Trauma as a workaround: Recognizing chronic pain as disability without medical documentation in the United States and France

Abstract

Since the 1970s, social movements and human rights frameworks have called for disability rights to be interpreted through a social model rather than a medical model of disability. However, neoliberal policy reforms that discourage disabled people's dependence on the state entrenched the role of medical gatekeepers to provide evidence of disability and authorize accommodations necessary for people with disabilities to participate in work and education. This paper uses disabling chronic pain as a case to examine how disability professionals in the United States and France recognize social trauma in the absence of medical evidence as justification for disability accommodations and entitlements. Drawing from interviews with doctors, chronic pain patient advocates, and disability service professionals in both countries, I first show how the biomedicalization of disability has stratified access to disability rights, privileging those who can comply with time-consuming and costly medical evaluation and treatment plans. For claimants without sufficient biomedical evidence of impairment, I then analyze how and why disability service professionals in each country have created a new path to accessibility. Disability professionals select some vulnerable disabled people to help bypass biomedical authority, reinterpreting disability in the logic of trauma to account for the distinct limitations of each country's healthcare and disability systems.