19.2: Sociological Perspectives on Health and Illness

The Functionalist Perspective

In the functionalist model, Parsons argued that illness is a form of deviance that disturbs the social function of a society.

Learning Objectives

Discuss the functionalist perspective on illness in society, specifically the role the sick play in a specific society and how that role affects others

Key Points

• Functionalism addresses society as a whole in terms of the function of its constituent elements (namely norms, customs, traditions, and institutions ), much like the interacting organs within the human body.
• Prominent functionalist theorists include Auguste Comte, Herbert Spencer, Talcott Parsons, Kingsley Davis and Wilbert E. Moore, Robert Merton, and Gabriel Almond and Bingham Powell.
• Functionalism is a framework that sees society as a complex system whose parts work together to promote solidarity and stability.
• Functionalists argue that a sick individual is not a productive member of society; therefore this deviance needs to be policed. This is the role of the medical profession.
• Structural functionalism reached the peak of its influence in the 1940s and 1950s, and by the 1960s was in rapid decline, replaced by conflict-oriented approaches in Europe and more recently by structuralism.

Key Terms

• deviance: Actions or behaviors that violate formal and informal cultural norms, such as laws or the norm that discourages public nose-picking.
• structuralism: A theory of sociology that views elements of society as part of a cohesive, self-supporting structure.

Structural functionalism, or simply functionalism, is a framework for building theory that sees society as a complex system whose parts work together to promote solidarity and stability. This approach looks at society through a macro-level orientation, which is a broad focus on the social structures that shape society as a whole. This approach looks at both social structure and social functions. Prominent functionalist theorists include Auguste Comte, Herbert Spencer, Talcott Parsons, Kingsley Davis and Wilbert E. Moore, Robert Merton, and Gabriel Almond and Bingham Powell.

Herbert Spencer: Herbert Spencer was a prominent functionalist sociologist, who likened the functioning parts of society as organs within a body.

Functionalism addresses society as a whole in terms of the function of its constituent elements; namely norms, customs, traditions, and institutions. A common analogy, popularized by Herbert Spencer, presents these parts of society as “organs” that work toward the proper functioning of the “body” as a whole. For Talcott Parsons (1902–1979), an American sociologist, “structural-functionalism” came to describe a particular stage in the methodological development of social science, rather than a specific school of thought.

The Sick Role

Sick role is a term used in medical sociology regarding sickness and the rights and obligations of the affected. It is a concept created by the American sociologist Talcott Parsons in 1951. Parsons was a functionalist sociologist who argued that being sick means that the sufferer enters a role of “sanctioned deviance”. This is because, from a functionalist perspective, a sick individual is not a productive member of society. Therefore this deviance needs to be policed, which is the role of the medical profession.

In the functionalist model, Parsons argued that the best way to understand illness sociologically is to view it as a form of deviance that disturbs the social function of the society. The general idea is that the individual who has fallen ill is not only physically sick, but now adheres to the specifically patterned social role of being sick. “Being Sick” is not simply a “condition”; it contains within itself customary rights and obligations based on the social norms that surround it.

The theory outlined two rights of a sick person and two obligations. The sick person’s rights are twofold: the first one is being exempt from normal social roles; the second one is not being responsible for their condition. Conversely, the sick person’s obligations included trying to get well and cooperating with the medical professionals. Parsons concluded that there are three versions of the sick role: conditional, unconditional legitimate, and illegitimate (a condition stigmatized by others).

Critics of the Functionalist Perspective

Critics of Parsons and the functionalist perspective point to different flaws they see with his argument. The model assumes that the individual voluntarily accepts the sick role. It also assumes that the individual may not comply with expectations of the sick role, may not give up social obligations, may resist dependency, and may avoid the public sick role if their illness is stigmatized. The model also blames the sick, where “rights” do not always apply.

Structural functionalism reached the peak of its influence in the 1940s and 1950s, and by the 1960s was in rapid decline. By the 1980s, its place was taken in Europe by more conflict-oriented approaches, and more recently by “structuralism”. While some of the critical approaches also gained popularity in the United States, the mainstream of the discipline has instead shifted to a myriad of empirically-oriented middle-range theories with no overarching theoretical orientation. To most sociologists, functionalism is now obsolete.

