Is Labour abolishing illness?

The new rules on incapacity benefit stake everything on a major gamble: that a large proportion of c

Incapacity benefit has become one of this year's favourite scare stories. Hardly a day passes without a new headline deploring its soaring costs and the rising numbers of claimants who get "something for nothing", at the expense of decent, hardworking taxpayers. We are told that we are footing an outrageously escalating bill for 2.4 million people, a million of whom shouldn't be on the benefit at all, and each successive work and pensions minister vows to be more ruthless than the last.

The true picture is somewhat different. The unreported version, which can be culled from Department for Work and Pensions (DWP) data, is that only 1.4 of the 2.4 million actually receive any payment, the rest get national insurance credits only, and numbers have been falling since 2003. The basic benefit is worth barely £3,000 a year. After two small rises in the first year there is no further increase, other than index-linking. All those who get the benefit have to pass a rigorous "personal capability assessment" (PCA) with doctors appointed by the DWP; and they can be re-examined at any time. The audited estimate of fraud is under 1 per cent - the lowest of any part of the social security system.

Nonetheless, the 2007 Welfare Reform Act is now being implemented across the country. It replaces support, as of right, for illness/disability (one of the planks of our rapidly disappearing welfare state) with a new, conditional employment and support allowance. Claimants are held on a basic allowance until it is confirmed that their capability for work is limited. This is determined by a "work capability assessment" tougher than the old PCA. Those deemed capable of one day returning to work (and the arbiters are health professionals rather than doctors) must engage in a series of "work-focused" interviews and activities. These include, among other things, "condition management", which in practice is likely to consist of group sessions loosely based on cognitive behavioural therapy. All this brings an additional slice of benefit that can, however, be cut for those who do not engage in it without "good cause" - a potential loss of 40 per cent of income. Ultimately, any whose capability for work remains limited through failing to follow medical advice, or "any prescribed rules of behaviour", face a period of disqualification. (A further provision of the act, to be piloted in nine areas, is that people served with Asbos - antisocial behaviour orders - can face cuts in their housing benefit for refusing local authority offers "to help address any problem behaviour".)

A main selling point of the reform was the great savings it would bring. It would staunch the outflow of benefits and get many people into jobs where they would pay tax and provide for their old age. This government's cherished goal is an employment rate of 80 per cent of the working-age population - though it is difficult to find any reasoned argument in support of this since our present rate of 75 per cent is, with Canada's, the highest in the world. The government accepts that employers must be paid to take on people with an illness record and, for the time being, it has pledged not to cut the benefits of existing claimants. Any immediate savings, therefore, can only come from bumping as many as possible off the benefit, shaving future benefit levels (already well in hand), and making it harder for newcomers to get it in the first place. Delivery is being farmed out to private agencies paid by results - which means, of course, the setting of targets. The next few years will be a bad time to have a crippling accident or succumb to a serious disease, particularly a psychiatric or neurological one that does not have obvious outward symptoms.

Blaming the "cheats"

The reform of incapacity benefit has been over ten years in the making, leaving in its wake a dense trail of commissioned reports. A curious thing about this voluminous material is how little information it contains on the actual health conditions for which benefit is paid. This is no accident, for the reformers long ago made up their minds that claimant numbers are too high, therefore a large proportion - usually put between a third and a half, but lately upped to 70 per cent in some quarters - must be spurious. An appeal to history is repeated like a mantra that, back in 1979, only 700,000 claimed the old sickness/invalidity benefits. Since then, money has been poured into the NHS while health care, living standards and longevity have improved beyond all expectations. People must be healthier, which proves that huge numbers are exploiting a slack and obsolete system. Who is to blame, apart from outright cheats? It can only be the self-indulgent, who fancy themselves sicker than they really are, and complacent GPs who let them think they are too ill to work.

Crucially, the reformers bracketed illness with disability. The disability lobby had long argued that "disability" was a discriminatory label imposed by society, and it was bent on removing the barriers to work that excluded those so labelled and kept them in poverty. But the bracketing brought confusions - for those with disabilities may be extremely fit (consider the disabled athlete), whereas the able-bodied can be extremely ill. More confusion arises with conditions such as "stress", "anxiety" and "chronic fatigue" that sound trivial. As for "back pain", how unreasonable is it to take time off sick for something best dealt with by a stiff upper lip and the odd aspirin? It is easy for those in good health to pooh-pooh such things, agreeing with the government that "Work is the best therapy".

