Lecture 3: Lecture 3 The Sick Role The Sick Role: The Sick Role Most associated with American sociologist Talcott Parsons (1902-1979)
Structural functionalist approach: social practices are seen in terms of their function in maintaining order or structure in society.
Parsons was concerned with understanding how the sick person related to the whole social system, and what the person's function is in that system.
The sick role and sick-role behavior could be seen as the logical extension of illness behavior to complete integration into the medical care system. Parsons (1951) on illness: Parsons (1951) on illness ...illness is a state of disturbance in the "normal" functioning of the total human individual, including both the state of the organism as a biological system and of his personal and social adjustments. It is thus partly biologically and partly socially defined. Participation in the social system is always potentially relevant to the state of illness, to its etiology and to the conditions of successful therapy, as well as to other things. Parsons (1951) on the sick role: Parsons (1951) on the sick role ...for common sense there may be some question of whether "being sick" constitutes a social role at all - isn't it simply a state of fact, a "condition"? ...The test is the existence of a set of institutionalised expectations and the corresponding sentiments and sanctions. Roles Rights and Obligations: Roles Rights and Obligations Sociologists conceptualize social roles as the expected behaviors (including rights and obligations) of someone with a given position (status) in society.
Generally, people hold a status (position) and perform a role (behaviors).
Parsons (1951) utilized these concepts to construct a theoretical view of individuals who are sick, hence the “sick role.” This theory outlines two rights and two obligations of individuals who become sick in our society Sick Role Rights: Sick Role Rights The sick person is exempt from “normal” social roles. An individual’s illness is grounds for his or her exemption from normal role performance and social responsibilities.
This exemption, however, is relative to the nature and severity of the illness. The more severe the illness, the greater the exemption.
Exemption requires legitimation by the physician as the authority on what constitutes sickness.
Legitimation serves the social function of protecting society against malingering (attempting to remain in the sick role longer than social expectations allow – usually done to acquire secondary gains, or additional privileges afforded to ill persons). Sick Role Rights: Sick Role Rights The sick person is not responsible for his or her condition.
An individual’s illness is usually thought to be beyond his or her own control.
A morbid condition of the body needs to be changed and some curative process apart from personal will power or motivation is needed to get well. Sick Role Obligations: Sick Role Obligations The sick person should try to get well.
The first two aspects of the sick role are conditional upon the third aspect, which is recognition by the sick person that being sick is undesirable.
Exemption from normal responsibilities is temporary and conditional upon the desire to regain normal health. Sick Role Obligations: Sick Role Obligations The sick person should seek technically competent help and cooperate with the physician.
The obligation to get well involves a further obligation on the part of the sick person to seek technically competent help, usually from a physician.
The sick person is also expected to cooperate with the physician in the process of trying to get well.
Sickness as a ‘moral’ state: Sickness as a ‘moral’ state “By institutional definition of the sick role the sick person is helpless and therefore in need of help. If being sick is to be regarded as "deviant" as certainly in important respects it must, it is as we have noted distinguished from other deviant roles precisely by the fact that the sick person is not regarded as "responsible" for his condition, "he can't help it."
Parsons (1951) The problem of being ‘sick’: The problem of being ‘sick’ Freud's concepts of transference and counter-transference led Parsons to see the doctor/patient relationship as analogous to that of the parent and child.
The sick person has conflicting drives both to recover from the illness and to continue to enjoy the 'secondary gains' of attention and exemption from normal duties stems from a Freudian model of the structure of the personality. Parsons on the doctor/patient relationship: Parsons on the doctor/patient relationship The D/P relationship is seen as a cooperative one.
As Parsons says
It is here, of course, that the role of the sick person as patient becomes articulated with that of the physician in a complementary role structure" (Parsons, 1951) Characteristics of the Doctor Patient Relationship: Characteristics of the Doctor Patient Relationship Affective neutrality (getting well is expected irrespective of feelings)
Universalism (common criteria are used to diagnose everyone )
Functional specificity (contact with doctors etc. is strictly confined to health matters)
Orientation to collective norms
Both doctor and patient should be committed to breaking up their relationship The Doctor’s Role: The Doctor’s Role To act only in the best interests of the patient,
To apply the highest standards of scientific knowledge and technical competence.
In return for which they are granted: unlimited access to the patient’s body and biography and an ‘exclusiveness of trust’ Problems with the ‘sick role: Problems with the ‘sick role The nature of medical authority
Weber identified three types of authority:
Individual doctors may have any or all of these types of authority in some situations. However it is assumed that their credibility as a profession is based on their patients accepting their rational/legal authority in making diagnoses, prescribing treatment etc.
Failure to comply may lead to diagnoses that transform sickness into stigmatised forms of madness or badness
What happens when a patients lose faith in physicians? Problems with the ‘sick’ role: Problems with the ‘sick’ role Easy to violate the “ability to get well” for a number of conditions (particularly chronic illnesses).
Individuals or groups may not possess the resources to “seek technically competent help” or to “cooperate with the physician” based upon health insurance, income, role conflicts to compliance (e.g. Jehovah’s Witnesses), etc.;
Certain illnesses may reflect an element of personal “blame” due to unhealthy lifestyle choices (i.e. smoking leads to emphysema)
Potential inability to be “exempt from normal social roles” due to issues of status (i.e. parent), income (need to work), gender, age, etc. Universalism: Universalism Variation in treatment of patients by social class (Buchanan & Richardson, 1973)
Social Class I 6.1 minutes/consultation
Social Class V 4.4 minutes/consultation
Middle Class patients more likely to get an explanation than working class ones
Differential explanations of certain illnesses depending upon gender and status
Moral character of patient (Sudnow, 1967) Problems with the ‘sick’ role: Problems with the ‘sick’ role Highly ‘normative’ ignoring the wide variation of illness and help seeking behaviours
Very much a sociology of the illness behaviour of the relatively affluent
Accepts the legitimacy of medical authority almost without question
Doesn’t address questions of power or conflict in the doctor/patient relationship (e.g. ‘malingering’ as a rational choice, pressure on doctors from state or employer) The ‘sick’ role and the ‘patient’ role: The ‘sick’ role and the ‘patient’ role Parson’s formulation concerns the patient not necessarily the sick person
Going to see the doctor is part of a complex process of ‘help-seeking’ behaviour
Undiagnosed incidence of many illnesses
Ideal patients and ideal doctors
Varying ‘legitimacies’ attached to certain medicalised conditions (e.g. aging, diabetes, pregnancy) ‘Deviant sickness’: ‘Deviant sickness’ Merton (1957) illness can be used as a permanent orientation to the social order in societies where emphasis is placed on material gain and worldly success (e.g. Drug addiction)
Pilowski (1978) ‘abnormal illness behaviours’ conflict between diagnosis and patient behaviour (e.g. Munchausen’s syndrome) Normal and abnormal illness: Normal and abnormal illness Doctor’s perception of illness
- + Munchausen’s
Syndrome Normal Sick Role Normal Health Role Flight into health
- of illness
Importance of sick role: Importance of sick role Demonstrates the way in which secular medical practice as social control has replaced ritual forms of social re-integration of the deviant
Illustrates the implicit conflict between individual and society characteristic of Western capitalist societies
Draws attention to the stigmatising consequences of illness in those societies