Skip to main content
SpringerLink
Log in

Active Solidarity and Its Discontents

  • Original Article
  • Published:
Health Care Analysis Aims and scope Submit manuscript

Abstract

Traditional welfare states were based on passive solidarity. Able bodied, healthy minded citizens paid taxes and social premiums, usually according to a progressive taxation logic following the ability to pay principle. Elderly, fragile, weak, unhealthy and disabled citizens were taken care of in institutions, usually in quiet parts of the country (hills, woods, sea side). During the nineteen eighties and nineties of the twentieth century, ideas changed. Professionals, patients and policy makers felt that it would be better for the weak and fragile to live in mainstream society, rather than be taken care of in institutions outside society. This might be cheaper too. Hence policy measures were taken to accomplish deinstitutionalization. This article discusses the implications of deinstitutionalization for distributive justice. It is argued that the weakest among the weak and fragile stand to lose from this operation. For able bodied citizens deinstitutionalization entails a move from passive to active solidarity. Rather than just pay taxes they have to actively care for and help the needy themselves. The move from passive to active solidarity tends to take advantage of benevolent citizens and burden the socioeconomically disadvantaged. This may be a reason to reconsider the policy move toward deinstitutionalization.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Notes

  1. In this article I shall refer to people with a chronic illness, a disability or a mental retardation as ‘the weak’, ‘the frail’, or ‘the frail and fragile’ and to the healthy minded, able bodied citizens who have to help them in one way or another as ‘the strong’. I am aware that this may be stigmatizing. I know that many people with a disability can be remarkably strong in other respects and that many able bodied citizens lack courage and perseverance. I hope the reader can forgive me. I intend to discuss the distribution of care obligations and that means that I have to distinguish between people receiving care and people who give care. Pointing out that everybody needs care during certain stages in life or that care giving can be very rewarding, although both very true, clouds the distributive issue. It is like talking about raising children. This is, most parents will readily say, the most rewarding experience life has to offer. But sometimes we must nevertheless discuss the distribution of caring obligations between fathers, mothers and the state and we cannot do that if we constantly have to mince our words because otherwise we get reminded that children are the best thing that ever happened to us. If we are only allowed to talk in terms of ‘our bundles of joy’ the social justice issue will elude us.

  2. A recurring pattern in research on deinstitutionalization is that parents disapprove of the whole idea. Usually the plans are carried out regardless and after a while parents tend to come around and see the move in a more positive light. This pattern makes hospital directors and policy makers dismiss the initial resistance as cold feet. Cf. [43].

  3. On a more general note Burtt [6] observes that “people become advocates of robust inclusion not from an abstract impulse of benevolence or compassion or justice, but from an experience of relatedness to individuals with disabilities”.

References

  1. Appleby, L., et al. (2006). Avoidable deaths. Five year report of the national confidential inquiry into suicide and homicide by people with mental illness. Manchester: University of Manchester.

    Google Scholar 

  2. Becker, H. (2003). Levenskunst op leeftijd. Geluk bevorderende zorg in een vergrijzende wereld. Dissertation Utrecht University.

  3. Bronneman-Helmers, H. M. (2008). Vijftien jaar onderwijsvernieuwingen in Nederland. Een beleidsanalytische studie ten behoeve van het parlementair onderzoek onderwijsvernieuwingen, TK 31007, nr. 7 (parliamentary archives).

  4. Brown, Ph. (1985). The transfer of care. Psychiatric deinstitutionalization and its aftermath. London: Routledge & Kegan Paul.

    Google Scholar 

  5. Brussig, M., & Knuth, M. (2010). Rise up and work! Workless people with impaired health under Germany’s new activation regime. Social Policy & Society, 9(3), 311–322.

    Article  Google Scholar 

  6. Burtt, S. (2007). Is inclusion a civic virtue? Cosmopolitanism, disability, and the liberal state. Social Theory and Practice, 33(4), 557–578.

    Article  Google Scholar 

  7. Commissie Fundamentele herbezinning WSW. (2009). Werken naar vermogen, Bijlage terreinverkenning, deel IV. http://www.werken-naar-ermogen.nl/advies/Bijlage_Terreinverkenning.pdf. Accessed August 7, 2009.

  8. Fakhoury, W., & Priebe, S. (2002). The process of deinstitutionalization: An international overview. Current Opinion in Psychiatry, 2(15), 187–192.

