Mental illness and the “sick role”

Adopting the “sick role” —
Image from Spectrumnews.org

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”?

Sick role, 1951 — Getty Images

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.
Sick role and your ‘right’ not to have to tidy up — Bigstock

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”

Mental illness and stigma — Twitter

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.

Panic attack — Image by Medicalnewstoday.com

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.

Seek help from a medical professional – Getty Images

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”?

Sources:

Parsons, T. The Social System. 1951. Glencoe, IL: The Free Press

Author: mentalhealth360.uk

Mum to two amazing sons. Following recovery from a lengthy psychotic episode, depression, anxiety and anorexia, I decided to train as a Mental Health Nurse and worked successfully in various settings before becoming a Ward Manager. I am a Mental Health First Aid Instructor and a Mental Health Awareness Trainer, Mental Health First Aid Youth and Mental Health Armed Forces Instructor. Just started my mental health from the other side blog.

51 thoughts on “Mental illness and the “sick role””

  1. I tend to think of the sick role as people not doing things they’re actually able to do because of whatever support or other benefits they gain from being sick. I view awareness, acceptance, and help-seeking related to actual restrictions imposed by illness to be a distinct concept.

    The notion of obligation to try to get well has a paternalistic feel to it, and I’m not sure it’s a great fit for mental illness, especially when there’s impaired insight.

    1. Yep, there are those that ‘stay sick’ because of the benefits they gain and I used to use this ‘secondary gain’ when working with long-term ‘malingerers’. Sorry to say that, but we did have some.
      It does have a paternalistic feel but I think more than ever, these days doctors go against the passivity that the sick role once implied. Patients are expected to collaborate with their care teams and to actively participate in getting better.

      I totally agree, I don’t think the sick role has any place in mentall illness. Thank you for commenting Ashley.

      1. Thanks for this post. I keep thinking and saying to my psychologist I feel I should be working. I see people looking at me sitting with my dogs having a coffee and chatting to people I sometimes feel as though I should not be out.
        I generally only leave my home once or twice a week, maximum. This is usually to go shopping or for an appointment. I also use this time to socialise. By this I mean I will chat to my local shop owners, I have a coffee and sit sometimes with people I know other times with people who are on holidays, or just having a break. Sometimes it seems I have people who are unwell themselves come and sit with me. I will always stay and listen, share and be very present with them. As from my own journey I know sometimes that I might be the only person the person who is sharing with has spoken with for a long time. That they may have pushed themselves through so much anxiety to just come out or to talk with me. Or they may have been very very lonely and or on the verge of something more. Others have been there for me in a similar way. If you dont meet anyone, it can make it such a hard day as you have put yourself out there.

      2. Oh I know about people thinking you shouldn’t be out. I lived 2 minutes from my job and people might see me out having a coffee, chatting to peeps like you (often patients would ask to come and sit with me).

        But hey, people with physical disabilities can go out i.e. those with a broken arm, leg or just after an operation. Do they have to stay indoors? No.

        Btw, I’m like you – if someone comes over to chat, I’ll engage with them cos I know they didn’t have anyone else that listens to them.