The government's declared mission is to "liberate" claimants, to bring them into its "reformed, coherent welfare state for the 21st century". It seeks to overturn a culture based on the "medical model" of illness that allows them to "drift" on to long-term benefits without realising that "symptoms, feeling unwell, sickness and incapacity are not the same" - hence the appeal of cognitive behavioural therapy, which it understands as a treatment that will talk the sick into believing they can lead normal lives.

Doctors - so often the refuge of desperate people trying to find out what is wrong with them - should as far as possible be excluded from the process. Even those working for the DWP have opinions that are "unfounded, of limited value and counter-productive", while GPs are "unaware of the importance of work, the absence of which leads to depression, poor health, higher rates of suicide and mortality, poverty, and social exclusion". (The quotations are from a 2005 study from the Unum Provident Centre for Psychosocial and Disability Research at Cardiff University, whose ideas and rhetoric infuse the reform. Unum Provident is an American firm, the largest disability insurance company in the world, which is currently in litigation in different countries for refusing to pay out on some of its policies.) A private agency has now taken over the running of its first GP surgery here, and doctors dealing with disability living allowance are advised not to invite patients to explain how their condition affects them.

Features of the reform are familiar from other policy areas. First, a demonisation of a needy or vulnerable group, followed by a rebranding: so claimants become not even "clients" but "customers" (as in the just published "Commissioning Strategy" document); incapacity benefit becomes employment and support allowance; sick notes are redrafted for doctors to certify, not what patients can't but what they can do. Next come "partnerships", on an unchallenged assumption that the public sector has failed. The new system is farmed out to for-profit or non-profit-making agencies paid by results. This entails targets, and where targets are set, sanctions follow, for any who "fail to recover".

There are features of the new programme that look intelligent and humane, doubtless owing much to the efforts of the disability lobby. They include a longer and more flexible bridging period (and a back-to-work grant) between benefits and work, and a broader view of "work- focused" activities. The crunch will come with those described as not able or prepared to engage "because [of] the nature and severity of their health condition, or more a matter of attitudes, perceptions and expectations which may or may not be accurate . . . It is a question of what the claimant cannot do vs what they will not do."

For the reform stakes everything on a gamble: that a large proportion of claimants, present and to come, are fit enough to work. There seems no way of proving or disproving this, other than trying it out, at the risk of much waste of public money, and much personal grief. Deliberate rejection of the "medical model" deprives us of all we might have learned (from the wealth of data available) of the impact of illness on our society.

I have scratched my head long and hard over this reform (among other things sending out lengthy submissions to all concerned during the long consultation phase in 2005-2006) because so much in its theory and rhetoric contradicts my own experience: of chronically and seriously ill family members and friends, of several years as a Mind volunteer, and further years of peripheral involvement in action groups for chronic fatigue conditions. All this has indelibly impressed me with the courage of many who live with horrible complaints, the sheer hard work involved in their day-to-day coping, their relentless search for any amelioration, let alone cure, often at costs hard to spare from limited resources.

I have witnessed, too, and at close quarters, the hurt and stress of living difficult lives as people have to do, in a perpetual culture of disbelief and threat, where some of the most valiant are blamed for their conditions and conflated with the alleged "can't work, won't work" unemployed. For the message of the reform that comes across, for all its fashionable rhetoric, is that a person is valued only as a productive unit. Compassionate cases aside, those too ill to work are outside society and money spent on them is wasted. Sickness, disablement and inability to work have no place in a modern society - they can't and shouldn't be afforded.

No one pretends that illness is not a blight, imposing personal and social costs going far beyond the financial; but - pace the government - no one as yet knows how to remove it from the human condition. Why waste valuable time and resources on an ill-founded reform, when they could instead be used to further understanding of the real impact of illness on our society?

Alison Ravetz is a professor emeritus of Leeds Metropolitan University who writes on housing policy and welfare reform

This article first appeared in the 05 May 2008 issue of the New Statesman, High-street robbery

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Death of a dictator

How Caesar’s murder set the template for political assassination.

The assassination of Julius Caesar on 15 March 44BC (“the ides of March” by the Roman system of dating) is the most famous political murder in history. Caesar had recently been made “dictator for life”, and he was killed in the name of “liberty” by a group of men he counted as friends and colleagues. In the aftermath, the assassins issued coins with a design specially chosen to celebrate the deed and press home the message: it featured the memorable date (“EID MAR”), a pair of daggers and the image of the small hat, “the cap of liberty”, regularly presented to Roman slaves when they were granted their freedom. This was liberation on a grander scale, freeing the Roman people from tyranny.

