The sick role revisited Understanding and misunderstanding Parsons

The ‘sick role’ revisited Understanding and misunderstanding Parsons’ contribution ESHHS - August 2006

Talcott Parsons 1902 -1979 • Topics: social action / social system • Fields: economics, politics, culture, health system • Publications: – Structure of social action (1938) – Social system (1951) – Toward a general theory of action (1951) – Social structure and personality (1964) • Harvard professor: 1939 -1972 ESHHS - August 2006 2

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Health, illness and the social system • Achievement: health and motivation • Illness – as incapacity sick role – as deviance passive withdrawal – as a psychosomatic issue • Social system – doctor and patiënt as a collectivity – checks and balances – unconscious psychotherapy ESHHS - August 2006 4

The sick role • • Exemption from duties Unwilful deviance Intention to get well Seek professional help Temporary regression Fears and irrational beliefs ESHHS - August 2006 5

The doctor’s role • • Welfare-oriented Maintain professional standards Right to enter privacy Exclusiveness of care Regulation motivational balances Secondary gain and countertransference ESHHS - August 2006 6

Critical reception Parsons: • Idealizes medical practice and profession • Overemphasizes normalization • Underestimates conflict Parsons: a ‘reactionary functionalist’? ESHHS - August 2006 7

Parsons revisited • The limits of medical technology – The role of the social and behavioural sciences – Evidence versus experience based interventions – The optimistic bias • The rise and decline of medical power – The medicalization of almost everything, yet: – Withering of trust in the consulting room – Decline of professional autonomy • The power of theory ESHHS - August 2006 8