  2. While the term ‘sick role’ does make it sound like one is being false and playing a part…In my own experiences, I pretty much ended up on a week’s leave with a doctor’s note at every job I ever managed to hold. I was not well, I was seeking treatment, and at that particular time, I simply could be there in the capacity required to perform my duties adequately. I never viewed it as making excuses or laziness or letting down the boss. I did everything to help myself get better so I could return.
    But then I was sick more than I was well after a medication interaction nearly killed me, and because my mental illness and mental deficit basically rendered me unable to do what I had previously been able to do and I do live in the perpetual state of being unstable, I was granted disability. People scoff at this because it’s a mental health diagnoses, but it’s comorbid with four other disorders. This was not just some “Feeling blue, can’t work, gimme money” thing. I tried to work and the employers loved me and were sympathetic…
    But the one thing the world requires is stability and it is the one thing I can not consistently deliver. Thus I do have a disability that hinders my ability to lead a normally functioning life.
    I see others who make this same claim yet they have zero problems going out to movies, concerts, parties-their only illness seems to be tied directly to working. My illnesses envelope every aspect of my life, right down to my child saying, “Mom, why are you always so sad?”
    Yes, I think people should have every right to be sick and not be punished for it. We all have the right to compassion, kindness, and normally for physical ailments, it is freely given. But in the 30 years I have been battling my mental illness, I’ve never gotten a get well card, a bowl of chicken soup, or even a potted plant to feel better. Seems to me the world has made it clear-physically sick, legit. Mentally sick, malingering faker.
    And it is time we stop sweeping mental illness under the rug and allowing the world to get along with this cruel, ignorant view. Unfortunately, stigma really knows how to quash the conversation we need to keep going on the subject.

    1. Aahh, bless. I really hope you haven’t been offended by this post Morguei? I think through the comments, we’ve agreed that the model is outdated and it really doesn’t have a place in mental illness.

      Mental illness is a whole different ballgame and some people do see it as being lazy and malingering. I’ve even had benefits people (when I first applied) intimating that I look well. Despite that fact that I have a very real but ‘hidden’ disability and mental health problems.

      I’ve never had a card or flowers either lol and as I said, I never saw them on the wards. I’ve lost friends because they lack empathy, compassion and understanding and believe me, it’s their loss, not mine.

      Having mental illness has clearly made me more aware of the shallow people in this world and I want nothing to do with them.

      The stigma definitely needs to stop and the more we all blog about mental illness, trying to raise awareness, the more people will start to understand. Caz x

      1. Oh, no, no, your post did not offend me. It is society’s outdated perceptions of mental health I find offensive. I hadn’t even heard of this sickness role thing here in the states so I am grateful for being educated. I think here they call it ‘self proclaimed victimhood’ or ‘hypochondria’, the stupid diagnostic manual is always changing. Before long liking chocolate will be a disorder.
        No, you did not offend me at all.
        Society…pisses me off. Well, ignorant people who opt to remain ignorant do. I’ve not given up hope that we can educate some on the mental health topic. I’ve also learned to accept some-like my own family- are in absolute denial and will not be swayed.
        To me, their issues are far more malignant than any of mine because I am seeking help and making an effort. They are content being ignorant and that is just a shame.

      2. Oh good 🙂 I’d hate to have offended you.
        Lol, liking chocolate – a disorder 🙂
        Me too, I get pissed off with people who’re unwilling to listen to other opinions or to educate themselves or to change their minds, particularly about ‘mad’ people. I get so sick of the negative words used to describe people with mental health problems – in the UK.
        Me, my sister and my brother (yes! that’s 3 out of 4 of us) are fortunate to have not only each other but a close family who learned about our different mental health issues and accept us all as we are.
        That’s why I blog and campaign and Tweet and shout from the rooftops – people are starting to listen to us all – and that can only be good news 🙂 Caz x

  3. Is there a name for the flip role? The one that is equal and opposite to the “sick role”? The role was somebody wishes to become a hero, for keeping going?
    I saw this with somebody, although it was physical, not mental. Same person year after year. She would come in clearly full of cold and flu, coughing and spluttering without any regard that she was infecting everybody else.
    As I worked as a consultant, it was very straightforward for me – if I didn’t work, I didn’t get paid. But I had to counter that with taking a day off here and there to nip something in the bud, lest it became a bigger problem farther down the line.

    1. Oh, perhaps it’s Martyrdom? Don’t you just hate them lol. There are certain illnesses where we had to be off work – not to infect patients or our colleagues.

      But we did have lots of staff who ensured they took their entire quota of sickness allowance each year. In fact, they’d come into the office to ask me how many days sick they have left!

