"It feels like they're constantly looming". A Pluralistic, Qualitative Exploration of How the UK Health-Based Welfare Systems Are Experienced By Those Living With Chronic Unseen Health Conditions

Abstract

Often framed as a ‘response’ to the growing numbers of individuals living with chronic health conditions, many countries have introduced policy instruments for promoting the employment of individuals with chronic illness. Within the UK, the two main ‘health-based’ welfare policies are Employment and Support Allowance (ESA) for individuals who are unable to work due to sickness or disability, and Personal Independence Payments (PIP). PIP aims to support individuals with the costs incurred due to illness or disabilities. Access to both PIP and ESA rest on processes of assessment and conditionality; processes that have been found to lead to feelings of marginalisation and stigmatisation. These feelings may be felt more keenly by individuals whose health conditions lack a visual signifier of disability. The work of this thesis aims to address the absence of psychological knowledge on the topic of health-based welfare. This was achieved through a pluralistic exploration of individuals’ experiences, whilst considering how knowledges around welfare have been constructed. A Foucauldian-inspired Media Framing Analysis aided an understanding of how stigmatising discourses were rooted in the creation of these policies, as well as the subject positions ‘made available’ for claimants of health-based welfare benefits. The empirical studies within this thesis made use of a longitudinal qualitative design. A dual focus analysis, applying Interpretative Phenomenological Analysis and Foucauldian Discourse Analysis to the same data set, enabled by an exploration of participants’ interview data in a way that illuminated how discourses around welfare are lived through. Amidst the disruption of a global pandemic, participants shared photographs that represented their day-to-day experiences. Through the rupture of the pandemic, participants were able to find new ways of being-in-the-world; lines of flight that enabled authentic ways of living. The results of these studies were used to make recommendations for changes to health-based welfare policies.