Download The sick role

HEALTH & SOCIETY - SOCIAL ROLES AND MEDICINE
Introduction
A system of healing, like any other structure, includes a set of roles for the major agents.
Within our modern health-care system, there is a set of social expectations around what it
means to be a "patient," how one comes to be a patient and, especially, what one is to do upon
becoming a patient. Nevertheless, it is rare that one finds a serious consideration of the role of
the patient within the whole practice of medicine.
NOTE: 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).
- complementary roles
- set of roles
- pervasive roles; family roles, occupational roles; temporary roles
Parson’s concept of the sick role
He introduced his theory of the sick role in his book The Social System (1951).
His concept is based on the assumption that being sick is not a deliberate and knowing
choice of the sick person. The sick person is considered deviant because he or she violates
the social norms but he/she cannot help it. Parsons warns, however, that some people may
be attracted to the sick role in order to have their lapse of social responsibilities approved.
→ Generally, society makes distinction between deviant roles (by punishing → punishment
because of suicide (attempting) and providing therapeutic care for sick. Both processes
function to reduce deviancy and change conditions that interfere conditions of social
agencies. The sick role involves behavioral based or institutional expectations and is
reinforced by the norms of society corresponding to these expectations.
The major expectation concerning of the sick role that they are unable to take care of
themselves. It thus becomes necessary for the sick to seek medical advice and corporate with
medical experts. It is based on the assumption that being sick is an undesirable state and the
sick person wants to get well.
Sickness is dysfunctional because it represents a mode of response to social pressure that
permits the hanging up completing social tasks and responsibilities. A person may desire to
retain the sick role more or less permanently because of exemption from normal
obligations and gaining other privileges (secondary gain).
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.
Rights:
(1) 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
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expectations allow – usually done to acquire secondary gains, or additional privileges
afforded to ill persons).
(2) 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 person will power or motivation is needed
to get well.
Obligations:
(1) 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. Thus, the sick person has an obligation to get well.
(2) 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.
Although this concept presents some flaws, it is a valuable contribution to understanding
illness behaviors and social perceptions of sickness. (It is perhaps best considered an ideal
type – a general statement about social phenomena that highlights patterns of “typical.”) We
discussed a number of criticisms of Sick Role theory, including: a violation in 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, etc.; certain
illnesses may reflect an element of personal “blame” due to unhealthy lifestyle choices (i.e.
smoking leads to emphysema); the potential inability to be “exempt from normal social roles”
due to issues of status (i.e. parent), income (need to work), gender, age, etc.
See: http://www.ucel.ac.uk/shield/parsons/Default.html
Week points of the theory
- People with chronic illness establish a rather practical knowledge and experience about their
disease, so they become quasi experts of the named problem.
- Stigmatization of illness
- In Parson’s concept the prescriptive nature of the social roles show behavioral domains
instead of strict social rules.
- Misunderstandings of the role content; confusions of role socialization
- Role conflicts and indefinite social roles.
- Lack of the sick identity → medical screening
- Health insurance companies: changing doctor patient relationship → service –customer
relationship
- Overcharged roles.
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Total institutions and the hospital → E. Goffman: Assylums
1.
2.
3.
4.
Stress and hospitalization
Depersonalization
Institutionalization → the “Magic Mountain- effect”
Total institutions
A total institution may be defined as a place of residence and work where a large number of
like-situated individuals, cut off from the wider society for an appreciable period of time,
together lead an enclosed, formally administered round of life. Prisons serve as a clear
example, providing we appreciate that what is prison-like about prisons is found in
institutions whose members have broken no laws.
Their encompassing or total character is symbolised by the barrier to social intercourse with
the outside and to departure that is often built right into the physical plant, such as locked
doors, high walls, barbed wire, cliffs, water, forests, [p.16] or moors. These establishments I
am calling total institutions, and it is their general characteristics I want to explore.
The total institutions of our society can be linked in five rough groupings:





First, there are institutions established to care for persons felt to be both incapable and
harmless; these are the homes for the blind, the aged, the orphaned, and the indigent.
Second, there are places established to care for persons felt to be incapable of looking
after themselves and a threat to the community, albeit an unintended one: TB sanitaria,
mental hospitals, and leprosaria.
A third type of total institution is organised to protect the community against what are
felt to be intentional dangers to it, with the welfare of the persons thus sequestered not
the immediate issue: jails, penitentiaries, P.O.W. camps, and concentration camps.
Fourth, there are institutions purportedly established the better to pursue some
worklike tasks and justifying themselves only on these instrumental grounds: army
barracks, ships, boarding schools, work camps, colonial compounds, and large
mansions from the point of view of those who live in the servants' quarters.
Finally, there are those establishments designed as retreats from the world even while
often serving also as training stations for the religious; examples are abbeys,
monasteries, convents, and other cloisters.
The central feature of total institutions can be described as a breakdown of the barriers
ordinarily separating these three spheres of life.




First, all aspects of life are conducted in the same place and under the same central
authority.
Second, each phase of the member's daily activity is carried on in the immediate
company of a large batch of others, all of whom are treated alike and required to do
the same thing together.
Third, all phases of the day's activities are tightly scheduled, with one activity leading
at prearranged time into the next, the whole sequence of activities being imposed from
above by a system of explicit formal rulings and a body of officials.
Finally, the various enforced activities are brought together into a single rational plan
purportedly designed to fulfil the official aims of the institution.
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In total institutions there is a basic split between a large managed group, conveniently called
inmates, and a small supervisory staff. Inmates typically live in the institution and have
restricted contact with the world outside the walls. The staff often operates on an eight-hour
day and is socially integrated into the outside world. Each grouping tends to conceive of the
other
in
terms
of
narrow
hostile
stereotypes.
Social mobility between the two strata is grossly restricted; social distance is typically great
and often formally prescribed. Even talk across the boundaries may be conducted in a special
tone of voice.
The physician’s role
According to T. Parsons model the physician’s function in the treatment of illness initially to
arrive to a diagnosis and then applying remedial action to the health disorder in such a way as
to return the patient to as normal a state as possible. The evaluation of illness by the physician
contains the medical definition of what is good, desirable, and normal as opposed to what is
bad, undesirable, and abnormal. This evaluation is interpreted within the context of existing
medical knowledge and the physician’s experience. On this basis, the medical profession
formulates medical rules defining biological deviance and seeks to enforce them.
The main pillars of the physician role-taking are
- Professional specificity and autonomy;
- Affect neutrality;
- Orientation toward universality;
- Functional specificity
Further reading (obligatory!)
Giddens, A.: Health, Illness and Disability. In Sociology. 5th edition, Chapter 8., 16-21. pp.
(266-271. Sociological perspectives on health and illness.)
See below:
http://www.polity.co.uk/giddens5/sample/samplechapter.pdf
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