This reflects a specific view of the sick:
- They Are Passive
- They Are Trusting
- They Are Prepared To Wait For Medical Help
- They Are Patient
(Sociology In Focus)
In this view, the sick must be looked after and the sufferers are not responsible for their illness. Disease is something that happens to people that they can’t control, therefore getting better can’t be achieved from people’s own accord other people have to look after them.
This makes people open to exploitation because first a doctor must examine them, so the patient has to submit their body to them and secondly the relationship is very unequal and requires the patient to have a certain degree of trust in the doctor. Therefore social regulation is required to protect the vulnerability of the patient.
However, in contrast, sick people are also a social threat. They are deviant because they have been relieved of their normal social obligations and this is socially threatening because it has its attractions and the more people who feel that, the greater the threat to the social system.
Deviance stresses the difficulty of identifying genuine sickness, the fear of society being exploited and the need for experts to distinguish between the sick and the fake. The medical profession acts against this form of deviance seeking to determine who is generally sick and who is a hypochondriac. The medical profession provides a form of social regulation to protect society.
Although Parsons analysis is useful it has also been criticised, Parson’s model assumes that due to prior socialisation, once sick the individual chooses to adopt the sick role. Although a sick person may be officially released from their obligations it doesn’t mean they will always comply especially if the individual doesn’t like to feel dependent on anyone else. As well as this certain people may not be able to afford medical treatment and some individuals may not accept the sick role because there is a stigma associated with their particular illness or disease. According to Interactionism even though some patients may feel uncomfortable being examined, the examination is usually negotiated.
Another criticism is that the sick person’s right to be absolved from blame and provided with care does not always apply and people are sometimes held responsible for their own disease. While acute illness such as measles are rarely considered the sick person fault, diseases such as alcoholism or lung cancer are usually blamed upon the sufferer because they inflicted the damage upon themselves
Here are some examples of disease that those who have been afflicted by them have been denied care or even persecuted:
- Epilepsy
- Leprosy
- Syphilis
- AIDS
A final criticism of Parson’s theory is that Parson’s model fits acute illness rather than chronic. Getting better is not an expectation of chronic conditions such as diabetes. In chronic cases, acting as the sick person is not always appropriate and less functional for both the individual and the social system. Whereas the acutely sick person is relieved of their normal responsibilities and encouraged into dependency, a more appropriate response to the chronically sick or impaired is to encourage them to continue their social role as far as they are able.
What Would Marxists Say About Health e.g. Inequality And The Physical And Mental Causes Of ill Health?
Marxists divide society into classes, which are linked to the economic base of the society. With regard to health and the social welfare system in general, the Marxist perspective regards health care and social welfare as a method of preventing revolution, by giving the proletariat adequate health care, housing, education etc, the bourgeoisie are ensuring that Capitalism survives and that the workforce remains healthy enough to work and contented enough not to revolt against the ruling classes. Marxist’s also argue that medicine is useful to capitalism as a legitimising force, by defining ill health as an individualistic disease based model and therefore ignoring the structural causes of mental and physical ill health
Marxists believe that it is not however the capitalist society that pays for these social welfare compensations but the individual worker through taxation and Marxists further argue that the greatest burden of taxation falls on those who can least afford to pay it. Marxists do acknowledge that it was probably working class pressure which caused the welfare state to be born.
Medicine is a major social institution, and in capitalist societies, it is shaped by capitalist interests. Marxist accounts of capitalist medicine have been developed by a number of sociologists and health policy analysts, notably Navarro (1985). According to Navarro, there are four features that define medicine as capitalist:
- “Medicine has changed from an individual craft or skill to ‘corporate medicine’.
- Medicine has become increasingly specialised and hierarchical.
- Medicine now has an extensive wage-labour force (including employees in the pharmaceutical industry and related industrial sectors).
- Medical practitioners have become proletarianised, that is, their professional status has gradually been undermined as a result of administrative and managerial staff taking over responsibility for health care provision.” (www.palgrave.com)
These four processes mean that medicine has become a market commodity, to be bought and sold like any other product. Furthermore, it has become increasingly profitable for two dominant capitalist interests: the finance sector, through private insurance provision; and the corporate sector, through the sale of drugs, medical instruments and so on. The power to direct and exploit the medical system has been seized by large corporations
that enjoy monopolistic control over related market sectors. This process is characteristic of (late) capitalism as a whole:
“Focusing on health Marxists argue that it is Capitalism itself that is the cause of many ailments and health problems, the working conditions for example, which cause many ailments such as stress, can lead to heart attacks and strokes, headaches and depression. There is also the issue of work related industrial diseases such as white finger and repetitive strain injury.” (Juan Baeza, 2005, Restructuring the Medical Profession)
Marxists argue that rather than treating the causes of these illnesses i.e. the working conditions, Capitalist societies treat the symptoms of the illness in order to make life within a Capitalist society more bearable for the workers. In many cases place the blame for the illness occurring on the dietary and lifestyle choices of the individual, labelling these lifestyle choices as unhealthy and stupid and it is the medical profession who act as agents of social control, deciding just who is allowed to have time off with pay when they are sick by grouping some illnesses as acceptable and others as unacceptable.
Marxists also regard the huge drug corporations as controlling just which individuals in society can be cured, those with the most money are able to afford the best medication and treatment, while the Governments turn a blind eye to the massive profits accumulated at the expense of the sick. Marxists also argue that the Government is contradictory with regards to its stance on the tobacco industry spending millions to educate people not to smoke tobacco while allowing companies to produce tobacco and raising taxes from the sale of tobacco products.
These views are open to criticism because they do not explain all illnesses such as genetic conditions, mental and physical disabilities and other illnesses, which are found in all social classes. Since the creation of the welfare state infant mortality rates have fallen, life expectancy has risen and continues to rise, working conditions for many have improved, with health and safety at work becoming an important issue.
Good health can however be linked to social class, the lower down the class scale an individual falls the greater the chance that the individual will experience mental or physical health problems. These problems can be directly linked to economics, less money means poorer housing, the consumption of cheaper, less healthy foods, greater stress and possibly a greater consumption of alcohol and cigarettes, a manual or physically strenuous job and worse working conditions, which are all contributory factors to poor health.
Marxism tends to concentrate on capitalism without actually examining the medical process in addition to this Marxism fails to address the diversity of capitalist systems and how they deal with health, for example in the USA a different system of health care exists, individuals have to take out private health care. “Wilkinson (1996) argues that it is not Capitalism itself that perpetuates inequalities in health but the inequalities in the distribution of wealth, he shows that in societies such as Sweden and Japan, where a more even distribution of wealth exists, all citizens enjoy better levels of health.” (M. G. Marmot, 2004, The Status Syndrome: How Social Standing Affects Our Health)
Marxists also claim that health problems are closely tied to unhealthy and stressful work environments. Rather than seeing health problems as the result of individual frailty or weakness, they should be seen in terms of the unequal social structure and class disadvantages that are reproduced under capitalism.
