PolyU-Hong Kong Community College


AD Scheme in Health Studies

CCN2040 Sociology for Health Studies
L2-3 Sick Role Theory & Structural Functionalism

Part 1: What is Society?

What is Society? What is Social Structure?

Social structure refers to the recurring patterns of behaviour in
social life.
Society consists of structure and culture.
Example:
Society is a stable system made up of interconnected
Role refers to the expected behaviour of a person who
social structures. occupies a status. Status is a position within a social system.
Society is also defined as a group of people who share Healthcare as a social institution include a whole set of role/
a culture. status, formal rules protecting the pattern (e.g. registration
for doctor and nurse, the law protecting patient’s privacy…
etc) and hidden rules of interaction.
 Examples What is Culture?
Culture refers to the totality of learned knowledge, customs,
material objects, values, and behaviours.
#1 There is no formal law defining what a father should
do and can do, but there is a societal expectation of his Material objects:

duty and authority. Anyone assumes the role of father e.g. Smart phones, food, diary,…
has to take these power and duty. Ways of thinking:

e.g. Values, beliefs, language, science, religion…
#2 Even though we don't know the doctor in person,
we know how to and will tend to behave like a patient Ways of acting:

when we get to the clinic. e.g. Norms, customs, table manner…

At its broadest, culture is a way of life.

Types of Norm
Norms ( ) refer to the shared rules that tell its members how to
behave in a given social context.

Folkways: fairly weak norms that are passed down from the past,
whose violation is generally not considered serious within a
particular culture.

Mores: strongly held norms whose violation would seriously offend

the standards of acceptable conduct of most people within a
particular culture.

Taboos: forbidden, highly offensive, and even unthinkable acts.

Laws: codified norms or rules of behavior that have been officially

legislated by a governing body and are backed by the use of force
Tokyo Metro Manner
Importance of Structure & Culture Deviance and Social Control
When people cannot perform the socially assigned role,
Humans need others for their very survival! they are considered as deviant.

While social structure provides a stable framework for our Deviance is defined as any act that violates the
interactions with others to take place, culture helps bind social norm in society.
people together by shared social beliefs.
Conformity to norms--> reward; 

They make communication effective and cooperation possible.
They constitute a stable social order—society. Deviance--> societal disapproval, punishment or other
forms of social sanctions.
This social order maintains from generation to generation by
socialisation, a process where people learn the ways of society Social control refers to the institutionalized sanctions by
and internalise those ways. which the agents of society’s institutions assure people’s
adherence to societal norms and maintain social order.

Views of “Sick”:
Disease, Illness & Sickness
The Medical view:

“Disease” refers to an adverse physical state of physiological dysfunction

Part 2: Sick Role Theory

within an individual.

The Psychological view:

Explaining sick behaviour sociologically “Illness” refers to the subjective state related to an individual’s
psychological awareness of the discomfort come with the disease.

The Sociological view:

“Sickness” refers to the social state, signifying an impaired social role for
those who are ill. It involves analysis of the expectations and normative
behaviour that the wider society has for people who are defined as sick.
 Sick Role Theory Sick Role Theory
Sickness is a _______. Sick role is a _____ _____, which is a Sickness is a status. Sick role is a social role, which is a set
set of patterned expectations that define the norms and values of patterned expectations that define the norms and values
appropriate to being sick, both for the individual and for appropriate to being sick, both for the individual and for
others who interact with the sick person. others who interact with the sick person.

Sick Role Theory The Doctor’s Role: Gatekeeper

Secondary The doctor is granted access to examine patients’ intimate
gain? physical and personal information.

The sick person is not responsible for his/her Right The doctor is granted considerable autonomy and dominance
in professional practice.
conditions.
Right The doctor acts as gatekeeper to most health resources and
The sick person is exempted from “normal” social control patients’ entry to sick role.
roles.
The doctor should follow the rules of professional conduct.
The sick person should try to get well.
The doctor should apply a high degree of knowledge and
Obligation expertise.
The sick person should seek technically competent Obligation
help and cooperate with the doctor. The doctor should act for the welfare of patients and
community rather than for their own interest.

The doctor should remain objective and emotionally detached.

Sick Role Theory: P-D Relationship
Although the relationship between doctors (D) (gatekeeper) and
patients (P) (deviant) is mutually obligatory and consensual, the

Part 3 Criticisms of 

power and status between them is asymmetrical. This is considered
inevitable and functional.

Sick Role Theory

It is functional for medical professionals to maintain a social distance
between doctor and patient.