The Conflict Perspective

Conflict theory argues that the economic and political structures of a society create social divisions, inequalities, and conflicts.

Learning Objectives

Examine the differing views on conflict theory from various sociologists, such as Karl Marx and C. Wright Mills

Key Points

• Conflict theories are perspectives in social science that emphasize the social, political, or material inequality of a social group.
• Of the classical founders of social science, conflict theory is most commonly associated with Karl Marx, who posited that capitalism would inevitably produce internal tensions leading to its own destruction.
• Marx advocated for the rejection of false consciousness (explanations of social problems as the shortcomings of individuals rather than the flaws of society ) and the claiming of class consciousness (workers’ recognition of themselves as a class unified in opposition to the capitalist system).
• The Polish-Austrian sociologist Ludwig Gumplowicz and the American sociologist Lester F. Ward approached conflict from a comprehensive anthropological and evolutionary point-of-view.
• C. Wright Mills has been called the founder of modern conflict theory. In Mills’s view, social structures are created through conflict between people with differing interests and resources.
• Conflict theory is most often associated with Marxism, but may also be associated with other perspectives such as critical theory, feminist theory, postmodern theory, queer theory, and race -conflict theory.

Key Terms

• functionalism: Structural functionalism, or simply functionalism, is a framework for building theory that sees society as a complex system whose parts work together to promote solidarity and stability.
• military-industrial complex: The armed forces of a nation together with the industries that supply their weapons and materiel.
• capitalism: A socio-economic system based on private property rights, including the private ownership of resources or capital, with economic decisions made largely through the operation of a market unregulated by the state.

Conflict theories are perspectives in social science that emphasize the social, political, or material inequality of a social group, that critique the broad socio-political system, or that otherwise detract from structural functionalism and ideological conservatism. Sociologists in the tradition of conflict theory argue that the economic and political structures of a society create social divisions, classes, hierarchies, antagonisms and conflicts that produce and reproduce inequalities. Certain conflict theories set out to highlight the ideological aspects inherent in traditional thought. While many of these perspectives hold parallels, conflict theory does not refer to a unified school of thought, and should not be confused with, for instance, peace and conflict studies.

Of the classical founders of social science, conflict theory is most commonly associated with Karl Marx (1818–1883). Based on a dialectical materialist account of history, Marxism posited that capitalism, like previous socioeconomic systems, would inevitably produce internal tensions leading to its own destruction. Marx ushered in radical change, advocating proletarian revolution and freedom from the ruling classes. At the same time, Karl Marx was aware that most of the people living in capitalist societies did not see how the system shaped the entire operation of society. Just like how we see private property, or the right to pass that property onto our children as natural, many of members in capitalistic societies see the rich as having earned their wealth through hard work and education, while seeing the poor as lacking in skill and initiative. Marx rejected this type of thinking and termed it false consciousness, which involves explanations of social problems as the shortcomings of individuals rather than the flaws of society. Marx wanted to replace this kind of thinking with something Engels termed class consciousness, which is when workers recognize themselves as a class unified in opposition to capitalists and ultimately to the capitalist system itself. In general, Marx wanted the working class to rise up against the capitalists and overthrow the capitalist system.

Healthcare reform supporter: Karl Marx wanted to replace false consciousness with class consciousness, in which the working class would rise up against the capitalist system.

Two early conflict theorists were the Polish-Austrian sociologist and political theorist Ludwig Gumplowicz (1838–1909) and the American sociologist and paleontologist Lester F. Ward (1841–1913). Although Ward and Gumplowicz developed their theories independently, they had much in common and approached conflict from a comprehensive anthropological and evolutionary point-of-view as opposed to Marx’s rather exclusive focus on economic factors.