    Article  Google Scholar 

  9. Giaglis, G. D., Michaillidou, B., Angelidis, G. F. (2008). Factors influencing attitudes of deinstitutionalized patients’ neighbours. European Psychiatry, Supplement 2, April, S363.

  10. Glendinning, C. (2008). Increasing choice and control for older and disabled people: A critical review of new developments in England. Social Policy & Administration, 42(5), 451–469.

    Article  Google Scholar 

  11. Goffman, E. (1961). Asylums: Essays on the social situation of mental patients and other inmates. New York: Doubleday Anchor.

    Google Scholar 

  12. Hodkinson, A. (2010). Inclusive and special education in the English educational system: Historical perspectives and future challenges. British Journal of Special Education, 37(2), 61–67.

    Article  Google Scholar 

  13. House of Commons Education and Skills Committee. (2006). Special educational needs. Third report of session 2005–2006, vol. I. Report together with formal minutes. http://www.publications.parliament.uk/pa/cm200506/cmselect/cmeduski/478/478i.pdf. Accessed September 12, 2011.

  14. Ingram, D. (2006). Antidiscrimination, welfare, and democracy. Toward a discourse-ethical understanding of disability law. Social Theory and Practice, 32(2), 213–248.

    Article  PubMed  Google Scholar 

  15. Inspectie Werk en inkomen. (2007). Uitvoering Wet sociale werkvoorziening 2006. www.iwiweb.nl. Accessed August 14, 2009.

  16. Jepma, I. J. (2003). De schoolloopbaan van risicoleerlingen in het primair onderwijs. Dissertation: University of Amsterdam.

    Google Scholar 

  17. Krieg, R. G. (2001). An interdisciplinary look at the deinstitutionalization of the mentally Ill. The Social Science Journal, 38(3), 367–380.

    Article  Google Scholar 

  18. Kwekkeboom, M. (2001). Zo gewoon mogelijk. Een onderzoek naar draagvlak en draagkracht voor de vermaatschappelijking in de geestelijke gezondheidzorg. Den Haag: SCP.

  19. Kwekkeboom, R. (2004). De waarde van vermaatschappelijking. Lectoraatsrede. Breda: Avans Hogeschool.

  20. Kwekkeboom, M., & Van Weert, C. M. C. (2008). Meedoen en gelukkig zijn. Een verkennend onderzoek naar de participatie van mensen met een verstandelijke beperking of chronische psychiatrische problemen. Den Haag: SCP/Avans.

  21. Lamb, H. R., & Bachrach, L. L. (2001). Some perspectives on deinstitutionalization. Psychiatric Services, 52(8), 1039–1045.

    Article  CAS  PubMed  Google Scholar 

  22. Lerman, P. (1982). Deinstitutionalization and the welfare state. Brunswick: Rutgers University Press.

    Google Scholar 

  23. Linders, L. (2010). De Betekenis van nabijheid. Een onderzoek naar informele zorg in een volksbuurt. Dissertation, Tilburg University.

  24. Mechanic, D., & Rochefort, D. A. (1990). Deinstitutionalization: An appraisal of reform. Annual Review of Sociology, 16, 301–327.

    Article  Google Scholar 

  25. Melke, A. (2010). Mental health policy and the welfare state. University of Gothenburg. Care. European Observatory on Health System and Policies.

  26. Mullen, P. E., et al. (2000). Community care and criminal offending in schizophrenia. The Lancet, 355, 614–617.

    Article  CAS  Google Scholar 

  27. Newman, J., & Tonkens, E. (Eds.). (2011). Participation, responsibility and choice. Summoning the active citizen in western European welfare states. Amsterdam: Amsterdam University Press.

    Google Scholar 

  28. Okin, R. L. (1995). Testing the limits of deinstitutionalization. Psychiatric Services, 6(46), 569–574.

    Google Scholar 

  29. Pavolini, E., & Ranci, C. (2008). Restructuring the welfare state: Reforms in long-term care in western European countries. Journal of European Social Policy, 18(3), 246–259.

    Article  Google Scholar 

  30. Plemper, E., & Van Vliet, K. (2003). Community care: de Uitdaging voor Nederland. Den Haag: RMO.

    Google Scholar 

  31. Pollitt, C., & Bouckaert, G. (2004). Public management reform. A comparative analysis. Oxford: Oxford University Press.

