Disablement and the ideological crisis in health care

Disablement from chronic illness presents medicine with a constant reminder of the limits to its therapeutic effectiveness, and challenges the political legitimacy of Welfare States. In this regard, chronic illness forms a crucial component of the 'crisis' in health care. In this paper I look at the different ways in which disablement stimulates this crisis--for medicine, for political economy, and for disabled people themselves. In looking at responses to the crisis I detect a certain reluctance, or inability, to move away from an atomistic perspective which underpins much of our thinking on health and social policy, and much else besides. I conclude by arguing, against post-modern cynics, that a reasoned defence of the Welfare State requires a broader concept of self-sufficiency and a perspective which both acknowledges the need for help, and recognizes the extent to which the provision of help may further disempower the disadvantaged.