks of investigation at a special unit, the jobseeker goes through several examinations, e.g. “ability to concentrate, perseverance, social ability”, as one administrative official explained. Another administrative official pointed out that by virtue of their skill in analysing an occupational disability, they are good at discovering “hidden disabilities”. During the course of the investigation, there are opportunities for the jobseekers to have conversations with social workers, psychologists and other experts in order to analyse their backgrounds and arrive at their current status. One administrative official at a special unit named “NEO Young Handicapped” recounted: “The staff have special competence within different areas of disability … we have skills in youth issues, in receiving young people where they are, and specifically for those that are disabled”.
Codification of Occupational Disability
Supported by their own studies, the administrative officials eventually make a so-called disability coding. The disability coding is necessary to realize labour market policy measures such as wage allowances or other public sheltered employment. This is emphasized in a pamphlet published by the National Labour Market Board for use by administrative officials at the NEO2: “It is important that you code occupational disabilities so that you can offer jobseekers special guidance or the labour market policy programs that are reserved for persons with a reduced working capacity”. In the document it is stressed that: “The concept of occupational disability has been created to emphasize that a person with a functional disorder may be occupationally disabled for certain tasks or a certain working environment”. Thus, the investigation that every administrative official has to carry out as a basis for the disability coding is intended to “identify which limitation the functional disorder signifies in relation to the requirements of working life”.
The document certainly emphasizes that the disability coding is not only important from the point of view of administration for the NEO, but also for the jobseekers, who via the coding will have significantly better possibilities to obtain a job through a labour market policy program: “Work for all is an important part of the labour market policy. In order to give those with an occupational disability the same possibilities as other jobseekers, there is the possibility of setting a disability code. The code allows access to more detailed service and/or access to the labour market policy programs”. In other words, the disability code is a certification that a person is entitled to extra efforts on the part of the Swedish state in order to provide assistance on the labour market, which is concretely brought about by the formal labour market policy effort that are available. Hence, becoming labelled occupationally disabled is a kind of certificate that you are entitled certain privileges as offered by the State.
In the current handbook, the types of disability that have been established in 14 codes are discussed in more detail, where some of the codes are of somatic/physiological character and rest is of psychic/social character. The 14 codes are:
- • cardio, vascular/and or lung disease (Code 11);
- • childhood deafness (Code 21);
- • hearing impairment (Code 22);
- • serious visual impairment (Code 31);
- • weak-sightedness (Code 32);
- • motor-handicap requiring movement aids like a walking frame or wheelchair (Code 41);
- • other motor handicap (Code 42);
- • other somatically related occupational disability (Code 51);
- • mental occupational disability (Code 61);
- • intellectual occupational disability (Code 71);
- • social-medical occupational disability (Code 81);
- • asthma/allergy/hypersensitivity (Code 91);
- • dyslexia/specific learning difficulties (Code 92); and
- • acquired brain damage (Code 93).
Each type of disability is defined and specified on two to four pages in the handbook, partly based on a general description of the disability, partly on the basis of a discussion about “characteristics and extent”. There is also a discussion about “things to think about”, which aims at making it easier for the administrative official to recognize the disability based on the available documentation and conversation with the jobseeker. The types of occupational disabilities and the descriptions of these, i.e. “indications” of the occupational disability, enable administrative officials to recognize occupational disabilities among jobseekers through their interaction with these. For example, Code 71, “intellectual occupational disability”, is defined as “an occupational limitation caused by limited learning ability resources”. In the document it is claimed that these persons can be recognized by the fact that they have “difficulty in carrying out assignments due to a deficiency in intellectual capacity”, for example by virtue of “insufficient ability for abstract thought” and “a slow ability for processing”. In his or her contact with such persons, the administrative official is encouraged to think about “taking time to listen, about speaking by using simple, short sentences, giving one piece of information at a time … speaking in a steady tempo”.
