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The Doctor is In.

Greetings, followers. In spite of these words of wisdom and insight that occasionally issue forth from her lips, Dr Then has to confess to being, sometimes, all too human: she has a sniffle. You know how it goes…there was one person in the office dripping nasally and spluttering over the photocopier and all of a sudden the rest of the team is coughing up a lung and looking reproachfully at “patient zero” who is now—of course—perfectly chirpy.

So today the subject of this missive is something dear to the hearts of social historians of medicine. Now, before the Big Reveal, I’m going to pause for a moment here for dramatic effect and to issue a warning: Egregious Technical Jargon Ahead. Oh yes, history of medicine is no more immune to scholarly impenetrability than [insert your favourite social science here] and does come with its own collation of terminology. Thankfully, I have tended to spare you much of it in these archives, but today you are all for it. I have a sniffle, and my public sympathy has gone fffsstt. So here’s a term I learned during those long, long, long years of postgraduate education and which means I am not just Ms Then, but Dr Then: sick role. Sick role is the topic of our discussion today.

What is the sick role? Sick role refers to the collection of behaviours that is considered appropriate for a person who is sick. The whole concept of the “sick role” in history of medicine links with an approach made popular in the 1960s: that it would be interesting to know what life in times past was like for average people—your Joe the Builder of 1650, for example. And since Joe the Builder sometimes got sick, it would be interesting to know what he was expected to do about it. History from the patient’s perspective—history “from below”—kitchen sink history—all that nobly normal, democratic stuff.

Typically, one feature of the sick role is that the sick person is given a get-out-of-regular-life-free card and is exempt from normal chores and responsibilities. No milking the cows! No ploughing the fields! No updating your Facebook status to “infectious”! But this is offset by the expectation that the sick person should be doing all they can to get better soon and quickly stop being such a pain in the a**e for the people having to listen to how raspy their sore throat is and could they possibly bring them a nice cup of tea…? You might be sick, but you’ve got obligations to try and not be: the sick role in a nutshell.

Now of course, different time periods and different people have quite different ideas as to those two critical features and what the details of them might be. For example, our current time is seeing a battle of opinions about that first point. (In fact, some historians proclaim “The Sick Role is Dead!” because of this disagreement. Dramatic bunch.) The fraught question is whether one should withdraw from the healthy world until one is better or…should one come to work and cough all over the post-it notes because one is so vital to the continued operation of the workplace? The good of public health collides with the good of productivity and self-esteem. Snigger, you may well do, but there is a whole line of pharmaceuticals dedicated to this rejection of the sick role: Solider On With Codral Cold and Flu Tablets. Dose Up, Reject Sick Role, and Infect.

And perspectives on that second point—what to do to get better—are also historically changeable. I, for example, favour the kettle-on-constant-reboil, good-book-in-bed approach and delicately scent my person with Vicks Vapour-rub. Très chic. Don’t you just wish these blogs came with smell’o’vision?

A physician, however, would expect that their patient ought to be following their prescriptions—taking their pills, and sometimes having very unpleasant things done to them such as cupping or blood letting to get better. And that’s something common to physicians ever since there were physicians. Doctors have been annoyed for thousands of years with patients who don’t do what they’re meant to: Hippocrates himself, the ancient Greek founder of medicine, spluttered (in ancient Greek) about his naughty patients. In the 1950s, physicians developed a term of their own for this pesky bunch: “non-compliant” patients. Non-compliant meaning, of course, “naughty”. Historians aren’t the only ones with a penchant for jargon.

So, there we are, with our brief foray into the concept of sick role. It’s a hugely productive idea—props to the sociologist who came up with it, Talcott Parsons. Need a research topic? Let’s investigate the sick role! When? Whenever!

I shall now shuffle off and give my demonstration of the sick role in an early twenty-first century, western urban environment. History as performance art.

Til next time, stay well, and if anyone’s passing by a kettle, I’m up for a cup.

Dr Then.

Interested? Want more?

Burnham, John. “The Death of the Sick Role”, Social History of Medicine online (2012)

Greene, Jeremy. “Therapeutic Infidelities: ‘Noncompliance’ Enters the Medical Literature, 1955–1975.” Social History of Medicine 17, no.3 (2004): 327-343.

Parsons, Talcott, Illness and the role of the physician: a sociological perspective.” American Journal of Orthopsychiatry 21, no.3 (1951): 452–460.

Porter, Roy. “The Patient’s View: Doing Medical History from Below.” Theory and Society 14, no. 2 (1985): 175-98.

Shorter, Edward. Bedside Manners: The Troubled History of Doctors and Patients. New York: Simon and Schuster, 1985.

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