LECTURE 3:

THE SOCIAL MEANINGS OF

SICKNESS
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SHDH 2040 Sociology of Health Studies
Lecturer: Dr. Lau Siu Lai
LECTURE FLOW
1. Change in the meanings of illness
2. From physical to social understanding
3. Illness as deviance
4. Parsons: The sick role theory
5. The professional role of doctors
6. Significance of the sick role theory
7. Problems of the sick role theory
7.1 The sick role is not necessarily temporary
7.2 The sick role is not always voluntary
7.3 Variability in sick role legitimacy
7.4 Responsibility for sickness
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8. Discrimination
9. Stigmatization
10. The medicalization of Deviance
11. Medicalization as: Social Construction of Health &
Illness
12. Medicalization of Madness
12.1 The historical development
12.2 Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)

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1. CHANGE IN THE MEANINGS OF ILLNESS
Primitive society:
Illness was defined as an autonomous forces or “being”, such as an
evil spirit that attacked people and settled within their bodies in order
to cause them pain or death.

Middle Age:
People define illness as a punishment for sin, and care of the sick was
regarded as religious charity.

Modern time:
Illness is define as a state of suffering as the result of a disease.

This definition is based upon the modern scientific view that an illness
is an abnormal biological affliction or mental abnormality with a 4
cause, a characteristic train of symptoms, and a method of treatment.
Each society’s definition of illness becomes
institutionalized within its cultural patterns.

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2. FROM PHYSICAL TO SOCIAL
UNDERSTANDING

 Disease:
an adverse physical state, consisting of a physiological dysfunction with
and individual.

 Illness:
a subjective state, pertaining to an individual’s psychological awareness
of having a disease and usually causing that person to modify his or her
behavior.

 Sickness:
a social state, signifying an impaired social role for those who are ill.

The wider society has normative behavior and expectative for people 6
who are defined as sick.
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DISCUSSION:
COMPARING THE DISEASE OF A TREE AND A HUMAN
 Tree can recover or they can die of disease. (Branches become
lifeless, leaves wither, and roots and trunks function poorly)

 Unlike trees, humans are expected to grapple with the experiential

aspects of sickness.

 Humans are capable of reflecting upon themselves, their bodily

conditions, and their self-perceptions.

 This reflexivity means that humans typically suffer not merely from
disease.

 They also suffer from their experience of illness and the meanings 9
that they and other attach to it.
3. ILLNESS AS DEVIANCE
 Durkheim (1938) asserted that every society has its own
set of norms.

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 The very existence of social norms means that there will
be deviance in all societies.

 Deviance serves to remind the entire social group of the

importance of certain collective values.

 Like crime, sickness is a form of deviance, or departure

form group-established norms.

 The way a society reacts to sickness and crime reaffirms

its core values.

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 Furthermore, the practices for sanctioning deviance
(such as punishing the criminal or treating the sick
person) reaffirm and revitalize the collective sentiments
and maintain social solidarity.

 The treatment of the sick in all healing systems serves to

reaffirm cultural norms and ideals for the sick and well
alike.

 Deviance is more a description of the social group that

defines it than an intrinsic nature.

 Labeling of an attribute or behavior as deviant is, in fact,

a social product. 12
 Cultures vary widely as to whether they consider deviant
such bodily conditions as facial scars, obesity, shortness,
and paleness.

 e.g. paleness in early 20th century in middle class was

regarded as a quality of refinement.

 Defining deviance is a social process involving factors

such as power and stratification.

 Power in a society includes having significant influence

in setting social norms and labeling deviance.
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 Socially established norms are imposed on people,
regardless of their own beliefs.

 Power is a factor in both the creation of a deviance label

and its application to some individual persons.

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4. PARSONS: THE SICK ROLE THEORY

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 Society must deal with individuals who differ significantly from
its norms.

 It will exert social control on the individuals to try to contain its

members’ behavior within various norms, including deterrents,
incentives, rewards, and punishments.

