Identity regulation in neo-liberal societies: Constructing the ‘occupationally disabled’ individual

Identity, neo-liberalism and the problem of exclusion

In the social sciences there is a long tradition of understanding identity predominantly in non-essential terms (e.g. Erikson, 1968; Fromm, 1941; Goffman, 1959) as ‘our ongoing efforts to address the twin questions, ‘Who am I?’ and—by implication—‘how should I act?’ (Alvesson et al., 2008: 6). This view of identity as a quest rather than as a solid and static entity has been underscored by the influence of post-structuralist works in the social sciences, in particular the works of Foucault (e.g. 1977, 1981, 1991). More specifically, individuals’ identities are typically seen as products of the discourses, surveillance techniques, and power/knowledge strategies that surround them and the ‘techniques of the self’ that are available to them (e.g. Knights and Willmott, 1989). Although the main focus has been on how individuals’ identities are shaped by impersonal forces, individuals have not emerged as passive in the face of these forces (e.g. Collinson, 2003; Thomas and Linstead, 2002). On the contrary, it has been underlined, on the one hand, how individual identities are caught up in contradictions and friction between ‘competing bases of identification’ (Knights and McCabe, 2003: 1589), and, on the other hand, how individuals are often active and willing in making use of discourses and expertise to know, to improve, and to discipline themselves (e.g. Alvesson and Willmott, 2002).

Individuals’ identities have hereby emerged as relational and dynamic, subject to influence and change, yet without necessarily being controllable. Even so, a considerable number of studies have taken an interest in how organizations are involved in attempting to regulate individuals’ ‘identity work’. In particular there has been a strong interest in how contemporary organizations seek more flexibility and creativity through new managerial programs and techniques that attempt to make up employees whose identities are saturated with a culture of enterprise (Cremin, 2003; DuGay, 1996; Garsten and Grey, 1997; Hancock and Tyler, 2004; Salaman and Storey, 2008); that is, active individuals who capably and willingly manage themselves in relation to managerial imperatives (Covaleski et al., 1998).

Such managerial programs and techniques have been found to operate less according to conventional disciplinary principles of power than according to what Foucault (e.g. 2007) referred to as principles of ‘pastoral power’. Authorities such as HRM specialists (e.g. Townley, 1993; Barrat, 2002), coaches (e.g. Costea et al., 2007), mentors (Covaleski et al., 1998), etc., are alleged not to subordinate employees to their discipline, but to stimulate them to avow what they think and feel about themselves, their work, life, work-life balance, etc., and, on the basis of this knowledge that they themselves utter, help them towards a better understanding of who they are and how they may actively ‘improve themselves’ in response to the opportunities and risks they face (Clegg et al., 2002; Newton et al., 1995).

This view of how organized power seeks to fashion self-governing, active, and entrepreneurial individual identities has been articulated in tandem with the broader sociological discourse on the transformation of welfare regimes into ‘neo-liberal regimes’ (e.g. Cruikshank, 1994; Dean, 1995, 2007; Greco, 1993; O’Malley, 1992; Rose, 1993). The seeds of this transformation were sown in the 1970s when the welfare regimes especially in Europe, Australia, and New Zeeland begun to be criticized for creating passive and state-dependent populations, overblown and inefficient public sectors and for crushing individual autonomy. Under the banner of ‘freedom’ (Rose, 1999), the principles of governing populations and individuals would now be based more on the play of market forces and individual choice than on state control (Dean, 1999). This, however, has not merely been a matter of releasing individuals from the shackles of state control, but also of rearranging state regulations for the sake of making individuals able and willing to act as clients or customers of the opportunities offered by the market (Dean, 2007; Gleadle et al., 2008). More specifically, to foster individuals with a ‘prudent relation to risk’ and an ‘enterprise orientation to life’, state-controlled social insurance is increasingly supplanted by market-distributed insurance arrangements (Cruikshank, 1994). Furthermore, the disciplinary principles of state-controlled educational authorities, medical professions, social workers, etc., tend to give way for the pastoral principles of experts such as private counselors, therapists, health specialists, etc., which all operate through the market (Rose, 2007). The aim of such pastoral authorities and the self-forming technologies that they bring is then not so much to help individuals discipline a particular normalized identity, but to help them constantly transcend themselves; working on themselves to reach their full potential (Rose, 2007).

