The incident

The narrator tells:

“This incident took place recently in my medical practice as GP. I was going to join a socalled trialogue with one of my patients and her caseworker in the local jobcentre. The focal point of this meeting would be her health problems and her request for an early retirement, given her diagnosis and permanent pain. But as part of this request, the trialogue and discussion was also about her perspectives and possibilities of participating in a work-oriented activity. This could usually be an internship, language school or other employment promoting activity. The background was a quite severe diagnosis, which made it really hard for her to even think of a job.

In the trialogue, the woman highlights her rheumatic disorder and diagnosis as arguments for her application for early retirement. These arguments were also supported by me. But then she also stresses that it is very important for her that she can be a good mother and a good wife, despite her permanent health problems.

Now the caseworker speaks and exclaims: “well, that´s laudable that you wish to be a good mother and a good wife. But then you also made a free choice not to be active in labour market. This is a choice that you make on a voluntary basis…”

I was shocked and dismayed by his words, since I knew that the consequence may easily be that the woman would lose her rights and access to social benefits, her total basis of support. I could feel that the woman was also astonished and confused about his opinions and his ways of turning her words against herself. Thus, I tried to soften him and point again to her diagnosis and permanent pain situation.

I also pointed to the fact that she actually tried many times through the years in Denmark to be active in labour market activities such as language learning, short internships etc. But each time, she had to give up because of her severe health problems.

Even though the case worker didn’t persist, I clearly felt that he was not at all convinced that there may be a reasonable basis for supporting her in her application for an early retirement. I could read in his eyes that the woman – from his perspective – should pull herself together instead of talking about her disease all the time. I had a very strong notion that in his eyes, she would appear to be another one of those migrants who are milking the Danish welfare system for money – and who would not really be bothered to work and contribute to the society and welfare system.

I don’t know what will happen in her case. But I really fear she may have a weak case. I really feel bad about it, knowing from my many years and practice in the integration efforts that we never really took on our responsibility as a society. We never really educated and socialised migrants to the mental and value part of the Danish concept of welfare, which includes the right to receive when needed and the corresponding duty to contribute to the community…”

1. Identities of the actors in the situation

The narrator is a private medical doctor, working as a GP in his own private practice. The narrator is in his mid-sixties, born in Denmark and practiced as a GP for many years. He has a large number of patients with a migrant or immigrant background. He also took part in several local development projects to improve the intercultural encounter between doctors and patients.

In summary, the narrator has been social-culturally engaged in improving the medical approach and methods towards migrants and immigrants in local society for many years.

Apart from the narrator, the incident involves the following persons:

A migrant woman, originally from Lebanon, who lived in Denmark since 1999 (perhaps 2000). The woman is in her early forties, and she suffered from a special rheumatic disorder since her childhood. She recovered very well during the years in Denmark, but she is still plagued by pain in joints and muscles. She has been diagnosed by a Danish medical specialist. She is unemployed and living on social benefits. Due to her own health problems and due to one of her children´s disease, she never really learned to speak Danish well. When she first arrived in Denmark, she was a quite skilled English speaker. But gradually, she lost this skill and she hardly speaks any English nowadays.

A male Danish-born case worker/job consultant from the local jobcentre. The case worker is in his early thirties or his mid-thirties. He would probably be educated in the Danish educational system either as a skilled social worker or even as an academic. Only a very few case workers would nowadays be uneducated in the Danish Employment and Social Service system.

Furthermore, an Arabic speaking interpreter. But it should be noted that the interpreter doesn’t in any way play an active or significant role in the incident.

We don’t know if the woman knew the caseworker beforehand. It is likely that they have met before. However, in many cases, caseworkers are replaced and covering each other, and citizens must respond to new caseworkers who have no firsthand knowledge of their case and individual situation.

2. Context of the situation

This incident takes place in the local jobcentre, where a migrant woman is going to have a conversation with her job consultant about her application for early retirement.  The narrator is present at the conversation as her GP in a socalled roundtable encounter – in this case arranged as a trialogue. This would be common practice in the Danish Employment and Social Service system, when this kind of application is the topic.

3. Emotional reaction

The narrator was shocked by the case worker´s lack of empathy for the woman’s health problems. The narrator perceives the case worker´s response as an abuse of power, as the woman is completely dependent on the case worker´s attitude in the further case management of her application for early retirement.

The narrator also felt bad and somehow powerless, as he is supposed to be the medical and professional expert in the woman’s health condition. Yet, in the situation, he is taken by surprise and contradicted by the case worker’s arguments, which have absolutely no relation to the medical arguments, namely the caseworker’s focus on the woman’s will – not ability – to remain in the labour market. The narrator perceives the whole process as a failure of the woman and her interests. He feels that he is overwhelmed by the case worker’s arguments without being able to fight back on behalf of the woman’s needs and interests.

