Medicalization and Legitimacy
Understanding the social character of illness through Parsons’ sick-role
In this essay, I will outline the ways in which Parsons’ sick-role model of a legitimate illness trajectory offers numerous generative insights for the contemporary landscape of medical anthropology and sociology. Particularly I will focus on applying the sick-role theorization to the case study of chronic fatigue syndrome as presented in the article Medicalisation reconsidered: toward a collaborative approach to care (Broom et.al., 1996). With this case study I will demonstrate how in contrast to assertions by Parsons’ critics (Gallagher, 1976, 209), the sick-role is a theory equipt to illuminate the reasons why chronic conditions, such as chronic fatigue syndrome, struggle to gain legitimation (Broom et.al., 369, 1996). To further demonstrate the sick-role’s theoretical efficacy, I will use Parsons’ theory of the deviant subculture of illness to unpack doctors’ dismissive treatment of patients chronic fatigue syndrome (Williams, 2005, 124) and I will highlight how Parsons’ sick role brings attention to the social character of illness and the benefits of medicalization from a social perspective (Broom et.al., 1996, 358). All in all, by applying Parsons’ sick-role theorization to the case study of chronic fatigue syndrome, I will demonstrate that Parsons’ sick-role is far from antiquated; on the contrary, the sick role still has much to offer contemporary medical anthropologists and sociologists.
Many detractors of the sick role critique the schema for its exclusion of chronic conditions (Gallagher, 1976, 209). However, this critique fails to apply the theory of the sick-role as a Weberian ideal type (De Maio, 2009, 32). An ideal type is an analytic tool coined by sociologist Max Weber, and it consists of typologies that capture certain elements seen as consistently present in particular social phenomena (Weber, 1949, 47). The sick-role as formulated by Parsons is an ideal type and therefore is not meant to explicitly capture every single case of the doctor patient encounter (De Maio, 2009, 32). As further proof of this, Parsons himself has acknowledged the realities of permanent disablement as a common type patient experience (Williams, 2005, 126). Rather than seeking to capture all social phenomena, the sick role simply draws our attention to common medical dynamics in which doctors function to contain the social deviance of sickness (Parsons, 1951, 452). When an illness type, such as chronic fatigue syndrome, isn’t able to fit within the sick role, doctors struggle to contain the ‘deviance’ of the illness leading to difficulties attaining legitimation (Broom et.al., 365, 1996). Applying the sick role theory to chronic fatigue syndrome, we can theorize reasons as to why the condition struggles to attain legitimacy in the medical space.
In Parsons’ sick-role the ideal patient’s exemption from social obligations is contingent upon them seeking medical help that will enable them to recover and return to fulfilling their social role (Williams, 2005, 124). Exemptions from social obligations cannot be justified within this framework by a condition such as chronic fatigue syndrome, where the patient can never recover and return to their previous social identity (Broom et.al., 376, 1996). Weberian studies of authority applied to a medical context show that legitimacy is contingent upon legibility either through existing rules [diagnostic categories] or sediment [established disease norms] (Spencer, 1970, 123). The sick role as an ideal illness trajectory is an established disease norm (Williams, 2005, 125), therefore conditions that fit within this trajectory gain easier legitimation by doctors and society alike. In the case of chronic fatigue syndrome, patient distress does not fit neatly into biological data or diagnostic categorization (Broom et.al., 362, 1996). The lack of empirical data about the condition and the chronic nature of the illness disrupts the ideal sick role trajectory that contains the disruptive potential of illness by healing the patient so they can return to their normative social role (Williams, 2005, 124). This social disruption caused by the perpetual nature of the illness bleeds into the doctor-patient encounter. Individuals with chronic fatigue syndrome reported high incidents of having unfavorable encounters with doctors, often experiencing dismissal of their condition and denial of treatment (Broom et.al., 365, 1996). Within the sick-role framework we can theorize that this dismissal is connected to the doctors discomfort with their inability to fulfill the ideals of the sick role in which they contain the disruptive potential of illness by facilitating a full recovery (Williams, 2005, 124). This theorization does match up with patient accounts, where they report doctors losing interest due to the ambiguity and perpetual nature of the condition (Broom et.al., 370, 1996).
