THE SICK ROLE

Being ill is more than a physical condition. Illness exists within a social context of societal norms and relationships. As Parsons (1951) pointed out in his classic work The Social System, being sick is a social role and like all social roles consists of both rights and obligations. Parsons argues further that being sick is a deviant status in the sense that an individual is unable to carry out the duties normally expected of someone in their social position. For example, a sick worker is unable to work, a sick parent is unable to parent, and a sick student is unable to attend class, and so on. Thus, while sickness may appear to be an individual problem, Parsons makes the connection between what he refers to as a form of personal disorganization and larger social disorganization. So, for example, the illness of a key worker, or a large number of workers (personal disorganization), can cripple the capacity of an organization (social disorganization). Similarly, the illness of a family member can upset the social organization of the family unit and the illness of a large number of students or teachers can disrupt the functioning of a school.

For Parsons (1951), then, being sick is deviant because of its implications for larger social systems. Due to its effects on group functioning, deviance in the form of failing to fulfill one's duties is normally negatively sanctioned in some way. For example, those who fail to contribute at work are likely to experience disapproval or even social banishment (being fired). Likewise, failure to fulfill the parenting role is likely to bring social disapproval or banishment as well (loss of custody).

But Parsons (1951) argues that there is a way to avoid such negative sanction. What he terms as the “sick role” (p. 436) serves as a form of protection against such disapproval. In essence, it exempts the individual, for a time, from some of the normal obligations of everyday life. For this to happen, this role must be endorsed by the social networks within which the individual is embedded and which are impacted by the illness. That is, one's story must be believable by key stakeholders. In the most concrete sense, one must have either tangibly or figuratively a “note from one's doctor.” As an illness extends temporally, more proof may be required, particularly in secondary instrumental relationships. In other words, one's own family is likely to demand less in the way of proof than is one's employer. An
employer, for example, may literally require a note from the doctor, but there is no guarantee that either the employer or coworkers will necessarily accept the diagnosis.

Performing Illness

To increase the likelihood of believability the individual must develop a presentation of self (Goffman, 1959) that is consistent with the diagnosis. In other words, the sick person must “perform illness” in a satisfactory way. An acceptable performance, fulfilling the obligations of the “sick role,” requires several elements. For example, as Parsons (1951) points out, performing illness often requires removing oneself from the normal flow of daily life. That is, a sick person is supposed to stay at home or in a medical facility until judged well enough to return to daily life. The expected duration of this absence varies according to the audience's perception of the seriousness of the condition. Note that our emphasis here is not on the time that is biologically required to recover sufficiently, but rather on the perceptions of others as to whether or not one has taken “too much” time, or, “too little” time.

At the same time, it is important that one should not be sick too often, as judged by the audience, or suffer the risk of overdrawing one's account in the “sympathy bank” (Clark, 1997). Another social rule might be that a person who has missed a few days of work with a cold or the flu should not arrive back at work looking well rested and full of energy. If the illness is chronic, say a back problem that allows one to work but not at the same level as fellow workers, then performing illness takes on a very public role. So, one must complain about one's back hurting (but not too much), perhaps wear a brace, and so on.