Hence, through such market based experts and their pastoral programs, self-governing, active and entrepreneurial individual identities fit for the emerging neo-liberal society are to be furthered. However, despite such transformative efforts, many studies have shown that large parts of the populations in Europe, Australia and the US are unable to develop the self-governing and entrepreneurial identity required by contemporary neo-liberal regimes (e.g. Dean, 1995; Greco, 1993; Rose, 1999). Hereby, more and more individuals risk being excluded from the labour market. Beatty and Fothergill (2002) as well as Fieldhouse and Hollywood (1999) stress that one sign of this exclusion problem is the general increase in ‘hidden unemployment’ in Europe. Bourdieu, (1999), Baumann (1998), and Wacquant (2003) go further and suggest that another sign of this exclusion problem is the general increase in most Western societies in criminality and in the concomitant expansion of the penal institutions. They argue that the neo-liberal regime come forth as liberal merely towards private enterprises and towards the enterprising social classes. Those that do not meet its criteria of conduct are more and more often defined as ‘dangerous individuals’ and are managed through paternalistic and punishing principles; i.e. authoritarian principles which emerge as the very opposite of those associated with the neo-liberal regime.

We suggest that a third sign of this exclusion problem relates to findings reported in sociological studies of disability, which show that there is a general increase in most reformed welfare states of the number of individuals who are labelled as disabled or as suffering from chronic disorders (e.g. Albrecht et al., 2001; Lane, 1997; Patti, 2000). These studies have then pointed towards the non-essential nature of disability, and in that connection, to the central role of medicine in socially constructing disability (e.g. Corker and Shakespeare, 2002; Oliver, 1990; Shildrick and Price, 1996; Thomas, 2002). Furthermore, they have pointed towards the close relationship between disability and the labour market (see Holmqvist, 2009). With medical expertise as an important point of authority, disability emerges in these studies as a boundary term separating those who fail to meet the demands of the labour market from those who don’t (Albrecht et al., 2001).

The study presented below is informed by these studies. Yet, as we will see, it goes beyond them in some important respects. While sociological studies of disability underline the non-essential, socially constructed nature of disability, they hold on to the view that disabilities are rooted in objectively given individual impairments. That is, disabled individuals are impaired, yet whether or not these impairments make them disabled are still open questions, which are determined by medical expertise in relation to societal demands, in particular those of the labour market (e.g. Oliver, 1990). Furthermore, these studies tend to criticize initiatives taken for disabled individuals (e.g. work programs) for seeking to adapt disabled individuals to society instead of attempting to adapt society to the impairments of disabled individuals, something which would then ‘undo’ their disabilities (e.g. Thomas, 2002).

In our study not only individuals’ status and identities as ‘occupationally disabled’ emerge as socially constructed in organized practices; but also the foundation of these disabilities, individuals’ impairments, come forth as socially constructed and gradually imprinted in their identities. In short, we suggest how individuals participating in Samhall’s work programs learn to identify themselves and to act as individuals with specific impairments. Furthermore, we show how individuals, once they have been labelled ‘occupationally disabled’, are examined, coached and mentored by experts, not to give them moral guidance and motivation to adapt to society in general and to the labour market in particular, but to help them adopt an identity that constitute them as the very antipode to the neo-liberal ideal of the active and self-governing individual.

Methods

All data collection that was carried out between 2003 and 2007 was done by Mikael Holmqvist with some complementary studies in 2009; but the data analysis is the result of our combined efforts.

