‘Sick Role’ or ‘Empowerment’? The Ambiguities of Life with an HIV Positive Diagnosis

Abstract

This paper addresses the relevance of Parsons' concept of the 'sick role' to the experience of illness in contemporary society by building on recent research, which suggests that the increasing predominance of chronic disease changes the temporal structure of the experience of illness. This has important implications for the structure of social expectations and obligations associated with the 'sick role'. In particular, recent advocates of 'insider' views of illness and the related promotion of ideologies of 'patient empowerment' have contested assumptions of dependency implicit within the concept of the 'sick role', presenting a far more 'independent' and 'proactive' vision of the sick individual. With specific application to a group of people living relatively long term with an HIV positive diagnosis, this paper addresses some of the implicit ambiguities manifest in the selfempowerment ethos, highlighting some implicit dependencies underlying the rhetoric of empowerment and concluding that a more structural analysis of illness experiences, such as that proposed by Parsons, may be apposite.

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“…Despite the criticism it has attracted, the sick role is still a useful concept because it highlights the fundamentally social nature of being sick (Crossley, 1998b;Gabe, Bury, & Elston, 2004).…”

“…Second, it adopts an overly rational perspective on behaviour by treating it as the outcome of cost-benefit calculations (Crossley, 1998a;Obermeyer, 2005;Yoder, 1997), and assuming that avoiding health problems is people's main priority (Crossley, 1998a;Obermeyer, 2005). This assumption is illustrated by the popularity of health education which presupposes that if people have correct information (e.g.…”

“…about the seriousness or causes of a health problem), they will choose to engage in healthy behaviours (Crossley, 1998a).…”

“…However, several scholars (Crossley, 1998a;Obermeyer, 2005) have emphasized the importance of interpersonal issues for people's engagement in health related behaviours. These include normative ideas and moral identities related to and evoked by certain behaviours (Crossley, 1998a;Smith, 2004 These studies suggest that people's decisions to act in certain ways 'have their own alternative logic', intertwined with 'the cultural and moral environment' in which people live (Crossley, 1998a, p.39).…”

“…These include normative ideas and moral identities related to and evoked by certain behaviours (Crossley, 1998a;Smith, 2004 These studies suggest that people's decisions to act in certain ways 'have their own alternative logic', intertwined with 'the cultural and moral environment' in which people live (Crossley, 1998a, p.39). Hence, researchers should examine how people themselves make sense of their actions (Crossley, 1998a;Stainton Rogers, 1999), and any normative and moral concerns which they make relevant.…”