Everyday Ethics of Dignity Work: What Social Workers Do to Promote the Dignity of Service-users in Times of Austerity Measures and Welfare Stigma

ABSTRACT

The social work profession is committed to recognising the inherent dignity of humanity, as reflected in global and national ethical codes. The article shows what this commitment implies as a part of everyday ethics by developing the concept ‘dignity work’. Dignity work is an ongoing effortful moral activity social workers perform to promote the dignity of service-users. Social workers’ narratives, collected with professionals in the Netherlands, revealed that they do this mainly to counter welfare stigma. Welfare stigma currently forms the biggest threat to dignity as it defines people dependent on welfare arrangements and professional help as ‘undeserving’, questioning their worth as a person. Social workers perform three strategies of dignity work: affirming, equalising and including. With these practices they negotiate the self-sufficiency norm, dominant in the Dutch context, and try to counter ideas and feelings of undeservingness and worthlessness of clients. Their practices lay bare the working of ‘stigma power’ as social workers have no choice but to relate to welfare stigma daily. The analysis shows that the ethical is intertwined with the political. Studying dignity work in the context of austerity and welfare stigma reveals that otherwise seemingly ordinary everyday acts are morally and politically significant.

KEYWORDS:

• Human dignity
• social work
• dignity work
• welfare stigma
• stigma power
• everyday ethics
• narrative analysis
• qualitative research

Introduction

Ethics is inherent to helping professions. Professionalism is distinct from bureaucracy and managerialism because of its commitment to the public good, making it a ‘secular calling’ or vocation, rooted in values such as health, education and justice (Freidson 2001). For social work ‘human dignity’ forms the foundation of ethical practice. Human dignity is also a guiding principle for professionals such as doctors¹ and nurses², but social work has specifically been defined as a ‘human rights profession’ (IFSW 1996, 2014; Healy 2008; Ornellas, Spolander, and Engelbrecht 2018). As dignity is the basis of the Universal Declaration of Human Rights (UDHR), with its first article famously stating that: ‘All human beings are born free and equal in dignity and rights’, social work’s commitment to dignity is apparent. This commitment is further substantiated by the central position of human dignity in the global and national ethical codes of social work. ‘Recognition of the inherent dignity of humanity’ is the first principle of the Global Social Work Statement of Ethical Principles (IFSW 2018). Dignity is also the first principle in the ethical codes of for example the UK, Sweden and The Netherlands, which often refer back to the UDHR.

The ‘textbook’ commitment to dignity, however, does not reveal much about an ‘everyday ethics’ (Banks 2016) of dignity in the context of social work practice. This article therefore develops the concept ‘dignity work’ and explores how this work is performed by professionals working with people with multiple-problems in the city of Utrecht, the Netherlands. The exploration of dignity work builds on Sarah Banks’ concept of ‘ethics work’. According to Banks (2016) social workers are moral agents that put effort into seeing ethically salient aspects of situations working out the right course of action in each circumstance. Ethics goes beyond individual rational decision-making and Banks states that it is therefore important to move away from a focus on general principles in ethics, such as human dignity, ‘to a view of ethics as embedded and embodied in everyday practice’ (36). To understand what a secular calling to human dignity looks like, an abstract notion of human dignity³ does indeed not suffice. There has been a move away from solely understanding ‘human dignity’ in terms of a universal principle expressing the inherent value of each person, to exploring ‘social dignity’ as the concept’s other side (Edlund et al. 2013; Killmister 2010; Pols 2013). This notion is crucial for investigating everyday ethics of dignity. Social dignity emerges in relational practices and can be lost or gained in interactions (Jacobson 2007; Kirchhoffer 2013; Leget 2013). This already implies that social dignity can be deliberately promoted.

Promotion of social dignity is best understood as a distinct, effortful activity which is most adequately captured by the concept dignity work (Schmidt, Trappenburg, and Tonkens 2021). Dignity work can be performed by individual and collective agents to promote either their own dignity or the dignity of others (Jacobson and Silva 2010). This article shows how social workers perform dignity work to counter stigmatisation of service-users. Promotion of social dignity in care and support for marginalised people is shaped by organisational and discursive constraints; social norms and organisational realities can hamper or further social dignity and shape the ways in which social workers perform their (dignity) work (Schmidt, Trappenburg, and Tonkens 2021). Today, austerity measures and welfare stigma shape that context (Banks 2011; 2014). Austerity measures and welfare stigma not only inform the conditions in which social workers do their job, but can affect the dignity of their clientele negatively as welfare stigma frames the service-user as ‘undeserving’ questioning their worth as a person (Tyler 2020). Therefore, in this article narratives about daily work practice that social workers put forward themselves as meaningful regarding dignity, are analysed and interpreted within the context of welfare stigma.