The practical procedure of the coding itself should take place in consultation with the jobseeker. However, the process of arriving at an occupational disability is normally not transparent to the jobseeker. One day, the administrative official presents the jobseeker with a suggestion of a code, which the jobseeker is to accept or not. In substance, the proposal to the occupationally disabled person is an individual decision by the administrative official, even if it was arrived at with the support of colleagues and external experts. Consequently, it is the experience the administrative official has of the jobseeker as an occupationally disabled person and not the jobseeker's personal experience as being occupationally disabled that is the deciding factor.
Based on the files of 308 occupationally disabled people at the NEO, in 2003 a government study (SOU 2003:95, 164–170) suggested that clients are typically classified as occupationally disabled after a relatively long period as unemployed clients with the NEO. In the vast majority of cases, no objective impairment in terms of physical or mental disorder is at hand, even though clients are medically classified as disabled. As an illustration to this, the study reproduced the file of how a young woman, Stina, born in 1982, eventually became classified as occupationally disabled according to Code 42, “other motor handicap”:
- 23 September 2000:
- Visits the NEO. Has not completed high school. She is now looking for a job. She wants to work with children.
- 5 October 2000:
- Visits the NEO.
- October 2000:
- Visits the NEO. She's been temporarily employed in a shop.
- 16 April 2001:
- Visits the NEO. Looking for a job as recreation leader. [The NEO decides to pay part of her salary as recreation leader as part of a trainee program].
- May 2001:
- She has been accepted as trainee at a rehabilitation agency.
- July 2001:
- The trainee period ends. Stina asks the rehabilitation agency for employment.
- 15 July 2001:
- Visits the NEO. She says she wants to learn about computers.
- 22 July 2001:
- She is granted a course in computing.
- 11 August 2001:
- Visits the NEO. Stina quits the course in computing. She doesn't feel she learns anything. A discussion is initiated on finding a new trainee position. She is codified as occupationally disabled Code 42 and accepts this.
Confirming Occupational Disability
The disability coding cannot be forced upon the person and the jobseeker must always confirm this by signing a document in which it is clearly stated that he or she agrees with the coding. ”You must never set a code without the agreement [of the jobseeker], you must always do this together with the jobseeker”, an administrative official at the NEO pointed out. In that respect “the jobseeker should be in agreement with being registered as an occupationally disabled person”, as it was stated in a government study (SOU 1997:64, 59).
As witnessed by staff at the NEO, not all people that are regarded by the NEO to have an “obvious impairment” accept this; as a consequence they are even less comfortable with the idea that they should regard themselves as occupationally disabled. But even among those clients who acknowledge that they have an impairment, such as reduced sight, few initially accept that they are occupationally disabled. This situation is even more obvious for the grey zone cases that consist of unemployed persons that never previously have thought about themselves in terms of impairment or disability. Hence, a number of government reports have stressed that few jobseekers regard themselves as “occupationally disabled” before they come into contact with the NEO (see e.g. SOU 2000:78, 2003:56, 95). As one unemployed woman claimed in a book on disability and unemployment: “I feel like I have been cajoled into sheltered employment. I only have a hearing impairment that I don't notice when I am wearing my hearing aid. I came to this sheltered employment primarily because I was unemployed” (see Aulin 2001:42). Typically, the onus is on the administrative official to convince the jobseeker that he or she has an impairment that can motivate a classification as occupationally disabled. Normally, the administrative official has documentation from investigations with the NEO, doctor's certificates, referrals from the social welfare service and others to support his or her argumentation. For their part, job seekers must rely on their personal experiences of themselves. A problem with not being able to realize one's problems is common, one administrative official thought. He observed: “You have to accept your problems if you are going to go on”. He took up an example of a female jobseeker: “She has great difficulty in realizing it … it is probably an experience that all the occupationally disabled have and which becomes difficult when you realize that you have limitations”. Another administrative official recounted that a common attitude among jobseekers was “there isn't really anything drastically wrong with me and I want a job like anybody else out there”.
