The Norwegian author and disability scholar Jan Grue once wrote — in words that can be paraphrased roughly like this — that disability itself is not necessarily tragic, but the world is often made tragic for disabled people. This idea captures something essential about the relationship between disability and mental health.
As psychologists, we are trained to look for explanations within the individual: symptoms, coping strategies, personality traits, or diagnoses. These perspectives are important. But when we talk about mental health in the disability community, something else deserves attention as well.
The effort required simply to navigate everyday life.
Globally, around one in six people live with significant disability. In the Nordic countries, the numbers are similar. At the same time, roughly one in six adults experience mental health difficulties at any given time. Yet surprisingly little attention is given to how these two realities are connected.
One concept that may help us understand this better is “invisible work,” a term introduced by Jan Grue.
Invisible work refers to the continuous and often unnoticed labour required for disabled people to function in environments that were not designed with them in mind. This work may involve planning transportation, coordinating assistance, navigating bureaucratic systems, adapting to inaccessible environments, or repeatedly explaining one’s needs to others.
Much of this work is cognitive and emotional in nature. It involves anticipating barriers, solving practical problems, negotiating support, and managing uncertainty. Because this labour largely happens behind the scenes, it often remains invisible to others.
Over time, this can have psychological consequences. Constant planning and vigilance may create chronic stress, while the need to anticipate barriers can lead to anxiety or fatigue.
Invisible work may also create what might be called identity strain. Disabled people often learn to present competence and independence to the outside world, while at the same time carrying a significant amount of internal labor — planning, coordinating, and managing risks. Balancing these two realities can create tension between the public and the private self and may gradually undermine confidence and make it harder to feel secure or at ease in everyday life.
For many people with Cerebral Palsy, this experience is familiar. Managing assistance systems, navigating physical environments, and balancing independence with necessary support all require time, energy, and emotional work.
Yet this effort is rarely acknowledged.
Recognising invisible work can therefore be an important step toward better understanding mental health within the CP community. Sometimes simply having language for an experience can help people make sense of their challenges and reduce feelings of personal inadequacy.
CP associations can play an important role by sharing knowledge about disability and mental health, developing accessible support resources, and encouraging research in this field.
Psychologists and other health professionals can also be important allies — but only if we are willing to question our assumptions. Too often psychological distress among disabled people is explained primarily by the disability itself.
In reality, the picture is often more complex.
Sometimes the problem is not the body — but the invisible work required to live in a world that was not built with that body in mind.
About the author
Sissel Garnes is a licensed psychologist based in Bergen, Norway. She works at the Educational and Psychological Counselling Service (PPT) and runs a private psychology practice. She has Cerebral Palsy, is a wheelchair user, and has long experience as a user of personal assistance schemes.