By focusing on the ways social workers try to promote the social dignity of service-users a tendency in the literature to understand social service providers as stigmatising agents is countered (see Jordan 2018; Schram et al. 2009). As Grainger (2021) points out, literature on stigma usually concerns the experience of service-users and the way professionals imposition stigma on them, not the ways in which social workers resist stigma for their clients. This article shows that social workers can even creatively draw on stigmatising norms to promote the dignity of their clients. However, this is not to imply that social workers cannot contribute to dignity violation of service-users. We have shown elsewhere that dignity violations indeed occur in social work practice in various ways, mostly despite good intentions (Schmidt et al. 2020). But the aim here is to demonstrate that it is worthwhile to understand social workers as moral agents that put effort into dignity work with no guarantee of success. In this way we take seriously the intentions, feelings and reflections of social workers and it becomes possible to understand otherwise seemingly mundane acts as significant in a context of austerity and welfare stigma. The research question is: How do social workers perform dignity work to counter stigmatisation of service-users?

Welfare stigma as a violation of dignity

Jensen and Tyler (2015) state that those who claim benefits and entitlements have become deeply stigmatised. Drawing on the historical article by Starkey (2000) they argue that ‘the welfare state was always a moral and disciplinary project, conditional upon certain kinds of behaviours and grounded in classificatory distinctions between ‘deserving’ and ‘undeserving’’ (471). Ever since austerity measures were implemented to counter rising costs in European welfare states, starting in the 1980s, welfare has become increasingly conditional. With welfare programs becoming more selective, there has been a move away from citizens’ rights towards citizens’ obligations with an emphasis on individual responsibility (Cox 1998; Dean 2015). Dependency was increasingly understood as deviant (Fraser and Gordon 1994) and it became a governmental goal to transform citizens from passive recipients of state assistance to active self-sustaining individuals (Clarke 2005). States declared that people should not only take greater responsibility for the management of their own well-being but also for the well-being of others in the family and community (Newman and Tonkens 2011). As Bredewold et al. (2018) show, in the Netherlands politicians argued that a too generous welfare state had undermined people’s ‘own strength’ [eigen kracht]. The notion of ‘self-sufficiency’ [zelfredzaamheid] became key, referring to being able to take care of yourself, providing and asking informal care if necessary. Self-sufficiency was clearly defined in terms of what it is not: making use of professional care and support. This specific form of independence was put forward as a necessary condition for a meaningful life (Grootegoed 2013). With self-sufficiency being the norm, service-users relying on welfare arrangements and professional support became increasingly stigmatised.

Scambler (2018) and Tyler (2020) argue that ‘welfare stigma’ serves a purpose: it legitimises austerity measures by framing service-users as unworthy of state support and thus extends the category of ‘undeserving’ persons to previously rights-bearing subjects. According to Tyler (2020), states cultivate stigma through the deployment of particular cultural figures, like the moral figure of the hard-working taxpayer opposite the abject figure of the welfare scrounger. This hardens the way people evaluate welfare and need and teaches them to feel revulsion for state dependency, even people who are dependent on welfare themselves, resulting in feelings of worthlessness. In defining service-users as undeserving and worthless, welfare stigma is an assault on human dignity, Tyler states. According to Margalit (1996) stigma is a fundamental violation of human dignity; an ‘injury to their very humanity’ (104). With this Margalit criticises Goffman, long seen as the authority in the field of stigma studies, for understanding stigma only as an injury to a person’s social identity. According to Margalit a violation of dignity means that someone is seen as ‘subhuman’ and is therefore excluded from the human community. This happens with stigma as the ascribed deviation from ‘the normal’ disqualifies its bearer from full participation in society, making them a ‘second-class citizen’ (168). In the Dutch context deviation from the self-sufficiency norm marks service-users as second-class citizens. In this way welfare stigma violates the dignity of service-users.

