Transcript The Sick Role

The Sick Role
SOCI 1050
Chapter 7
Social Concepts of Illness
• A measure of societal development
– Primitive society – illness is autonomous force
or “being”, i.e., evil spirit
– Middle Ages – illness is punishment for sins
and caring for the sick is seen as religious
charity
– Modern concept – illness is based on
scientific view of biological pathology
or mental abnormality -with cause,
symptoms and prescribed treatment
Illness as Deviance
• Medical view – illness is deviance
from a biological norm of health and
feelings of well-being
– Pathogenic mechanism
– Correlation of symptoms with knowledge of
physiological functioning
Traditional Identifying Criteria of
Disease
• Patient’s experience of subjective
feelings of sickness
• Finding by a physician that the patient
has a disordered function of the body
• Patient’s symptoms conforming to a
recognizable clinical pattern
• In diagnosis, logic is the basic
tool
Physician’s Traditional Role
• Arriving at a diagnosis
• Applying remedial action to the
disorder so that the patient is returned
to the most normal state as is
possible
• Interpreted within the context of
existing medical knowledge and
physician’s experience
Disease, Illness and Sickness
• Disease – an adverse physical state,
consisting of a physiological dysfunction
within an individual
• Illness – a subjective state pertaining to an
individual’s psychological awareness of
having a disease and causing the
individual to modify
his or her behavior
• Sickness – a social state signifying
impaired social role for those who
are ill
Viewing Sickness as Deviance
• Sociologists have traditionally seen
sickness as a form of social deviance
• Deviance is any act or behavior that
violates the social norms (rules)
• Talcott Parsons – The Sick Role –
described the normative behavior a person
typically adopts when feeling sick
• “being sick is a disturbance of the
“normal” condition – both biologically
and socially
Defining Deviance
• Variation from the statistical average
• Socially, defining a situation as deviance
involves a social judgment about right and
proper behavior
• Conformity to norms is usually rewarded
by group acceptance and approval
• Deviance can lead to disapproval,
punishment or other forms of social
sanctions applied against the
offender
Consequences of Deviance
• Deviance is often seen as negative and
deserving of punishment (i.e., crime)
• Not all forms of deviance produce
undesirable consequences (i.e., art,
theater, music, literature)
• Sickness is regarded as undesirable for
both the individual and the society
– Individual = economic hardship and
suffering
– Society = reduction in ability of group to
carry out its usual tasks and/or functions
• The physically sick, like the insane and
criminals, represent a social category of
people removed from mainstream society,
if their illness is judged severe enough
• Insane and criminals are much more
stigmatized by society than the physically
ill but the pattern of treatment (removal
from society and treatment by specialists)
allows the person who is physically
sick to be similar in definition
Functionalist Approach
• What makes social life possible is the
expectation that people will behave in
accordance with the norms and
values common to their society -- it is
functional because it results in social
harmony
• Dysfunctional aspects include
violation of norms, i.e., crime
and mental illness
• A social system may have problems
with crime and delinquency, but still
be “healthy” because of its overall
capacity to function efficiently – just
as a person with a chronic condition
can continue to function
productively within his/her positions
• Because functionalist theorists perceive
social systems as composed of various
closely interconnected parts, they argue
that changes
, decisions and
definitions made in one part of the system
inevitably affect all other parts of the
system, to some degree
• What is adaptive for in individual may be
perceived as deviant by the larger society
• Sickness is dysfunctional because it also
threatens to interfere with the
stability of the social system
The Sick Role
• While the criminal is thought to violate social
norms because he/she ‘wants” to, the sick
person is only deviant because he/she “cannot
help it”
• Some people may be attracted to the “sick role”
in order to ‘get out of’ responsibilities in an
approved
way (malingering)
• A major expectation concerning the sick is that
they are unable to take care of themselves.
It is thus necessary for the dick to seek
medical advice and cooperate with
medical experts.
