The sick role as a two-sided form

The sick role is a two-sided form. In a society informed by capitalistic reciprocity and achievement, sickness is tolerated because it is supposed to be temporary. The temporal dimension is important. In an article on Talcott Parsons’ concept of the sick role, Matthias Zick Varul (2010) writes,

The loss of autonomy is, paradoxically, informed by the high value placed on autonomy, ‘compulsive independence’ (Parsons,1958: 345), in modern societies. Disease is a threat to autonomy as it disables social contributions which legitimize individual freedoms; and, of course, it impacts directly on autonomy by way of incapacitation. The renunciation of individual autonomy in the sick role is only tolerable because it is relinquished solely in order to fully regain it. As a strictly transitional role, the sick role defines a spatially and temporally delineated world of illness (Parsons, 1978: 32).

“Talcott Parsons, the Sick Role and Chronic Illness.” Body & Society

As a transitional role, sickness is a liminal condition. But what about chronic illness?

Chronic illnesses – from the 1970s onwards more significant than acute illnesses – by definition exclude recovery. In this situation the sick role’s spatial and temporal containment of illness becomes untenable. . . . For chronic patients the doctor patient relation therefore never really ends; they remain dependent on, and therefore under the authority of, the medical system. Even in the case Parsons quotes as relatively easy to control (mild diabetes) the regimen has an infantilizing aspect: being told what and what not to eat (Cohn, 1997). . . . Without the prospect of regaining full capacity, the ‘job’ of recovery becomes a life-time employment. The discipline of the sick role is partly replaced by self-disciplines of the chronic patient.

Matthias Zick Varul

This is all about role expectations, or making social life relatively predictable. Similarly, following the death of a family member or loved one, people are expected to take on particular roles, such as following mourning traditions. The mourning role is like the sick role in that it is “an institutional arrangement to bridge discontinuities” (Varul). Mourning is supposed to be temporary; therefore, unending mourning is considered pathological.

In the sick role, a person is expected to do certain things–follows the doctor’s orders and try to get better and regain autonomy and productivity. This means that the sick person is not completely incapacitated; they still have rationality and purposefulness, or the faculty/sense of will. If they refuse to comply with treatment, they would be considered totally sick–physically and morally. Again, this is a two-sided form. The sick person is not supposed to be willingly sick. There is supposed to be willingness to cross over to wellness.

The normative background of the Parsonian sick role thus
contributes substantially to an explanation of the double expectations
of conformity in normalization: the routine observance of a
regimen, self-monitoring and crisis management as prolonged
compliance on the one hand, and the expectation to perform as
far as possible in normal roles on the other. Regaining legitimacy
by minimizing unreciprocated dependency (Charmaz, 1983: 188;
G. Williams, 1993: 93) is a central motive in the reorganizing
efforts towards a new normality.

Matthias Zick Varul

The chronically ill person tends to learn a lot about their illness and, therefore, doesn’t rely totally on the physician; this may actually be a social expectation. Thus the asymmetry in knowledge between doctor and patient decreases. When knowledge is symmetric it can easily pass between people; that is, people can share knowledge or reciprocate. Doctor and patient then act more like partners. But when two-sided forms are asymmetrical, crossing is difficult.

Varul goes to argue, following Parsons, that in a capitalist-informed society good health for its own sake is not rewarded. Good health is supposed to be a mere precondition for productive labor. Labor is exchanged for money and esteem.


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