      1. Yes that is interesting. Kacha posted on it, just yesterday, but from the other side of the fence, i.e. hauled in to explain her absence if the numbers were too great. I think the answer is to have an environment in which people *want* to work, but of course that has nothing to do with illness directly.

      2. It is interesting especially now with the new virus. If you are coughing and feeling achy have a temperature you should NOT be at work ever. or out and about. I get so annoyed when people are martyrs. (not talking about a cold necessarily) but they are not thinking of others at all. The people who catch what ever they have bought into work. I like the chinese system wearing masks if you are unwell.

        When I worked in Emergency I was always horrified how some people () would just cough all over me, without covering their mouths, some people were too unwell I accept that. I have actually given someone a mask as they were a smoker had a smokers cough and some cold (went home with no antibiotics) Without a thought for other peoples well being in the waiting room or the staff when they were brought through.

        Emergency nurses and doctors ambos, police are all exposed to so much but we get no extra time of for illness.

        People in work situations or just traveling in and out to where ever, sending their kids to school, do not think of those who may be immune compromised, it annoys me. (in case you had not worked it out lol)

      3. Yew! I know that. We had one of the hardest jobs, dealing with people who are sick, either physically or mentally and exposed to all kinds of things.

        It gets on my nerves in GP waiting room or Hospital A&E where, like you said, coughing all over you. The noise of people hacking up phlegm etc – yew!

        Oh I worked it out already Tazzie, and I agree with you, totally!

        Caz x

      4. I have done all those and more lol. In Hobart Public Hospital if their is a body fluid spill nurses had to clean it up not cleaners! So on a night shift buzzers would be going off while a nurse was cleaning a floor and the cleaner was often sitting down reading. I am not putting cleaners down, I have been a cleaner in a past time so I respect them. They just must have super union in tasmania. I do hope it has changed This is only four years ago though.

  4. The sick roll sounds like going into recovery recovery mode. Recovery mode is totally useless outside of a doctor’s office. Absolutely individuals should seek medical care when ill, however, if individuals are always always talking about symptoms outside doctor’s offices then the mentally ill individual is basically stating I am wrong about everything and what I say should not be given weight. I always knew I was ill, however, I held despite that I still had worthwhile points of view. If there is a difference of opinion the mental illness of an individual can and almost always will be used against that individual. Individuals who are mentally ill must themselves be aware of how ill they are but talking about being mentally ill to others and adopting the sick role can have very negative affects on life for individuals who are mentally ill. There are, of course, places where mental illness can be talked about openly and safely, for example, on a WordPress blog.

    1. I get you Thomas. Even some nurses would use the patient’s illness against them when seeking help and advice, like “I told you all this last week and you must have forgotten because you were unwell.” or say things like “Oh, what would you know? I’m the nurse so I know what I’m saying is right.”

      I think if you look at some of the comments, we’ve agreed that this ‘sick role’ model is outdated because more and more people are trying to get better, get up and get on with it. We’re also expected to actively participate in our ‘recovery’ rather than waiting for the care team to ‘make’ you better somehow.

      Some have also agreed that the ‘sick role’ model doesn’t fit with mental illness.

      I agree with you that there are great, safe places to engage with people on the same topics here on WordPress blogs 🙂 Thank you for your comments, you always make me think! Caz

  5. I tend to go into full sick mode when I’m hormonal. My periods make me feel godawful at times, like physically and emotionally all at once; and I just quit expecting any sort of productivity from myself whatsoever until I feel better. The first full day of my period is especially notorious. My body quits digesting food right. (I have no idea what’s up with that.) But I go full-out sick. Like, I’m not doing anything.

    In a broader sense, I feel sad for how hard I used to try to function at the workplace (something I’ve given up on entirely). I struggled just to seem normal, even in the face of employers asking me if I was afraid (which I was trying to hide). So now I get the big disability bucks, and God bless. But I don’t act “sick” all the time. I just act like someone who sure can’t work, but who can do other things.

