The current drive to cut public spending has focused attention on a ‘dependency culture’. The summer’s riots were seen by some as the consequence of a dysfunctional welfare system destroying informal community bonds by institutionalising individual dependence on state hand-outs, thereby fostering a widespread and antisocial sense of individual entitlement. Even some supporters of the welfare state concede there is something wrong when generation after generation in some areas do not expect to work, and that the problem is not as simple as a lack of jobs or opportunities. In particular, many feel there is something dodgy about the high number of people claiming incapacity benefit. But is the problem about a minority of malingerers ‘on the sick’, or is there a broader cultural malaise, whereby people are encouraged to see themselves as ill? Labour MP John Cruddas has said we are not suffering from a crisis of welfare dependence but one of ‘mass chronic ill health caused by worklessness and poverty’. Nowadays those deemed too ill to work seem as likely to be suffering from mental health conditions as the industrial ailments and diseases of old: over a third of successful incapacity claimants have been diagnosed with mental or behavioural disorders. But do these disorders owe more to the welfare system itself than to the economic situation?

It is not just benefit claimants who are accused of being on the sick. Last year, the government replaced sick notes with ‘fit notes’ – asking doctors to suggest types of work the patient may be fit for - in an attempt to claw back the estimated £100 billion per year lost due to employee illness. But can politicians and pundits plausibly complain about a ‘sick-note culture’ when the constant refrain from these same commentators is that contemporary society makes us ill? From the beginning of the economic crisis, experts lined up to tell us impending hardship threatened our mental health, while Cameron’s happiness agenda is underpinned by the notion that modern life makes us depressed.

Is it true, as some allege, that the rise of poor health is genuine, a product of precarious employment and an inequitable society? If sickness is psychological, isn’t it still ‘real’? Or are we simply talking people into being ill? Can the welfare system be reformed in such a way as to encourage resilience and help people regain their independence while still guaranteeing a safety net for those who need it? Is it time to rethink the welfare state more generally?