This article aims to show that dignity work is a useful specification of Banks (2016) concept of ethics work. Banks points out that the significance of her concept lies in its focus on social workers as moral agents in a ‘context of challengeable framings, norms, rules and policies about social justice, social responsibility and societal compassion’ (46). Ethics work emphasises the embeddedness of ethical issues but Banks does not yet show how ethics and context intertwine in social work practice. By empirically studying how professionals try to promote the social dignity of service-users in relation to the main threat to it: welfare stigma, it becomes tangible how everyday ethics is structured by political context. This is achieved by bringing a politicised understanding of stigma (Scambler 2018; Tyler and Slater 2018) into a study of social dignity; dignity as it emerges in practices and relations of care (Leget 2013). The analysis is sensitive to the workings of ‘stigma power’ (Link and Phelan 2001; Tyler 2020) in the daily activities of social workers by showing the ways in which they negotiate the self-sufficiency norm and try to counter ideas of undeservingness and worthlessness of their clients through their dignity work.

Methods

This article is part of a larger research project on experiences of dignity in the context of care and support for people with multiple problems in Utrecht, the Netherlands.⁴ In this article the Netherlands functions as a representative case (Gerring 2007) of the way European welfare states emphasise individual responsibility for well-being, leading to the stigmatisation of those on welfare, here specifically through the notion of self-sufficiency. Working from a constructivist grounded theory approach the aim was to get as close to empirical reality as possible (Charmaz 2009). Therefore, the study has an ethnographic design consisting of three phases: (1) participant-observation, (2) interviews, and (3) focus groups.

Data-collection took place from spring 2016 until the end of 2017. This article draws on the data collected with social workers who were approached through key informants at the municipality of Utrecht and at sites where participant-observation took place. Community center activities and locally organised events aimed at service-users were visited on 29 occasions. Additionally, participant-observation consisted of accompanying a social worker on the job on six occasions. 13 formal interviews with social workers were conducted which were taped and transcribed verbatim. Finally, a focus-group was held with social workers (n = 23). 24 social worker-respondents are female and 12 are male. Length of service ranged from just finishing an internship to having over 40 years of experience. Job roles varied extensively too, most importantly in terms of proximity to state policy. For the largest part, the social workers included in this research work at social care organisations that receive subsidy from the local government but whose connection to state policy is rather vague. Others work in generalist neighbourhood teams that have become the dominant way of organising social work in the Netherlands after the decentralisation of care to local governments, meaning that the organisation is closer to state policy but still operates independently from the local government. The focus group was held with the adult social care team from the municipal department of public health. These social workers are therefore closest to state policy with some of its members deciding on the distribution of resources.

In line with the constructivist grounded theory approach the study was inductive in nature with special attention for the way data and analysis are created from shared experiences and relationships with participants (Charmaz and Belgrave 2012). During data collection the research topic was made explicit and social workers were invited to reflect on issues of dignity in their work. No definition of dignity was given, the interview schedule focused on daily work experiences, dilemmas encountered and notions of when things go right. According to Banks (2016) giving an account of their practice in ethical terms is part of the ethics work social workers perform – presenting themselves as ‘doing ethics’. Therefore, the ways in which social workers constructed narratives regarding dignity towards the researcher or others present received special attention in the analysis; looking at their reasoning and the intentions they put forward as guiding their moral actions as well as their testimonies about their own moral emotions surrounding a particular situation. Data analysis took place during the same time as data collection, employing broad sensitising concepts like ‘dignity promotion’ (Bowen 2006). The coding process consisted of open and focused coding and was performed using Atlas.ti (Charmaz and Belgrave 2012). A range of activities social workers put forward as relevant in terms of dignity promotion were finally clustered in the three overarching strategies presented in this article.

Ethical issues

The current study was evaluated by Medical Ethical Review Committee Utrecht, who confirmed that the Dutch Medical Research Involving Human Subject Act (WMO) did not apply, as participants were not patients but mentally competent citizens, and participants were not subjected to treatment or required to follow a certain behavioural strategy as referred to in the WMO (art.1b). Subsequently, official approval of this study by the Medical Ethical Review Committee was not required (protocol:13-176/C).

The aims and procedure of the research were discussed with informants on site, informed consent was acquired verbally. No written consent forms were required according to Dutch regulation at the start of the project in 2016.⁵ In the case of formal interviews, the informants were given the opportunity of a ‘member check’, i.e. they received their interview transcript via email and could comment or make changes if desired. All data were anonymised to ensure confidentiality of the informants. Pseudonyms are used to refer to informants.

Results

Three verbs best express the work social workers do to promote the dignity of service-users: affirming, equalizing and including. As will become apparent these strategies are employed through various everyday activities that are part of social work. Instead of focusing on specific activities the data is analysed in terms of these three underlying aims with which for example a compliment is given, a certain type of care is provided, or a form of support is granted.

