Introduction
The sick role was first suggested as a concept of a patient’s behavior by Talcott Parsons in 1951. Varul (2010) states that Parsons’ notion of the sick role was “widely accepted as a historically adequate account of normative expectations around illness in the middle of the 20th century” (p. 72).
Another major author to describe the patient’s sick role was Alice Stewart Trillin, who wrote about her life as a cancer patient in her article ‘Of Dragons and Garden Peas’ (1981). In the work, she describes what is considered to be the sick role from a patient’s perspective, discussing the fear of dying, communicating with other patients, and other experiences that are part of living with such a serious illness.
In this essay, I aim to describe the sick role as represented by Parsons (1951) and Trillin (1981), as well as how my personal experience of being in this role fit their description and whether or not the concept of the sick role still applies to the contemporary society.
Parsons’ Four Components of the Sick Role
The idea of ill people fulfilling a certain ‘sick role’ was first introduced by Parsons (1951) in his book The Social System. Parsons (1951) writes: “Illness, in our society, is undoubtedly motivated to a high degree and therefore may legitimately be regarded as a type of deviant behavior” (p. 285). For Parsons (1951), patients undertook the sick role in an attempt to go against the expectations of the society: for instance, a person could develop the sick role as a way of denying his obligations to other people (p. 284). The sick role has several distinctive features.
As Parsons (1951) argued, it is inevitably associated with some form of dependencies, such as the dependency on other people for aid or the dependency on medication to ease pain or symptoms (p. 285). Moreover, Parsons (1951) suggests that this dependency is usually associated with alienation, where the caregiver provides aid and support, while the ill person is not equally involved in the relationship (p. 285). Even though such a relationship is usually comfortable for the patient, however, he or she still has a goal “to get well as expeditiously as possible” (Parsons, 1951, p. 291).
The sick role, according to Parsons (1951), is also a role that involves relative legitimacy, “so long as there is an implied ‘agreement’ to ‘pay the price’ in accepting certain disabilities and the obligation to get well” (p. 312). The institutionalized system of expectations with relation to the sick role, thus, consists of four main components. First, the sick role involves the refusal of the person’s normal social role and the responsibilities associated with it (Parsons, 1951, p. 436).
Secondly, sick people cannot be expected to get better on their own, which is why a process of recovery is always embedded in the sick role (Parsons, 1951, p. 437). Next, the state of being ill is considered by the patient to be undesirable in itself, and therefore a patient must have a desire to get well soon (Parsons, 1951, p. 437). The final component of the Parsons’ (1951) sick role is the aid-seeking behavior, where the person seeks the help of a professional and not merely a friend or relative (Parsons, 1951, p. 437).
Trillin’s Sick Role
Trillin’s perspective on the sick role, on the other hand, is entirely personal. She was a lung cancer patient who has spent considerable time in treatment. Some of the ideas she expressed in her essay ‘Of Dragons and Garden Peas’ are similar to the ones Parsons (1951) attributes to the sick role. For instance, her desire to get better is evident throughout the story: “the thought that my children might grow up without me was as ridiculous as the thought that I might forget to make appointments for their dental checkups and polio shots. I simply had to be there” (Trillin, 1981, p. 700).
As someone being in the sick role, she also relied on professional help: “The very best doctors […] share their power with their patients” (Trillin, 1981, p. 699). Moreover, the sense of alienation is also evident in her experience. For example, Trillin (1981) discusses the fact that everyone sees the changes in the sick person as permanent: “everyone – with the single rather extraordinary exception of my husband – regarded me as someone who has been altered irrevocably” (p. 699). In her case, Trillin (1981) argues, the alienation happened because of the people’s “inability to understand the ordinariness, the banality of what was happening to [her]” (p. 699).
However, Trillin (1981) also explores some sides of the illness that Parsons (1951) does not address. For example, she describes that there is a feeling of connectedness among the patients: in the community of cancer patients and survivors, people support each other and share their stories (Trillin, 1981). The author also states that the combination of the connectedness among the patients and their alienation from the people who are well creating a sense that two separate worlds exist: one that Trillin (1981) calls ‘The Land of the Sick People’ and the other, ‘The Land of the Well People’ (p. 699-700).
Trillin (1981) also discusses the relationship with the doctors and the pressure to be a good patient: “If we get well, we help our doctors succeed; if we are sick, we have failed. Patients often say that their doctors seem angry with them when they don’t respond to treatment” (p. 700). Another significant theme of the article is the fear of dying and the tendency to seek control over the illness, particularly by obtaining more knowledge about it from the doctor (Trillin, 1981, p. 700)
My Experience
Thankfully, I have never had a serious illness with extensive long-term treatment. However, as a child, I had quite poor health and used to catch colds and food poisonings quickly, which frequently resulted in me having to spend several days in the hospital. To me, the hospital always felt like an entirely different world, which was completely isolated from the outside world’s problems and events. Few people from the department watched television to keep up to date with the news, but most of us formed a separate community, similar to what Trillin (1981) was referring to as ‘The Land of the Sick People’.
Also, like Trillin (1981), I felt the need to be a good patient and to let the nurses perform any necessary procedures for me to get better. I can also say that I enjoyed being cared for, although, according to Parsons’ (1951) concept, it also meant depending on other people for treatment and entertainment. Overall, I was quite comfortable with being in the hospital; however, I still had a desire to get well as soon as possible to get back to ‘The Land of the Well People’.
When my parents or friends visited me, I could still see that there was some sense of alienation between us, not just because sometimes I was contagious, but also because I was surrounded by different people and could not keep talking to them regularly. In general, I can say that my experience of being in a hospital was somewhat similar to what Trillin (1981) discusses, although there were also some similarities between my story and what Parsons (1951) defines as the sick role.
The Sick Role in Contemporary Setting
Nevertheless, I also believe that Parsons’ (1951) concept does not apply well to the modern environment. Nowadays, people have more chronic diseases that require making certain lifestyle alterations but do not necessarily involve being dependent on other people for treatment nor the desire to avoid social interactions, which is one of the primary components of the sick role (Parsons, 1951, p. 436).
Moreover, where Parsons (1951) argues that such people cannot get well on their own, most people who live with certain chronic diseases and conditions can control them without the use of medication or professional help. Varul (2010) agrees that the increase in the number of people living with chronic diseases is a notion that Parsons’ (1951) theory no longer seems to cover, and states that “Even in the shrinking field of acute illnesses the sick role has been predicted to disappear soon due to marketization and patient empowerment” (p. 72).
Conclusion
Overall, I think that both Parsons (1951) and Trillin (1981) describe the role of the patient in an institutional setting quite well, although the authors take two different approaches to the sick role. Trillin’s (1981) words come from her experience as a patient, whereas Parsons (1951) writes from a rather professional point of view.
However, I think that in the contemporary world, the life of the patients is changing every day due to the new developments in healthcare and science, and the people generally feel more empowered, no longer fitting the sick role prescribed to them.
References
Parsons, T. (1951). The social system. London: Collier-Macmillan Limited.
Trillin, A. S. (1981). Of dragons and garden peas. New England Journal of Medicine, 304(12), 699-701.
Varul, M. Z. (2010). Talcott Parsons, the sick role and chronic illness. Body and Society, 16(2), 72-94.