Nevertheless, most people agree to be disability coded. One administrative official explained: “People [the jobseekers] are pragmatic … it's about being able to pay the rent and buying food, they'll have to accept certain things” (i.e. being labelled as disabled). Another officer said: “They get status, can take out loans, they can get an apartment, it brings with it many positive things”. That it is expedient to accept a proposed disability code is even clearer by observing the formal framework of rules surrounding unemployment benefits. As a jobseeker, you are formally at the disposal of the labour market and normally receive unemployment benefit. Refusing a disability coding is certainly possible “but then the NEO usually submits a report to the affected unemployment benefit fund to call into question unemployment benefits” as observed in a government study (SOU 2003:56, 83). Thus, usually people accept to be classified as disabled, even if many experience it as “a real come-down, of being set aside” as one administrative official at the NEO formulated it.
Occupational Disability and Labour Market Conditions
In my study of the sheltered-employment program “Samhall”, (Holmqvist 2005, 2008), I reported that the recruitment to this organization had links to trading conditions on the rest of the labour market3. In my interviews, one Samhall manager said the following: “Sometimes it has been difficult to get employees to Samhall due to trading conditions, when not so many have been classified as disabled … then five years pass and suddenly things are reversed and there are very many occupationally disabled”. Another manager at Samhall recounted that many of the jobseekers to Samhall had “turned round and round in the system” for quite a long time, i.e. gone through different kinds of labour market policy training programs, received different kinds of support and finally “accept that they have a disability … abuse problem, or whatever can be the case. This was quite common during the mid-1990s, those arriving were new employees then, typically those that had been the victims of rationalizations and needed to get back into the swing of things again”.
It is hardly conceivable that it is the jobseekers themselves that are disposed to being coded as disabled, a process over which they lack significant influence. Rather it is the administrative officials of the National Employment Office who are more disposed to coding jobseekers as occupationally disabled in times or environments where it is difficult to obtain or retain a job. Thus, the government agency Statistics Sweden could observe in its study from 2003, The Situation of the Disabled on the Labour Market, that the sparsely populated County of Norrland had more occupationally disabled people than the vibrant County of Stockholm. Internal statistics from Samhall report that there are 16.6 Samhall employees per 1000 inhabitants in the County of Jämtland, which has suffered from steep unemployment for many years, as opposed to 2.9 in the County of Stockholm (the average for the nation is 5.6) (Samhall 2005:9). Potentially, people are not significantly more “objectively impaired” in certain areas than in others, which could explain a relatively high frequency of occupational disability. A government study emphasized that “the decisive thing is thus that the occupational disability is related to the agreement between the possibilities of the jobseeker and the structure of the surrounding market and the demand for manpower. In theory and possible even in practice, this entails that a jobseeker can be occupationally disabled in city X but not in city Y. A jobseeker can be occupationally disabled in February but not in June” (SOU 1991:67, 67). The fact that it is the possibility of obtaining or retaining a job that defines an occupational disability and not a personal condition in the form of an established medically definable functional disorder has also been the focus of several government studies within this sector, e.g. in a study from 1997: “Many people, even with extensive functional disorders can manage an individual placement on the regular labour market. By no means all individuals with a functional disorder are thus occupationally disabled. The occupational disability occurs in a situation when the functional disorder makes participation in working life difficult or impossible” (SOU 1997:64).
According to this definition, it is the personal occupational disability that is used to explain a social problem in the form of difficulties to obtain or retain a job, which can be based on a given physiological condition, linguistic difficulties, generally deviant social behaviour, or a low level of education. This was emphasized in a government study: “Even if the situation of the labour market has improved since the mid-1990s, the fact remains that the requirements of the labour market have increased substantially, with regard to both work rate and competence requirements. Generally speaking, persons with occupational disabilities have a lower level of education. The possibilities for persons with occupational disabilities and other groups with a weak position on the labour market being able to obtain a regular job have thus diminished” (SOU 2003:56, 262). In this perspective, a low level of education is what can generate an occupational disability on the labour market – it is a well known fact that people with a low standard of education find it difficult to obtain or retain a job in today's society, just as it is primarily the poorly educated who are occupationally disabled in official statistics. With this interpretation, people with a low standard of education together with other groups of people who have difficulties in finding employment, e.g. those who are ill, immigrants, etc., risk becoming occupationally disabled, and should thus be the subject of societal rehabilitant efforts. The fact that “people with functional disorders have a higher level of unemployment than the population average”, as was observed in a government study from 1991 (SOU 1991:67, 92), therefore comes as no surprise.
