Perhaps Parsons’s most influential work in medical sociology is his analysis of the "sick-role". The sick-role encapsulated types of behaviours surrounding illness, when individuals’ social obligations are suspended. Gerhardt (1989) identifies two models of illness in Parsons’s work on the sick-role. The first, she describes as the "capacity model" (p. 16) in which patients fail to stay healthy. This, she argues, is not the result of human motivation to remain ill but a natural occurrence which offers patients the opportunity to recover. The second, more complex, model treats illness as deviance. Importantly, Parsons did not see medical knowledge as being socially defined in the way that many now accept.1 Scambler (1997) suggests that prior to the 1950s, "the term ‘deviance’ was reserved for behaviour for which individuals could be held responsible; infractions of the law were seen as paradigmatic" (p. 171). Scambler goes on to suggest, however, that the outlook of deviance significantly changed with the work of Parsons (1951) who defined illness as being deviant as it served to disrupt the social system by inhibiting people’s performance of their regular social roles. Parsons believed that if such disruption was to be reduced, then the behaviour associated with illness must be controlled. As such, control was employed through the management of social roles for the sick and for doctors treating the sick (Scambler, 1997). For Parsons, the sick-role is universalistic in that all people, regardless of their status, age or gender may be admitted. In the process of the sick-role, doctors are regarded as
1
That is to say, the general shift in the social sciences towards more qualitative approaches (firstly feminism and latterly post-structuralism) questions whether medical knowledge, is "truth"/reality congruent, or whether alternative forms of knowledge, for example, lay knowledge about the body, are equally or more valid.
gatekeepers, policing the access to and exit from the sick-role, reinforcing the importance and facilitation of the latter in particular. In formulating the "sick-role" therefore, Parsons sought to explain the relationship between medical professionals and those who are ill. Parsons’ analysis has four principal themes:
1) the sick role legitimates exemption from normal social responsibilities; 2) the sick person needs help and cannot be expected to become well through
unaided action;
3) there is an obligation on the sick person to get well;
4) there is an obligation to seek technically competent help and to cooperate with that help in trying to get well (1951: 436-437).
Parsons’s first theme emphasises that sick people are allowed, and perhaps required, to take time away from (or give up) some of their everyday activities and responsibilities. Second, they are regarded as being in need of some form of care. Given Parsons’s contention of sickness as deviant and in need of legitimation and social control, the individual is obliged to seek the aid of others. Thus, in accepting the sick-role, and fulfilling their obligation to get well, power is invested in others (such as doctors), who are responsible for deciding who is legitimately sick and what action needs to be taken to enable their return to a socially accepted role. In this regard, medical professionals such as doctors are facilitated by the admittance of a patient into the sick-role as patients are required to access their services. It is useful to consider patients and doctors as occupying interdependent social roles that facilitate interaction where both parties are required to meet their personal expectations and obligations so as to ensure patients return to their everyday social roles (Morgan, 1997).
The purpose of Parsons’s analysis is to show that the relationship between the doctor and patient is a temporary and not a permanent system of interaction. Another aspect of Parsons’s deviance model is the notion that the sick-role may become an attractive alternative to working pressures, thus providing a way of "evading social responsibilities" (Parsons 1951: 431). Parsons’s analysis identifies the general societal expectations on doctors and patients, and indicates how commitment to these expectations facilitates the process of interaction. In this regard, Bissel and Traulsen (2005) contend that doctors and patients "construct patterns of stable interaction and learn appropriate social roles" (p. 43). Both doctors and patients are aware of how each other is expected to behave and, by accepting these roles, they reduce the potentially unsettling effects illness could cause in society. Indeed, the prospect that illness may jeopardize social order is central for functionalists such as Parsons for, as Bissel and Traulsen (2005) argue, "the feelings of stigma, shame and responsibility which accompany many illnesses result not just from the threat to bodily integrity, but because of the threat to the social system and social order more generally" (p. 45).
Having highlighted the central features of functionalist approaches to the medical professions, the following discussion seeks to highlight some critical questions concerning the adequacy of this approach. It addresses four central themes including: the problems associated with consensus; assumptions of uniformity of professional and functional unity; its macro-orientation and its conception of power.