Several of the characters whose biographies feature in Plutarch’s Lives – Caesar, Brutus, Cicero, Antony, Pompey – had a role in the story of the murder. Julius Caesar was the victim, his dying moments vividly described by Plutarch. In this account, there were no famous last words, “Et tu Brute?” or whatever; after a futile attempt to fight back, Caesar pulled his toga over his head and took the 23 dagger blows that killed him. Brutus was the leading figure behind the assassination, a frankly messy business, as Plutarch makes clear (with several of the assassins “caught in friendly fire”, accidentally wounded by blows from their own side), and he was soon more or less forced to leave the city.

Cicero, the Roman politician, philosopher, poet, wit and orator, was not party to the plot but was very likely an eyewitness of the murder, and was straight away consulted by the assassins about what on Earth to do next (one of their main problems was that they had not thought ahead). Antony was Caesar’s right-hand man, gave the address at his funeral, and tried to take on the role of Caesar’s defender and successor – though he soon found an even more powerful rival for that position.

Pompey was already dead by 44BC. He had been killed four years earlier in a civil war, leading those Romans who had then been prepared to resort to pitched battles to resist the growing power of Caesar. But his shadow hung over the assassination. Caesar was murdered in an expensive new meeting hall whose building Pompey had funded, and he fell in front of a statue of Pompey, splattering it with his blood. It was as if Pompey was finally getting his revenge.

 

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The death of Caesar has provided the template for assassination ever since and has been the focus of debate on the rights and wrongs of political violence. In 1865, John Wilkes Booth used the word “ides” as the code word for the planned date of the assassination of President Lincoln. Shakespeare in Julius Caesar, largely drawing on an early translation of Plutarch’s biography, used the events of 44BC to reflect on the nature of political power, ideology and moral conscience. Others have seen the assassination as a useful reminder of the futility of such attempts at direct action. For what did it achieve? If the assassins had really wanted to quash the rise of one-man rule in Rome, if they had wanted to kill the tyranny as well as the tyrant, they were strikingly unsuccessful. More than a decade of civil war followed (a major theme in Plutarch’s biographies of Brutus and Antony), but the end result was that Caesar’s great-nephew – “Augustus”, as he was later known, and the man who rivalled Antony as Caesar’s heir – became the first Roman emperor. He established autocratic rule on a permanent basis. So much for the return of “liberty”.

In the long history of Rome – founded, as the Romans calculated it, around 750BC – the murder of Caesar, for all its later notoriety, was just one of many political crises, which became particularly intense and violent in the 2nd and 1st centuries BC. This was a period of expansion, political change, even revolution. There were vast Roman conquests overseas and, as a consequence, an enormous influx of wealth into the city. Gleaming marble from Greece, rather than local brick and stone, began to be used for temples and other public buildings in the city; slaves started to make up the majority of the workforce; and so many people flocked to Rome that its population topped a million, the only Western city of that size until London in the early 19th century.

But this age also saw repeated outbreaks of civil war at home, political disintegration, mass pogroms of citizens and the final fracture of what had once been a more or less democratic system of government. As a leading politician, Caesar was almost typical in coming to a violent end. None of the men I have mentioned died in their beds, nor fighting some “barbarian enemy”. They were killed in conflict with other Romans, by Roman hands, or on Roman orders. Pompey, for example, after losing in battle to Caesar, was decapitated by an Egyptian eunuch, ably assisted by a couple of Roman veteran soldiers; Cicero was put to death in 43BC in one of the pogroms, on Antony’s instructions, his head and hands later pinned up in the centre of Rome as macabre trophies for the crowds to leer and jeer at. A little over a decade later, Antony ended up killing himself after he lost in battle to Caesar’s great-nephew and successor.

The Romans described and fiercely debated the stresses and breakdown of their political system, trailing all kinds of explanations and possible solutions. For this period was also one of intellectual revolution in Rome, when the rich tradition of Roman literature began. Starting in the early 2nd century BC, Roman writers for the first time tried to tell the history of their city, to reflect on its problems and on how they thought it should be governed; and they used writing, too, for political attacks, insults in verse, self-advertisement in public, and personal letters in which they shared their aspirations, fears and suspicions.