    Google Scholar 

  32. Prick, L. (2006). Drammen, Dreigen. Draaien. Hoe het Onderwijs Twintig Jaar Vernieuwd Werd. Amsterdam: Mets en Schilt.

    Google Scholar 

  33. Ramesar, P. (2012). Na een cola en wat sigaretjes knapte er iets bij Stanley A. Trouw 3 March.

  34. Reich, R. B. (2008). Supercapitalism. The transformation of business, democracy and everyday life. New York: Vintage.

    Google Scholar 

  35. Rood, E. (2008). Vermaatschappelijking van de zorg: geluk(t) voor iedereen? Een onderzoek naar de gevolgen van en voorwaarden voor vermaatschappelijking van de zorg. Barneveld: Bestuur en Management Consultants.

  36. Roulstone, A., & Morgan, H. (2009). Neo-liberal individualism or self-directed support: Are we all speaking the same language on modernising adult social care? Social Policy & Society, 3(8), 333–345.

    Article  Google Scholar 

  37. Schuyt, K. (1998). The sharing of risks and the risks of sharing: Solidarity and social justice in the welfare state. Ethical Theory and Moral Practice, 1(1), 297–311.

    Article  Google Scholar 

  38. Smilde, M. (2011). Raarhoek. Amsterdam: De Arbeiderspers.

    Google Scholar 

  39. Stadelman-Steffen, I. (2011). Social volunteering in welfare states: Where crowding out should occur. Political Studies, 59(1), 135–155.

    Article  Google Scholar 

  40. Svallfors, S., & Taylor-Gooby, P. (Eds.). (2007). The end of the welfare state? Responses to state retrenchment. London: Routledge.

    Google Scholar 

  41. Tabatabainia, M. M. (2003). Listening to families’ views regarding institutionalization and deinstitutionalization. Journal of Intellectual & Developmental Disability, 28(3), 241–259.

    Article  Google Scholar 

  42. Teeuwen, M. (2012). Verraderlijk gewoon. Licht verstandelijk gehandicapte jongeren, hun wereld en hun plaats in het strafrecht. Amsterdam: SWP.

    Google Scholar 

  43. Tossebro, J. (1998). Family attitudes to deinstitutionalization before and after resettlement: the case of a Scandinavian Welfare State. Journal of Developmental and Physical Disabilities, 10(1), 55–72.

    Article  Google Scholar 

  44. Trappenburg, M. (2008). Genoeg is genoeg. Over gezondheidszorg en democratie. Amsterdam: Amsterdam University Press.

    Book  Google Scholar 

  45. Van Lange, A., & Wajon, T. (2007). Het gewone voorbij. Bevindingen van persoonlijk begeleiders in de zorg met vermaatschappelijking. Den Haag: Avans Hogeschool.

  46. Verplanke, L., & Duyvendak, J. W. (2010). Onder de mensen? Over het zelfstandig wonen van psychiatrische patiënten en mensen met een verstandelijke beperking. Amsterdam: Nicis Institute.

  47. Widrick, G. C., Brambley, J. A., & Frawley, P. J. (1997). Psychopathology in adults with mental retardation before and after deinstitutionalization. Journal of developmental and physical disabilities, 9(3), 223–242.

    Article  Google Scholar 

  48. Wong, S. I. (2007). The moral personhood of individuals labelled ‘Mentally Retarded’: A Rawlsian response to Nussbaum. Social Theory and Practice, 33(4), 579–594.

    Article  Google Scholar 

  49. Yoon, J., & Bruckner, T. A. (2009). Does deinstitutionalization increase suicide? Health Services Research, 4(44), 1385–1405.

    Article  Google Scholar 

Download references

Author information

Author notes

  1. M. J. Trappenburg

    Present address: Utrecht School of Governance, Utrecht University, Bijlhouwerstraat 6, 3511 ZC, Utrecht, The Netherlands

Authors and Affiliations

  1. Department of Sociology and Anthropology, Amsterdam University/Aias, Plantage Muidergracht 12, 1018 TV, Amsterdam, The Netherlands

    M. J. Trappenburg

Authors
  1. M. J. Trappenburg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. J. Trappenburg.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Trappenburg, M.J. Active Solidarity and Its Discontents. Health Care Anal 23, 207–220 (2015). https://doi.org/10.1007/s10728-013-0260-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10728-013-0260-5

Keywords

Search

Navigation