This post is going to be about part of Sociology affects Mental Health Nursing including looking at Models of Health and in this post Functionalism and the Sick Role. So in Sociology there are different models of health, I’ve done a fair bit of reading around this stuff and I’ve found it quite interesting and so I thought I would do a run down of some of the main societal models of health over a few posts.
Functionalism and The Sick Role
Talcott Parsons designed the “sick role” in the 1950’s, it was the very first theoretical concept to explore medical sociology. Essentially Parsons saw society as a group of people each with their own functional role be it mother, worker, student etc with family at the centre of society. All functional people worked together to build a working society.
So rather than looking at illness like a medical malfunction or an invasion of bugs it was more like a sanctioned period of non function or deviant behaviour. Parsons was a fan of Freud and felt that a doctor patient relationship was like a parent child relationship, he was conscious that there is a conflicting situation for the patient, a need to get better and a need to receive attention and care and he built a fail safe in to his model to correct this and focus the ill person on getting well.
So in order to “opt out” of being a functional member of society whilst sick and take on the “sick role” the sick person is expected to seek medical advice promptly and follow medical orders carefully and fully. In fact the key points were:
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Submit fully to the doctors recommended regime.
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Be treated not as an individual but as a case.
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Co Operate
and as long as they follow those rules they obtain certain rights, those rights are held whilst they are part of the Sick Role. They are:
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Not held responsible or liable to punishment
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Offered and expects to receive support
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Expected to leave the sick role quickly
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Expected to return to health and functional role quickly
There are considerable criticisms of this model, especially in the modern world, and they almost take apart every part of the model really.
First of all, it idealises the role between the sick person and the doctor, it presumes that there is a level of respect between both people and does not address the the power balance in this situation. The patient has no input or control and the doctor holds all the power in the sick role, this is ethically dubious at best but also expects the doctor to be ethically sound and competent. Murcott (1981), Sacks (1967), Bloor & Horobin (1975) would dispute that the relationship between doctor and patient Parsons would like to see would be very rare.
It also sees the doctor as the first port of call when sick and non functional, where as it’s been recognised that a patient will more than likely consider the opinion of lay people first and then a doctor. This shows there is some need to understand and have input in their condition rather than just submit to a regime dictated to them.
It also doesn’t take in to account that the doctor and patient are individuals who will respond differently in every situation. There maybe no consistency in diagnosis or treatment between doctors and illnesses have different treatments within them, different severities and differing opinions on diagnosis. There are also differentiation in social class, gender, ethnicity, age, working background, which will effect diagnosis, patient / doctor relationship, and the need and desire of the sick to be well again.
Outside of the patient and doctor criticisms, there is the ideal that the patient is exempt from blame or responsibility. A functioning member of society rarely has the opportunity can be exempt from responsibility, it isn’t the case in the modern world for a number of reasons. Financial or family pressures mean that a functional member of society carry a burden whether or not they are sick. They are not exempt from bill paying or rearing children.
There is an increased awareness and control of our personal health in more modern society which negates the idea that the patient is free from responsibility. There are regularly news stories on how to reduce the risk of certain illnesses through diet, exercise or all manner of things. It is becoming more socially unacceptable to partake in risk taking activities such as unprotected sex, drinking excessively, smoking, becoming obese and reckless behaviour, and those who do partake in those actions are increasingly accused of being a drain on the health service, often reduced to monetary parts of society rather than personal individuals. Chalfont & Kurtz: 1971, summed up this criticism when talking about alcoholism, considering that not only is the alcoholic considered responsible for their illness they are also stigmatised by it and maybe not considered ill at all therefore unable to fit in to the sick role as Parsons described it.
The most targeted criticism is that the model only applies to the acutely ill and doesn’t allow for chronic illness. If you cannot recover but only manage your condition then the sick role does not fit as you are not expected to recover but you are still expected to return to your function in society if you have a condition such as diabetes. It is seen as more appropriate for the chronically ill to have some independence and understanding of their condition without continual medical intervention. I think that at the time of writing (1950’s) that there was more of a community and extended family life and chronic conditions were less medically managed and more community and family managed.
There is also the consideration that this model considers all people functional within society, it has a working age bias and considerable amount of illness experienced after working age would not be accounted for within the sick role model and it is worth considering how the functional model devalues those who have no defined working role and what is considered functional. There is still a considerable bias in medical resources towards those of working and reproductive age with those of retirement age not receiving the same level of care and treatment when they are considered less “functional”. The Guardian talked about cancer care being discriminatory in March 2012 and in June 2012 those over 65 won the right to sue if they were denied medical treatment because of their age reported the Independent.
Mental Health Nurse In Training 