One hundred and twenty-four interviews were carried out: 30 with administrative officials of the National Employment Office; five with members of the top management team of Samhall; 30 with supervisors, medical experts and local branch managers at Samhall and 59 with occupationally disabled individuals employed by or in the process of becoming employed by Samhall. Interviews were theoretically sampled (Strauss and Corbin, 1998) to represent various social, medical and organizational categories—men and women, physically and mentally impaired, senior members and newcomers, staff and employees, etc. Most of the interviews with the occupationally disabled employees or Samhall’s supervisors lasted around 40 to 60 minutes and were made during the course of the working day, either when they carried out their work or during breaks. Interviews with the occupationally disabled persons were focused on how they experienced the process of recruitment to Samhall in terms of their individual expectations and requirements; their feelings about the work offered and their thoughts about leaving the organization. When interviewing supervisors, questions were asked on their role in the introduction of new personnel; how they organized work for the disabled persons and what efforts were made to find a job for their employees outside Samhall. Further, questions were posed regarding job rotation, counselling and other activities related to the idea that ‘Samhall activates its employees through a developing and meaningful work environment’, as it is suggested in official documents.

In addition to interviews, participant observation was conducted at ten sites, located in different regions in Sweden; four of which were visited during two periods. The sites chosen offered insight into both operations and activities in cities and on the country side; as well as the production of both goods and services. Each observation period lasted about ten working days. When staying at a site Holmqvist wore the same clothes as the occupationally disabled employees, ate lunch with them, took coffee breaks with them, and so on. He participated in such work activities as cleaning, maintenance, archival work, production of food, manufacture of furniture, etc. During work he chatted with employees about Samhall, about their careers and about their jobs in particular. Of particular importance was to learn more about both employees’ and supervisors’ behaviours during practical work: how they interacted; how they addressed one another; and what issues were discussed. Also, daily routines and ceremonies were important, such as ‘morning meetings’ where all employees were gathered before starting their work, as well as leisure activities organized by the supervisors. Observational activities were important to gain some deeper understanding of what was going on in Samhall; how people looked upon themselves, how their careers progressed, how the supervisors organized the work, etc.; specifically what kind of identities were valued, idealized and appreciated in the daily round of activities.

Finally, three sources of archival data were gathered. (1) the Samhall staff magazine, Samhall i Fokus (Samhall in Focus) which consists of articles on single employees’ careers with Samhall, as well as comments on Samhall’s general mission in society; (2) ten government reports on Samhall published between 1980–2005, Statens Offentliga Utredningar (The State’s Official Enquiries) (SOU) that consisted of studies of Samhall’s economic dealings, its ability to reach its official goals and comments upon the organization of work; and (3) books about Samhall written by Samhall employees (see, e.g. Aulin, 2001) or persons formerly employed by Samhall (see, e.g. Rådahl, 1990) that proposed anecdotal accounts of the inner world of Samhall. All written materials were in Swedish.

Findings

Samhall (www.samhall.se) was founded in Sweden in 1980 through a mandate by the Swedish Parliament and is today one of Scandinavia’s largest employers (25 000 individuals when the study was undertaken and a turnover of 1.1 billion dollars), competing on product markets providing medical technology, telecom equipment and furniture and service markets providing cleaning, property-services and home-help. It is also Sweden’s largest subcontractor, working in close partnership with major international corporations, municipalities and government agencies. With a presence in most of Sweden’s municipalities, it is in addition Sweden’s most geographically spread company.

Samhall receives an annual grant from Parliament of around 600.000 dollars to compensate for its operative employees’ alleged needs of a work environment ‘specifically adapted to their individual disabilities’. Generally, Samhall is imbued with political goals regarding the distribution of welfare; social goals regarding rehabilitation of ‘people with disabilities’ and economic goals pertinent to its business operations. Its official assignment is accordingly ‘to produce goods and services that are in demand [on the market] by providing meaningful and developing employment for persons with disabilities’.

