Between health, morality and pragmatics: common mental disorders and decision-making for disability benefits in the Norwegian welfare state

Abstract

Across Europe, the number of young adults with common mental disorders receiving disability benefits is on the rise. The suggested reasons for this increase reflect different ideological perspectives. However, no available research has investigated how different ideological perspectives may influence the decision-making process for granting disability benefits. By analysing 12 qualitative interviews with the professional groups involved in the Norwegian decision-making process, we delimited different interpretative repertoires about common mental disorders and assessed the consequences of framing disability benefits within these specific repertoires. We employed a discursive psychological framework and described three interpretative repertoires: medical, moral, and pragmatic. Young applicants for disability benefits appeared in these repertoires in different subject positions as ill, lazy, or pitiable, but ill for practical reasons. We further identified an ideological dilemma caused by the ambivalent character of common mental disorders as a legitimate reason for allocating disability benefits. Points of interest Norwegian case managers and general practitioners apply different perspectives when making decisions regarding disability benefits due to common mental health problems. The different perspectives create dilemmas for case managers and general practitioners and concerns the applicants need for a medical diagnosis. A medical diagnosis is only partly able to capture the underlying reasons for the granting of disability benefits.