THE SICK ROLE THEORY

Sick role theory is a concept in medical sociology that states that someone suffering from
sickness has their own set of rights and responsibilities. The sick role sociology dictates that
those who are sick have privileges as well as obligations associated with their illness.
The Sick Role Concept
Sick role theory was developed in 1951 by Talcott Parsons. The theory states that anyone
suffering from an acute illness has a different set of rights than someone who is well.
Components of the sick role
The sick role comprises four aspects:
(1) exemption from normal social role responsibilities,
(2) the privilege of not being held responsible for being sick,
(3) the desire to get better and
(4) the obligation to find proper help and follow that advice.

The Sick Role Theory

Sick role theory is a concept in medical sociology that states that someone suffering from
sickness has their own set of rights and responsibilities. The sick role sociology dictates that
those who are sick have privileges as well as obligations associated with their illness. The idea
behind sick role theory is based on the belief that an illness challenges a person's immune system
making the patient less capable of meeting the demands of normal society.
Sick role theory states that someone suffering from illness has certain rights and responsibilities.

An example of the sick role can be analyzed with a patient suffering acute appendicitis.
Appendicitis is spontaneous so therefore it is out of the person's control. Appendicitis generally
involves abdominal pain and fevers. The illness necessitates a visit to a medical provider
followed by emergency surgery to remove the infected appendix. Sick role theory states that the
ill patient should be excused from their normal societal obligations such as school or work. They
have the right to obtain a comprehensive medical assessment and obtain treatment. They also
should not be responsible for their own care and have the right to someone caring for them when
ill.
Criticisms of the Sick Role Theory
The sick role theory has a number of criticisms based on its fundamental rules. The biggest issue
is that the theory does not universally apply to all patients and does not question possible
motivations for illness. These criticisms include:
Rejecting the Sick Role
 This model assumes that the individual voluntarily accepts the sick role.
 Individual may not comply with expectations of the sick role, may not give up
social obligations, may resist dependency, may avoid public sick role if their illness is
stigmatized.
 Individual may not accept ‗passive patient‘ role.
Doctor-Patient Relationship.
 Going to see a doctor may be the end of a process of help-seeking behaviour,
(Cokerham, 2003) discusses importance of 'lay referral system' lay person consults
significant lay groups first.
 This model assumes 'ideal' patient and 'ideal' doctor‘s roles.
 Differential treatment of patient, and differential doctor-patient relationship-
variations depend on social class, gender and ethnicity.
Blaming the Sick
 ’Rights‘ do not always apply.
 Sometimes individuals are held responsible for their illness, i.e. illness associated
with sufferer‘s lifestyle, e.g., alcoholic lifestyle.
 In stigmatized illness sufferer is often not accepted as legitimately sick.
Chronic Illness.
 Model fits acute illness (measles, appendicitis, relatively short-term conditions).
 Does not fit Chronic/ long-term/permanent illness easily, getting well not an
expectation with chronic conditions such as blindness, diabetes.
 In chronic illness acting the sick role is less appropriate and less functional for both
individual and social system.
 Chronically ill patients are often encouraged to be independent.
Strengths
In spite of its shortcomings the idea of the sick role has generated a lot of useful far-
reaching research. Arguably, it still has a role in the crosscultural comparison of ways
in which ‘time-out’ from normal duties can be achieved or in which deviant behaviour
may be explained and excused.
The sick role theory is also a valuable contribution to understanding illness
behaviours and social perceptions of sickness. (It is perhaps best considered an ideal
type – a general statement about social phenomena that highlight 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); but individuals or groups may sometimes 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 lung cancer); 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. as exist.