Swedish employment rates have been among the highest in the world. Furthermore, Sweden has a reputation for having an effective approach to combat exclusion and is often considered a successfully reformed welfare state pursuing a neo-liberal activation policy (see, e.g. Lindert, 2004; Saunders, 2005; Van Berkel and Hornemann Moller, 2002). Samhall is part of the core of this approach, offering activation to the most ‘hard-to-employ’ cases. This is not to say that Samhall and the Swedish approach to battle social exclusion is unique. In Europe, a number of organizations equivalent to Samhall exist that are members of the global network Workability International. For instance, a similar organization in the UK is Remploy (www.remploy.co.uk) which currently employs 2,400 people. Given that the population in the UK is 61.5 million compared to Sweden’s 9 million people, this makes Remploy both nominally and relatively a much smaller organization than Samhall, illustrating the fact that ‘by international comparison, Sweden has an especially strong emphasis on labour market policy programmes for the disabled’ (Wadensjö, 2007: 131–132). Indeed, Sweden is distinguished by the relatively large number of individuals which are labelled as ‘occupationally disabled’. When the study was carried out, more than 5 % of the working population in Sweden, i.e. 280,000 persons were officially classified as occupationally disabled (see the government report SOU, 2003: 56).

According to statistics from the National Employment Office, this figure began to increase in the mid-1990s when a fiscal crisis forced Sweden to replace the Keynesian full-employment policy that Sweden had held on to since the 1950s. A neo-liberal emphasis of a more restricted public sector was introduced, at the same time the country experienced a growing private sector that provided resources and services dedicated to maintain the working population’s employability. The economic crisis and the political reorientation first resulted in that the number unemployed in Sweden rose from 4 to 8 %. Already in 1996 unemployment decreased to levels which were more normal from a Swedish point view. Yet, the decrease in unemployment was accompanied by a rapid increase in the number of persons officially classified as occupationally disabled. In fact, since the mid-1990s the number of occupationally disabled have increased by approximately 350%. This increase not only indicates that the neo-liberal turn in Sweden is directly related to social exclusion from the labour market, it also suggests that the classification of individuals as occupationally disabled is closely related to this issue.

Discussion

In the introduction to this article we proposed that the study of the organization of occupationally disabled at the NEO and Samhall suggests a subtle solution to the exclusion problem of contemporary ‘neo-liberal societies’; a solution which manages to evade both the ‘hidden unemployment’ problem discussed by Beatty and Fothergill (2002), and the renaissance for punitive institutions suggested by Waquant (2003) and Bourdieu (1999). We have seen how this ‘solution’ builds on how the Swedish State through the NEO and Samhall manage to juxtapose a compassion for the sick and disabled with an imperative of putting people to work. The central mechanisms of this endeavour are medicalization and individuals’ identities, or to be more precise, the medicalization of individuals’ identities (See Holmqvist, 2008, 2009). By ‘medicalization’ we mean the processes in which more and more of everyday life come under medical scrutiny, and where more and more behaviours which divert from what is considered ‘normal’ are defined in medical terms (Conrad, 2007; Zola, 1993). In the account above medicalization refers to the processes where long-term unemployed individuals are analysed and eventually diagnosed as ‘occupationally disabled’ by medical expertise or by state officials who are authorized to speak in its name. Furthermore, it refers to how the label occupationally disabled turns individuals, who up till this point have been considered unqualified to get specific jobs, into individuals who are considered disabled for all available and thinkable jobs on the labour market. Hence, medicalization highlights the social construction of disability (see Corker and Shakespeare, 2002; Thomas, 2002) and refers to how the NEO and Samhall lead parts of the working population into the peculiar form of ‘sick role’ (Parsons, 1951) that the label ‘occupationally disability’ implies. This label is fundamental to the ‘solution’ that we suggest, because without it, it would neither be legitimate for the NEO and Samhall to remove these individuals from society in general and from the labour market in particular, nor to include them in Samhall’s socially sealed off production facilities where they perform ‘dirty work’ for the sake of their ‘activation’, ‘rehabilitation’ and ‘normalization’.