    I also think there’s a certain thrill to first being diagnosed. Like, “I’m schizophrenic? What? Holy [bleep], that sounds serious!” But life tends to move forward, and it loses its luster.

    1. Wow, that’s not good about your periods — I never realised they could be that bad. And to be sad for how hard you used to try to function – aaww.

      Me too, I don’t ‘act’ like I’m sick but those close to me know when I’m in pain and when I just need to lie low for a few days. I’m lucky to have my family and a really small circle of friends who are all very supportive.

      Lol – a thrill “I’m Schophrenic”, you do make me laugh Meg 🙂 xx

      1. Periods can be so incapacitating for some women. I had a friend who was in agony and bled so heavily for five days. She was so exhausted and anemic very very hard on her. She could not go to work, for the first three days sometimes for the five. It took her going to a female GP to finally get decent help. (this was quite a few years ago, I hope things have changed.

        I was pleased to get my diagnosis as I knew it was more than just depression. It was not a thrill…I guess for some perhaps.

        I just tell people why I cant work. Thought centrelink here (government benefits) dont seem to understand why I behave why I do sometimes. Umm do you think i want to be screaming at you, I have a mental illness this situation triggered my illness and this is what happens. This is part of why I CANt work imbeciles!

      2. Ouch, your poor friend. I honestly never knew it could get that bad. Unfortunately, we had a few malingerers who wouldn’t produce a sick note. e knew there were some who were just faking because it wasn’t every month and it was always a date that didn’t tally up with their first request.

        Of course, it’s better having a dianosis – it’s something to work with.

        Lol, I know – the first time I went for my benefits (with my physical disability), the lady was awful and I just burst into tears. She wanted me to keep looking for jobs – I told her I’m still employed by the NHS and after a year they stop paying sick pay – so I don’t need to look for a job!!

        I won’t bore you as you seem to have similar there. But like I said to her, I’ve worked for 36 years and paid all my taxes, NI etc, more than can be said for many (in the UK) lol.

      3. It is so frustrating, and I don’t know your situation but here you can go and speak to one person and the next day return and have another person say something completely different. It sounds as bad as here. So many physically and mentally ill people give up from even trying to get benefits. I have no idea how they cope!

      4. Oh I know, you don’t get allocated a person to work on your case – you have to see lots of different people and repeat yourself over and over. And they wonder why people get so frustrated and angy. Our local job centre had 3 (that’s really 3) security men working there. On my assessment day I asked them “Really, you all work here full time?” One replied laughing “Ah I can see this is your first time here.

      5. We had a security person at our little office in Huonville, to get him they took a staff position away! How does that make it better for those waiting and waiting ..?

      6. I would actually like to see politicians have to live for a week on unemployment (not in their own home, in a rental and have the rent taken our, also have to go into deal with the centrelink people There are some wonderful people in Huonville, office working. It seems to me the ones who come down from Hobart to work, have no idea of what rural life is like.

  6. I think my body has the right to be sick once in a while and my mind too. Don’t you think it would be scary when you never got sick? How can you appreciate health?
    When I am sick with the flu or something, I feel like I can let go, finally! I hope that someone would visit me then but that is not always the case, but it should be like that.
    In some religions, like Judaism, it is a Mitzva (a good deed) when you care for sick people and while you’re doing that you don’t need to do all the other obligations. I think you can skip maybe some of the prayers.
    That all said, I don’t take the role of being sick good all the time, with my mental problems i try to surrender, let it go, let it pass but once in a while I’m so fed up with it that I put up a great big fight by ‘being normal’ and it always comes back to bite me in the a**.
    There is a lot of creativity, strength and perseverance to be found in ‘ill’ people and that is the role that I would like to see in the spotlight more when it comes to (mental) illness.

