- Apply functionalist, conflict theorist, and symbolic interactionist perspectives to health issues
Each of the three major sociological theoretical perspectives approach the topics of health, illness, and medicine differently. You may prefer just one of the theories that follow, or you may find that combining theories and perspectives provides a fuller and more accurate picture of how we experience and understand health and wellness.
According to the functionalist perspective, health is vital to the stability of the society, and therefore sickness is a sanctioned form of deviance. Talcott Parsons (1951) was the first to discuss this in terms of the sick role: patterns of expectations that define appropriate behavior for the sick and for those who take care of them.
According to Parsons, the sick person has a specific role with both rights and responsibilities. To start with, they have not chosen to be sick and should not be treated as responsible for their condition. The sick person also has the right of being exempt from normal social roles; they are not required to fulfill the obligation of a well person and can avoid normal responsibilities without censure. However, this exemption is temporary and relative to the severity of the illness. The exemption also requires legitimization by a physician; that is, a physician must certify that the illness is genuine.
The responsibility of the sick person is twofold: to try to get well and to seek technically competent help from a physician. If the sick person stays ill longer than is appropriate (malingers), they may be stigmatized.
Parsons argues that since the sick are unable to fulfill their normal societal roles, their sickness weakens the society. Therefore, it is sometimes necessary for various forms of social control to bring the behavior of a sick person back in line with normal expectations. In this model, doctors serve as gatekeepers, deciding who is healthy and who is sick—a relationship in which the doctor has all the power. Moreover, medical providers function as dispensers of resources for the healing of the sick. But is it appropriate to allow doctors so broad discretion in deciding who is and is not sick? And what about people who are sick, but are unwilling to leave their positions for any number of reasons (e.g., personal/social obligations, financial need, or lack of insurance)?
Theorists using the conflict perspective suggest that issues with the healthcare system, as with most other social problems, are rooted in capitalist society. According to conflict theorists, capitalism and the pursuit of profit lead to the commodification of health: the changing of something not generally thought of as an abstract object into something that can be bought and sold in a marketplace in order to create profit for someone somewhere. In this view, people with money and power—the dominant group—are the ones who make decisions about how the healthcare system will be run. They therefore control the degree to which the individuals and groups without political and economic power will remain subordinate. This creates strife within the larger healthcare system and also results in personal health disparities between the dominant and subordinate groups. The inequality that is seen in other spheres and institutions is pervasive in healthcare access, further accumulating disadvantage to already subordinate groups.
Alongside the health disparities created by class inequalities, there are a number of health inequalities created by racism, sexism, ageism, and LGBTQ+ discrimination. When health is a commodity, the poor are more likely to experience illness caused by inadequate diet, to live and work in unhealthy environments, and are less likely to challenge the system or its authority. In the United States, a disproportionate number of racial minorities also have less economic power, so they bear a great deal of the burden of poor health. It is not only the poor who suffer from the conflict between dominant and subordinate groups. For many years, and only until very recently, homosexual couples had been denied spousal benefits, either in the form of health insurance or in terms of medical responsibility. Further adding to the issue, doctors hold a disproportionate amount of power in the doctor/patient relationship, which provides them with extensive social and economic benefits.
Discrimination is often the result of stigma towards specific groups or medical conditions. This stigma is rooted in the perception of an undesirable condition or attribute. Take HIV/AIDS, for example. Because of their illness, individuals with HIV/AIDS have lost jobs, been denied educational opportunities, been kicked out of their homes, or have been mistreated (or not treated at all) by the healthcare system. Most importantly, because of the stigma attached to the disease, individuals have foregone medical assistance and have passed away as a consequence. Legal protections have been put in place, yet the stigma and discrimination remain prevalent. Until we de-stigmatize the condition itself, and despite the implementation of policy, individual acts of discrimination will likely continue. HIV continues to be an epidemic in parts of Africa, not necessarily because of stigma, but because of the lack of available treatment resources.
This first video clip gives some examples of ways that those with HIV are discriminated against, even within the medical community. The second clip shares the story of Joe and his experiences dealing with the stigma of being HIV positive.
While conflict theorists are right to point out certain inequalities in the healthcare system, and their critiques have propelled equity-driven policy, they do not give enough credit to medical advances that would not have been made without an economic structure to support and reward researchers, a structure that has typically been dependent on profitability. While this market solutions model has indeed provided many advances, a conflict theorist would likely respond that greater state-sponsored investment–with better public health outcomes as the goal–could also effect the same evolutions in treatment. Also at issue for conflict theorists and their critics is the degree to which the hard-won medical expertise possessed by doctors and not patients might render a truly mutual understanding elusive.
According to theorists working in this perspective, health and illness are both socially constructed. As we discussed in the beginning of the module, interactionists focus on the specific meanings and causes people attribute to illness. The term medicalization of deviance refers to the process that changes “bad” behavior into “sick” behavior. A related process is demedicalization, in which “sick” behavior is normalized again. Medicalization and demedicalization affect who responds to the patient, how people respond to the patient, and how people view the personal responsibility of the patient (Conrad and Schneider 1992). Under this perspective, as our perception of a condition changes, so do the social consequences of that condition.
An example of medicalization is illustrated by the history of how our society views alcohol and alcoholism. During the nineteenth century, those who drank too much were considered bad, lazy people. They were called drunks, and it was not uncommon for them to be arrested or run out of a town. Drunks were not treated in a sympathetic way because, at that time, it was thought that it was their own fault that they could not stop drinking. During the latter half of the twentieth century, however, people who drank too much were increasingly defined as alcoholics: people with a disease or a genetic predisposition to addiction who were not responsible for their drinking. With alcoholism defined as a disease and not a personal choice, alcoholics came to be viewed with more compassion and understanding. Thus, “badness” was transformed into “sickness.”
There are numerous examples of demedicalization in history as well. During the Civil War era, slaves who frequently ran away from their owners were diagnosed with a mental disorder called drapetomania. This has since been reinterpreted, unsurprisingly, as a completely appropriate response to being enslaved. A more recent example is homosexuality, which was labeled a mental disorder or a sexual orientation disturbance by the American Psychological Association until 1973.
While interactionism does acknowledge the subjective nature of diagnosis, it is important to remember who most benefits when a behavior becomes defined as illness or condition. Pharmaceutical companies make billions treating illnesses such as fatigue, insomnia, and hyperactivity that may not actually be illnesses in need of treatment.
Watch this video to review and see examples of how each of these key paradigms views medicine.
Think It Over
- Which theoretical perspective do you think best explains the sociology of health? Why?
- What examples of medicalization and demedicalization can you think of?
- the changing of something not generally thought of as a commodity into something that can be bought and sold in a marketplace
- the social process that normalizes “sick” behavior
- the act of a physician certifying that an illness is genuine
- medicalization of deviance:
- the process that changes “bad” behavior into “sick” behavior
- sick role:
- the pattern of expectations that define appropriate behavior for the sick and for those who take care of them
- Hiv.gov. (May 2017). Activities Combating HIV Stigma and Discrimination. Retrieved from https://www.hiv.gov/federal-response/federal-activities-agencies/activities-combating-hiv-stigma-and-discrimination. ↵