Yet, the subtle efficiency of the medicalization processes devised by the NEO and Samhall does not merely concern a distant labelling of individuals by medical experts and state officials, it also concerns the ways in which the label occupational disability gradually becomes part of the Samhall employees’ identities, i.e. their sense of who they are and how they should act (cf. Alvesson et al., 2008). The study points towards two groups of methods which are central in this process: on the one hand the mapping procedures and the formal disability coding and on the other hand the work-driven therapy and coaching procedures. The first group of methods establishes a taxonomy that make the jobseekers objects of a particular form of knowledge and, in that connection, objects of a particular way of seeing the jobseekers (cf. Burell, 1988; Foucault, 1972). That is, the mapping procedures and the disability coding establish a knowledge system that appreciates nothing but occupational disabilities and they further among the NEO officials a scrutinizing gaze that sees and seeks to uncover nothing but the occupationally disabled individual. As reported in the case files of some of Samhall’s occupationally disabled employees, ‘a tendency to drink too much alcohol when distressed’, ‘difficulties concentrating’, ‘poor writing and reading skills’, ‘lack of social skills’, i.e. character traits and inabilities, which could be used to describe a considerable amount of people who hold regular jobs and who generally are considered to be ‘normal’, are here observed and analysed as potential signs of occupational disabilities.

As Foucault (1972) has pointed out, in addition to providing information about who the person ‘really is’, the disciplinary examinations and the taxonomies also contribute to making people subjects of this knowledge. Presenting experts’ truth claims about occupational disabilities to long-term unemployed persons often burdened with poor self-confidence, becomes, as it were, a way of offering them a new identity, an identity as occupationally disabled, which is as comforting as it is stigmatizing; for by committing to it the individual is at once transformed into a disabled person and relieved from having to accept the responsibility for his or her inabilities of finding and keeping a job.

Hence, the series of disciplinary examinations that the potential and actual Samhall employees undergo provide them with ‘scientifically endorsed’ signs of their occupational disabilities (cf. Burrell, 1988). In this connection, the second group of methods, the work therapy and the coaching procedures offered to the potential and actual Samhall employees, appear to build on the aura of scientific truth thus established. Under the watchful gaze of authoritative figures, be it medical doctors, therapists, NEO/Samhall officials or mentors/co-workers, the opportunity to confess weaknesses and inabilities here helps the potential and actual Samhall employee commit to the ‘truth’ about their new identity as occupationally disabled (cf. Chan, 2000).

The significance of the confessional element should be underscored, because the medically informed judgements of social welfare professionals are not by themselves enough for the label ‘occupationally disabled’ to become a lawful description of individuals’ specific conditions; the potential Samhall employee must also sign a contract declaring that he or she sees himself or herself as occupationally disabled. Basically, this is because the term occupational disability refers not only to individuals’ physical, psychological and social traits, but also to how these traits are valued by the labour market. And as is well-known, the labour market is not a static entity. Before it became possible for industrial corporations to outsource factory production to low wage countries in South East Asia, and before most Western governments begun to abandon their ‘full employment policies’ for the sake of reducing taxes, inflation, and interest rates, many of those individuals that today are long-term unemployed could get jobs, either in factories or in public organizations (Butcher, 2002; Considine, 2001; Lindert, 2004).

In relation to this issue we saw how a medical frame of reference helped the social welfare professionals at the NEO and Samhall to legitimately make judgements about the long-term unemployed individuals’ bio-medical conditions. Yet, we also saw how the extent to which these conditions made them unable to participate on the labour market was still partly an open question. Hence, it is here, in relation to the ambiguity of the label ‘occupational disabled’ that the combining of the initial mapping procedures and the formal disability coding with the work and coaching procedures become so important, not the least from a strict juridical point of view. For it is first when the potential Samhall employee avows that he or she in fact is occupationally disabled and when the label occupationally disabled hereby becomes part of the potential employee’s identity that the information that comes from the examinations is verified and becomes a legitimate truth.