4. Representations, values, norms, ideas, prejudice: The frame of references of the person who experienced the shock.

Norms and values of empathy and human compassion / Communication

In the eyes of the narrator, the case worker is deliberately emphasising the woman´s statement of being a good mother and a good wife – instead of kindly reminding her that this would be her private priorities which cannot serve as arguments in the labour market system. By acting in this way, the case worker would manage the case on the basis of his personal prejudices about migrants’ lack of interest in contributing to the community – rather than on the basis of an objective assessment of the woman’s health situation. In the eyes of the narrator, this is not only despicable and petty – it is also unprofessional.

Norms and values of the Nordic welfare state and societal solidarity / Prejudice

In the eyes of the narrator, this kind of attitude is, ultimately, in conflict with the Danish welfare system and the basic values of citizens to provide according to their abilities and to receive according to their needs. In this case, the woman actually has an objective need, no matter what her private values are. From this perspective, the case worker is rather serving the socalled competitive state than the welfare vision of a welfare society characterised by a fair redistribution of wealth and resources in society. On the contrary, the case worker is serving a system of control and immediate suspicion towards citizens who are asking for help and support in a very dire situation. In the eyes for the narrator, this attitude (very much discussed in Denmark nowadays) and the general idea of new public management tends to threaten citizens’ legal rights and legal certainty.

Norms and values of respect for professional – medical – expertise

Feeling powerless and somehow embarrassed at the situation, the narrator would also feel that the case worker is behaving arrogantly towards the narrator’s medical assessment and expertise. The caseworker shows no interest in the medical facts, but focuses on the woman’s opinions on motherhood etc.

5. What image emerges from the analysis of point 4 for the other group (neutral slightly negative, very negative, "stigmatised", positive, very positive, real, unreal) etc?

The words would be:

  • Abuse of power
  • Abuse of welfare values
  • Pettiness and lack of professional approach
  • Lack of format
  • Lack of empathy and caring feelings
  • Negative preassumptions and even prejudices about migrants and their propensity to cheat on the system
6. Representations, values, norms, prejudice: The frame of references of the person or group that is causing the shock / that caused the shock in the narrator.

Norms and values of gender roles and women’s prioritising of work respectively family life and motherhood.

The woman is causing a kind of culture shock to her antagonist in the incident – the municipal case worker – when she justifies her early retirement application with the need to be a good mother and a good wife.

The woman is clearly marked by a desire to be present in the home and be available for her family, be it both husband and children. In the Danish societal and cultural context, she would be described as a traditional housewife, living by traditional norms about gender division of labour and gender roles.

After many years in Denmark, the woman is probably aware that the Danish labour market system and welfare system is not based on those values. Public support is, in fact, reflected in the labour market attachment and employment, not in the homeworking practice. Public support will come into force when citizens no longer have the opportunity to work and support themselves. If a family wishes the mother to be present in the home, it is seen as a private, not a societal priority. With this background, one may somehow wonder why the woman brings the question about her own role in the family into the trialogue. It is reasonable to believe that this priority is a very strong value for her and her family.

One could argue that she should act more tactical in a situation where she has alot at stake with her application. But we must assume that she speaks of an open and honest heart – thus expressing norms and values that are important and decisive for her quality of life.

Norms and values of a social balance between rights and duties in the welfare state.

The case worker is actually causing a culture shock to both the narrator and the woman, when he seizes the opportunity to “misunderstand” the woman’s statement about being a good mother and a good wife. Instead of showing empathy and professional understanding of her health problems, he uses her “slip of the tongue” to state that public welfare is not just a right. It reflects in the duty to try to be as active as possible in the labour market.

The case worker takes the opposite position compared to the woman. In the trialogue, he represents the most firm and rigid version of the general labour market policy. But there is no reason to doubt that he has internalised the system’s values and acts out of basic convictions on both a professional and personal level.

He experiences a deep value discrepancy between himself and the system on the one hand – and the woman´s attitudes on the other side. It’s a cultural difference in family values. But furthermore, there would also be a gender distance. He exhibits a kind of contempt for a woman, who from both a cultural and gender perspective represents a weakness and lack of understanding of basic societal values and needs to maintain a balance between providing and receiving. Due to both her culture and her gender, she can only grasp her family and the intimate sphere – not the societal sphere and the collective responsibilities, which are the cornerstones of the welfare state.

7. Does the situation highlight any problem concerning the professional practice, or in general about the respect of cultural differences in intercultural situations?

As mentioned by the narrator himself, this incident highlights a basic dilemma in the Danish integration efforts: the many years of neglect in integration efforts to raise awareness and understanding of the welfare state’s fundamental values and building blocks. It is no wonder in Denmark that so many migrants and their descendants had difficulties to figure out the built-in balance between providing and receiving.

When many migrants approach the public employment and service system with the automatic expectation of public support and access to various services – this attitude would simultaneously cause a backlash among many case workers who interpret such expectations as an abuse of public services – a “scrounging” of public means. This results in mutual prejudices. Migrants experience unequal treatment and abuse of power from public service providers – who in reverse are confirmed in the preconception that people with other ethnic-cultural backgrounds parasite on society and abuse the basic values of the welfare state and system.

Thus, we create a vicious, downward spiral, which basically is more about poor integration than cultural differences.