The doctor’s leverage is maintained through three techniques: 


(1) professional prestige

(2) situational authority

(3) situational dependency of the patient

Criticism: Type of Disease Criticism: Patient’s behaviour

Sick role theory is more applicable to acute illness than Patients are not that passive. They can be innovative.
chronic illness (e.g. diabetes and Alzheimer’s disease).
Lay referral is common
Limited application in some ambiguous form of medical
illness or deviance (e.g. Premenstrual syndrome, mental Patient is now the target of preventive measures rather
illness) than therapeutic measures
Modified Model of Patient-Doctor (P-D) Relationship Criticism: Behavioral Variation
Szasz & Hollender’s Sick-Role Model--Three Models of P-D Relationship and Middle-class Orientation
Doctor’s Patient’s Clinical Prototype of The theory assumes the universalistic character of
Model
Role Role Application Model
treatment of patients regardless of age, gender, ethnicity,
Activity- Acute trauma, Parent- religion, social class, etc.
Dominant Recipient
passivity coma infant
Sick role theory has a strong middle-class orientation: 

Acute Parent-child/ --Strong emphasis of the merits of individual
Guidance-
Instructive Cooperation infectious parent-
cooperation
disease adolescent responsibility and the deliberate striving of good health. 



Most chronic
Mutual
Empowering Partnership illness, Adult-adult
--Fails to understand the lives of those people who live
participation in long term poverty and may tend to deny the sick role.
psychoanalysis

Patient-Doctor (P-D) Relationship Criticism:Patient-Doctor (P-D) Relationship

Ignores the possible conflicts of interests between doctor and patients:

Medical malpractice (Are doctors always affective neutral, altruistic,

Sick role theory assumes an ideal, harmonious competent, and treat everyone the same?)
relationship between doctor and patient:
Conflicts between doctors and patients are class-based. Sometimes conflicts
Patient: compliant, grateful, passive arise because they live in two completely different social and cultural worlds.

The quality of p-d relationship may vary with class background:

Doctor: affective neutral, competent, altruistic,
universal beneficiary Lower class people: more passive, lower sense of control over health
matters (how would they respond to their illness?)

Entry into the sick role is voluntary Middle class people: more active, higher sense of negotiation with doctors

Middle class patients have a longer consultation time and more likely to
receive explanation than the lower class patients
Criticism: Professional Dominance
Sick role theory is criticized for legitimizing the professional
dominance of doctors. Part 4: Structural Functionalism,
How do doctors assert their professional dominance?
Sick Role Theory & 

Language use: Interrupting the patients, the use of diminutives
Healthcare Institution
Medical record: The doctor has more information about the
patient than the patient has about the doctor.

Social control of time: Doctor exerts control over time according

to the expectation and rewards for doctors, not necessary for the
interest of patient. e.g. Making patients wait for care.

Sometimes the professional dominance may hinder the delivery of

quality care to patient.

Structural-functionalist
perspective:
Society is a stable, orderly system

Structural functionalism is the sociological perspective Different interrelated parts serving specific functions
that is closely related to sick role theory. work together

Shared moral values and strong social bonds are very

important to a society

Promote solidarity and stability

 Image of Society Manifest Function
Intended
Analogy between human body and society


Body Society Dysfunction Function

Negative Positive
Organ Institution
Homeostasis Equilibrium

What are the functions of healthcare institution? Latent Function

unintended
How does healthcare institution cooperate with other
institution?

Structural-functionalist
Social Function
perspective
Function: the observable, positive consequences of a
social structure that promote stability and solidarity in Deviance is considered as societal dysfunction.
society.
Society has to keep the level of dysfunction low to
Dysfunction: the observable consequences that negatively maintain its equilibrium.
affect the ability of a social system to survive.
The definition of deviance is a social judgement but
Manifest function: recognized and intended not a moral judgement. No act is inherently deviant.
consequences of any social pattern
Deviance is defined as such by the society.
Latent function: unintended consequences.
 Evaluating Parsons’Sick
Medicine as Social Control
Role Theory
Sickness=deviance Taking a structural functionalism perspective, Talcott Parsons
posited sick role theory. He is the first sociologist bringing a
Medical care = medical control = social control sociological point of view to the role of healthcare and medicine:

sickness is not just a biological condition but a form of

Medicine’s task is to control abnormal behaviour by deviance
medical means to protect the public’s health and
maintain social stability. medicine is not treating the body but a form of social control

Structural functionalism often assumes a stable, harmonious

Diagnosis and therapy serves to return the deviant order of society and explains every structure as positive and
individual to the normal population. functional to this end. They think this is a general condition for
any society to survive.

This perspective has received numerous criticism for

Required Reading
ignoring the power and inequality dividing our society.

Similarly, sick role theory is also criticised for

legitimising doctor’s power over patient and ignoring
the differences among different social groups.
Cockerham, W. C. (2012) Sick Role Theory. In Medical
Sick role theory may better be viewed as an ideal type. Sociology (pp.166-174,178-183). Upper Saddle River, N.J.:
It highlights particular aspects of behaviours that are Pearson Prentice Hall.
commonly found in certain social contexts, and acts as
the basis for comparison among different socio-cultural
contexts.