When Plutarch in the early 2nd century AD was writing these biographies, he could base his narrative on plenty of contemporary material from the age of Caesar. Some of this we can still read, including Caesar’s one-sided account of his campaigns against the tribes of Gaul and later against Pompey (one of the very few eyewitness descriptions of ancient warfare to have come down to us) and volumes of Cicero’s political speeches, philosophical treatises and hundreds of his private letters, made public after his death by his loyal heirs. This writing helps us to understand what lay beneath all that chaos.

The rapid growth of the Roman empire was a crucial and destabilising factor. For us, why Rome grew in a few centuries from a small, moderately successful town in central Italy to one with control over more of Europe and the Mediterranean world than any state before or since is one of history’s big puzzles. Most modern observers put it down to some unfathomable combination of greed, a highly militaristic ideology, a dose of good luck and a happy knack of converting those they conquered into Roman citizens, and so into new soldiers for the Roman cause. The Romans were less puzzled on this score, pointing to the support of the gods, their piety and a succession of defensive rather than aggressive wars, in which they intervened to protect allies under threat. They were more troubled by the consequences of overseas growth for society and politics back home.

Despite their popular modern image, the Romans were not simply thoughtless and jingoistic imperialists. Some worried that the wealth and luxury that came with conquest overseas undermined what they saw as old-fashioned Roman austerity, a few about the cruelty of conquest (there was even
one, perhaps not entirely serious, proposal to put Caesar on trial for genocide during his conquest of Gaul). Others faced the question of how to adapt the traditional structures of Roman government to cope with new imperial demands. For how could you control and defend a vast empire, stretching from Spain to Syria, with a power structure and a system of military command developed to run nothing more than a small town?

That was one of the big issues behind the revolutionary changes of this period, and one of the factors that promoted the rise of dynasts such as Caesar. The political traditions of Rome, going at least as far back as the end of the 6th century BC, had been based on the principle that power was only ever held on a temporary basis and was always shared. The citizens as a whole elected the city’s officials, who combined both military and civilian duties, held office for just one year at a time, ideally not to be repeated, and never had fully independent decision-making power.

That there had always been not one but two consuls (the most senior of these annual officials) is a clear sign of that long-established commitment to power-sharing. But it was a principle ill suited to governing a far-flung empire and to fighting wars that might take place several months’ distance from Italy; you could hardly travel there and back in the regular year of office.

The Romans improvised various solutions to that problem: sending men out to the provinces, for example, after their year of office in Rome. But increasingly the Roman people voted more and more power into the hands of ambitious individual politicians on an almost permanent basis, even though those votes were often ­controversial and sometimes violently resisted.

 

 

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Caesar was not the first to challenge the traditional model of power-sharing. Despite leading the traditionalists against Caesar in 49BC, Pompey had, only 15 years or so earlier, been granted unlimited power for years on end across the whole of the eastern Mediterranean, first to deal with the pirates and human traffickers operating on the sea, then to deal with one of Rome’s remaining enemies in the East, King Mithridates of Pontus (in modern Turkey). Cicero was one of those who successfully spoke up, in a speech whose text we can still read, to quell the opposition to this grant, which was regarded as a dangerous step in the direction of one-man rule.

Even Brutus, despite his fine slogans on the subject of “liberty”, seems not to have been entirely immune from similar dreams of personal power. The coin celebrating Caesar’s assassination may have displayed the daggers and cap of liberty on one side. But on the other was an image of the head of Brutus. In Roman eyes, heads of living people on coins smacked of autocratic ambitions: Caesar was the first to risk such a display at Rome, Brutus the second.

So one side of the age of Caesar, richly documented in Plutarch’s Lives, was a series of “big men”, bankrolled by the vast profits that followed imperial conquests, competing for personal power. And that competition often came down to open fighting – whether in the streets of Rome, where there was no police force or any form of peacekeepers to maintain order, or across the empire more widely (the final battle in the Roman Civil War between Caesar and Pompey was fought in northern Greece, and Pompey was brutally finished off on the coast of Egypt). As the coin of Brutus hints, Caesar’s murder came too late to put the clock back to old-fashioned power-sharing. If Augustus had not established permanent one-man rule, Antony or some other rival would surely have done so.