4 Basic Categories of Sick Role
• The sick person is exempt from normal
social roles
• The sick person is not responsible for his
or her condition
• The sick person should try to get well
• The sick person should seek technically
competent help and cooperate with his/her
physician
(See p. 148-9)
Physician-Patient Role
Relationship
• The sick role evokes a set of patterned
expectations that define the norms and values
appropriate to being sick, both for the individual
and for others who interact with the person.
• Neither party can define his or her roles
independently of the role
partner
• Relationship is intended to be therapeutic in
nature
• Mutuality in the form of behavioral
expectations
Physician
• Exercises leverage through three
basic techniques
– Professional prestige
– Situational authority
– Situational dependency of the patient
• Patient professes some faith in the
physician’s power to heal
• Despite medical advancements,
physician must still sometimes act
on the basis of a hunch
Physician-Patient
• Akin to parent-child relationship
• For some, illness can foster a child-like
state of dependence
– Both child and sick person lack the capacity to
perform the usual functions of the adult
• Physician can be like a parent figure in
that he or she provides support and
controls rewards significant to the
dependent party
– Gatekeepers for professional health
resources
Medicalization
• Should medicine be an agent of
social control of deviant behavior?
• Parsons implies that it should be…..
• Acts that might have been seen as
sin or crime are increasingly regarded
as illnesses to be controlled through
medical care
Biomedicalization
• Capacity of computer information and new
technologies to extend medical
surveillance and treatment interventions
well beyond past boundaries, by the use of
genetics, bioengineering, chemoprevention, individualized drugs, multiple
sources of information, patient data banks,
and other innovations
• Also important are: Internet,
advertising, consumerism and the
role of pharmaceutical companies in
marketing their products
Criticisms of the Sick Role
• Parsons’ sick role theory can be
criticized because of
– Behavioral variation (lack of uniformity among
various persons)
– Types of diseases (seems to apply best to
acute diseases)
– The patient-physician relationship (seems
limited to 1:1 doctor’s office interactions)
– The sick role’s middle-class orientation
(does not apply to lower class patients
who deny the need to give in to illness)
Labeling Theory
• Based on the concept that what is
regarded as deviant behavior by one
person or social group may not be
regarded so by other persons or
groups
• Deviance is defined by social groups
who make the rules or norms
• Deviance is not a quality of the act a
person commits, but instead is a
consequence of the definition applied
to that act by other people
• Labeling theory does not have an
explanation that is as completely
developed as Parsons’ sick role
Legitimacy
• Freidson indicates that the key to
distinguishing among sick roles is the
notion of legitimacy
• In illness states, there are three types
of legitimacy
– Conditional legitimacy
– Unconditional legitimacy
– Illegitimacy
Conditional Legitimacy
• The deviants are temporarily
exempted from normal obligations
and gain some extra privileges in the
proviso that they seek help in order to
rid themselves of their deviance
• i.e. acute illness such as a cold or
influenza
Unconditional Legitimacy
• Deviants are exempted permanently
from normal obligations and granted
additional privileges in view of the
hopeless nature of their deviance
• i.e., terminal cancer
Illegitimacy
• Deviants are exempted from normal
social obligations by virtue of their
deviance, for which they are
technically not responsible, but gain
few privileges and take on handicaps
such as stigma
• i.e., a stammer or epilepsy
Criticism of Labeling Theory
• Does not explain the causes of the
deviance, other than the reaction of
other people to it
• What is being explained by labeling
theory? Deviance or the reaction to
it?
Stigma
• If one’s sickness is unpleasant to
other people, he/she may be
stigmatized
• Three main forms of stigma
– Abominations of the body
– Blemishes of individual character
– The tribal stigmas of race, religion and
nationality
• Can have a negative impact on the selfconcepts of those who are stigmatized
• Stigma affects health situations in four
ways
– Psychological stress
– Fear of stigma and discrimination
– Adverse reactions from others in health
care settings
– Communities do not provide adequate care
facilities for those who are stigmatized