The sick role theory states that sick people are exempt from normal social roles and responsibilities. Rather, they have their own responsibilities and ‘social role’. Central among these is the expectation that they seek medical treatment with the goal of returning to their usual social role.
Sick role theory emerges from medical sociology. It suggests those who are ill have both rights and responsibilities to their society, but these rights and responsibilities are different from people who are well.
This concept is based on the thought that an illness compromises a person’s immune system, which detrimentally affects their capability to handle the expectations of the general public.
Sick Role Theory Definition
“Sick role is a theory whereby the behaviors, rights and responsibilities of a patient deviates from societal norms because of their disease or disorder.” (DeLaune et al., 2019)
Sick role theory was developed by American sociologist Talcott Parsons in the 1950s.
It asserts that there are certain necessary actions needed to ensure that people who are sick receive appropriate medical care, allowing society to be relatively unburdened by their illness.
Parsons saw illness as an unexpected happening which caused a disturbance in the standard roles that people had to fulfill, such as working or attending classes. Cheshire et al. (2021) explain that, according to Parsons,
“…entering this role was thought to free a person from some social expectations (e.g., work) and blame for being sick, while they temporarily occupied the role. However, the role is considered an irregular or dysfunctional societal role and is governed by a range of expectations and responsibilities, including the ‘sick’ person wanting to get well and ‘submitting’ to medical experts to do so” (para 4).
The work of Parsons was most profoundly shaped and influenced by Emile Durkheim’s work on functionalism.
Fact File: What is Functionalism?
Functionalism is a sociological theory that sees society as a series of institutions that each has an important part to play in keeping the whole society working effectively. In relation to sick role theory, it holds that sick people have a part to play (their ‘sick role’) and are obliged to submit to medical institutions that will do their role in ensuring health and welfare of the population.
Parsons believed that the medical industry has a vital job to do in maintaining society’s correct functioning and effectiveness.
In Parsons’s opinion, the function of the medical field was to get a sick person back into their social role as quickly as possible. If they are not able to achieve this, it could then result in a major disruption of the social ‘body’, causing and have a negative domino effect on other elements of society.
Parsons (1975) states:
“There are, however, three primary criteria of accepting the social role of being sick. The first of these is the assertion with the view to its acceptance by both self and others, that being in a state of illness is not the sick person’s own fault, and that he should be regarded as the victim of forces beyond his control. A second social-structural feature of the sick role is the claim of exemption from ordinary daily obligations and expectations, for example, staying at home in bed instead of going to school or office. The third is the expectation, if the case is sufficiently severe, of seeking help from some kind of institutionalized health service agency” (p. 262).
Sick Role Theory Examples
- Paid sick leave: A society that embraces sick role theory may normalize the idea that you take time off of work to recover from an illness. The society may even pay for that time off.
- Expectation to seek medical help: When you get sick, it is expected that you seek medical help either by going to a hospital or contacting a medical professional.
- Respect for the social status of a doctor: You take medication that a doctor gives you, and you follow any advice about lifestyle changes that you need to make to recover.
- Normalized self-quarantine for the flu: You try and restrict your activities in an effort to get better and prevent the spread of the illness. For example, not going out to a concert, or dinner with friends.
- Universal healthcare: Society provides you with the healthcare services that you need; it is an expectation that people have healthcare when they need it.
- Travel insurance expectations: When you purchase travel insurance, it may provide stipulations about how to behave when sick, such as the insistence that you seek a doctor within 24 hours.
- Government benefits for the sick: In some cases, a person may not have the financial means to pay for medical treatment, they should apply for government benefits, or ask for financial assistance to cover medical costs.
- Expectation of rehabilitation participation: If the sickness or illness is severe, it is the patient’s role to actively participate in rehabilitation programs. Some examples include: physical therapy, behavioral therapy, or counseling.
- Segmentation of the ill: Health care agencies should provide the proper facilities for people with chronic illnesses, so that they can recover.
- Medicalization: Sick role theory can be associated with medicalization, a concept that refers to the over-prescription of medicines for conditions such as ADHD and menopause.
Sick Role Theory Case Studies and Research Basis
1. Social Obligations to the Sick
Premise: Society provides you with the healthcare services that you need; it is an expectation that people have healthcare when they need it.
Emke (2002) says,
“For Parsons, individuals played set roles within particular institutional settings, such as the family, the workplace, the legal apparatus, the medical system, and so on. Parsons argued that the ill take on a sick role, which (like all roles) provides them with a set of responsibilities and privileges.”
One of those privileges is:
“…an exemption from responsibility to get well by one’s own actions alone. In other words, the sick person cannot be expected to get better on her/his own, and has the right to assistance” (p. 82).
Sadly, this right is often either flatly ignored, or not provided by certain societies. According to research conducted by Tanne (2008) :
“Many more Americans die because of a lack of health insurance than previously thought, concludes a new state by state study by Families USA, a non-profit organization that advocates health care for all Americans. More than 26 260 Americans aged 25 to 64 died in 2006 because they lacked health insurance—more than twice as many as were murdered, Families USA said. In the seven years from 2000 to 2006 an estimated 162 700 Americans died because of lack of health insurance…..for many of the uninsured, the lack of health insurance has dire consequences. The uninsured face medical debt, often go without necessary care, and even die prematurely”(para 1).