Three strategies of dignity work

Affirming

Affirming dignity work practices concern acts that attempt to make service-users feel better about themselves or their situation despite difficult circumstances. This dignity work strategy is performed by indirectly or directly addressing questions of deservingness and worthiness in interactions with service-users. During the focus group social workers reflect on the possibility to treat clients as a unique person to promote their dignity and what it is like when you feel you are not able to do so. Social worker Kate looks back on the time she worked handling requests for resources and often had to tell service-users ‘no’:

Kate: It depends on the context you’re working in, doesn’t it? When I work my consultation-hour at the homeless shelter I can imagine it [treating a person as a unique individual]. But the consultations I used to do, concerning housing, then I didn’t get any energy or satisfaction from rejecting people or putting them in the system. But I thought: okay, they have been rejected but they go home feeling that they were heard. Even if they didn’t get what they wanted … 

Colleague: But that’s your own feeling then?

Kate: It is. But what I’m talking about is: how do you keep going in this line of work? […] You have to reject people; I don’t enjoy that. But I do enjoy it when people would say: okay, I was rejected, but I really liked that you listened to me so well.

For social workers rejection of people asking for help can be a central part of the job. Kate shares that she does not like this and counters moments of rejection by affirming dignity work. When clients do not meet the conditions to get a certain form of aid, listening to them is a way to make them feel deserving of support despite this rejection and to make them leave their office as dignified as possible.

Social workers also perform more directly affirming practices in interactions with clients, regularly relating to the self-sufficiency norm. When accompanying social-worker Christa on a day of difficult home visits the mood significantly lightens on the way to the house of Sadi:

In the hallway Christa whispers: ‘I also have a gift for her, so that’s really nice, because she always works so hard and does everything herself.’ When we are seated at the kitchen table Christa enthusiastically hands Sadi an envelope: ‘Because you always work so hard.’ Sadi reacts surprised: ‘Wow, that’s lovely!’ The envelope holds a certificate for a visit to the hair salon. Later Christa asks how Sadi feels now about having to sell her house. She is in a debt restructuring scheme⁶ that requires her to do so.

Sadi: ‘Well emotionally … I’m not really happy with how things are going, actually I don’t like it.’

Christa: ‘But now it’s all properly sorted out and you don’t have to feel guilty about it. It’s a bunch of crooks at those banks. It’s not right that they’ve lent you money at such high interest, now is it? Moreover, they’ve seen your debt rise. Every bank has a social department.’ […] Sadi nods.

Christa: ‘So, you don’t have to feel guilty at all. You’ve done well. That’s why you’re allowed to keep your budget management. You work so hard and do everything yourself.’

After we leave Christa explains how ‘bad luck’ put Sadi in a situation of severe debt. She comments that ‘she’s such a wonderful woman, she works so hard’. Christa emphasises every chance she gets that Sadi, despite her debt and the help she receives for it, actually lives up to the norm of self-sufficiency by pointing out that she does everything herself. This affirming dignity work is further substantiated by the gift. When Sadi expresses negative feelings about her situation Christa actively counters these by stating that she does not need to feel guilty, referring to malicious banks and pointing out again Sadi’s self-sufficient behaviour.

Shima is part of a local care organisation that works mostly with local Moroccan and Turkish communities. She reflects on a conversation she had with one of her clients who felt sad and insecure and really needed to get a load off her mind. Shima shares:

What really touched me was that she … and this hurts me sometimes, that people feel like they aren’t allowed to ask any more questions and that they won’t get enough time. She kept apologizing: ‘Sorry, I just can’t do this right now’. She was so ashamed about feeling down and not being able to sort out practical matters. And then I told her: ‘We can all go through this in our lives, that you just can’t figure it out anymore. And then it’s nice when we help each other’. And that really made me think because I’ve had such clients before. Clients that really feel like they have to be able to do it all themselves. And if you can’t, then you should be ashamed. I really hate that.

In contrast to Christa, Shima affirms her client not by emphasising that she adheres to the norm of self-sufficiency but by challenging this norm. This might be related to the fact that self-sufficiency is an official part of the policy of the care organisation Christa works for whereas for Shima this is not the case. Shima tells her client she does not need to be ashamed for not being able to do things herself at this point in her life as this can happen to anyone.

 A third example in which the self-sufficiency norm is negotiated is by social-worker Fedoua who is just finishing her internship at a local care organisation that attends to people with a migration background. She explains that a lot of her (female) clients struggle with a sense of worthlessness:

I think that clients that have no support-network don’t feel dignified. That they think: I’m worthless. Nobody comes to see me, I’m not needed. That impacts your self-esteem. […] Despite having a family, they feel that way. […] So we sometimes try to build that self-esteem up again a little. […] By indicating that they have achieved a lot actually. That they have children, that their children do well in school, and that they are the kind of woman that does manage everything in the household. So, appreciate that, that you can do that.