    1. Oh yes, we all have the right to be sick and it would be nice to get some visits or attention occasionally. Oh I do for my physical sickness but rarely for mental illness. But I suppose I don’t really mentioned to people when I’m low or anxious, I just isolate myself. Like you say,
      it’ss hard work trying to feel and appear normal. I totally agree with the creativity, strength and perseverance – if only more people appreciated that 🙂

      1. Kacha I totally agree about being sick and being able to just let go. No one to help me and I cant ask for help.. I hate having the flu but that day when you actually have energy again and you don’t ache. ahh

        yes the way people manage to ‘cope’ in every day life when you have chronic long term permanent illness is astounding.

  7. When we first went to the trauma hospital, we told our Spouse and Children they could own their own stories. No obligation what to say or not say to anyone. We gave up our privacy cuz we recognized they would need support from their communities.

    Turns out, we received dozens of cards and letters at the hospital. It was supportive.

    Fast forward three years, and we rarely hear from anyone. We don’t make much effort either. Shame.

    When we hear someone is ill or lost a family member, we try to reach out months later to let them know we still care.

    People get busy with what is important to them. We have remained important to a few people. That is nice of them

    1. Wow, that’s great that people sent cards and letters. Yes, I understand, people get busy, which was hard to understand in the beginning and I felt quite angry.

      But now, I just accept it and thankfully, I too have remained important to a few people, which I appreciate.

      Thanks so much for commenting.
      Caz 🙂

  8. It does seem like people with physical (or rumored physical) injuries are more likely to get rewarded for playing the sick role than people with invisible mental health issues, although I have seen people who manage to play up a supposed mental/emotional problem for sympathy. Part of it is the obvious signs–cast, being in a hospital bed, etc.–that let us immediately spot physical injuries.

    However, I also get the sense that the whole sick role thing only works for relatively short periods of time. Showering someone with attention is time- and energy-consuming, so most people will only keep it up for so long. After that, the role-player has to “get well” and restart later. Of course, there are also people who have a real issue, but they use it to gain sympathy rather than focusing on resolving their situation or creating healthy coping strategies. Those are the hardest to deal with because it isn’t all an act, but trying to “help” can sometimes make them cling harder to their condition.

    1. Your right, people with physical ailments tend to get more rewards/benefits because their illness if more visible.

      And yes, the carers/friends/family all have their own lives too and perhaps can’t keep on supporting the sick person, particularly if they are ‘milking it’ or not making any effort to get better. However, it is difficult when it comes to mental illness – as in we can’t just get over it and get on with it as some might suggest. Some of us have agreed that the sick role concept is outdated and doesn’t particularly ‘fit’ mental illness.

      I have to admit I had a few patients over the years, that didn’t particularly want to get well. I’d done some work with 2 very intelligent, middle class females and they were capable of listing the secondary gains of remaining unwell – they preferred the sick role than getting better.

      1. Yes, chronic conditions can be very draining and are sadly sometimes treated as someone playing the sick role when they’re just trying to survive. Mental health issues often fall into that category. An infection can be cured, a broken leg set, but bipolar, anxiety, etc. are more accurately managed rather than completely cured.

  9. It is interesting from a nursing perspective over the years, when I first started people wore pyjamas in hospital, and at home you stayed in bed and in your jammies or lay on the lounge being miserable. People spent more time in hospital, as many took on the sick role. Now we get you up and out as soon as possible we discourage people from wearing pjays, (yes even the older folk who bring in their lovely nighties and pjays nothing else. So we ask them to have someone bring in some clothes for them.

    1. I know, it’s so different now and I’m not sure which system is best. I feel for some people who have say a knee replacement, a day after you have to get up and walk. On the second you have to climb stairs and if you can do that – you’re discharged.
      Also, just my opinion, once baby is your you can go home that day. I wonder about some of the young girls who’ve never held a child, bathed it etc….. No one gave us a book, I know, but I do think some people are being discharged too quickly.

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