The sick role according to Pearson

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.
Talcott Parsons and the Theory of the Sick Role by Damian E M Milton
Think of the last time that you were ‘ill’:
1. What was the illness and how did you view being ill?
2. Did you visit a doctor and if so, how were you treated?
3. Did you follow medical advice?
4. How did others respond to you (e.g. family, friends, employers etc.)?
5. What did you no longer have to do because you were ill (if anything)?
This was the first major theory within sociology that analyzed the role of health and illness in
social life was devised by the functionalist theorist Talcott Parsons (1951) in his book ‘The
Social System’. Parsons did not disagree with the dominance of the medical model of health in
determining illness, yet argued that being ill was not just a biological condition, but also a social
role (with a set of norms and values assigned to the role). Parsons saw illness as a form of
deviant behaviour within society, the reason being that people who are ill are unable to fulfil
their normal social roles and are thus deviating away from the consensual norm. Parsons argued
that if too many people claimed to be ill then this would have a dysfunctional impact on society,
therefore entry into the ‘sick role’ needed regulating. Parsons therefore devised the ‘sick role
mechanism’ of how ideally a doctor and patient should interrelate. Within this mechanism, ill
people and doctors had to abide by a number of ‘rights’ and ‘obligations’ attached to their
respective roles in order to keep entry into the sick role tightly monitored. The ‘function’ of this
mechanism was to prevent what Parsons called a ‘subculture of the sick’ from developing.
Individuals who claimed the sick role who were not actually ill were classed as ‘malingerers’.
Talcott Parsons Influences on Parsons’ work Emile Durkheim – The biggest influence on the
work of Parsons was that of the founding father of Functionalism Emile Durkheim. The medical
profession as an institution has an important role to play in keeping society functional and
efficient. According to Parsons the aim of the medical profession was to return an individual to
conventional social roles. If this were not to happen it would have a knock-on effect on other
institutions and could lead to a breakdown of social ‘body’. Max Weber – Although a
functionalist, Parsons was also influenced by the founder of interpretivist sociology Max Weber,
in particular his views on authority. Parsons believed that doctors can utilize traditional,
charismatic and rational / legal authority, yet their role depends upon rational / legal authority in
order to be qualified to be able to define who is sick and who is not. Hence, the role of the doctor
was to be a ‘gatekeeper’ to the sick role. Parsons was also influenced by a method of analysis
used by Weber, that of the ‘ideal type model’. This is to build a theoretical model of how an
institution should ideally be run. Parsons sick role mechanism model was devised on this basis,
in the sense that it represents what should ideally be in terms of roles and responsibilities (not
necessarily how the mechanism works in practice). However, as we shall see, not all theorists
agreed with Parsons as to the roles that should be undertaken by the doctor and patient. Sigmund
Freud – Freud had a huge impact on many theorists within the field of Psychology and beyond,
particularly in America. Parsons was no exception to this and was highly influenced by Freud’s
ideas on the formation of personality. One of these influences was in how Parsons saw the ‘ideal’
doctor-patient relationship. Using Freud’s theories of transference and counter-transference,
Parsons likened the relationship to that of a parent and child, with the doctor playing the
powerful ‘parental’ role over a passive patient. This is actually where the phrase patient comes
from. Being a patient required an individual to be passive, trusting and willing to wait for
medical treatment, to literally be ‘patient’. Parsons was also influenced by Freud’s notion of
‘conflicting drives’ within a personality. When applied to being sick, Parsons’ argued that there is
a conflict between the need to get better and the patient enjoying the ‘secondary gains’ of
occupying the sick role.
Emile Durkheim, Max Weber, Sigmund Freud the Rights and Obligations of the Sick Role
According to Parsons’ model, the sick person can be expected to be afforded two rights. These
rights however were conditional on the patient following two obligations, yet if these obligations
were not met that their rights as a ‘sick person’ would be withdrawn.
Rights
1. The sick person is temporarily exempt from performing ‘normal’ social roles (such as going to
work or housekeeping). The more severe the sickness, the greater the exemption.
2. A genuine illness is seen as beyond the control of the sick person and not curable by simple
willpower and motivation. Therefore, the sick person should not be blamed for their illness and
they should be taken care of by others until they can resume their normal social role.
Sick Role Rights (According to Nash in Nash Patient Information Handbook)
1. A patient has the right to respectful care given by competent workers.
2. A patient has the right to know the names and the jobs of his or her caregivers.
3. A patient has the right to privacy with respect to his or her medical condition. A patient’s
care and treatment will be discussed only with those who need to know.
4. A patient has the right to have his or her medical records treated as confidential and read
only by people with a need to know. Information about a patient will be released only
with permission from the patient or as required by law.
5. A patient has the right to request amendments to and obtain information on disclosures of
his or her health information, in accordance with law and regulation.
6. A patient has the right to know what facility rules and regulations apply to his or her
conduct as a patient.
7. A patient has the right to have emergency procedures done without unnecessary delay.
8. A patient has the right to good quality care and high professional standards that are