Fedoua tries to boost the self-esteem of clients who do not feel like they have a meaningful role in society by emphasising that housekeeping and raising children are valuable. The self-sufficiency norm is not so much challenged but there is a shift in emphasis from something like paid work to household management in order for the client to be able to answer the norm and be proud of their accomplishments.

The affirming strategy is most commonly part of the interactions between social worker and service-user. It is done through small acts of attentiveness in otherwise technical conversations about distribution of resources where welfare stigma could easily be reproduced. It is also performed in giving compliments to service-users and countering negative ideas service-users have about themselves because of not adhering to the self-sufficiency norm. The social workers in this research negotiated feelings of guilt and shame regarding this norm to promote their clients’ dignity. In the process the norm itself can both be confirmed or challenged, dependent on context.

Equalising

In challenging the self-sufficiency norm and affirming her client Shima, discussed above, also engages in equalising dignity work. She does this by pointing out that not being able to manage life by yourself can happen to anyone and that it is therefore ‘nice when we help each other’. This choice of words is striking, as is Shima’s indignation about the shame imposed on people who cannot fully manage on their own. She relates this to her own experiences:

If I look at myself in that period of my life, that I had the feeling that I just couldn’t make anything work, I was lucky that I had someone that told me: ‘that’s okay for now’.

Equalising dignity work practices concern acts that attempt to make the relationship between social worker and service-user more equal despite its inherent inequality; in terms of resources, power and knowledge and the mere fact of having a help-seeking and help-providing party. This strategy of dignity work is engaged in as an antidote to the shame invoked by the stigma of being dependent on welfare and not living up to the self-sufficiency norm. By pointing out that service-user and social worker are not so different, social workers normalise the client’s position to alleviate shame.

Experienced social worker Paul who is head of a local care organisation, reflects on working with a Moroccan family with a severely disabled son that they want to keep at home. He talks about the period he first started working with them when his role was to just ‘bear witness’.

The first time I went to see them, I wasn’t really allowed to ask questions. Bearing witness for me meant that I shouldn’t say anything, just do things for them. And in some way that stands for: I have to accept you, without any inhibitions. […] No, I won’t reject you, I won’t. I won’t say that you're a bad Muslim, or Moroccan person, or bad as a family that makes the choice to keep the boy at home. Everybody wanted the boy to go to an institution […]. They said we won’t. And there were many reasons to do it, and I had to let go of all those reasons myself too […]. I had to bear witness to the family. They were having a really hard time; they are having a really hard time.

Social workers point out that service-users often have many negative experiences regarding trust in others, in the context of care and support and beyond. Paul emphasises that this family had encountered ongoing negative judgements and he had to counter this by just doing things for them. Offering hands-on help first is a part of equalising dignity work that was mentioned by many social workers. This work can be understood as creating a safe space where the client is not questioned in terms of deservingness, and conditionality is kept at bay as a way to ward off stigma and shame. The social worker demonstrates to the service-user that they are committed to being helpful and supportive first and foremost so that trust can be established.

Social worker Najia, who works at a local care organisation, provides an explicit critique of the self-sufficiency norm as threatening equality in the relationship between social worker and service-user as it evokes judgement and creates distance.

Especially because that whole turn happened where people need to rely on their ‘own strength’ [eigen kracht]. There’s way more of this now; informal networks, people have to do things independently, a lot is being asked of citizens. […] The trick is to do it with the attitude: someone needs to be self-sufficient eventually, has to get out of their problems eventually. […] But the starting point is, for me at least […]: the human that has problems, you sit next to them. […] Only later you move forward. And not: sit on opposite sides with the idea: ‘what can you do and what do you need?’ No, you have to sit next to them, say: ‘I see, you are in this situation, gee that’s tough. How are we going to get out of this?’

Najia advocates an approach where social worker and service-user work on problems together, especially at the beginning, instead of focusing on what clients can do themselves so that critical questions can be avoided and a safe space is offered. Najia sees self-sufficiency as a long-term goal that follows after a period of support, it is not a place from which to start a relationship with a client.

