Britain is crippled. More of us than ever before are disabled. One in four, at the last count. But it is a statistic so obviously at odds with reality that anyone with working eyesight should question it. Instead, it has been adopted as fact by government, doctors, charities and benefits assessors.
This mass collapse in health – nearly four million more people describing themselves as disabled in the past decade – is driven, we are told, by genuinely worsening mental health and a surge in diagnoses of conditions such as ADHD and autism. So vast is the problem that a government review last week found the sickness-welfare system ‘not fit for purpose’. No wonder, when the number of working-age Britons claiming disability benefits is rising faster than the estimated disabled population itself.
I just don’t believe all these people really are disabled. The word itself has lost all meaning, and I should know.
My instinct to reject the disability label spurred me on, and it must have saved the taxpayer a few bob
A declaration of interest: I am a spastic. I have cerebral palsy – left hemiparesis, to be exact – and, unlike many ‘disabled’ people today, I’d much rather I didn’t. I am lucky. As an adult, it causes me relatively little trouble, beyond a strong aversion to standing up for too long. But my childhood was spent wearing a splint and undergoing medical procedures, some of which are now considered so barbaric that they are no longer carried out by the NHS.
My condition also brought with it what I fondly misremember as playground high jinks: shouts of ‘pegleg’ and ‘Spazzy McGee’, and classmates hiding my splint in the roof void when I took it off for swimming lessons.
But leave the character-building aside and what really upset me was not the pain. It was the determination of every adult around me to make me accept the label ‘disabled’ when I – desperately, above all – wanted to be normal and judged on the same terms as anyone else.
‘Michael,’ my NHS physiotherapist would say, ‘you qualify for a free travel pass and leisure centre membership. Why won’t you sign up?’ I was so stubborn in my refusal to accept help from ‘Support for Learning’ that it repeatedly tipped into belligerence and landed me in detention. I rejected ‘balance class’, extra time in exams and, later, disability-access schemes when applying to university or for my first job. The idea of any sort of leg up (forgive me) was offensive to my pride.
My instinct to reject the disability label, I think, paid dividends. It spurred me on to moderate success, and it must have saved the taxpayer a few bob too. But I’m not deluded; I’m aware I was only a product of the environment at the time, in which labels were to be shunned.
Since then, things have changed. Labels have become cool. Were I at school today, I suspect I would have embraced the disabled badge. I’d certainly have felt cool on crutches. In Scotland, where I grew up, nearly half of pupils now qualify for additional support. They are the new in-crowd.
Indeed, I witnessed this new institutional attitude to disability when lightning struck again in my early twenties and I was diagnosed with a spinal cord tumour. ‘You’re very unlucky to get this on top of your CP,’ observed my thankfully on-the-spectrum neurosurgeon. My immediate challenge was survival; the next was avoiding being dis-abled by the NHS.
When I woke up from the surgery I had to remain flat for the first few days. That sent some tests skew-whiff and led the young registrar to matter-of-factly declare: ‘I think we have paralysed you. But don’t worry, we’ll be back in a few days to fit you with a catheter and an erection pump.’ I responded rationally by battering the dose button on my self-administered morphine.
Thankfully, this agony was quickly broken by the consultant, who came breathlessly bounding into the ward, having seen the notes, to tell me the registrar was talking nonsense and I was most certainly not paralysed. He also dismissed as ‘defeatist rubbish’ a standard NHS leaflet that I’d been given which stated that the majority of spinal patients never return to work. Months of gradually starting to walk again and an opioid withdrawal programme followed, as, again: ‘Most people who have taken the amount of opioids you have never come off them.’
Finding myself in the hands of this particular surgeon was lucky because he pushed back against all the systemic incentives that now seem to be dragging society towards disability and dependency. He shared my worldview. Now, perhaps our Presbyterian approach to disability – that it is something to overcome and disguise rather than celebrate and display – is unhealthy. But today’s instinct is surely worse. Disability is in vogue. Diagnosis has become identity.
That cultural change – which I am so lucky to have avoided – is plain in the data. The Family Resources Survey – the source of the one-in-four statistic – shows most of the newly crippled are young people. Break the figures down by age and the pattern is alarming: among 16- to 24-year-olds, the disabled proportion has nearly doubled over the last ten years. Among the over-65s – the group in which age-related disability should, if anything, be climbing – the rate has actually fallen a little.
Yet the rise is overwhelmingly driven largely by mental-health and neurodevelopmental conditions. Other data shows that the traditional categories – multiple sclerosis, cerebral palsy, serious physical disability – have barely moved. The boom is taking place at the softer, more subjective end of the definition.