continually maintained and reviewed.
9. A patient has the right to make informed decisions regarding his or her care and has the
right to include family members in those decisions.
10. A patient has the right to information from his or her doctor in order to make informed
decisions about his or her care. This means that patients will be given information about
their diagnosis, prognosis, and different treatment choices. This information will be given
in terms that the patient can understand. This may not be possible in an emergency.
11. A patient given the option to participate in research studies has the right to complete
information and may refuse to participate in the program. A patient who chooses to
participate has the right to stop at any time. Any refusal to participate in a research
program will not affect the patient’s access to care.
12. A patient has the right to refuse any drugs, treatment or procedures to the extent permitted
by law after hearing the medical consequences of refusing the drug, treatment or
procedure.
13. A patient has the right to have help getting another doctor’s opinion at his or her request
and expense.
14. A patient has the right to care without regard to race, color, religion, disability, sex, sexual
orientation, national origin, or source of payment.
15. A patient has the right to be given information in a manner that he or she can understand.
A patient who does not speak English, or is hearing or speech impaired, has the right to
an interpreter, when possible.
16. Upon request, a patient has the right to access all information contained in the patient’s
medical records within a reasonable timeframe. This access may be restricted by the
patient’s doctor only for sound medical reasons. A patient has the right to have
information in the medical record explained to him or her.
17. A patient has the right not to be awakened by staff unless it is medically necessary.
18. A patient has the right to be free from needless duplication of medical and nursing
procedures.
19. A patient has the right to treatment that avoids unnecessary discomfort.
20. A patient has the right to be transferred to another facility only after care and
arrangements have been made and the patient has been given complete information about
the hospital’s obligations under law.
21. A patient has the right to a copy of his or her bills. A patient also has the right to have the
bill explained.
22. A patient has the right to request help in finding ways to pay his or her medical bills.
23. A patient has the right to help in planning for his or her discharge so that he or she will
know about continuing health care needs after discharge and how to meet them.
24. A patient has the right to access people or agencies to act on the patient’s behalf or to
protect the patient’s right under law. A patient has the right to have protective services
contacted when he or she or the patient’s family members are concerned about safety.
25. A patient has the right to be informed of his or her rights at the earliest possible time in
the course of his or her treatment.
26. A patient has the right to make advance directives (such as a living will, health care
power of attorney and advance instruction for mental health treatment) and to have those
directives followed to the extent permitted by law.
27. A patient has the right to personal privacy and to receive care in a safe and secure setting.
28. A Medicare patient has the right to appeal decisions about his or her care to a local
Medicare Review Board. The Facility will provide the name, address, and phone number
of the local Medicare Review Board and information about filing an appeal.
29. A patient has the right to be free from all forms of abuse or harassment.
30. A patient has the right to be free from the use of seclusion and restraint, unless medically
authorized by the physician. Restraints and seclusion will be used only as a last resort and
in the least restrictive manner possible to protect the patient or others from harm and will
be removed or ended at the earliest possible time.
31. A patient has the right to designate visitors who shall receive the same visitation
privileges as the patient’s immediate family members, regardless of whether the visitors
are legally related to the patient.
32. A patient has the right to pastoral care and other spiritual services.
33. A patient has the right to be involved in resolving dilemmas about care decisions.
34. A patient has committee for ethical issues, such as starting or stopping treatments to keep
patients alive, differences of opinion or when advance directives cannot be honored.
35. The patient has the right to appropriate pain management.
36. A patient has the right to be free from financial
exploitation by the health care facility.
Stages of the sick role
Edward Suchman (1965) devised an orderly approach for studying illness behavior with his
elaboration of the five key stages of illness experience:
(1) symptom experience;
(2) assumption of the sick role;
(3) medical care contact;
(4) dependent patient role; and
(5) recovery and rehabilitation.
In Defense of Parsons: Parsons was heavily criticized for the ‘ideal’ picture he portrayed of
doctor-patient relationships. However, it should be noted that he did state that a number of
different relationships were possible and that they took the following forms:
1. Paternalism – where the doctor has a high degree of control over the patient
2. Mutuality – where both have relevant knowledge and the relationship is on an equal footing
3. Consumerist – where the patient has a high degree of control and has choices over treatment
given
4. Default – where the doctor reduces the level of control in the consultation, yet the patient
remains in the passive role, giving the doctor power and control by ‘default’ Parsons however
saw ‘Paternalism’ as the ideal relationship in the majority of cases.
As has been seen above, this was not agreed upon by all (e.g. Byrne and Long). It could be said
from a Postmodernist view that healthcare in general is becoming much more ‘Consumerist’ in
nature, as part of the consumerization of society.