As solving acute problems for and building trust with clients may take time, equalising dignity work often requires patience and investment in long-term relationships. Social workers point out that showing a bit of themselves to their clients is often part of this endeavour. Social worker Victor reflects on his work at a community center:

They [service-users] also ask how I’m doing, how my holidays have been. I find that very sweet. I shouldn’t cut out those questions, I have to do something with them. I try to tell something about myself in an appropriate way when they ask. […] It’s also about equality. I try to show a bit of myself to the extent that they are interested. I don’t shield that off too much. Because it’s about reciprocity, trust, friendliness; about the bond from which other things can happen.

By sharing about themselves social workers show that they and the service-user are not that different and build trust.

The equalising strategy is performed to alleviate shame stemming from stigmatisation service-users encounter, by creating a non-judgmental space where deservingness is not questioned, and need does not have to be proven. Social workers try to show that their help is (at first) unconditional and the relationship is equal, while both are never fully the case. This is done in interactions by emphasising sameness and togetherness and by acts like providing hands-on help instead of asking critical questions. Equalising dignity work is often a long-term effort geared at building trust. In this way equalising practices can also be a prerequisite for successful affirming and including dignity work, especially when norms are challenged and therefore normalising the clients’ ‘deviant’ position is required.

Including

Including dignity work practices concern acts that counter experiences of exclusion caused by stigma. Community building efforts are one way in which this is attempted by social workers. Victor builds on equalising practices at the community center to help people extend their activities and networks. Victor’s relationship with John, a regular at the community center, is a good example of this.

John came here through Petey, he had few social contacts, was very shy, kept a low profile. Now he does all sorts of things. He said himself: ‘sometimes I can’t believe it’. He does jobs for people, bartends at the community center […] in his old neighbourhood. Reconnected with old friends. While he used to live as a hermit for years after his business went bankrupt and his relationship ended, debts. […] Those are the things … I love seeing that.

Many of the problems that service-users encounter, including stigma and shame, may lead to social isolation. This is an issue that social workers often cannot solve directly, but in this case Victor’s including practices seem to be a successful contribution to John’s inclusion. Victor later reflects: ‘What’s my goal? That a number of people generate positive dignity here’.

However, most including dignity work to counter stigma is performed through forms of direct advocacy. Aya, who works for a local neighbourhood team tells the story of her client Mohammed who was in a debt restructuring scheme but had a conflict with his debt administrator. Aya explains that the administrator tried to kick Mohammed out of the arrangement, which Aya tried to prevent.

He felt depressed, even told me at some point: ‘I might as well end my life because this woman is driving me crazy.’ I told him: ‘you can’t do that. Don’t let it get to you. You really need us right now. We will fight for you so that you won’t be kicked out.’ […] We had a conversation in court, we had to work on a few things. And we did. It was two months before the end of his trajectory. If they would terminate it, it would be so unfortunate. Because Mohammed did accurately take care of his administration, there were never any deficits. […] We also help him answer the questions of the debt administrator, these were very difficult. This man really didn’t understand. […] We went to court again, last Friday. We won. The judge didn’t terminate the arrangement. I’ve argued in court that Mohammed is really looking for help. That he isn’t just letting it all slide […] I feel that a person who looks for help and really tries to commit to the trajectory should be rewarded. You cannot terminate an arrangement because somebody doesn’t understand things.

This is an example of how social workers ‘fight’ for their clients. Direct advocacy is needed according to social workers because others stigmatise service-users as undeserving and unworthy of support. Aya counters the imminent exclusion of Mohammed from debt restructuring by keeping his spirits up, accompanying him to court and testifying on his behalf. She uses the self-sufficiency norm to plead Mohammed’s case by stating that he is putting in the required effort and that insufficiencies are due to misunderstandings. Aya tells this story with pride, happy to have proven that Mohammed deserves support.

Including dignity work is performed by accompanying clients and acting on their behalf to care and support organisations where they are not taken seriously or listened to. Paul elaborates on how he does this for the Moroccan family with a severely disabled son discussed earlier.

I often had to accompany them to doctors, to the hospital, to the Social Insurance Bank […]. To explain their situation. And to explain to those organizations: ‘the procedures you are using are usually correct, but they also systematically exclude these people’. That requires continuously pointing out to others how such a family is pushed to the margins. […] When he [brother of the disabled son] calls the care administration office they give him a runaround. I’m sitting next to him. When I call later and have the same conversation, they give an answer. […] He feels it and says: ‘why don’t they tell me that?’

Paul expresses indignance about how this family was denied proper care because they wanted something else for their son than was recommended. Paul explains that the family’s right to support was previously set too low and due to his efforts, they get more help now. Paul relates the way the brother is treated on the phone to his foreign accent. Others also point out that especially people with a migrant background are often excluded from receiving help.

