In 1951, Talcott Parsons created a concept regarding sickness and the rights and obligations of those affected, it was a way to explain the rights and responsibilities of those that were ill. Parsons (1951, cited in Scarince, 2016) stated that people who are diagnosed with a medical condition or illness cannot fulfil the same duties/tasks as that of a fit and healthy person. Society adapted to this concept and allowed a reasonable amount of difference in expectations and behaviour than that expected from a healthy person. Parsons saw the sick role as a form of deviance (an action or behaviour that violates social norms) because an ill person supposedly had different behavioural patterns than that of a normal person. Healthy people are meant to be hard-working and productive, an ill person would not fulfil this criteria (Scarince, 2016).â
A doctor or the authorities would have to approve whether an individual was ill, they were positively sanctioned, without this sanction any absence from work or school would be deemed unauthorised (deviant) however, if you were at home sick in bed this would be an authorised absence. A doctor or medical professional would have to certify the illness making it legitimate; legitimising the illness was proof that a person was actually sick and in need of medical intervention, this is the equivalent of a doctor’s note today (Scarince, 2016).â
Parsons (1951, cited in Scarince, 2016) stated that an individual has two rights and two responsibilities when they are ill, these were; that a patient has a right to not be blamed for their illness and a right to be given leeway with regards to normal expectations and obligations. â
It is the patient’s responsibility to make recovery a priority and they have a responsibility to seek appropriate treatment for their condition, by seeing a medical professional they are agreeing to becoming a ‘patient’. These rights and responsibilities are only in effect whilst the individual is ill and therefore may be temporary (Scarince, 2016).â
Parsons work provided insight into an experience that affects society at some point in their lives however, would a person today find that their sickness/absence from work, matches Parsons description from 60 years ago? (Scarince, 2016).
Today an individual can self certify themselves sick for up to seven days before going to see a doctor, a doctor has to diagnose and certify the illness to make it legitimate (authorised) and you have to take a leave of absence if acutely ill or if you feel that you cannot fulfil the responsibilities and obligations of your role (FitForWork.Org, d.u.).
The sick role that our society has created defines the appropriate patterns and behaviours that an individual should have whilst ill. Parsons (1951, cited in Long-Crowell, 2016) sick role states that a person should be released from their normal obligations and responsibilities (no work or school), that they deserve sympathy as they are not responsible for their illness and that they should seek medical help if the condition is serious. However, in today’s society people cannot just claim to be ill, they must look and act the part, if they do not fulfil all of the expected criteria it can lead to a negative social reaction (Long-Crowell, 2016).
Parsons’ sick role works best with acute or short term illnesses, the behaviour patterns of someone with a stomach bug or a broken bone are clear and expected, a chronic long term condition changes these set behaviours and expectations (Long-Crowell, 2016). This raises the questions, how sick is the person? And, how should they be acting? The answers to these questions change depending on the length of time a person is in the sick role. The expectations are also affected by social factors such as age, gender, ethnicity and social class; these are all determinants of the social model of health (Long-Crowell, 2016).
Essay: “How is medicine used as an institution of social control for different groups within society?”
This essay will evaluate three groups within society; the Feminists, Postmodernists and the Marxists, providing information and supporting the theory that medicine is being used as an institution of social control. These sociological perspectives explain how the medical profession uses normal life events to control individuals.
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Medicalisation is a process where non-medical problems become defined and are treated as medical problems, this is claimed to be a determinant of control within society (Conrad, 1992). A consequence of medicalisation is that it can be conceived as a form of social control into daily aspects of life under the guise of medicine or biomedicine.
Parsons (1951, cited in Conrad, 1992) was one of the first to state that medicine was used as an institution of social control, especially with the sick role conditionally legitimising the deviance termed illness.
Although biology influences health, it does not determine it, health inequalities between the sexes are the result of the interaction of biology and society. It determines how society can structure and influence our lives (Matthews, 2015).
Many feminist perspectives have drawn on the medicalisation of a woman’s body, illustrating social control (Annandale, 2014, cited in Matthews, 2015).
The Boston Women’s Health Book Collective – Our Bodies, Ourselves (2011), states that corporate and pharmaceutical interests influence medical research, information and care. This leads to the unwarranted medical surveillance of a woman’s body, with them wanting to reclaim control from male-dominated medicine (Boston Women’s Health Book Collective, 2011).
Women receive a disproportionate amount of attention to their health with intrusive surveillance and interventions such as; mammography, smear tests, infertility treatments, and prenatal care, as well as reproductive health and aesthetic procedures.
Menopause- has been medicalised since the 1930’s as a disease of deficiency, often recommending hormone replacement therapy as treatment,
Infertility- was once considered an individual or social problem, it is now deemed fixable and over time has come under the scrutiny of medical professionals. Infertile couples now seek medical interventions to enhance their reproductive capabilities (Waggoner and Stults, 2010).
