Medicine and Politics in America (2001)
4 Certifying Medicine
...The medicalization of disability represents a giant step in the transformation of the welfare state into the therapeutic state. While the two systems resemble one another, both being need-based and paternalistic, there are important differences between them:
• The welfare state seeks to relieve poverty and unemployment; its beneficiaries are not helped against their will; it is a constitutional state, regulated by the rule of law.
• The therapeutic state seeks to remedy personal and social problems defined as diseases; its beneficiaries are often helped against their will; it is a totalitarian state, governed by the rule of therapeutic discretion.
Whether a person is disabled from being gainfully employed or working as an independent producer depends less on his medical condition than on his educational level, motivation for work, and the personal, economic, and political opportunities open to him. Nevertheless, the concepts of disease and disability are typically yoked together, with medical certification for disability focused on what the subject cannot do because of his medical impairment, rather than on what he can do in spite of it.
In1990, there were more lawyers in the United States than all the rest of the world combined.