Social Control and the Sick Role

So far, we have looked at how medicine functions as an institution of social control by defining individuals as sick or defective. Medicine can also work as an institu- tion of social control by pressuring individuals to abandon sickness, a process first recognized by Talcott Parsons.

Parsons was one of the first and most influential sociologists to recognize that illness is deviance. From his perspective, when people are ill, they can’t perform the social tasks normally expected of them. Workers stay home, homemakers tell their children to make their own meals, students ask to be excused from exams. Because of this, either consciously or unconsciously, people can use illness to evade their social responsibilities. To Parsons, therefore, illness threatened social stability.

Parsons also recognized, however, that allowing some illness can increase social stability. Imagine a world in which no one could ever “call in sick.” Over time, production levels would fall as individuals succumbed to physical ailments because they were denied needed recuperation time. Morale, too, would fall while resent- ment would rise among those forced to perform their social duties day after day without relief. Illness, then, acts as a kind of pressure valve for society—something we recognize when we speak of taking time off work for “mental health days.”

From Parsons’s perspective, then, the important question was how did soci- ety control illness so that it would increase rather than decrease social stability? His emphasis on social stability reflected his belief in the broad social perspective known as functionalism. Underlying functionalism is an image of society as a smoothly working, integrated whole, much like the biological concept of the hu- man body as a homeostatic environment. In this model, social order is maintained because individuals learn to accept society’s norms and because society’s needs and individuals’ needs match closely, making rebellion unnecessary. Within this model, deviance—including illness—is usually considered dysfunctional because it threatens to undermine social stability.

Defining the Sick Role Parsons’s interest in how society allows illness while minimizing its impact led him to develop the concept of the sick role. The term refers to social expectations regarding how society should view sick people and how sick people should behave. According to Parsons, the sick role as it currently exists in Western society has four parts. First, the sick person is considered to have a legitimate reason for not fulfilling his or her normal social role. For this reason, we allow people to take time off from work when sick rather than firing them for malingering. Second, sickness is considered beyond individual control, something for which the individual is not held responsible. This is why, according to Parsons, we bring chicken soup to people who have colds rather than jailing them for stupidly exposing themselves to germs. Third, the sick person must recognize that sickness is undesirable and work to get well. So, for example, we sympathize with people who strive to recover from illness and question the motives of those who seem to revel in the attention illness brings them. Finally, the sick person should seek and follow medical advice. Typically, we expect sick people to follow their doctors’ recommendations regarding drugs and surgery, and we question the wis- dom of those who don’t.

Parsons’s analysis of the sick role moved the study of illness forward by high- lighting the social dimensions of illness, including identifying illness as deviance and doctors as agents of social control. It remains important partly because it was the first truly sociological theory of illness. Parsons’s research also has proved important because it stimulated later research on interactions between ill people and others. In turn, however, that research has illuminated the weak- nesses of the sick role model.

Critiquing the Sick Role Model Much recent sociological writings on illness— including this textbook—have adopted a conflict perspective rather than a func- tionalist perspective. Whereas functionalists envision society as a harmonious whole Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it held together largely by socialization, mutual consent, and mutual interests, those who hold a conflict perspective argue that society is held together largely by power and coercion as dominant groups impose their will on others. Consequently, whereas functionalists view deviance as a dysfunctional element to be controlled, conflict theorists view deviance as a necessary force for social change and as the conscious or unconscious expression of individuals who refuse to conform to an oppressive society. Conflict theorists, therefore, have stressed the need to study not only deviants but also social control agents.

The conflict perspective has helped sociologists identify the strengths and weaknesses in each of the four elements of the sick role model (see “Key Con- cepts: Evaluating the Sick Role Model”). That model declares that sick persons are not held responsible for their illnesses. Yet, as we saw earlier in this chapter, society often does hold individuals responsible for their illnesses . In addi- tion, ill persons are not always considered to have a legitimate reason for abstaining from their normal social tasks. Certainly, no one expects persons with end-stage cancer to continue working, but what about people with arthritis or those labeled malingerers because they can’t obtain a diagnosis after months of pain, increasing disability, and visits to doctors?

Other aspects of the sick role model are equally problematic. The assumption that individuals will attempt to get well fails to recognize that much illness is chronic and by definition is not likely to improve. Similarly, the assumption that sick people will seek and follow medical advice ignores the many people who lack access to medical care or who can’t afford to take time off from work or purchase medications when ill. In addition, it ignores the many persons, especially those with chronic rather than acute conditions, who have found mainstream health care of limited benefit and who therefore rely mostly on their own experience and knowledge and that of other nonmedical people. Similarly (and understandably), it could not anticipate the ways the Internet has enabled lay people—both sick and well—to seek health information on their own and occasionally challenge or ignore medical advice as a result