Sick Role Concept Research Articles

“A Hydra with a Thousand Heads”: Dis(ease) and Wellness in Harold Pinter’s A Kind of Alaska and Brian Friel’s Molly Sweeney

ABSTRACT This study examines the social structure of healthcare through Talcott Parsons’s sick role concept from his seminal work The Social System (1951), analyzing the characters of Deborah in Harold Pinter’s A Kind of Alaska (1982) and Molly in Brian Friel’s Molly Sweeney (1994). In both plays, the female protagonists compromise their personal freedom by submitting to healthcare workers. Although Deborah and Molly experience their medical ordeals differently, they intersect on various social, somatic, cultural, and political levels. Reading both plays in conjunction, the article critiques the authoritative power dynamic between male doctors and female protagonists. Drawing on Parsons’s sick role and the doctor-patient relationship, the study analyzes Deborah and Molly’s journeys toward recovery and explains why they fail to reestablish themselves in their societal roles, as outlined in Parsons’s health concept. The article concludes with an appeal for a more empathetic approach to contemporary medical practices.

Why sociologists abandoned the sick role concept

The concept of the sick role entered sociology in 1951 when Talcott Parsons creatively separated the sick person out of the doctor–patient dyad. The idea became fundamental in the subdiscipline of medical sociology. By the 1990s, the concept had almost disappeared from the research literature. Beyond the generational and theoretical changes that explain how the sick role idea could become irrelevant or unnecessary to sociologists, there were two immediate factors: the negative politicization of the concept and the shift of medical sociologists to a focus on applied health behavior. In the later, fragmented discipline of sociology, final, total abandonment was still uncertain.

How do patients come to be seen as ‘difficult’?: A mixed-methods study in community mental health care

Across all health care settings, certain patients are perceived as 'difficult' by clinicians. This paper's aim is to understand how certain patients come to be perceived and labelled as 'difficult' patients in community mental health care, through mixed-methods research in The Netherlands between June 2006 and October 2009. A literature review, a Delphi-study among experts, a survey study among professionals, a Grounded Theory interview study among 'difficult' patients, and three case studies of 'difficult' patients were undertaken. Analysis of the results of these qualitative and quantitative studies took place within the concept of the sick role, and resulted in the construction of a tentative explanatory model. The 'difficult' patient-label is associated with professional pessimism, passive treatment and possible discharge or referral out of care. The label is given by professionals when certain patient characteristics are present and a specific causal attribution (psychological, social or moral versus neurobiological) about the patient's behaviours is made. The status of 'difficult' patient is easily reinforced by subsequent patient and professional behaviour, turning initial unusual help-seeking behaviour into 'difficult' or ineffective chronic illness behaviour, and ineffective professional behaviour. These findings illustrate that the course of mental illness, or at least the course of patients' contact with mental health professionals and services, is determined by patient and professional and reinforced by the social and mental health care system. This model adds to the broader sick role concept a micro-perspective in which attribution and learning principles are incorporated. On a practical level, it implies that professionals need to look into their own role in the perpetuation of difficult behaviours as described here.

Talcott Parsons, the Sick Role and Chronic Illness

Parsons’ sick role concept has become problematic in the face of the increased significance of chronic illnesses and the growing emphasis on lifestylecentred health promotion. Both developments de-limit the medical system so that it extends into the world of health, fundamentally changing the doctor-patient relationship. But as the sick role is firmly based on the reciprocities of a resiliently capitalist achievement society it still informs normative expectations in the field of health and illness. The precarious social position of chronic patients between being governed by and being consumers of medicine, I will argue, can only be adequately understood if one involves, as Parsons did, the moral economy surrounding health and illness.

Stressors and Social Support Perceptions Predict Illness Attitudes and Care-Seeking Intentions: Re-Examining the Sick Role

Parsons' (1951) sick role concept has had a profound impact on the study of sickness as a social phenomenon. The sick role might be better conceived as a set of illness attitudes and care-seeking intentions rather than a set of social norms. This investigation purports (a) to explore the relationships among illness attitudes, (b) to examine the ability of illness attitudes to predict medical care-seeking intentions, and (c) to investigate differences in the sick role as a function of stressors and social support perceptions. Participants (N = 148) completed a survey questionnaire assessing daily hassles, life events, perceived social support, dependence, self-criticism, and the sick role. Results of a factor analysis on the sick role measures revealed four attitudinal (Release, Consideration, Burden, and Deviance) and two behavioral (Denial and Consult) factors. The attitudinal factors were moderately intercorrelated, with some ability to predict care-seeking intentions. Regression analyses revealed that stressors and support perceptions did exhibit some ability to predict the sick role. Results are discussed in terms of their implications for health communication research.

