When I worked as a senior mental health nurse, we had a particular male support worker who regularly adopted the “sick role”. He called in, yet again one Friday and whispered, “Hello……… I been to my Doctor today…….. he tells what is wrong with me……” pausing for effect and in that desperate manner, giving the impression he just he had a month to live “My Doctor insists me to take one week off sick.”
“Ah, okay. What’s the problem Bimbola?”
“He tell me I have hayfever and now, I go to the chemist to buy some medication and I will come back next week.”
Holding back my giggles, “Aw, you poor thing Bimbola. Okay, get yourself off to the chemist and then — get your backside into work. I’ll see you in half an hour.”
The above was something I wrote on a friends blog the other day, in answer to one of his questions — which led to him further questioning my use of the term “sick role”. Hence this post.
So, what is the “sick role”?
It’s a term used in medical sociology regarding sickness and the rights and obligations of the affected i.e. the patient. It’s a concept created by American Sociologist Talcott Parsons, 1951.
His sick role prescribed customary rights and obligations based on the social norms for the patient.
The rights included;
- the sick person should be excused from social roles and should not be held responsible for the illness;
while the obligations included;
- the sick person should try to get well and should seek technically competent help from the medical professional.
So, in plain English, if you were sick it was your right to take to your bed, not to go into work, to hand over the school run to someone else or to ignore the housework.
And it’s not your fault you broke both legs, so no one can blame you for the pile of dishes in the sink, the sort-yourself-out-dinner or the kids emptying the kitchen cupboard contents onto the floor then thought it funny to crack half a dozen eggs into the mix.
However, you have an obligation to try to get well — like taking pain medication, sitting in A&E for hours on end, having x-rays, a cast and attending outpatient appointments.
Do people still adopt the “sick role”?
Do you remember when people went into hospital say to have their tonsils out and often stayed for days, a week even? They lounged around in their best nightgown, a woolley cardi and slippers, looking pale and sickly. They actually played out the “sick role“, smiling weakly and almost whispering when visitors arrived. Never mind they were only in there to have an ingrown toenail sorted out.
For all that, times have moved on and it seems that most of us no longer voluntarily accept the sick role and we don’t comply with those old rights and obligations of the sick role.
With our busy lives, we have no time to comply with the rights like taking to bed for a few days. We tend to get up and get on with our social obligations like washing up, making dinner or taking three kids to karate, swimming and football. We’re more inclined to resist help, decline medication and not worry about visiting our GP.
Mental illness and the “sick role”
We tend to avoid the sick role even more if our illness is stigmatised — like mental illness. At first and for many years, I hid my mental illness. I was scared and I didn’t want people to judge me for having a mental illness, hence my initial fear of seeking help and treatment.
For someone with say a wrist fracture, playing the “sick role” enables them adopt an identity (Look at me, I’m sick) that, more often than not, brings support and acceptance from others — they receive cards saying ‘Get well soon’ and people call to ask how they’re doing. Hospital admission also offers that person a clearly defined place in a social network — they’re off work, sick, they get lots of visits from family and colleagues who come bearing grapes, flowers and chocolates.
Not so with mental illness.
I might have seen a dozen or so get well cards in fifteen years working in mental health and I most certainly never saw flowers or a bunch of grapes. Visitors, even family members, were few and far between on acute mental health in-patient wards. Families that initially turned up, often looked down their noses at other patients with mental illness saying, “my son doesn’t belong here — these people are all mad, my son is sick,” or they never visited again.
Let’s be clear here. We don’t want to adopt the “sick role”. We don’t want to have anxiety, depression, OCD, PTSD, schizophrenia, bipolar or personality disorder any more than someone else wants broken legs.
According to the WHO (World Health Organization), mental health is:
“… a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.”
And people with mental illness want to be able to fulfil our social obligations and just get on with it, to work productively and to contribute towards our communities.
Does that mean we have to adopt the “sick role” so that, perhaps we’ll be diagnosed sooner and the quicker the symptoms can be treated?
It took eighteen months before my GP finally pulled me aside, when I’d taken the boys to be seen about their asthma. Once he’d seen them he sent them out, turned to me and, with his hand resting lightly on my arm, he said “Tell me, what is the problem? You so thin and though you smile, I think you very sad.”
As a single parent, working part-time and taking the boys to the various activities most nights and each weekend, there was no “sick role” rights for me — I couldn’t take to my bed and curl up into a ball.
However, my “sick role” obligations were carried out as I sought competent help from a medical professional (well help found me really — in the form of my GP.
What are your thoughts about the sick role model. Do you think it’s outdated? Perhaps you know someone who constantly adopts the “sick role”?
Parsons, T. The Social System. 1951. Glencoe, IL: The Free Press