Words and medical/scientific terminology do
matter, and I believe that multiple definitions and the use of certain words and phrases may contribute to ambiguity and misunderstanding.
As an example, I view the use of “seeking attention” in the following context to be synonymous with seeking medical attention, seeking medical advice, or seeking medical help –- all of which are commonly-used phrases. Adding the word “medical” may have seemed awkward or superfluous to the authors or a copy editor, but that’s just a guess on my part.
Until the cause of the ailments that afflict patients seeking attention for what they believe is Lyme disease is better understood and managed, the controversy will likely continue.
“Sick role” was coined by a sociologist, and I don’t believe it wasn’t intended as a derogatory term at the time. Wikipedia does a pretty good job of summarizing both the origin and criticisms of a term that is used primarily (but not exclusively) by medical sociologists.
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 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. Genuinely, Parsons argued that the best way to understand illness sociologically is to view it as a form of deviance-which 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 ‘state of fact’ or ‘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 is exempt from normal social roles
The sick person is not responsible for their condition
The sick person should try to get well
The sick person should seek technically competent help and cooperate with the medical professional
There are three versions of sick role: 1. Conditional 2. Unconditionally legitimate 3. Illegitimate role: condition that is stigmatized by others
Rejecting the sick role.
This model assumes that the individual voluntarily accepts the sick role.
Individual may not comply with expectations of the sick role, may not give up social obligations, may resist dependency, may avoid public sick role if their illness is stigmatised.
Individual may not accept ‘passive patient’ role.
Doctor Patient relationship.
Going to see doctor may be the end of a process of help seeking behaviour, Freidson (1970) discusses importance of 'lay referral system'- lay person consults significant lay groups first.
This model assumes 'ideal' patient and 'ideal' doctor roles See- Murcott (1981), Sacks (1967), Bloor & Horobin (1975).
Differential treatment of patient, and differential doctor patient relationship- variations depend on social class, gender and ethnicity. See- MacIntyre & Oldman (1984), Buchan & Richardson (1973), Sudnow (1967).
Blaming the sick.
‘Rights’ do not always apply.
Sometimes individuals are held responsible for their illness, i.e. illness associated with sufferers lifestyle. (See Chalfont & Kurtz: 1971, on alcoholism).
In stigmatised illness sufferer is often not accepted as legitimately sick.
Model fits acute illness (measles, appendicitis, relatively short term conditions).
Does not fit Chronic/ long-term/permanent illness as easily, getting well not an expectation with chronic conditions such as blindness, diabetes.
In chronic illness acting the sick role is less appropriate and less functional for both individual and social system.
Chronically ill patients are often encouraged to be independent.
The term “sickness behavior” was apparently first introduced in the 1980’s, and it was intended as scientific/medical shorthand for physiological and behavioural responses to infection in both animals and humans. Unfortunately, the term may lend itself to misuse by those who like to imply there may be a maladaptive psychological component to something with a very clear biological basis.
Neurosci Biobehav Rev. 1988 Summer;12(2):123-37.
Biological basis of the behavior of sick animals.
1Department of Physiological Sciences, School of Veterinary Medicine, University of California, Davis 95616.
The most commonly recognized behavioral patterns of animals and people at the onset of febrile infectious diseases are lethargy, depression, anorexia, and reduction in grooming. Findings from recent lines of research are reviewed to formulate the perspective that the behavior of sick animals and people is not a maladaptive response or the effect of debilitation, but rather an organized, evolved behavioral strategy to facilitate the role of fever in combating viral and bacterial infections. The sick individual is viewed as being at a life or death juncture and its behavior is an all-out effort to overcome the disease.
[PubMed - indexed for MEDLINE]
The following article abstract contains a definition of sickness behavior. It also hints at a proposed treatment approach for what is now considered “inappropriate, prolonged activation of the innate immune system” in certain medical conditions.
Brain Behav Immun. 2007 Feb;21(2):153-60. Epub 2006 Nov 7.
Twenty years of research on cytokine-induced sickness behavior.
Dantzer R1, Kelley KW.
1Integrative Immunology and Behavior Program, Laboratory of Integrative Immunophysiology, Department of Animal Sciences, University of Illinois at Urbana-Champaign, IL 61801, USA.
Cytokine-induced sickness behavior was recognized within a few years of the cloning and expression of interferon-alpha, IL-1 and IL-2, which occurred around the time that the first issue of Brain, Behavior, and Immunity was published in 1987. Phase I clinical trials established that injection of recombinant cytokines into cancer patients led to a variety of psychological disturbances. It was subsequently shown that physiological concentrations of proinflammatory cytokines that occur after infection act in the brain to induce common symptoms of sickness, such as loss of appetite, sleepiness, withdrawal from normal social activities, fever, aching joints and fatigue. This syndrome was defined as sickness behavior and is now recognized to be part of a motivational system that reorganizes the organism's priorities to facilitate recovery from the infection. Cytokines convey to the brain that an infection has occurred in the periphery, and this action of cytokines can occur via the traditional endocrine route via the blood or by direct neural transmission via the afferent vagus nerve. The finding that sickness behavior occurs in all mammals and birds indicates that communication between the immune system and brain has been evolutionarily conserved and forms an important physiological adaptive response that favors survival of the organism during infections. The fact that cytokines act in the brain to induce physiological adaptations that promote survival has led to the hypothesis that inappropriate, prolonged activation of the innate immune system may be involved in a number of pathological disturbances in the brain, ranging from Alzheimer's disease to stroke. Conversely, the newly-defined role of cytokines in a wide variety of systemic co-morbid conditions, ranging from chronic heart failure to obesity, may begin to explain changes in the mental state of these subjects. Indeed, the newest findings of cytokine actions in the brain offer some of the first clues about the pathophysiology of certain mental health disorders, including depression. The time is ripe to begin to move these fundamental discoveries in mice to man and some of the pharmacological tools are already available to antagonize the detrimental actions of cytokines.
[PubMed - indexed for MEDLINE]
Free PMC Article