Trapped in the labyrinth: The structural violence of disability support for people with chronic pain

This paper examines how systems of income support for Canadians living with chronic pain operate as forms of structural violence. Drawing on a secondary analysis of data from an institutional ethnographic study of chronic pain and marginalization, the paper traces the everyday “work” required to access and maintain Long-Term Disability and Workers’ Compensation benefits. Through analysis of 28 interviews with people who identified as both socioeconomically marginalized and living with chronic pain, we developed four themes: 1) the work of filling out forms; 2) misalignment between bureaucratic requirements and the ambiguity of chronic pain; 3) bureaucracy as harm and 4) long term disability and the retrenchment of poverty. Overall, participants’ accounts demonstrate that bureaucratic processes are labyrinthine, opaque, and frequently harmful – aggravating both physical pain and emotional distress. We show that claimants must continually prove their incapacity while navigating systems that presume claimant deceit, producing suffering that is embedded within institutional design rather than resulting from individual malice. The analysis demonstrates how the very processes intended to provide economic security instead deepen precarity and mistrust, forcing marginalized people with pain to perform narratives of deficiency to access insufficient support. Conceptually, the paper expands the application of structural violence to the chronic pain context, arguing that the bureaucratic management of disability-related income support constitutes a normalized form of harm that sustains social inequities. It portrays Canada’s income support systems as a labyrinth that traps people in poverty while demanding proof of worthiness for relief.