The Rights and Obligations of the Doctor’s Role Rights

1. Status and reward due to the functional importance of their role and to encourage individuals
to go through long years of training.
2. Considerable autonomy (personal control and power over one’s own actions) in their
professional practice.
3. A position of authority in relation to the patient (as they are the trained expert and the
‘gatekeeper’ to the social role of being sick).
4. The right to examine the patient physically and to enquire into intimate areas of the patient’s
physical and personal life.
Obligations:
1. To be highly trained and bring a high degree of skill and knowledge to their work.
2. To be motivated by concern for the patient and the community, rather than seeking
professional gain.
3. To be objective and emotionally detached.
4. To be bound by rules of professional conduct (e.g. ‘The Hippocratic Oath’).
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 ‘medicalization’ 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. Medicalizing 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):
1. Clinical Iatrogenesis – 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.
2. Social Iatrogenesis – Refers to the increasing medicalization 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.).
3. Cultural Iatrogenesis – Refers to how once areas of life have become medicalized it becomes
increasingly difficult to deal with a stressful life event, other than by seeking help from a doctor.
Feminist Criticisms
Feminists have also criticized 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 medicalization had taken power away from
the previously female dominated area lay-caring and replaced this by a male dominated medical
model. Women’s health issues were seen as often treated and defined differently than that of
men.
Interpretivist Criticisms
The biggest critics however of Parsons’ theories regarding health could be said to be the
Interpretivists. 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 Interpretivists it 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 legitimized 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 criticized 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 relationships 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:
1. Identifying staff by their uniform (symbolizing the amount of power a staff member has over
the patient).
2. Having personal items removed such as clothing being replaced by a gown.
3. Being subject to hospital routines (e.g. when and how someone takes a bath).
4. Difficulties encountered in maintaining personal identity (e.g. conversations with staff etc. are
often limited).
5. Lack of decision-making power in the hands of the patient.
Practiced questions
Make a list of factors that could influence the relationship between doctor and patient (e.g. type
of illness, age of patient etc.)
In Defense of Parsons: Parsons was heavily criticized for the ‘ideal’ picture he portrayed of
doctor-patient relationships. However, it should be noted that he did state that a number of
different relationships were possible and that they took the following forms:
1. Paternalism – where the doctor has a high degree of control over the patient
2. Mutuality – where both have relevant knowledge and the relationship is on an equal footing
3. Consumerist – where the patient has a high degree of control and has choices over treatment
given
4. Default – where the doctor reduces the level of control in the consultation, yet the patient
remains in the passive role, giving the doctor power and control by ‘default’ Parsons however
saw ‘Paternalism’ as the ideal relationship in the majority of cases.
As has been seen above, this was not agreed upon by all (e.g. Byrne and Long). It could be said
from a Postmodernist view that healthcare in general is becoming much more ‘Consumerist’ in
nature, as part of the consumerization of society.