Another important side of the period was the increasingly intense debates about what we would call “civil liberties”. How was it possible to protect the rights of the individual Roman citizen in this violent turmoil? How were the rights of citizenship to be balanced against the safety of the state? This came to a head almost 20 years before Caesar’s assassination, in 63BC. As Plutarch and others described it, Cicero was consul and believed that he had uncovered a terrorist plot, masterminded by a bankrupt and desperate aristocrat named Catiline, to eliminate some of the leading politicians, Cicero included, and to burn down much of the city. Once he had frightened Catiline out of Rome, Cicero rounded up those he believed were his accomplices and had them all executed without trial, even though they were Roman citizens and, as such, had a right to due legal process. “Vixere” (“They have lived” – that is, “They are dead”), he said in a particularly chilling euphemism, as he left the jail after super­vising their execution.

Not everyone at the time approved. Caesar was among those who stood up and objected. He was what we can still recognise as a classic populist, combining – as many have since – aspirations for dictatorship with a knack for popular rhetoric and an ability to appeal to the interests of the people (though, unlike some more recent examples of his kind, he also had a strong sense of popular justice). But in general Cicero was hailed as a hero who had saved the state from destruction.

The approval did not, however, last for long. Despite claiming the protection of an ancient equivalent of the Prevention of Terrorism Act, Cicero was banished into exile, on the charge of executing citizens without trial. He was recalled within a few months but, during his absence, his house had been demolished and a shrine to the goddess Liberty had pointedly been erected on the site.

The rights and wrongs of this case were debated ever after. How far, the Romans wondered, were elected officials allowed, or obliged, to transcend the law to save the state? We now debate very similar issues; how far the interests of homeland security make it legitimate to suspend the rights and protection that citizenship ought to ­offer, or how far we can stomach the idea of detention without trial, or summary deportation, if it prevents the “bad dudes” from doing us harm. That is why this is one of the Roman causes célèbres that speak to us most directly.

 

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The age of Caesar, then, was one of political murder, street violence, constant warfare both inside and outside Rome and fundamental disagreements about how the state should be run, how democracy and liberty might be preserved, while the demands of empire and security were met. It is impossible not to wonder what it was actually like to live through – and not just for the elite, rich and male political leaders who were the leading characters and celebrity victims in the conflicts and the focus of all ancient writers. What of the ordinary men and women who were not in the limelight? Did life for them go on much as before, while the big men and their armies fought it out? Or did the violence and bloodshed touch almost everyone?

It is hard to know and wrong to generalise. Just occasionally, Plutarch does take his eyes off those at the top of the pile and throw a fleeting glance at ordinary people carrying on with their lives more or less as usual in the chaos around them. We meet in passing Cicero’s wives and his daughter, Tullia who, like so many women in the Roman world, died from complications of childbirth, along with her infant son. We have a glimpse of an enterprising trader from northern Italy, a man called Peticius, who in 48BC just happened to be travelling in his ship along the coast of Greece when he spotted Pompey, on the run after his defeat by Caesar – and gave him a lift south.

Most engagingly of all, thanks to information he had picked up from his grandfather, Plutarch gives us a tiny but vivid insight into the practices “below stairs” in the kitchens of the palace in Alexandria that – to the horror of many Romans – Antony eventually came to share with Queen Cleopatra. Apparently, the cooks were so concerned about preparing the wild boar to perfection, whenever the company upstairs decided to eat, that they had eight boars roasting, each put on to cook at a different time, so that one would be sure to be just right when dinner was summoned (do the cooks at Mar-a-Lago or, for that matter, Balmoral have the same problem?). It is a nice image of ordinary people living in their own world and dealing in their own way with (and maybe laughing at) the capricious demands of the world leaders they served.

But not all were so lucky. One memorable story told by Plutarch, repeated and made even more famous by Shakespeare in Julius Caesar, tells the fate of an unfortunate poet called Cinna. This man was not quite as ordinary as Peticius or the cooks in Alexandria; he was a friend of Caesar but he was not in the political mainstream. A couple of days after the assassination, he went to the Forum to see his friend laid out for his funeral and fell in with a crowd of Caesar’s mourning and angry supporters. These men mistook the poet for a different Cinna, who had been one of the assassins, and so tore the poor man limb from limb.

The message of the story is clear. Assassinations have innocent victims, too. Simple cases of mistaken identity (and there must have been many of those at Rome, in the absence of any form of official ID) can leave a blameless bystander dead. Shakespeare’s plaintive line “I am Cinna the poet, I am Cinna the poet” is a haunting reminder of the many who must have been caught in the crossfire when the leaders of the Roman world clashed.

“The Age of Caesar: Five Roman Lives” by Plutarch, translated by Pamela Mensch and edited by James Romm, is newly published by W W Norton

This article first appeared in the 06 April 2017 issue of the New Statesman, Spring Double Issue

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