As noted earlier, sociological studies of disability (e.g. Albrecht et al., 2001; Oliver, 1990) have pointed towards the central role of medical expertise in socially constructing disability and have in that connection suggested that the label disability establishes a boundary separating those who are able to participate on the labour market from those who are not. As relevant and related these points are to the present study, they say little about how and why individuals’ designated status as disabled makes them unfit for all conceivable lines of work. Differently put, they do not explain how a status as disabled can legitimately be translated into the status as ‘occupationally disabled’.

We suggest this study helps to resolve this issue. As we have seen, the subtle efficiency of this combination of disciplinary examinations and pastoral confessions relates to how it simultaneously contributes to producing occupational disabilities as legitimate disability roles, occupationally disabled individuals who can fill these roles, and how it manages to let this whole process emerge as the very opposite of what it is: the term ‘occupational disability’ comes forth as a scientific label that neutrally represents intrinsic properties of individuals—and not as a label that becomes ‘scientific’ as individuals commit to it. Hence, the combination of disciplinary examinations and pastoral confessions appear merely to reveal occupational disabilities that were already there before the jobseekers came in contact with the NEO and Samhall—and not as means of producing these occupational disabilities.

Conclusions

There are obvious connections between the findings presented here and those of other organization studies of programs and techniques for the regulation of individuals’ identities. The examinations (the formal disability coding) devised by the NEO and Samhall operate in ways similar to those outlined by critical scholars of HRM (e.g. Barratt, 2002; Costea et al., 2007; Maravelias, 2009, Townley, 1993); they produce knowledge about the potential and actual employees, which is used not primarily to give them instructions, but to inform them in their ‘identity work’, i.e. in their own struggles and attempts to fashion a sense of self that is adapted to the circumstances in which they work and live. Furthermore, the work-based therapy and coaching procedures devised by Samhall give rise to similar effects as those for instance found by Covaleski et al. (1998) in their studies of mentorship in accountancy firms; by providing the employees with opportunities to avow their inner most feelings and ideas about their careers and about themselves to mentors, the employee is helped to make him or herself up as ‘a ‘corporate clone’, a distinct entity that nevertheless maps the goals of the organization’ (Covaleski et al., 1998: 294).

However, whereas most earlier studies of identity regulation have revealed programs and techniques aiming to make up ‘corporate clones’ that work hard to become active, self-governing, and efficient in work as well as in life (e.g. Cremin, 2003; Du Gay, 1996; Garsten and Grey, 1997; Hancock and Tyler, 2004; Salaman and Storey, 2008), this study stresses how the programs and techniques devised by the NEO and Samhall make up ‘corporate clones’ that actively fashion a passive identity—the identity of the occupationally disabled. The process in which individuals first accept and then, gradually, begin freely to see themselves and to act as occupationally disabled relies on a medical frame of reference and the authority it gives Samhall officials to tell ‘the truth’ about the Samhall employees. Yet, claiming that this gradual acceptance of an identity as occupationally disabled relies solely on the authority of medicine would be to take the argument too far; for over and above specific examinations and therapies, individuals’ identities as occupationally disabled derive from how the whole organizational arrangement set up by the NEO and Samhall surrounds and absorbs the employees.

Let us briefly develop this point by relating it to an argument found in several studies of identity formation and regulation in organizations. Individuals have typically been found to be surrounded by contradictions and insecurities, which constantly threaten to undermine any identity-securing project (e.g. Alvesson and Willmott, 2002; Collinson, 2003; Knights and Willmott, 1989; Svenningsson and Alvesson, 2003; Watson, 2008). This has led Thomas and Linstead (2002: 75) to conclude that ‘identity is in a flux, in a permanent state of becoming as various social and linguistic constructs (or discourses) vie with one another for supremacy’. Furthermore, it has led Knights and McCabe’s (2003) to argue that individuals rarely become completely absorbed by the sources of identification offered them via HRM techniques or corporate culture programs. Their work lives and private lives are too open ended; individuals, Knights and McCabe point out (2003), are surrounded by and struggle to come to terms with several ‘competing bases of identification’.