 How society responds to an instance of perceived deviance

depends largely upon its determination of the individual’s
responsibility form the deviant behavior.

 Like all social role, the sick role is primarily a description of

social expectations on sick person.

 However, it does not describe how sick persons actually behave 16

and feel.
 According to T. Parson (1951), the sick role entails certain
responsibilities as well as certain privileges:

 1. The individual’s incapacity is a form of deviance from

social norms, but since it is not deliberate, the individual is not
held responsible;

 2. The sickness is legitimate grounds for being exempted from

normal obligations, such as work or school attendance;

 3. The legitimacy of this exemption is, however, predicated

upon the sick person’s intent to get well;

 4. The attempt to get well implies as seeing and cooperating 17

with competent helps to treat the illness.
5. THE PROFESSIONAL ROLE OF DOCTORS
 Grant right to examine patients physically and to enquire into
intimate areas of physical and personal life;

 Grant considerable autonomy in professional practice;

 Apply a high degree of skills and knowledge to the problem of

illness;

 Act for welfare of patient and community rather than for self-
interest;

 Be objective and emotionally detached;

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 Guided by the rules of professional conduct.
6. SIGNIFICANCE OF THE SICK ROLE
THEORY
 It highlights the social control functions of how society
treats sickness.

 It also emphasizes the extent to which social definitions

of sickness reflect larger cultural values of modern
western societies.

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7. PROBLEMS OF THE SICK ROLE
THEORY
7.1 The sick role is not necessarily temporary

o Assumption of “intent to get well” is irrelevant if the illness

is, by definition, permanent or lethal. (Chronic and Acute
illness)

o Feeling about whether a chronic illness is sufficient grounds

for exemption from normal responsibilities are also
ambiguous.

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7.2 The sick role is not always voluntary

o Many people resist the expected the childlike dependency the

role often entails.

o Some people simply cannot afford to withdraw from normal

obligations; the sick role is a threat to their subsistence.

o Many persons are placed into the sick role by others,

regardless of their own wishes.

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 E.g. children, loss of consciousness, too sick to have
good judgement, what etc.?

In many such cases, the social control functions of the

sick role are more coercive and less benign then it
described.

 In contrast, some people seek to enter the sick role and

are denied access.

 A process of subtle negotiation occurs when an individual

claims the sick role. This claim must then be accepted as
legitimate by others, especially authoritative others. 22
o Often, medical personnel such as the school nurse and
the company doctor are the critical gatekeepers who
have the power to determine who will be admitted to
the sick role in their institutional setting.

o entry into the sick role is thus essentially a social

and political process.

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7.3 Variability in sick role legitimacy

o The criteria for exemption for duty may differ

according to gender, social class, and subcultural
expectation.

o Unskilled worker, for example, may not have any

paid sick days.

o Indeed, the idea that absence due to sickness should

not be a basis for dismissal is relatively recent.

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o Even today sickness is not a legitimate exemption for
many workers, and they have no legal protection of
their jobs

o Assumption of universalistic character of patients

regardless of age, gender, ethnicity, religion, social
class, etc.

o It’s found that medical professions differentiate

patients into different class positions, and offer them
different treatments.

o Living in the same “social world” as medical 25

professions, middle class patients are better served.
7.4 Responsibility for sickness

o Parsons’s model of the sick role held that, unlike

crime, sickness was not the responsibility of the
deviant person.

o He also considered the professional diagnosis and

treatment of medical deviance to be purely technical,
neutral, and unbiased.

o However, the very definition of illness is socially

constructed, and social groups often impute
responsibility for the illness to the sick person.
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 Unlike infectious disease, chronic ailments are more
likely to be considered partly the fault or the
responsibility of the sufferer.

 E.g. high blood pressure, lung cancer, are believed to be

brought on partially by the sufferer’s lifestyle.