By continuing to provide help for service-users and improve their situation despite the odds stacked against them, social workers perform including dignity work. In the focus group with the municipal social care team, senior member Nicky brings in the case of a particularly difficult client of hers. The woman struggles with severe addiction and health problems but (sexually) harasses social workers who come to see her. Nicky is the only one who still helps her.

Colleague 1: From the rest of the world, I get from the story, she is banned. Everybody avoids her. The approach is patching up and keeping it together. Believing in the good in people. Actually, Nicky is upholding the dignity of the person. […]

Colleague 2: May I ask, patching up and keeping it together, what is dignified about that? […]

Nicky: The professional care that is in place for her, you can’t put her there. If you could get her clean, stop drinking, you would maybe get somewhere. But that’s not going to happen. Therefore, you just try to keep it bearable.

While this example goes beyond dignity work to counter stigmatisation it is interesting how Nicky explains her actions to her co-workers in terms of dignity. Later Nicky says that if she would also give up on her client, she would ‘disappear’. Nicky finds it difficult to take her client to places like the hospital because her behaviour is embarrassing, but she maintains that somebody has to do it as the client is still human and needs care.

The including strategy is about trying to establish that the service-user is not alone and that they are indeed deserving and worthy of attention and support. This is performed by trying to further social ties but most importantly through demonstrating solidarity with the service-user by forms of direct advocacy. Direct advocacy is needed in cases where others, often specific (representatives of) care organisations, question deservingness and worthiness or bluntly do not take a service-user seriously at all. Finally, including dignity work is performed in continuing to provide support for someone who demonstrates challenging behaviour, especially when no one else will. As exclusion is a main characteristic of stigmatisation is it no surprise that acts of inclusion are an important part of dignity work.

Discussion

Dignity work is an ongoing moral activity social workers perform to counter the welfare stigma their clients face through affirming, equalising and including practices. The affirming strategy is most commonly part of the interactions between social workers and service-users. Social workers try to affirm the deservingness and worth of their clients by listening to them and negotiating negative ideas and feelings service-users have due to not living up to the self-sufficiency norm. In this process this norm can be confirmed or challenged. This demonstrates the workings of stigma power (Link and Phelan 2001; Tyler 2020); it reveals that in daily practice social workers often relate to the self-sufficiency norm even if they can be creative in doing so. To challenge the self-sufficiency norm social workers employ the second dignity work strategy: equalising. Deviance from the norm has to be normalised by social workers showing that service-user and social worker are not so different from each other, as the social worker might not be self-sufficient at times either. Equalising dignity work is performed to alleviate shame stemming from welfare stigma.

Social workers perform equalising work by suggesting that their help is unconditional and the relationship is equal through interactions emphasising sameness and togetherness and by acts like providing hands-on help without having to prove need first. With this they offer a safe space for the service-user where deservingness is not questioned and trust can be built.

Including is the final strategy and consists of community building and forms of direct advocacy to counter experiences of exclusion caused by stigma. In this way social workers establish that the service-user is not alone and that they are indeed deserving and worthy of attention and support, even if others, often specific (representatives of) care organisations, question this or do not offer support at all.

The elaboration of dignity work presented here is a useful specification of Banks (2016) concept of ethics work. Ethics work asserts the embeddedness of ethical issues in a socio-political context for social work. This article shows what this looks like on the job. By analysing the narratives of social workers about dignity from a politicised understanding of stigma (Scambler 2018; Tyler and Slater 2018) it becomes apparent that the ethical is intertwined with the political (Mattingly 2014). Social workers daily engage with the current context of welfare stigma in their work as they continuously negotiate the norm of self-sufficiency and ideas about the deservingness and worthiness of their clients. Sometimes their activities become more overtly political, as with forms of direct advocacy, at other times the political significance is more covert, for example when providing hands-on help in the context of welfare stigma. The political nature of micro practices of social work is relevant in relation to the call for more political social work that deals with structural roots of social problems on the macro-level (Dominelli 2002; Ferguson 2008).

Dignity work reveals what the abstract commitment to human dignity looks like for social work in terms of everyday ethics by understanding how social dignity emerges in interactions between social workers and clients. The picture painted here could seem like a modest achievement; one might hope that recognising ‘the inherent dignity of humanity’ would entail more than warding off stigma and shame for service-users. This study demonstrates however, that stigma power is so pervasive that affirming, equalising and including practices to counter stigma are necessary first steps in upholding dignity for clients. Only from that point can dignity work be extended to practices that further service users’ quality of life more substantially, such as ‘empowerment and liberation’ (IFSW 2014). The fundamental engagement with welfare stigma distinguishes social work from other helping professions. While doctors and nurses might encounter stigmatised people in their work it is not an equally inherent part of the job as it is for social workers.