In line with Parsons’ theory that the sick-role functions as a lever of social control (Williams, 2005, 130), patients with chronic fatigue syndrome report having encounters with doctors where their pain is dismissed in favor of them pushing through discomfort and returning to their social obligations (Broom et.al., 370, 1996). Maintenance of patients' social roles take precedence over seeking to assist them in their experience of pain and illness. Parsons’ theory of a deviant subculture of sickness help illuminate the levers of these doctor-patient interactions (Williams, 2005, 131). The Parsonian doctor is charged with preventing a deviant subculture of sickness from forming in which patients seek to accrue the benefits of illness; i.e. dependency and alleviation of social obligation (Williams, 2005, 131). Doctors working with chronic fatigue syndrome patients perceive their patients through this Parsonian lense of deviance, using their medical authority to dismiss patients with chronic fatigue syndrome in fear that they will form dependency and withdraw from their social obligations (Broom et.al., 366, 1996). In line with Parsons’ theory of containing a deviant subculture of sickness, doctors handling chronic fatigue syndrome are seen reducing the condition to a psychological sickness that they must remedy through the therapeutic avenue of denial and medical dominance (Broom et.al., 366, 1996).
Critics of the sick role say the illness trajectory denies realities of permanent disability that exist in the case of chronic fatigue syndrome (Gallagher, 1976, 209). Yet, in reality, the sick role tends to the social dimensions of illness experience (Broom et.al., 358, 1996), which is a prominent part of discourses on disability (Fulcher 1989). Chronic fatigue patients narrate the early manifestation of their illness using their ability to fulfill social obligations as the metric by which they decided to seek out treatment (Broom et.al., 370, 1996). Parsons’ conceptualization of illness as social deviance fits patient’s experience of chronic fatigue syndrome as a decline in their ability to fulfill their social obligations (Broom et.al., 370, 1996). To contain this deviance, chronic fatigue patients promptly sought to submit themselves to the processes of medicalization to contain the disruptive potential of illness in their social lives (Broom et.al., 373, 1996). Submitting themselves to the diagnostic process or the sick role becomes necessary to legitimate their withdrawal from normative responsibility (Broom et.al., 373, 1996). The sick role in this case study can help medical anthropologists and sociologists understand that patients submit themselves to medicalization to contain the disruption illness poses to their social identity.
Tending to chronic fatigue syndrome using Parsons’ theorization of the sick role illuminates the struggles individuals with chronic fatigue syndrome face in attaining medical legitimacy within a climate of medicine that is designed to curtail deviant subcultures of illness. Detractors of Parsons’ mistake the theoretical applications of the sick-role in medical anthropology and sociology. As an ideal type the illness trajectory of the sick-role is not meant to be accommodating for all illness experiences (Williams, 2005, 126). Rather it reveals to us integral themes that are present in the asymmetry of doctor-patient encounters (Williams, 2005, 133). These integral themes sensitize medical sociologists to the social character of illness (Williams, 2005, 124), reveal the benefits of medicalization (Broom et.al., 1996, 373), and explain how doctor-patient encounters can go wrong when illnesses, such as chronic fatigue syndrome, challenge the medical impetus to restore social function to the patient experiencing illness (Broom et.al., 1996, 366). As the application of chronic fatigue syndrome demonstrates, Parsons’ sick role retains its relevance as a generative theory capable of provoking insights into contemporary doctor-patient encounters.
Bibliography
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Broom, Dorothy. and Woodward, Roslyn. (1996) Medicalisation reconsidered: toward a collaborative approach to care. Sociology of Health and Illness, 18(3): 357-378.
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Fulcher, G. (1989) Disability: a social construction. Sociology of Health and Illness: Australian Readings.
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Spencer, Martin E. “Weber on Legitimate Norms and Authority.” The British Journal of Sociology 21, no. 2 (1970): 123–34. https://doi.org/10.2307/588403.