 Certain conditions are typically viewed as the

responsibility of the sick individual and thus are treated
relatively punitively.

 e.g. sexually transmitted diseases, substance abuse

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o there are also other kind of sickness that, while not
considered the fault of the sick person, are
nonetheless stigmatized.

o Goffman (1963): Stigma is a powerful discrediting

and tainting social label that radically changes the
way an individual is viewed as a person. (E.g. being
an illegitimate child)

o Many sicknesses carry a stigma. Leprosy, epilepsy

and AIDS, for example, all carry connotations of
disreputability and even evil.
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o Stigma can result in various forms of discrimination:
Persons with epilepsy, for instance, have experienced
job discrimination, difficulty in obtaining a driver’s
license, prohibitions against marrying, and difficulties
in obtaining insurance.

o Even after someone has been treated and pronounced

cured of such a condition, the stigma often remains on
that person.

o The stigma frequently spreads to the family and close

friends of the sick person. E.g. AIDS

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o The source of stigma is not the disease itself but
rather the social imputation of a negative connotation.
E.g Leprosy is highly stigmatized in India, but far less
so in neighboring Sri Lanka.

o Specific social and historical conditions lead to the

stigmatizing of a sickness.

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8. DISCRIMINATION

 Certain categories of people are either excluded from or

disadvantaged in the distribution of power, property, or
satisfaction.

 It occurs in two levels:

 individual level
bias personal opinion inscribed in interaction
 institutional level
Implementation of policy

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9. STIGMATIZATION
 Humans communicate through symbol.

 Language contain message not just on the denotation

( 本義 ) level. It happens also at the connotation ( 意涵 ,
言外之意 ) level.

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DISCUSSION:
WHAT DOES EACH WORD IN THE FOLLOWING CONNOTE
TO YOU?
 inflammation—genital inflammation
 Organ dysfunction—sex organ dysfunction

 Addiction—Sexual Addiction

Those words associated sex tend to convey negative or

demeaning overtone.

These words, originally had neutral connotations. Over time, these

words were debased, a process known as semantic derogation ( 語
意上的貶損 ).

This is associated with our cultural tendency on stigmatization of 33

sex.
 Media is a great social force that actively shape our
thinking and ideology.

 It shapes our thinking in two ways:

 Setting the agenda

 The media select items for attention and provide rankings of what is
and is not important.
 In other words they ‘set an agenda’ for public opinion.
 E.g. news, magazines, advertisment

 Symbolic annihilation
 The media ignored, trivialized, or condemned certain types of people
or labels.
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TAKING THE EXAMPLE OF AIDS

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TAKING THE EXAMPLE OF AIDS

 https://
www.youtube.com/watch?v=Ht2QQLb7PGQ&list=PL_
p04dLUcBG174mr8yqgR-37W1mx6WouP&index=73&
app=desktop

 https://www.youtube.com/watch?v=46NVqTwljHM

 https://www.youtube.com/watch?v=oDW9mQYHEjY

 https://www.youtube.com/watch?v=W9hHnUnc25Y
36

 https://www.youtube.com/watch?v=Kmjqemq62r0
10. THE MEDICALIZATION OF DEVIANCE
 Religious, legal, and medical institutions have all contributed
to the definition of deviance in society. (e.g. stealing)

 In a process called the medicalization of deviance, medical

systems increasing also define what normal or desirable
behavior is: Badness becomes sickness.

 The relative influence of religious, legal, and medical

institutions in defining deviance has shifted in Western
societies.

 As the Middle Ages passed and these three institutions became 37

increasingly differentiated form each other.
 The religious organizations still had the greatest weight in
defining deviance.

 This preeminence continued into the eighteenth century.

 But later on, the legal mode of defining deviance gained

ascendancy.

 The significance of legal definitions of deviance has diminished

somewhat in the 20th Century, and medical definitions have gain
importance.