Another review, commissioned by Wes Streeting before he resigned as health secretary, has already published its interim findings, with the final report due out soon. Its conclusions will be, I am told, ‘terrifying’. Rather than relying on the easily manipulated and flawed surveys favoured by campaign groups and trade unions, it will draw on decades of population data. It will finally, I hope, force ministers to confront the possibility of widespread overdiagnosis.
Recorded autism diagnoses are up roughly 640 per cent; ADHD diagnoses up nearly 1,600 per cent
But to do that, it must confront the standard defence: that doctors are merely catching up on generations of missed cases. Diagnosis should slow as it catches up with true prevalence. Leukaemia, diagnosed by blood test rather than clinical judgment, has barely changed since 2000; recorded autism diagnoses are up roughly 640 per cent, and ADHD nearly 1,600 per cent. Categories without a hard biological test can evidently expand far faster. Demand is accelerating too: waiting lists for ADHD and autism assessments have risen fifteen-fold since 2020, compared with a doubling across general mental-health services. One senior clinician believes that, if diagnosis rates have not already overtaken true prevalence, they soon will.
Diagnostic fashion has plainly played a part. The folding, 13 years ago, of autism’s various subtypes into a single ‘spectrum’, which ranges from kids we might have described as ‘bookish’ to those completely unable to function, has mechanically inflated the counts. Children whom we would have classed as having conduct disorder started to be moved to the more popular ADHD category. Uta Frith, who pioneered the expanded autism category, even admits the new definition has become so wide that it has ‘lost all meaning’ and was a mistake.
The blame does not lie solely with doctors. Diagnosis carries powerful institutional, financial and cultural incentives. Whereas parents once wanted there to be nothing wrong with their child, now they find that a neurodevelopmental label can be the only reliable gateway to school support. Around that need has grown a private assessment industry with an obvious interest in finding something to diagnose. The geography of certain conditions should make us curious: unlike with depression, anxiety, schizophrenia or self-harm, ADHD’s recorded prevalence has shifted from deprived towards affluent postcodes, increasingly following money and parental pushiness. Meanwhile, the line between serious impairment, ordinary difficulty and individual eccentricity has blurred almost beyond recognition – and the rest of us dare not question it.
We live in a society in which disabled people must be described as merely ‘differently abled’, while apparently requiring more state support than ever before. It is a society in which autism is idiotically advertised as a ‘superpower’ – a slogan particularly galling for those families caring for people who cannot speak or live independently.
Doctors know this but few speak out. Many privately describe the visible ‘exhilaration’ on the faces of patients they have just diagnosed with in-vogue conditions such as ADHD. They’re gobsmacked when they see the same patients announce the news on social media as though they’ve won the Lottery rather than received confirmation of a lifelong disorder.
Increasingly it seems the label is the cure, with the diagnosis becoming a total explanation of the self, a means of medicalising eccentricity or explaining away bad behaviour. Don’t take my word for it, it’s in the data. Prescriptions for amphetamines – a pretty effective treatment for ADHD – have not kept pace with the diagnostic boom, which shows that once they’ve got their desired label, many patients don’t want to bother with any treatment.
The line between serious impairment, ordinary difficulty and eccentricity has blurred beyond recognition
There are costs and consequences to all this. Britain already spends more on health and disability benefits than on defence (£83 billion vs £63 billion) and the Office for Budget Responsibility (OBR) expects the gap to widen. Once a disability label has been gained, it removes the expectation that the unemployed should seek work and turns what would otherwise be pretty miserly benefits into extremely generous ones.
The label also allows schools to tolerate persistent absence – probably the worst outcome for a mentally unwell child. In fact, add in the disability category to our economic outlook and the problems seem far worse: nearly half of all NEET (not in education, employment or training) young people are now classed as disabled – more than double the rate in 2011 – and the single biggest reason they give is their mental health.
Defenders of the status quo point out that welfare spending has barely moved as a share of GDP. But that stable headline conceals a crippling shift from temporary unemployment support towards long-term exclusion from the workforce. Nor does the benefits bill capture the full cost: people classified as disabled may disappear from the unemployment statistics, but not from the taxpayer’s bill. The OBR estimates that a 1.5-point health-driven fall in labour-force participation would add 0.5 per cent of GDP to welfare spending while cutting income-tax and national insurance receipts by another 0.4 per cent.
Labels matter. I was very fortunate to encounter professionals who expected me to recover, work and live rather than organise my life around incapacity. Such people are now scarce. A compassionate state should generously support those who have profound disabilities. But the rest of us – those whose physical or mental conditions hold us back only a little – should at least ask whether we are meaningfully disabled, or whether we would be better served by shutting up and getting on with living.
The data is, after all, pretty clear: most of those queuing for a label may not need any medical intervention at all. Compassion does not require us to turn every difficulty into a disability, or every eccentricity into a disorder.
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