C. Wright Mills has been called the founder of modern conflict theory. In Mills’s view, social structures are created through conflict between people with differing interests and resources. Individuals and resources, in turn, are influenced by these structures and by the “unequal distribution of power and resources in the society. ” Mills argued that the interests of the power elite of American society (for example, the military-industrial complex) were opposed to those of the people. He theorized that the policies of the power elite would result in the “increased escalation of conflict, production of weapons of mass destruction, and possibly the annihilation of the human race. ”

Conflict theory is most commonly associated with Marxism, but as a reaction to functionalism and the positivist method, it may also be associated with a number of other perspectives, including critical theory, feminist theory, postmodern theory, post-structural theory, postcolonial theory, queer theory, world systems theory, and race-conflict theory.

The Interactionist Perspective

According to theorists working in the symbolic interactionist perspective, health and illness are socially constructed.

Learning Objectives

Explain and give examples of social constructions of health according to the symbolic interactionist perspective

Key Points

• Symbolic interactionist researchers investigate how people create meaning during social interaction, how they present and construct the self, and how they define situations of co-presence with others.
• Constructivist grounded theory emphasizes the development of an interactive relationship and mutual construction of knowledge between researcher and participants.
• Medicalization of deviance refers to the process that changes “bad” behavior into “sick” behavior.
• Demedicalization refers to the process when “sick” behavior is normalized again.

Key Terms

• medicalization of deviance: The medicalization of deviance refers to the process that changes “bad” behavior into “sick” behavior.
• demedicalization: Demedicalization refers to the process when “sick” behavior is normalized again.
• symbolic interactionist: Symbolic interactionist researchers investigate how people create meaning during social interaction, how they present and construct the self, and how they define situations of co-presence with others.

According to theorists working in the symbolic interactionist perspective, health and illness are socially constructed. Symbolic interactionist researchers investigate how people create meaning during social interaction, how they present and construct the self (or “identity”), and how they define situations of co-presence with others. One of the perspective’s central ideas is that people act as they do because of how they define situations.

Constructivist grounded theory emphasizes the development of an interactive relationship and mutual construction of knowledge between researcher and participants. Symbolic interactionists believe that objects have meaning only through people’s interactions with them in the environment, that the meanings people have for things develops through social interaction and that those meanings are handled and modified by a constant and ongoing interpretive process by individuals.

An example of the social construction of health the the Rate of Perceived Exertion, or RPE. This scale measures the intensity of a person’s workout on a scale of 0 to 10. This scale was developed by Gunnar Borg, and it is used by medical professionals to assess a person’s health in a variety of ways.

In essence, 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.

An example of medicalization is illustrated by the history of how our society views alcohol and alcoholism. During the 19^th century, people 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 20^th century, however, people who drank too much were increasingly defined as people with a disease or a genetic predisposition to addiction. 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”.

Alcoholism: In this engraving from the 19th century, “King Alcohol” is shown with a skeleton on a barrel of alcohol. The words “poverty,” “misery,” “crime,” and “death” hang in the air behind him.

While interactionism does acknowledge the subjective nature of diagnosis, it is important to remember who benefits the most when a behavior becomes defined as illness. Pharmaceutical companies make billions of dollars treating illnesses such as fatigue, insomnia, and hyperactivity that may not actually be illnesses in need of treatment, but opportunities for companies to make more money.

The Labeling Approach

The labeling approach to health and illness claims that mental illness is manifested solely as a result of societal influence.

Learning Objectives

Analyze the pros and cons of labeling theory, especially the implications it has for the “mentally ill” and HIV/AIDS patients

Key Points

• Developed by sociologists during the 1960s, labeling theory holds that deviance is not inherent to an act. The theory focuses on the tendency of majorities to negatively label minorities or those seen as deviant from standard cultural norms.
• The social construction of deviant behavior plays an important role in the labeling process that occurs in society.
• Labeling theory was first applied to the term “mentally ill” in 1966 when Thomas J. Scheff published Being Mentally Ill. Scheff challenged common perceptions of mental illness by claiming that mental illness is manifested solely as a result of societal influence.
• Hard labeling refers to those who argue that mental illness does not exist. They note the slight deviance from the norms of society that cause people to believe in mental illness.
• Soft labeling refers to people who believe that mental illnesses do, in fact, exist. Unlike the supporters of hard labeling, soft labeling supporters believe that mental illnesses are not entirely socially constructed.