 This shifting balance is clearly reflected in the 1954 precedent-

setting case in United State, in which the court ruled that “an
accused is not criminally responsible if his unlawful act was the 38
product of a mental disease or mental defect.”
 The shift in balance favoring medical definitions of deviance
corresponds with a period of the rapid professionalization of
medicine.

 Part of the reason for the declining importance of religious

definition is that they appear too non-rational and, in a
religiously pluralistic country, lack society-wide acceptance.

 Legal definitions, while more rational, seem to hinge too

greatly upon human decisions, such as the judgment of
twelve ordinary citizens on a jury.

 Medical definitions, by contrast, appear to be more rational

and scientific, and based upon technical expertise rather than
human judgment. 39
 The concept of sickness, however, far from being a
neutral scientific concept, is ultimately a moral one.

 It establishes an evaluation of normality or desirability.

 The medical profession (especially its psychiatric

branch) has defined a wide range of disapproved
behavior as “sick”: alcoholism, homosexuality,
promiscuity, drug addiction, suicide, civil disobedience.

 Moral judgement is also applied in the evaluation of

“good” patient behavior.
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 When sicknesses thus labeled are defined as “bad”, the
doctors who join or organize efforts to eradicate or control
them function as “moral entrepreneurs”.

 That means who make an enterprise out of moral concerns.

 Moral entrepreneurs engage in considerable political efforts to

get their definitions of sickness accepted and implemented.

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11. MEDICALIZATION AS:
SOCIAL CONSTRUCTION OF HEALTH & ILLNESS
 Medicalization is a social and historical process that
defines non-medical problems as medical ones.

 It normalizes human behaviours.

 Medical professions monopolize definitions of health

and illness
 Conceptual Level: the use of medical vocabulary to describe
the problem but medical professions and treatments may not
be involved
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 Interactional
Level: as part of P-D relationship, with the
doctor medically defining and treating the patient’s problem

 InstitutionalLevel: the adoption of medical approach to

particular problem by organization, medical profession may
be the gate keeper for the organization

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12. MEDICALIZATION OF MADNESS

12.1 The historical development

 In the Middle Ages: leprosy as madness

 Enlightenment: witchcraft as madness

 17th century: houses of confinement were used to

accommodate “mad” people, e.g. beggars, criminals,
prostitutes, and the poor (What is the rationale?)

 19th century: madness began to be defined as a medical

issue, requiring medical and scientific interventions(e.g. 44
neurology)
 Growth of asylums further consolidated the authority of
psychiatrists. The number of mental illness patients also
rapidly increased at the close of the 19th century.

 Rise of psychoanalysis & the invention of ‘mood

altering’ drugs reinforced the medical nature of medical
illness

 → Madness is only a label!

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12.2 Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV)

 published in 1994 by the American Psychiatric

Association.

 as the guideline for understanding and categorizing

“mental disorders”.

 “bible” of modern psychiatry.

 a list of 374 disorders

 used by many different professional groups and across 46

various settings
DISCUSSION:
THE DSM CLASSIFICATION SYSTEM

o all members of a diagnostic class are homogeneous

o clear boundary between classes
o the different classes are mutually exclusive

Is it the reality?

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MYTH OR FACT?!
 Is mental illness completely explained by biochemistry, physiology
and neurology? (mental illness = physical disease, i.e. disease of the
brain)?

 the classification system does not objectively sort signs and

symptoms into consistent diagnostic categories
involve psychiatrist’s subjective interpretations and personal bias as well as
stereotypical social and public attitudes

 the implications of changes in the DSM

 homosexuality
-the emergence of the gay liberation movement and gay rights organizations
-deleted in 1974

 post-traumatic stress
-the emergence of strong campaign and political activities of Vietnam war veterans 48
-added in 1980
13. READINGS
1. Freund, Peter E. S. & McGuire, Meredith B. 1995.
Health, illness and the social body: a critical sociology
(chapter 6). New Jersey: Prentice Hall.

2. White, Kevin. 2017. An Introduction to the sociology

of health and Illness (chapter 8). London: Sage.

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