Overall, people with occupational disabilities constitute what a government study about persons with difficulties in obtaining a job on the labour market termed “hard to employ”. Therefore, “it seems less appropriate to use the term disabled in discussions about the disabled and the labour market” (SOU 1972:54, 63). In other words, the occupationally disabled are in many cases “people who have been in working life for many years, but have been let go due to a shortage of work or illness and as a consequence of this have been unemployed for a long time”, as it was expressed in another government study (Riksrevisionsverket 1999:18, 17). It is clear that among those people who are designated as occupationally disabled, there are many persons that have suffered serious illnesses which limit the possibility of them competing with others on the labour market. However, there are also many people who are considered to be occupationally disabled without being impaired in a medical sense, which is the point of departure in two recently completed government studies (SOU 2003:56, SOU 2003:95), e.g. immigrants, certain groups of young people and persons in sparsely-populated areas. One of these studies observed that “persons with an immigrant background – especially in metropolitan areas – have been assigned sheltered work at Samhall more as a result of their language difficulties than that they – in a formal sense – have an occupational disability” (SOU 2003:56, 193).
So as to be able to determine whether job applicants who have difficulties in finding and keeping a job are legally and administratively disabled, it is necessary for these applicants to undergo an organized assessment process. This assessment is one of the most important events that influence the job applicant's subsequent experiences. The documentation and analysis that takes place in the search for “symptoms of occupational disability” at the NEO can have two effects: partly an improved diagnosis of the applicant's personal qualities and limitations, which perhaps can help him or her find a job; and partly a personal experience of how it is to be disabled, which motivates the assessment itself. The experience of being occupationally disabled cannot be accomplished in any other way than through the organized assessment process in which the administrative official of the NEO and the job applicant participate. Becoming occupationally disabled is the result of organizational enactment; not of personal impairments. The assessment routines create a degree of certainty in the interpretation of the stream of varying and ambiguous experiences that an administrative official can experience in his or her contacts with job applicants and makes it possible to identify certain job applicants as something, that is, as occupationally disabled, who as a rule the NEO assumes is a group of people who have really major problems; problems that can explain their lack of success in the labour market.
This being so, it is reasonable to conclude that occupational disability originates initially from within the NEO through interactions between administrative officials and clients, where the former act as “street-level bureaucrats” (see e.g. Evans & Harris 2004, Fineman 1998, Lipsky 1980, Meyers, Glaser & MacDonald 1998), doing the evaluation, interpretation, processing and codification. Of course, the NEO is not the place where occupational disabilities invent themselves, but the organized environment that makes possible the assimilation of certain experiences of job applicants into an experience of occupational disability. Officials enact certain official programs of occupational disability, making social definitions of personal problems come true. Routines of analysis and documentation have been developed over the years within the NEO that seek to identify the occupationally disabled by organizing them in specially adapted activities, where the activities result in the job applicant ceasing to behave individually and behaving instead in an organized fashion on the basis of certain assumptions as to how the occupationally disabled typically behave. These organizational practices are less concerned with identifying occupational disability than with constructing it.
In this activity, the official has substantial discretion in interpreting human behaviour as occupational disability (see Evans & Harris 2004). This is why certain people are regarded as having a “clear occupational disability”, often with regard to motor difficulties or partial sight, while other people instead are perceived as ambiguous “grey zone” cases. That some job applicants are recognized by the administrative officials at the NEO as occupationally disabled is however, a result of the applicant's behaviour as occupationally disabled, which is a result of their being formally organized by the NEO as occupationally disabled. Consequently the formal disability coding of the occupationally disabled can be understood as the organized observation that the NEO's administrative officials assume in certain situations, making possible the interpretation of experiences as an expression of occupational disability and which can therefore come to substantiate the obvious in what previously were ambiguous (or non-existent) experiences of occupational disability. To this extent, disability coding is an administrative rationalization of a “difficult to employ” person's case (see Prottas 1978).
