Sick Role

Sick roles are the culturally established expectations for how a person should act when he or she is ill or is perceived as ill/abnormal in a particular group. Each person learns these sick roles through a process known as socialization, in which people are subtly educated in the norms of a particular group.

While the term socialization can be used to refer to modest processes such as introducing a new employee to the norms of a business or institution, here we are interested in the broader and more fundamental socialization that teaches a person how to become a member of society. This process starts neonatally and occurs at each moment of interaction with others. Over time, by living and interacting with others within a given society, each person internalizes the norms and expectations of others, sometimes to such an extent that they seem essential and natural—the only way the world could possibly be and the only way people could possibly behave within it. When this occurs, those “essential” norms and expectations become tinged with morality so that people refer to them with “shoulds” and “ought tos” and look disapprovingly at any ideas, behaviors, or realities that flaunt them. This process embeds within each person more or less a similar sense of appropriate behavior, for example, that murder and theft are bad and following traffic rules is good. Socialization makes society possible in a very fundamental way. And yet, the [Page 1456]socialization of the sick role, the assumption that people with any illness or disability are morally obligated to behave in a particular way, has become deeply problematic in American society. But before exploring this, let us review the scholarly history of the notion of the sick role so that we might understand the recent backlash against it.

The first scholarly work on the subject of sick roles was published in 1929 in German by the medical historian Henry E. Sigerist. Sigerist, examining Western civilization but also drawing on cross-cultural information, defined illness as whatever disturbed the rhythm of a person's life so that the physiological symptoms isolated him or her, making that person suffer in helplessness, pain, and fear. For Sigerist, this sick role of isolation, dependency, and fear was the universal outcome of physiological suffering.

Talcott Parsons, the mid-twentieth-century American sociologist who made the notion of sick roles famous, did not take such a universalistic approach and instead grounded sick roles in the cultural and social dynamics of American medicine in the 1940s and 1950s.

Parsons recognized that for Americans of that era, illness and disability were both a deviation from an idealized norm of health and a deviation from the normal expectations of society. Parsons outlined basic features of the American sick role. First, the person who showed signs of deviating from health is exempted from his or her normal social activities and obligations and is exonerated from normal expectations of self-responsibility; in essence, the person takes on a dependent, childlike social status. Second, and largely because of the first feature, the person is socially isolated. Third, the person must accept that he or she is in this undesirable state, in need of help, and morally obligated to cooperate with others' therapeutic efforts at restoring the person to society's ideal of normal health so that the person can resume or take on normal social activities and obligations. The most appropriate source of therapy was seen as Western biomedicine.

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