Chronic back pain sufferers—striving for the sick role

The paper draws on data from a Norwegian online discussion list for back pain sufferers and from open, in-depth interviews with Norwegian back pain sufferers. In both sources, back pain sufferers express a fear that the reality of their pain is being questioned. The paper discusses how these experiences of delegitimation can be understood as a result of the back pain sufferers’ inability to achieve the sick role. Many of these individuals strive and frequently fail to achieve clinical and social characteristics that make up appropriate sickness behaviour. A lack of proof that they are sick, including a lack of medical diagnosis, appropriate health care treatment, and visible disabilities, can lead to accusations, both felt and enacted, of malingering, hypochondria and/or mental illness. This in turn can lead to problems in the achievement and/or legitimisation of sick role benefits such as sick leave and medication. The sick role concept has been criticised as being inappropriate for describing the experiences of the chronically ill. The paper argues that the sick role concept still appears to reflect the expectations of health professionals, the public and the patient himself. The study does not support the view that chronic illness is related to a decreased dependency on the medical profession. Instead, doctors’ inability to offer chronic back pain sufferers a clear diagnosis, explanation, and/or a course of treatment or cure appears not to liberate the patient but rather prolongs his or her dependence on the doctor.

Awareness of being a patient and its relevance to insight into illness in patients with schizophrenia

This article presents the development of the Awareness of Being a Patient Scale (ABPS), a 25-item self-report scale to measure the awareness of schizophrenic patients. Awareness is defined in terms of a patient's psychological attitude toward the psychiatric situation, and is to be evaluated from the stand-point of Parsons' sick-role concept by assessing the recognition of the need for treatment and acceptance of the treatment situation. It is hypothesized that awareness is a factor in the motivation to receive treatment. Closely related to the awareness is the insight into illness, a clinical construct comprising a patient's understanding of psychotic illness and symptoms. There also seems to be an overlap between them. However, the difference is that awareness principally pertains to a patient's perspective, not addressing the precise understanding of illness and symptoms, while the frame of reference in assessing insight is from the viewpoint of psychiatry. In examining properties of the ABPS, it is demonstrated that the ABPS has satisfactory reliability, favorable concurrent validity, and significant value in discriminating between long-term stable outpatients and recently admitted and long-term hospitalized patients. This study indicates that the awareness of being a patient has clinical importance and the ABPS is an efficient means of measuring such awareness.

Pain, disability, and illness

T he Focus article is timely and stimulating. It appears to be a response to societal concerns (particularly in the U.S.) over the burgeoning costs of compensation for pain-related disability. The main thrust of the article is that low back pain patients can be rehabilitated and, until this has been attempted , it is not possible to provide a medical opinion as to the long-term outcome of the patient's condition . In fact , the doctor who does so is contributing to the patient's disability. From the outset it is clear that the authors are using a theoretical framework derived from medical sociology, in particular the sick role concept as described Talcott Parsons. They state that by sanctioning disability ascribed the patient to low back pain, the physician commun icates to the patient not only society's legitimation of non-working status , but also that there are derangements of body function that cannot be altered through patient efforts at rehabilitat ion. If we accept Parsons' view of the sick role then the aforementioned constitutes a distortion of what he described. First, the sick role is a partially and conditionally legitimated role, that gives the individual relief from normal social role responsibilities, as well as from responsibility for the condition. These privileges are worth examining more closely. The relief from role responsibilities, such as work, is not total and takes into account the nature of the impairment. It may involve a change in the type of work. For example, a machinist with a painful back; may be assigned to another task, such as the supervision of new apprentices . Second, the exemption from responsibility for the refers to the judgement that the patient is unable to terminate the disorder a simple act of willin other words he is not malingering and is entitled to care and assistance.

The Sick Role Concept: Understanding Illness Behavior

The Sick Role Concept: Understanding Illness Behavior

Medical and social work students' perceptions of deviant conditions and sick role incumbency

As part of a social change which has been referred to as the “medicalization of deviance”, perceptions of many deviant behaviors are in transition. Following Freudian thought, the deviant individual is increasingly being viewed as needing psychological help rather than traditional types of punishment. These observations are consistent with the sociological literature which emphasizes common elements between deviant behavior and illness, especially the approach which holds that the key to both illness and deviant behavior is the individual's failure to meet the expectations of social roles and tasks. Most significant in this context is the sick role concept, which can be utilized to help understand shifts in orientation which are reinterpreting deviant behavior as needing the attention of physicians, rather than representatives of the religious and legal systems. In this study the sick role concept is utilized with a sample of English medical and social work students to determine acceptance patterns of legitimate sick role incumbency for three physical, two mental, two addictive and three socially deviant conditions. A hypothesized continuum of legitimate sick role acceptance is supported for the total sample. Medical students are found to exhibit higher sick role acceptance rates than social work students for each of the 10 conditions. Comparison between 1st yr and more advanced students reveals that differences in acceptance rates are not significant, suggesting that orientations are established before entry into programs and that the socialization experiences in medical and social work schools have little effect on perceptions of deviant conditions and sick role incumbency. Extensive ambivalence among sample members is also observed, with a higher ambivalence percentage among social work students, suggesting that medical students are firmer in their judgments relative to sick role incumbency than are social work students. Substantiation of the hypothesis of a continuum of sick role acceptance for the conditions considered in the study has important implications for our understanding of the general sociological approach to illness and deviance. For example, the findings help to understand similarities among a variety of different social behaviors. The approach helps to understand some of the directions of contemporary social change, especially the narrowing of the range of social responses to behaviors which once generated significantly different reactions.

Intrinsic and Extrinsic Meanings of Work as Related to Disability Inclination: Another Look at the Sick Role Concept

(1971). Intrinsic and Extrinsic Meanings of Work as Related to Disability Inclination: Another Look at the Sick Role Concept. Sociological Focus: Vol. 4, No. 4, pp. 88-98.