People who are disability coded and eventually offered a job on the labour market as occupationally disabled naturally exhibit a high degree of variation in their personal characteristics that perhaps can be used by both experts and non-professionals to explain why they have found it difficult to get or keep a job. But since they all are subject to a standardized organizational coding process, they are confronted by essentially the same personal experiences. These common experiences are engendered through their behaving according to certain organizational routines and rules that are coupled to the NEO's preconceptions on the suitable organization of the occupationally disabled. Because these similarities of experiences and their response to them do not come from their personal condition, they seem to have arisen despite their condition. Thus they can be said to stem from the organizational practices that arise from the fact that occupational disability has a uniform social status, to which is attached a common fate and finally a common personal mentality. There are therefore no a priori theoretical, logical or practical grounds that are of use as a basis for defining certain people as “occupationally disabled”, even though there exist a number of formal rules and routines for identifying people as occupationally disabled. The current administrative definitions of occupational disability are quite simply an imprecise method for categorizing people who have found it difficult to get or hold down a job, thus leaving administrative officials more or less free to act within a setting characterized by ambiguous rules and routines (see March & Olsen 1979). Ultimately, however, it is not a technical/administrative definition that determines who will or will not be coded as occupationally disabled: the final decision, and with it the practical sorting of occupationally disabled in the labour market, rests with the occupationally disabled who accept the coding on the basis of their personal behaviour that they eventually may come to understand as a sign of disability.
It is a familiar idea that organizations select those behaviours that they need for their rational and effective functioning and eliminate in one way or another those that do not fit (see Perrow 1979:141, Selznick 1984:21). “If no persons are available to be selected, they will have to be invented – or rather, they will be produced in accordance with the required specifications” (Berger 1963:128). From the perspective of the NEO, it is functional to classify more people as occupationally disabled and to encourage them to embrace such an identity. The NEO's primary goal is to help people find a job, even if they have to be designated as occupationally disabled. The more occupationally disabled persons in Sweden, the greater the need for the NEO's services that have been designed to help and accommodate the occupationally disabled. Thus, the NEO may unwittingly contribute to the relatively large number of disabled in Swedish society, where the organization enacts personal problems of disability for which it has certain solutions. As March and Olsen (1979) expressed in their seminal study of organizational behaviour, created by the problems among humans that required them, eventually organizations create the problems among humans that they require.
Of course, the idea of social construction of disability has been a key frame of reference to a number of important sociological studies of disability (e.g. Bowe 1978, Branson & Miller 2002, Lane 1992, Scott 1969, Zola 1982). Likewise, standard textbooks on disability often challenge a “bio-medical model of disability”, which assumes that disability is real, that it exists in the objective experience of the individuals that carry out disabled activities and of those who respond to them (e.g. Davis 1997, Oliver 1990). However, in most previous studies on the labelling of disability, the organized character of this activity has remained obscure. By proposing how the formal organization of NEO enacts its environment in terms of prospective occupationally disabled clients, this paper contributes to the synthesis of standard sociological ideas on organizational behaviour with standard sociological ideas on disability. The enactment of disabled clients by the NEO is not only the result of social construction through the interplay between clients and street-level bureaucrats; it is also the result of certain organizational norms, routines and ceremonies.
Further, in most empirical studies and conceptual frameworks in the sociology of disability, in fact in some of the best of them, there is a combination of medical/biological and sociological orientations to disability. For example, in Scott's (1969) seminal analysis of how sight-impaired people are taught the role of blind by blindness agencies, the social role of blindness assumes the existence of the objective attribute of visual impairment. As Thomas (2004:577–580) concluded in her extensive review of the sociology of disability literature, it is generally assumed among students of disability that without some kind of objective impairment or similar disorder that can be discovered through regular medical examination, no experience of disability can emerge within the consciousness of the disabled individual, nor among those around him or her. According to this line of inquiry, social factors cannot alone cause disability. In most disability studies, impairment is seen as a fundamental prerequisite of disability; disability is ultimately caused, unquestionably and in the main, by impairment, whether it is associated with disease, genetic problems or other disorders.
