The ‘Sick Role’ and Perceptions of Disability

I was recently introduced to the concept of the sick role, something which has been rattling around in sociology since 1951, when it was discussed by Talcott Parsons. Sociologists are very interested in the structure and function of  society, and people who are sick or disabled play an interesting social role. Both as individuals and as objects of perception. The theory behind the sick role, while not necessarily designed to talk about disability specifically (focusing in particular on sickness as a temporary state) actually has some interesting impacts when it comes to talking about disability and trying to reframe social constructs which surround disability.

The underlying idea behind the sick role is the concept that society, as an entity, craves order. Society likes structure, clear limits, and obviously delineated roles for all members, because otherwise it starts to break down. People who are sick break the rules of society because they are viewed as nonproductive members. Yet, unlike other “deviants,” people who are sick or disabled are not setting out to be deviant. They are forced into that role.

The term I see used is “sanctioned deviance,” based on the idea that society tolerates this divergence from social norms and expectations because of the understanding that there are extenuating circumstances which must be weighed when evaluating the situation. Whether or not this is actually true is a matter for legitimate debate, I think, and it’s an area where the concept of the sick role really falls short. In fact, society does not sanction deviance on the part of people who are sick or disabled, as evidenced by the fact that people feel pressured to work or “contribute” even when they are not able to. It only sanctions it among people with particular types of sickness and disability, and it only sanctions people who behave in a particular way.

But, back to the fundamentals of the sick role. The theory goes that people need to figure out where people who are sick fit into the social framework so that they know how to relate to them and how to deal with them. By codifying the social role of sick folks, people generate the social attitudes to go along with that role. This obviously plays directly into social perceptions of disability because disability can involve sickness and is often viewed as a “sickness,” although I would beg to differ. But we’re talking about social constructs here, not my view of disability.

Parsons theorized that members of society view sick people in a position of having both rights and obligations by nature of their illness. Under the theory, the “rights” afforded to the sick include “exemption from normal social roles” and an understanding on the part of society that sickness is not the fault of the sick person. This, again, I think is something which is very much open to debate, which I will be discussing in a moment.

The responsibilities of the sick are the obligation to get better, and the obligation to seek out and follow a course of treatment. Being sick may not be your fault, persay, but you are expected to take every step to make yourself better. You have, indeed, an obligation to be healthy, which feeds directly into concern trolling about things which are not directly related to health, like being fat.

Using this framework, I think we can point to a lot of examples in society in which sickness is stigmatized, and in which disability is stigmatized, and we can see the origins of the stigma from within the framework of the sick role. In a society which needs order and needs people to adhere to specific behavioral patterns, people who do not perform the sick role to the satisfaction of others are viewed as suspect.

For example, people with mental illness who refuse to take their medications are stigmatized because they do not identify and follow a course of socially approved treatment. Likewise, psych survivors are stigmatized for not giving credence to the psychiatrization of their identities. People with lung cancer are not given respect because their illness is presumed to be their fault. Similarly, people who are sick and don’t get better are subject to social abuse because, again, they break the rules of the sick role by not getting better. They aren’t fulfilling their social obligations as sick people.

This manifests in some really interesting ways with people who have disabilities or illnesses which are not easily read by observers. (“But you don’t look sick!”) These individuals are hard for people to codify because of the fact that they don’t appear to be sick (or disabled) so they can’t be slotted into the sick role and they are also not being “productive” in the estimation of the observer. They are, as it were, unsanctioned deviants. Which explains why some disabilities are disparaged and treated as fake, because it’s easier to dismiss the fact of the disability than it is to confront the ways in which it conflicts with the sick role.

The sick role plays into so many things, like the hierarchy of disability which treats some disabilities as more “real” than others, and the good cripple archetype, which is essentially the disability-centric version of the sick role. The good cripple is an object of pity, but also has social obligations which include not making people feel uncomfortable and being stoic about disability. It plays into the way in which people with disabilities are treated by medical professionals, and in particular into the perception of bad cripples who do not play their parts as required by society.

While the sick role is focused on sickness as a temporary condition, it is interesting to note that many disabilities are treated, surprisingly, as temporary states even when they are not. And, furthermore, disabilities are treated as things which are undesirable. Things which people would want to make better if they could. To say otherwise would be to dismantle the framework of the sick role; if disability isn’t something which needs to be “cured” then both of the obligations of the sick role go flying out the window.