Our study suggests how some of the newly appointed employees of Samhall implicitly resist the identity of occupationally disabled by holding on to the view that they merely ‘play along’. That this initial resistance gradually disappears, that the employees gradually become so absorbed by and homogenously identified with their occupational disabilities appear to relate precisely to the relative lack of what Knights and McCabe, 2003 refer to as ‘competing bases of identification’ or of what Thomas and Linstead (2002) refer to as discourses that ‘vie with one another for supremacy’.

As such, Samhall shows more similarities with the hospital than the modern work organization. We thus come back to the importance of medicalization. For, as Valverde (1996) has noted, placing individuals in such sealed off, clinical procedures, is only acceptable in a liberal society if it can legitimately be shown that the individual requires treatment, which can improve the individuals’ condition. Given that only medical professionals can make such judgements, it is fair to say that the sealed off, clinical nature of Samhall’s whole operation is built on and depends on the authority of medicine.

Yet, the uniqueness of Samhall is not its ability to use medicine to reform its employees, but its ability to combine medically based expertise and care with the efficiency goals of the profit driven enterprise. In this regard, our study relates closely to Cornelius et al.’s (2008) recent claim that medical expertise in the form of doctors, nurses and therapists, who have traditionally been regarded as part of the civic good, are in neo-liberal societies becoming means of turning ‘economically burdensome’ individuals into ‘economically feasible’ individuals; individuals who are active and willing to make rational use of the services and opportunities provided by the state and the corporations. In this regard our study also relates to Rose’s (2007) point that medical expertise has become part of the government of neo-liberal societies not only in matters of ‘bio-politics’, i.e. in concerns with the administration of the conditions of life of the population, but also in matters of ‘ethopolitics’. The latter, argues Rose (2007) revolves around the self-techniques that individuals are meant to use, not to normalize (discipline) themselves, keeping their selves and their conduct within certain limits, but to improve and to vitalize themselves, constantly transcending what momentarily appears as the limits of their individual potential.

On the one hand, our study confirms both these points. Certainly, medical experts have no direct and formal authority over the process of labelling people as ‘occupationally disabled’; they are only asked to evaluate their general medical condition. And in some cases, the NEO even bypasses its own rules to always rely on medical certificates in order to classify people as disabled. Nevertheless, the study stresses how the alliance between the NEO, Samhall and medical expertise manages to turn long-term unemployed individuals into a feasible part of the working population. Yet, the study also diverts from both Cornelius et al.’s (2008) and Rose’s (2007) arguments in one important respect. For whereas both Cornelius et al. (2008) and Rose (2007) appear to assume that the route from ‘economically and politically burdensome’ to ‘economically and politically feasible’ proceeds through efforts that improve individuals’ self-esteem, their capacities, their sense of having an identity as a full-worthy, competitive and active citizen, this study shows that this route may in fact also proceed through efforts that work in the opposite direction; efforts that teach individuals to see and to accept themselves as individuals with significant limitations who lack crucial abilities, which eventually make them unable to compete and to take part in society as full-worthy and active citizens.

Such efforts may have substantial economic, political and social ‘merits’: they put long-term unemployed individuals to forms of work that the labour market finds too simple, too dreary, too dirty, and too expensive to handle with ordinary employees; they keep unemployment levels low and they show that the State upholds a society that takes care of the less fortunate groups of its population (Fieldhouse et al., 1999). Furthermore, such efforts indicate that what we are dealing with is not merely the subordination of medicine to issues relating to the performance of the economy, but also that medical and economic expertise are combined into a medico-economic discourse within which matters of health, illness and disability are related to matters of agency—those who are able to exercise it and those who are not. From this perspective, a healthy individual does not merely pass a clinical test without showing any signs of illness; he or she also lives an active life and is both motivated and capable of taking care of himself or herself with regards to professional and private concerns (Holmqvist and Maravelias, 2011). Conversely, that a person is judged as ill or, as we have seen, (occupationally) disabled may not imply that the person fails to pass a clinical health test, but that the person lacks initiative and thereby fails to take hold of the opportunities and services offered by the state and the corporations.