My data suggest that no biological impairments or other objective disorders are necessary for the emergence of occupational disability; that disability in a contemporary welfare context is wholly the effect of social construction. It is a discursive creation, the result of a certain organized system's intentions and activities rather than a consequence of single individuals’ attributes. Potentially, this can explain why the number of occupationally disabled persons in Sweden has grown so dramatically during the last years. Clients that become classified as disabled do not necessarily have a personal physical or mental impairment; rather the main reason is their unemployment, thus making any unemployed individual, irrespective of his or her attributes, a potentially occupationally disabled client. Classification as occupationally disabled by the NEO is based on factors such as weak local labour markets rather than problems in the labour market caused by individual impairments. “In this view, there is nothing inherent, or ‘pre-social’, in individuals’ bodily states that can sustain the idea of ‘real’ bodily differences – ‘impaired’ and ‘disabled’ people are entirely discursively constructed” (Thomas 2002:51). This radical constructionist position that is often associated with feminist social constructionism assumes that phenomena experienced as “objectively existing” are in themselves discursive constructions. Such an approach is becoming all the more accepted in the sociology of disability, offering new insights into the complex lived experience of disability (see e.g. Corker & Shakespeare 2002, Shildrick & Price 1996) – but the full theoretical as well as political implications of this perspective have not yet been tapped. If anyone can become disabled in modern welfare society, as my case study suggests, what does this mean for the relation between individual and society? Disabled people are commonly seen as less accountable, less competent, and less potent, thus inviting society to offer this particular group relief, assistance, and guidance. Disabled people are more than others the subject of society's organization and control: Would in fact a society be interested in educating some of its citizens to act in a disabled manner? What could potentially happen to individual freedom and responsibility if all the more “non-disabled people” are socialized as “disabled”?
Certainly, as a socially constructed role in a particular organized welfare context, occupational disability is often considered as something negative or oppressive, which is very much in line with the mainstream conversations on disability. For instance, Thomas (2004:573) emphasized that “the term disability only makes sense if it is understood to mean restrictions of activity”. Indeed, most students of disability adhere to a view that disability means a physical or mental condition that limits a person's movements, senses, or activities (see e.g. Bury 2000, Shakespeare & Watson 2001, Williams 1999). As noted by Lupton (1997:101), most students of disability often represent medical power as overwhelmingly coercive and confining in procedures of classifying people as unhealthy or disabled. However, as Foucault (2003) has repeatedly stressed, labelling power is not only repressive, it is also productive. Becoming occupationally disabled in the NEO of Sweden through a number of administrative practices carried out by the NEO can instead make a person able in a particular organized welfare system that has been designed to accommodate the disabled. In this way, the individual becomes an organization member that carries out certain rules and routines (see March & Simon, 1993). Also, by enacting unemployed persons as disabled they can be managed as “productive” actors that can contribute to a welfare society's effective accomplishment of one of its main purposes; namely to provide social welfare in an ongoing and repetitive manner to the benefit of “disabled individuals”. On the other hand, this may contribute to generate the legendary pathological effects of institutionalization in terms of pressure to expand the definition of who are the disabled. By more human behaviours becoming identified and treated as disabled by an expanding social welfare system, more people are likely to be asking for welfare support that they experience to be in need of given their individual disabilities. The result may, in the end, be a self-fulfilling prophecy.
Potentially, my observations are not only relevant for a Swedish context. In the standard literature on welfare programs and the welfare state it is emphasized that classification of disability has become one of the major paths to assistance in most welfare countries today (see e.g. Abberley 2002, Albrecht, Seelman & Bury 2001, Drake 1999, Lane 1992, Stone 1985). Perhaps this can explain why these countries have the largest amount of disabled people in society (see Fujiura & Rutkowski-Kmitta 2001:78–79)? Stone (1985:183) suggested that social welfare programs for the disabled on the one hand seek to reduce the number of problem cases who need their services, but on the other hand need to demonstrate that problem cases abound: “A rehabilitation agency, for example, needs clients in order to survive and grow”. Therefore, they have a stake in identifying more people as disabled, i.e. as their clients. Likewise, Scott (1980) argued that the requests by disadvantaged people and the needs by the welfare organizations often run in two separate orbits. According to Scott welfare organizations often become all the more concerned with their own needs of preservation and survival. This may explain why much disability can be regarded as a “learned social role” according to certain organizational norms and interests.