Sick role: Difference between revisions

Content deleted Content added

Inline

Latest revision as of 14:32, 12 September 2023

Sick role is a term used in medical sociology regarding sickness and the rights and obligations of the affected.^[1] It is a concept created by American sociologist Talcott Parsons in 1951.^[2] The sick role fell out of favour in the 1990s replaced by social constructist theories.^[3]

Concept

Parsons was a functionalist sociologist, who argued that being sick means that the sufferer enters a role of 'sanctioned deviance'. This is because, from a functionalist perspective, a sick individual is not a productive member of society. The patterns of sickness are often caused by persistent pain which helps to support their attitude of not wanting to take positive action to get better.^[4]^[5] Therefore this deviance needs to be policed, which is the role of the medical profession. Generally, Parsons argued that the best way to understand illness sociologically is to view it as a form of deviance which disturbs the social function of the society.

The general idea is that the individual who has fallen ill is not only physically sick, but now adheres to the specifically patterned social role of being sick. ‘Being Sick’ is not simply a ‘state of fact’ or ‘condition’, it contains within itself customary rights and obligations based on the social norms that surround it. The theory outlined three rights of a sick person and two obligations:

Rights:
- The sick person is exempt from normal social roles
- The sick person is not responsible for their condition
Obligations:
- The sick person should try to get well
- The sick person should seek technically competent help and cooperate with the medical professional(s) ^[6]

There are three versions of sick role:

Conditional, wherein both rights and duties apply
Unconditionally legitimate - wherein obligations may not apply (the terminally ill are not obligated to try to get well)
Illegitimate role: condition that is stigmatized by others (wherein rights do not apply as the sick person is blamed for their condition)^[6]

Criticisms

Critics of Parsons and the functionalist perspective point to different flaws they see with his argument. The model assumes that the individual voluntarily accepts the sick role, and ignores that the individual may not comply with expectations of the sick role, may not give up social obligations, may resist dependency, and may avoid the public sick role, particularly if their illness is stigmatized. The model also blames the sick, where “rights” do not always apply.

The sick role fell out of favour in the 1990s, with alternatives conceptualisations in terms of labeling theory viewing illness as a social construction to label socially deviant as inferior, with the medical system and physicians used as a means of control. Burnham argues that this rejection was combined with an explicit or implicit rejection of the idea unconscious (replaced with cognitive-behavioral theories) together with an explicit or implicit adoption of a Marxist perspective that disease was caused by economic circumstances.^[3]^: 76

References

^ Millon, Theodore; Paul H. Blaney; Roger D. Davis (1999). Oxford Textbook of Psychopathology. Oxford University Press US. pp. 446. ISBN 978-0-19-510307-6.
^ Parsons, Talcott (1951). The Social System. Glencoe, IL: The Free Press.
^ ^a ^b Burnham, John C. (2014-02-01). "Why sociologists abandoned the sick role concept". History of the Human Sciences. 27 (1): 70–87. doi:10.1177/0952695113507572. ISSN 0952-6951. S2CID 145639676.
^ Liebenson, Craig, Rehabilitation of the Spine: A Patient-Centered Approach, 3rd Edition, Copyright (c) 2020 Lippincott Williams & Wilkins.
^ Main CJ, Watson PJ. Psychological aspects of pain. Man Ther. 1999;4:203-215
^ ^a ^b Clarke, Juanne Nancarrow (2008). Health, Illness, and Medicine in Canada (5th ed.). Oxford University Press. p. 7. ISBN 9780195428421.

[1] Millon, Theodore; Paul H. Blaney; Roger D. Davis (1999). Oxford Textbook of Psychopathology. Oxford University Press US. pp. 446. ISBN 978-0-19-510307-6.

[Parsons_(1951)-2] Parsons, Talcott (1951). The Social System. Glencoe, IL: The Free Press.

[:2-3] Burnham, John C. (2014-02-01). "Why sociologists abandoned the sick role concept". History of the Human Sciences. 27 (1): 70–87. doi:10.1177/0952695113507572. ISSN 0952-6951. S2CID 145639676.