Key Terms

• self-fulfilling prophecy: a prediction that, by being voiced, causes itself to come true
• social construction: A concept or practice that is the construct (or artifact) of a particular group, meaning that the concept or practice is understood differently by various groups and institutions.
• deviance: Actions or behaviors that violate formal and informal cultural norms, such as laws or the norm that discourages public nose-picking.

Labeling Theory on Health and Illness

Labeling theory is closely related to social-construction and symbolic-interaction analysis. Developed by sociologists during the 1960s, labeling theory holds that deviance is not inherent to an act. The theory focuses on the tendency of majorities to negatively label minorities or those seen as deviant from standard cultural norms. The theory is concerned with how the self-identity and behavior of individuals may be determined or influenced by the terms used to describe or classify them. It is associated with the concepts of self-fulfilling prophecy and stereotyping.

1857 Lithograph by Armand Gautier: Shows personifications of dementia, megalomania, acute mania, melancholia, idiocy, hallucination, erotic mania and paralysis in the gardens of the Hospice de la Salpêtrière. A mental disorder or mental illness is a psychological pattern, potentially reflected in behavior, that is generally associated with distress or disability, and which is not considered part of normal development of a person’s culture.

The social construction of deviant behavior plays an important role in the labeling process that occurs in society. This process involves not only the labeling of criminally deviant behavior—behavior that does not fit socially constructed norms—but also labeling that reflects stereotyped or stigmatized behavior of the “mentally ill.” Hard labeling refers to those who argue that mental illness does not exist; it is merely deviance from the norms of society that cause people to believe in mental illness. Mental illnesses are socially constructed illnesses and psychotic disorders do not exist. Soft labeling refers to people who believe that mental illnesses do, in fact, exist, and are not entirely socially constructed.

Labeling theory was first applied to the term “mentally ill” in 1966 when Thomas J. Scheff published Being Mentally Ill. Scheff challenged common perceptions of mental illness by claiming that mental illness is manifested solely as a result of societal influence. He argued that society views certain actions as deviant. In order to come to terms with and understand these actions, society often places the label of mental illness on those who exhibit them. Certain expectations are placed on these individuals and, over time, they unconsciously change their behavior to fulfill them. Criteria for different mental illnesses, he believed, are not consistently fulfilled by those who are diagnosed with them because all of these people suffer from the same disorder. Criteria are simply fulfilled because the “mentally ill” believe they are supposed to act a certain way—over time, they come to do so.

Another issue involving labeling was the rise of HIV/AIDS cases among gay men in the 1980s. HIV/AIDS was labeled a disease of the homosexual and further pushed people into believing homosexuality was deviant. Even today, some people believe contracting HIV/AIDS is punishment for deviant and inappropriate sexual behaviors.

Labels, while they can be stigmatizing, can also lead those who bear them down the road to proper treatment and recovery. The label of “mentally ill” may help a person seek help, such as psychotherapy or medication. If one believes that being “mentally ill” is more than just believing one should fulfill a set of diagnostic criteria, then one would probably also agree that there are some who are labeled “mentally ill” who need help. It has been claimed that this could not happen if society did not have a way to categorize them, although there are actually plenty of approaches to these phenomena that don’t use categorical classifications and diagnostic terms (for example, spectrum or continuum models). Here, people vary along different dimensions, and everyone falls at different points on each dimension.

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• Sick role. (CC BY-SA; Wikipedia via en.Wikipedia.org/wiki/Sick_role)
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• Functionalist perspective. (CC BY-SA; Wikipedia via en.Wikipedia.org/wiki/Functionalist_perspective)
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• Herbert Spencer. (Public Domain; Wikipedia via en.Wikipedia.org/wiki/File:Herbert_Spencer.jpg)
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• Herbert Spencer. (Public Domain; Wikipedia via en.Wikipedia.org/wiki/File:Herbert_Spencer.jpg)
• Health care reform supporter 2 at town hall meeting in West Hartford, Connecticut, 2009-09-02. (CC BY; Wikimedia via commons.wikimedia.org/wiki/File:Health_care_reform_supporter_2_at_town_hall_meeting_in_West_Hartford,_Connecticut,_2009-09-02.jpg)
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