The dignity work social workers perform to counter stigma therefore deserves more public recognition. These activities are easily overlooked as they happen before any measurable progress can be made and are difficult to grasp in terms of evidence-based practice. Dignity work instead, is part of intuitive knowledge. Intuitive knowledge is often not discussed because the frameworks to do so are lacking but at the same time intuitive knowledge forms a large and important component of the knowledge professionals use (Fook 2002). Accounts of ethics work are not intended to provide a normative ethical framework but serve as an analytical description of the ethical dimension of social work (Banks 2016). The dignity work strategies presented in this article could be used by social workers and in social work education to reflect on what they intuitively do to promote the dignity of clients and to possibly employ the strategies in a more focused way.

The Netherlands is a representative case (Gerring 2007) of the way European welfare states have moved towards individual responsibility, leading to stigmatisation of those on welfare. It is therefore likely that social workers in other countries also employ the dignity work strategies found in Dutch social workers. A limitation of this study is that the sample did not allow for a thorough comparison of dignity work in different organisational settings.⁷ Methodologically this research showed that in social workers’ narratives on dignity their own moral emotions can signal dignity work. They describe negative feelings like anger about their clients facing injustice in relation to which their dignity work follows, and recount positive feelings like pride when they experienced their dignity work to be successful. It can be recommended to study social workers presenting themselves as ‘doing ethics’ (Banks 2016) through a mixed-method approach consisting of observations, interviews and focus-groups. In this way the presentation of the moral self, including the display of moral emotions, can be studied as it is performed towards clients, colleagues and researchers. This approach could result in an in-depth understanding of dignity work for various helping professions. For different contexts of care dignity violating elements other than welfare stigma could be identified in relation to which dignity work can be studied.

This article shows that a commitment to dignity in times of austerity measures and welfare stigma means that social workers put ongoing efforts into managing these threats as much as they can, making situations as dignified as possible for their clients. This hard work largely goes unnoticed and this article hopes to contribute to its recognition.

Acknowledgements

First and foremost I want to thank the social workers who shared their stories as part of this study. I would also like to thank the research team: Carlo Leget and Alistair Niemeijer for their ideas and for gaining the funding that made this research possible in the first place, and my supervisors Evelien Tonkens and Margo Trappenburg for their insights and support throughout the research and writing process. Finally, I want to thank Molly Fitzpatrick, Melissa Sebrechts and Simon van der Weele for the inspiration and the useful comments they offered me while writing this article.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by ZonMw under Grant 70-73000-98-096.

Notes on contributors

Jante Schmidt

Jante Schmidt’s PhD research focusses on experiences of (in)dignity in the context of care and support for people with multiple-problems. The project was conducted at the University for Humanistic studies in Utrecht, the Netherlands. For this project, Schmidt looked at ways in which a highly moral concept such as human dignity can be approached from a sociological perspective. As such, she is interested in how micro-level interactions and macro-level structures together inform experiences of (in)dignity. Schmidt has dedicated time to translating the findings of this research project to a wider audience through the means of a research report (in Dutch), an animated video (see: https://www.youtube.com/watch?v=GxPVYj8o1Fk), and presentations for people from the social work field. Currently, Schmidt is affiliated with VU Amsterdam as a postdoc researcher looking at relational care in nursing homes and assessing the role of emotions, morality and dignity therein.

Notes

1 See: European Council of Medical Orders. Principles of European Medical Ethics (1987)

2 See: International Council of Nurses. Code of Ethics for Nurses (2013)

3 ‘Human dignity’ has also been criticized for being too vague to be of use (Leget 2013), most famously by Macklin (2003).

4 The project was conducted in collaboration with the municipality of Utrecht, see Schmidt et al. 2020 for further project description. The research team consisted of the author, Alistair Niemeijer, Carlo Leget, Evelien Tonkens and Margo Trappenburg.

5 The Netherlands Code of Conduct for Academic Practice (2014) (https://www.vsnu.nl/wetenschappelijke_integriteit.html)

6 In the Netherlands the Debt Rescheduling for Natural Persons Act (Wet schuldsanering natuurlijke personen) regulates debt restructuring for individuals under the Dutch law, to have a right to such an arrangement certain conditions need to be met.

7 See Hill and Laredo (2020) for a comparative case study of a statutory and a voluntary social work agency in England.