Pregnancy and childbirth- this is the clearest example of medicalisation in females, it has changed throughout the years. It was once a social event that occurred in the home with a midwife, now it is set in the medical environment of a hospital with an obstetrician and doctor (Waggoner and Stults, 2010).
These are naturally occurring life events that the medical profession has defined and rebranded. They now need a diagnosis, treatment and can cause medical problems (Brandeis University, 2010).
To widen the scale of control medicalisation also takes control of biomedical and cosmetic enhancements within women; this is a form of self-improvement in a contemporary society. Aesthetic surgery serves as an active example of medicalisation, with consumers actively seeking out procedures from medical doctors to conform to society’s perceived image of beauty (Waggoner and Stults, 2010).
To summarise; medical interventions, policies and treatments are encroaching on the private lives of women to gain control, using their normal life events and conditions against them (Conrad, 2005 cited in Brandeis University, 2010). Changes have to be made in medicine and what constitutes appropriate medical treatment needs to be amended. However, it can also be argued that maternal and infant mortality rates have improved with the intervention of male obstetricians within the childbirth process (Yuill et al., 2010).
Medicalisation forms a key part in the control of different societal groups however, many institutions are also using surveillance as a form of social control.
Foucault (1973) dubbed this form of surveillance, ‘The clinical gaze’. This centred on medical training and is characterised by its emphasis on intrusive clinical observations. This occurred in specialised clinics, with large numbers of compliant populations volunteering to be observed and scrutinised by a limited number of clinicians and their students. The clinicians and students were socialised into a specific way of seeing and defining and their social order increased along with their status. The institutionalisation of the clinic, hospital and its hierarchy all served to exert power over the compliant individuals and their, ‘docile’ bodies (Foucault, 1973).â
This new construction of power formed a hierarchal relationship between the professional and the patient. It dissolved a patient’s opinion and their claim to ‘authenticity’ in the face of ‘expert’ medical knowledge (Foucault, cited in Pryce, d.u.). The ‘medical gaze’ didn’t only occur inside the clinics, there were concerns that the gaze not only explored localised pathologies but also observed social networks and relationships. The postmodernist view of society focuses on an individual’s right to make their own choices about their personal lives; they believe that society and social structures cease to exist (Browne, 2008).
In today’s society Foucault’s ‘medical gaze’ can be found in a number of ways, surveillance devices or fitness trackers are used by large organisations to monitor their employees and control them. The information collated from these devices are used to enforce workplace rules and regulations. A postmodern society involves a media-saturated consumer culture, individuals are free to pick their own lifestyles and identities (Browne, 2008). Individuals can also be observed with invasive monitoring and disciplining of those accessing public services, such as state benefits, public education, or healthcare; it can been classed as security screening or profiling practice, however, it is still a collection of personal information.
Surveillance systems amplify existing social inequalities, reproducing regimes of control and the possible exclusion of marginalised groups within society (Monahan, 2008).
Taylor and Field, (2008) state that an individual can choose from a constantly changing range of goods and leisure activities. Surveillance devices such as, fitness trackers and Apple products are popular; with smartphones being a consumer’s main purchase. The smartphone is the main product that monitors your information, using it to target an individual via advertising, suggestive selling and specific websites. The information that you see is sponsored by search engines and is chosen based on what you browse whilst using your device.â
When looking at the marxist sociological perspective; it is stated that a dominant economic structure of society can determine inequality and power within the social classes. The upper and middle classes are the societal groups that gain more from health services than people within the lower classes. This is known as the inverse care law (Le Grand et al., 2008). The health care system within capitalism results from the interaction between the social classes. Capitalism provides technologies and advances which allow different relationships and forms of healthcare to emerge. The social relationship between labour (the proletariat) and capital (the bourgeoisie) affects the social force that sets the agenda for the health care system (Goodman, 2013).
Marxists are interested in a capitalist society, they believe that medicine is a market commodity that can be bought and sold like any other product. An example of this can be found with the aids drug, it was purchased by a pharmaceuticals CEO who raised the price by 5000%, he also raised the price of a medication taken by children for a rare kidney disease. This causes health services to refuse the purchase of these drugs as they are too expensive, regardless of their effectiveness. Meaning that only individuals from upper classes would be able to afford these medications (Dearden, 2015).
To summarise, the above models can be seen as negative models of social control. Intrusive procedures and medical intervention for normal life events are a form of control. Society can also be controlled via surveillance by institutions, companies and the medical profession and also by using capitalism to raise the price of pharmaceuticals. Whilst these are negative factors they can also be seen as positive. The information collated from the fitness trackers and also the results collated from some of the intrusive tests can provide vital health information to individuals. This information can then be used to improve their wellbeing, moving them from ill to healthy, leading to a longer life expectancy and a healthier lifestyle.