Illness forces the person to assume a social posture to which he is unaccustomed, called the sick role by Parsons and Lederer. In the sick role he comes into contact with the caretakers-doctors, nurses, or other health workers-whose jobs are defined by society. In addition, society defines who is sick and who is well. What is considered illness in one culture is not so considered in another.
In the sick role the person has declared himself to be in a position in which he must we take care of. Society and the health care system reinforce that he is not competent to care for himself. He cannot do-and supposedly does not know-what needs to be done. Thus he must follow the orders of others and let others make decisions for and about him. The sick role frees the person from responsibility for the illness, but it carries the obligation to cooperate with caretakers and to get well. Medical workers get frustrated, angry, or judgmental when it appears that the person will not or cannot get well. While the person is “working” to return to an independent, healthy status, society frees him from his ordinary duties, obligations, and responsibilities. Thus the sick person`s two right are: (1) exemption from usual responsibilities and (2) absolution of blame for illness. His three obligations are to : (1) view illness as undesirable, (2) want to get well, and (3) seek competent help from and cooperate with caretakers.
Certain Adaptive Behaviors normally unacceptable to society are common during illness and are considered helpful in promoting rest and recovery. By accepting illness, the structure of the person`s world becomes simpler and more constricted. The person becomes somewhat dependent and regressed, either because of the unpleasant sensations, physical weakness, and helplessness caused by the illness; because of society`s expectations; or from egocentricity, feelings of helplessness, and concerns about body functions and routines administered for his welfare. Withdrawal into self rather than interest in others, a focus on the present rather than on the past or the future, and a reduced ability to concentrate and to think abstractly are all typical behaviors of the sick person. Routines may seem too burdensome, so that daily activities such as taking a bath and personal grooming may be avoided, if possible, by the sick person. Through social, emotional, and physical regression and in compliance with the medical plan, the sick person redistributes his energies to encourage the healing process.
The patient is simultaneously in a position of great power and of extreme weakness. This combination of domination and dependence provokes a difficult inner conflict, a certain ambivalence similar to what young children feel at times. The patient in essence loves the authority figure (the nurse or doctor) for taking care of him, while simultaneously feeling angry toward him or her for being powerful while he is essentially helpless.
Certain Deviant or Maladaptive Behaviors in the sick role may occur and be so labeled by the medical team because the behaviors do not assist the person in getting physically well or regaining independence. When the person uses illness for secondary gain, attention, escape from responsibility, control, or manipulation of others in his environment, he does not move through the sick role to return to health at the expected pace or in the expected way.
The health team also considers the patient deviant if he is unable to accept the dependent sick role. Often his pattern occurs when the person has unresolved dependency-independency conflicts. The patient may fear becoming dependent, or he way actually long to be dependent and feel guilty about his urge. Strongly independent behavior such as protracted denial of illness, unwarranted physical activity, or refusal to cooperate with health care workers may be a signal of such inner conflicts. Recognize, however, that in some cultures the ill person may refuse a dependent role because of expectations of himself and others. On the other hand, excessive dependency, using illness as a refuge, and refusing to engage in self-care activities within one`s strength limitations are as detrimental to getting well as is excessively independent behavior.
The patient may hinder progress by becoming apathetic or uninterested in recovering. Overly compliant, submissive, docile behavior should not be mistaken for cooperation with the treatment plan. Rather, the person`s feelings of powerlessness and hopelessness, the lack of initiative and enthusiasm, signs of physical and emotional depression, or an apparent retreat as if waiting for death appear to diminish natural body responses for recovery.
References :
Lederer, Henry, “How the Sick View Their World”, Journal of Social Issues, 8, 1952.
Parsons, Talcott, The Social System. New York: The Free Press, 1951.
Vincent, R., “Factors Influencing Patient Non-Compliance: A Theoretical Approach”, Nursing Research, 20: No. 6, 1971.
Wu, Ruth, Behavior and Illness. Englewood Cliffs, N.J.: Prentice-Hall, Inc., 1973.
Murray, RB and Zentner JP., Nursing Concepts for Health Promotion, Second Edtion, Prentice-Hall, Inc, Englewood Cliffs, N.J, 1979.