[4] Liebenson, Craig, Rehabilitation of the Spine: A Patient-Centered Approach, 3rd Edition, Copyright (c) 2020 Lippincott Williams & Wilkins.

[5] Main CJ, Watson PJ. Psychological aspects of pain. Man Ther. 1999;4:203-215

[Clarke-6] Clarke, Juanne Nancarrow (2008). Health, Illness, and Medicine in Canada (5th ed.). Oxford University Press. p. 7. ISBN 9780195428421.

[1]

[2]

[3]

[4]

[5]

[6]

@@ Line 1: / Line 1: @@
+{{Medical sociology sidebar}}
-'''Sick role''' is a term used in [[medical sociology]] regarding sickness and the rights and obligations of the affected.<ref>{{cite book|last=Millon|first=Theodore|author2=Paul H. Blaney|author3=Roger D. Davis|title=Oxford Textbook of Psychopathology|publisher=Oxford University Press US|year=1999|pages=[https://archive.org/details/oxfordtextbookof0000unse_a1c5/page/446 446]|isbn=978-0-19-510307-6|url-access=registration|url=https://archive.org/details/oxfordtextbookof0000unse_a1c5/page/446}}</ref> It is a concept created by American [[Sociology|sociologist]] [[Talcott Parsons]] in 1951.<ref name="Parsons (1951)">{{cite book|last1=Parsons|first1=Talcott|title=The Social System|url=https://archive.org/details/socialsystem00pars|date=1951|publisher=The Free Press|location=Glencoe, IL}}</ref>
+'''Sick role''' is a term used in [[medical sociology]] regarding sickness and the rights and obligations of the affected.<ref>{{cite book|last=Millon|first=Theodore|author2=Paul H. Blaney|author3=Roger D. Davis|title=Oxford Textbook of Psychopathology|publisher=Oxford University Press US|year=1999|pages=[https://archive.org/details/oxfordtextbookof0000unse_a1c5/page/446 446]|isbn=978-0-19-510307-6|url-access=registration|url=https://archive.org/details/oxfordtextbookof0000unse_a1c5/page/446}}</ref> It is a concept created by American [[Sociology|sociologist]] [[Talcott Parsons]] in 1951.<ref name="Parsons (1951)">{{cite book|last1=Parsons|first1=Talcott|title=The Social System|url=https://archive.org/details/socialsystem00pars|date=1951|publisher=The Free Press|location=Glencoe, IL}}</ref> The sick role fell out of favour in the 1990s replaced by [[Social model of disability|social constructist]] theories.<ref name=":2">{{Cite journal|last=Burnham|first=John C.|date=2014-02-01|title=Why sociologists abandoned the sick role concept|url=https://doi.org/10.1177/0952695113507572|journal=History of the Human Sciences|language=en|volume=27|issue=1|pages=70–87|doi=10.1177/0952695113507572|issn=0952-6951|s2cid=145639676}}</ref>
 ==Concept==
-Parsons was a [[Functionalism (sociology)|functionalist sociologist]], who argued that being sick means that the sufferer enters a role of 'sanctioned deviance'. This is because, from a functionalist perspective, a sick individual is not a productive member of society. Therefore this deviance needs to be policed, which is the role of the medical profession. Generally, Parsons argued that the best way to understand illness sociologically is to view it as a form of deviance which disturbs the social function of the society.
+Parsons was a [[Functionalism (sociology)|functionalist sociologist]], who argued that being sick means that the sufferer enters a role of 'sanctioned deviance'. This is because, from a functionalist perspective, a sick individual is not a productive member of society. The patterns of sickness are often caused by persistent pain which helps to support their attitude of not wanting to take positive action to get better.<ref>Liebenson, Craig, Rehabilitation of the Spine: A Patient-Centered Approach, 3rd Edition, Copyright (c) 2020 Lippincott Williams & Wilkins.</ref><ref>Main CJ, Watson PJ. Psychological aspects of pain. Man Ther. 1999;4:203-215</ref> Therefore this deviance needs to be policed, which is the role of the medical profession. Generally, Parsons argued that the best way to understand illness sociologically is to view it as a form of deviance which disturbs the social function of the society.
 The general idea is that the individual who has fallen ill is not only physically sick, but now adheres to the specifically patterned social role of being sick. ‘Being Sick’ is not simply a ‘state of fact’ or ‘condition’, it contains within itself customary rights and obligations based on the social norms that surround it. The theory outlined three rights of a sick person and two obligations:
@@ Line 9: / Line 11: @@
 ** The sick person is exempt from normal social roles
 ** The sick person is not responsible for their condition
-**has right to be taken care of
 *Obligations:
 ** The sick person should try to get well
-** The sick person should seek technically competent help and cooperate with the medical professional
+** The sick person should seek technically competent help and cooperate with the medical professional(s) <ref name = Clarke>{{cite book |last=Clarke |first=Juanne Nancarrow |title=Health, Illness, and Medicine in Canada |edition=5th |page=7 |publisher=Oxford University Press |year=2008 |isbn=9780195428421}}</ref>
 There are three versions of sick role:
-# Conditional
+# Conditional, wherein both rights and duties apply
-# Unconditionally legitimate
+# Unconditionally legitimate - wherein obligations may not apply (the terminally ill are not obligated to try to get well)
-# Illegitimate role: condition that is stigmatized by others
+# Illegitimate role: condition that is stigmatized by others (wherein rights do not apply as the sick person is blamed for their condition)<ref name = Clarke/>
 ==Criticisms==
+Critics of Parsons and the functionalist perspective point to different flaws they see with his argument. The model assumes that the individual voluntarily accepts the sick role, and ignores that the individual may not comply with expectations of the sick role, may not give up social obligations, may resist dependency, and may avoid the public sick role, particularly if their illness is stigmatized. The model also blames the sick, where “rights” do not always apply.
+The sick role fell out of favour in the 1990s, with alternatives conceptualisations in terms of [[labeling theory]] viewing illness as a [[Social model of disability|social construction]] to label socially [[Deviance (sociology)|deviant]] as inferior, with the medical system and physicians used as a means of control. Burnham argues that this rejection was combined with an explicit or implicit rejection of the idea [[Unconscious mind|unconscious]] (replaced with [[Cognitive behavioral therapy|cognitive-behavioral]] theories) together with an explicit or implicit adoption of a Marxist perspective that disease was caused by economic circumstances.<ref name=":2" />{{Rp|page=76}}
-'''Marxist criticisms'''
-Some of the main critics of the biomedical model of health and Parsons’ theory of the sick role are
-those of a Marxist persuasion. Far from seeing the medical establishment as a vital and consensual
-set of institutions which are there to benefit everyone equally, the Marxists often argue that
-increasing ‘medicalisation’ has had damaging effects and is driven by profit rather than the health of
-the population.
-McKeown (1973) argued that the huge rises in life expectancy during the 20th century were not
-driven by medical advances, but by improved sanitation and hygiene. Vincent Navarro (1978)
-suggested that the medical establishment are profiteering from individual misfortune. Medicalising
-as much of human behaviour as possible in order to make profits for multi-national corporations.
-The most famous Marxian theory against the increasing power of the medical establishment was
-that of Ivan Illich (1975). Illich argued that going to seek medical advice and following it often leads
-to more serious problems than the patient suffered in the first place. Illich called this ‘Iatrogenesis’,
-meaning doctor-induced illness. He classified three types of Iatrogenesis (listed below):
-. Clinical Iatorgenesis – This is when actual treatments or the hospital environment makes the
-patient more ill. Examples of this can be seen in the side-effects of drug treatments,
-botched or inappropriate surgery and hospital-based infections such as MRSA.
-. Social Iatrogenesis – Refers to the increasing medicalisation of life, so areas of life that had
-been hitherto seen as normal diversity have become medical issues (e.g. hyperactivity, mild
-depression, bereavement etc.).
-. Cultural Iatrogenesis – Refers to how once areas of life have become medicalised it becomes
-increasingly difficult to deal with a stressful life event, other than by seeking help from a
-doctor.
-'''Feminist Criticisms'''
-Feminists have also criticised Parsons’ theory of the sick role. Ann Oakley (1974) suggested that the
-rights of the sick role were not afforded to women in the same way they are for men. When a
-woman is ill they are rarely excused from their ‘normal social role’ of being the housekeeper /
-mother. Ehrenreich and English (1978) argued that medicalisation had taken power away from the
-previously female-dominated area lay-caring and replaced this with a male-dominated medical model.
-Women’s health issues were seen as often treated and defined differently than those of men.