See More: Examples of Social Obligations
2. Sick Leave from Work
Premise: Because you are sick, you take time off of work to recover.
The sick role theory states that when people get sick, they are excused from their day-to-day duties and jobs.
This will allow them to recover, and society should not punish, or look down on them, for doing so.
This theory, however, typically only applies to medical conditions that are not self-inflicted. Standal et al. (2021) states:
“Being on sick leave influence an individual’s identity and social roles. For example, societal and personal expectations of sick leave may also influence individual behavior when sick-listed. Such expectations were described by Parsons’ ‘sick role’ theory which illustrates how society has viewed illness behavior. In this theory, the sick individual is seen as having lost the capacity to do valued tasks, albeit not being responsible for falling ill. This loss of capacity affects all of the individual’s roles at work and outside of work. Consequently, the person is exempt from their normal roles and obligations and enters a ‘sick role’ where their new obligation is to spend their time and effort to get well as quickly as possible. Thus, withdrawing form society is the expected behavior to fulfill the sick role”(para 4).
Criticisms of the Sick Role Theory
Numerous criticisms of the sick role theory have been debated heavily in academia. Are the rights and obligations put on medical professionals and patients are too rigid?
One of the main lines of criticism, Williams (2005) explains, is:
“…his formulation of what in effect is a patient role which neglects the illness iceberg; the limited applicability of the sick role to chronic illness and other conditions such as pregnancy; and his failure to address factors such as class, gender, age and ethnicity in medical encounters”(p. 125).
In an example of the sick theory failing to address cultural issues, Heidarnia and Heidarnia (2016) state:
“In some minority cultures, although health is still a shared value, being ill may not lead to a serious search for technically competent help to get well. In some Moslem communities within Western modern societies, for instance, illness is believed to be atonement for sins committed by the sick person and a test from God hat must be treated with patience and submission. Illness, here, is not a condition that is undesirable and the sick are not expected to combat it, but one of the forms of experience by which humans arrive at a knowledge of Allah”(p. 132).
Sick Role Theory Strengths and Weaknesses
|Helps to explain how society deals with illness and how individuals are treated by peer, employers, and doctors when they are unwell.
|Ignores the reality that sick people often have to maintain other roles such as parent or employee, leading to role conflict.
|Recognizes that illness is not just a physical state, but also a social state. It affects how people are perceived and treated in social situations.
|Requires social consent that people will seek help (and, often, exclusively western medicine help) when ill, which may not be the case in all cultures or situations.
|Provides a good analytical framework for understanding relationships between people who are sick and members of their community.
|Can be used to justify discrimination against people who do not fit within the normative expectations of sick role behaviors. For example, a person with chronic fatigue who feels well enough to go shopping may be judged for being out and about.
|Creates a framework for social workers, doctors, and others working in the healthcare industry to help people through living with an illness. It also creates a framework for activism for special social treatment for people with illnesses.
|Does not take into account the fact that illnesses have varying degrees of severity and may change day-to-day, meaning their ability to occupy various social roles changes regularly.
|Can help healthcare providers to better understand and communicate with patients who are experiencing illness.
|Places expectations on people to embrace the ‘sick role’, which often restricts their agency or affects how they can choose to relate to their sickness.
Sick role theory has its pros and cons. While it helps to create a framework for patient advocacy and the importance of society in supporting people who are sick, it can sometimes constrain people’s agency and force them into social roles that they did not choose to embrace. In a sense, it can be a type of post-birth ascribed social status.
Cheshire, A., Ridge, D., Clark, L., & White, P. S. (2021). Sick of the Sick Role: Narratives of what “Recovery” means to people with CFS/ME. Qualitative Health Research, 31(2), 298–308. https://doi.org/10.1177/1049732320969395
DeLaune, S. C., McTier, L., Tollefson, J., Lawrence, J., & Ladner, P. K. (2019). Fundamentals of Nursing: Australia & NZ Edition 2e. Cengage AU.
Emke, I. (2002). Patients in the new economy: The “Sick Role” in a time of economic discipline. Animus, 7, 81–97. www.swgc.mun.ca/animus
Heidarnia, M. A., & Heidarnia, A. R. (2016). Sick Role and a Critical Evaluation of its Application to our Understanding of the Relationship between Physician and Patients. Novelty in Biomedicine, 4(3), 126–134. https://doi.org/10.22037/nbm.v4i3.10648
Parsons, T. (1975). The Sick Role and the role of the physician reconsidered. The Milbank Memorial Fund Quarterly. Health and Society, 53(3), 257–278. Doi: https://doi.org/10.2307/3349493
Standal, M. I., Foldal, V. S., Hagen, R., Aasdahl, L., Johnsen, R., Fors, E. A., & Solbjør, M. (2021). Health, Work, and Family Strain – Psychosocial Experiences at the Early Stages of Long-Term Sickness Absence. Frontiers in Psychology, 12. Doi: https://doi.org/10.3389/fpsyg.2021.596073
Tanne, J. H. (2008). More than 26 000 Americans die each year because of lack of health insurance. BMJ, 336(7649), 855.2-855. https://doi.org/10.1136/bmj.39549.693981.db
Williams, S. (2005). Parsons revisited: from the sick role to. . .? Health, 9(2), 123-144. Doi: https://doi.org/10.1177/1363459305050582