-'''Interpretivist Criticisms'''
-The biggest critics however of Parsons’ theories regarding health could be said to be the
-Interpretivism. They have argued that building an ideal-type model of all doctor-patient interactions
-with only one type of relationship (led by the ‘expert’ doctor) is both unrealistic and misguided. For
-Interpretivism is very rare that both the patient and doctor live up to the expectations as set out by
-Parsons.
-Weberian theorist Elliot Friedson (1970) found in his studies that when people become ill, they on
-average ask the opinion of a dozen friends and family members before approaching a doctor.
-Friedson called these ‘lay-referrals’ and claimed that gaining access to the sick role was not just
-legitimised by a doctor, but others around the patient needed to be convinced that the individual
-really was ill. Friedson also found that depending on the type of illness, patients had differing levels
-of access to the sick role. Firstly, the ‘conditional sick role’ as set out by Parsons that applies to
-short-term illnesses that people can recover from. Secondly, the ‘unconditional sick role’ which
-refers to the long-term ill and disabled who have no hope of recovery and lastly, the ‘illegitimate sick
-role’ where patients are blamed for their illness due to their own choices, where people are not
-always offered the rights of the sick role. Friedson highlights one of the biggest problems with
-Parsons’ theory, which is that it only takes into account acute illnesses and not long-term chronic
-illnesses and disabilities. Another Weberian theorist Bryan S. Turner (1973) argued that doctors are
-not always professional in their conduct (e.g. Harold Shipman!) and patients are not always passive,
-trusting and prepared to wait for medical help.
-Symbolic Interactionists also criticised Parsons, for instance, Byrne and Long (1976) argued that
-Parsons was misguided in believing the doctor should be in a position of power over the patient.
-Byrne and Long argued that a ‘patient-centred’ rather than ‘doctor-centred’ interaction was
-preferable to the patient. For instance, it could be argued that a ‘home birth’ (when possible) is
-preferable to a new mother due to the greater control the patient has over their environment and
-over their interactions with professionals. Byrne and Long argued that doctors direct conversations
-towards what they are interested in and see as important and limit the contribution made by the
-patient. Johnson (1972) suggested that restricting the information that is given to patients is a:
-‘professional strategy to protect the social distance between doctor and patient by reinforcing the
-perception by the patient of a competency gap’ (cited in Taylor et al, 1998:439).
-Ann Cartwright (1967) found that: ‘56% of the general practitioners she surveyed complained that
-their patients lacked sufficient humility and that more than a quarter complained that half their
-patients consulted them for trivial reasons’ (Taylor et al, 1998:439).
-The above quote shows that both doctors and patients were not necessarily following the prescribed
-roles as set out by Parsons and that doctor-patient relationship show considerable variation from
-one patient to another.
-Symbolic Interactionist Erving Goffman (1961) wrote a seminal work called ‘Asylums’, within which
-he called hospitals, nursing homes and particularly mental asylums - ‘total institutions’ (meaning the
-institution took over all aspects of an individual’s life). He suggested that doctors have far more power within the hospital setting and that patients are far more likely to be submissive to this
-power. Upon admission to such an institution, Goffman argued that personal identity is stripped
-away in a process called ‘the mortification of self’ and replaced by an institutional identity in the
-process of ‘becoming a patient’. This process has a number of characteristics that can be identified:
-. Identifying staff by their uniform (symbolising the amount of power a staff member has over
-the patient).
-. Having personal items removed such as clothing being replaced by a gown.
-. Being subject to hospital routines (e.g. when and how someone takes a bath).
-. Difficulties encountered in maintaining personal identity (e.g. conversations with staff etc.
-are often limited).
-. Lack of decision-making power in the hands of the patient.
 ==See also==
@@ Line 108: / Line 30: @@
 ==References==
 {{Reflist}}
-==External links==
 [[Category:Medical sociology]]