This document summarizes Matthias Zick Varul's article analyzing Talcott Parsons' concept of the sick role and how it relates to chronic illness. The key points are:
1) Parsons' sick role concept is based on acute illnesses and becoming problematic with the rise of chronic illnesses which do not conform to the sick role's expectations of a temporary deviation from social roles and recovery.
2) Parsons viewed illness as a disruption of social and economic contributions in capitalist societies where health underlies economic productivity. The sick role provides legitimacy and social support during illness by exempting patients from normal roles and obligations in exchange for seeking treatment.
3) For chronic illnesses, the sick role's expectations of
introduction
Sociology and psychology in public health
Theories of sociology and psychology
Sociological and psychology methods, investigations and interventions.
Developing interventions to change health-related behaviour and;
Conclusion
introduction
Sociology and psychology in public health
Theories of sociology and psychology
Sociological and psychology methods, investigations and interventions.
Developing interventions to change health-related behaviour and;
Conclusion
Organisational culture and communication: The introduction of Peer Workers to...Louise Miller Frost
An examination of some of the issues accompanying the introduction of a peer worker program to acute mental health facilities. What works, what doesn't, where are the problems and barriers and who are the drivers of change.
When the cold war was over at the end of 1980th, we expected that the 21st century would be peaceful, progressive, and politically stable. On the contrary, the strong consciousness of ETHNICITY was dramatically emerged in eastern European ethnic groups that were controlled by the old Soviet Union. The worse situation was the case of old Yugoslavia where were divided into three parts with arms. As we know, that war was the terrible genocide as we know.
What is “ Medical Anthropology?
Health and Sickness could be defined as the dynamic studies. Because, the concept of the sickness and health is depended on the indigenous values. It means “dynamics”.
2. Biomedicine and cultural( behavial sciences can be understood reciprocally.
Cultural Diagnosis.
The fact that the past scientific research and analysis gather so many different specialists needs to be stress. No profession can get alone the right perspective to comprehend the destructiveness of violence, we need different points of view to fight against it and hopefully to transfer this knowledge to the policy making body. It is my hope that our policy makers and society will begin to realize the importance of the anthropological aspects which I am going to discuss in this short paper.
Now, I would like to take this opportunity to share the role of Anthropology in this issue with policy makers and anthropologists but, let me first show about the role of anthropology in the process of development and its connection with violence. I believe that the anthropological theory should apply to the practical field. Another word, I would say that anthropologists must put on two hats (theoretical and practical).
The work was presented during the II Workshop on Medical Anthropology in Rome, October 14th - 15th 2011.
The Nature and Scope of Sociology include all the followings:
* The Sociological Perspective
*Seeing the Broader Social Context
*Foundation of Sociology
and many mores :)
Hope that this my Slides will help you to understand all the information :))
Affect of Social Capital on Mental Health OutcomesRuby Med Plus
This research Paper discuss affect of social capital on Mental Health. Psycho social Processes and Social Capital, Empowerment and Social Capital, Social Networks and Social Capital, Measurement of social capital, The Mental Health Index indicators integration, The Social and Mental Well Being Index integration, Health-related Behaviors and Social Capital, Access to Mental Health Services and Amenities, Stressed Problems in Communities affecting social capital and mental health, Model of Overlapping Clusters of Problems, Suicide, Anti-social Behaviour and Social Capital.
Abstract—Theories of sociology of health and illness defy the biomedical model of disease as many of them are ‘concerned with the social origins and influence on disease’ rather than pathological reasons only. There are five sociological perspectives of health and illness: Social Constructionism, Marxism, Feminism, Foucaulian analysis, and Functionalism. These different sociological perspectives were critically analyzed through this article as for better understanding of conceptualize management of health services Social Constructionism is a sociological perspective focus on the sociology of knowledge and reality. Marxism focuses on equity between social classes and emphasizes inequality in capitalist society. According to Marxism inequality of distribution healthcare services in capitalist society arise from the marginalization of some categories of the population who do not contribute to economic system. Feminist theory is to understand and explore the multiple and various reasons for inequalities between the genders. In the healthcare sector, feminists believe that healthcare organizations are hierarchical systems, where doctors (usually men) are at the top level while nurses (usually women) have a lower level of importance. Main areas that Foucault theory emphasizes are power, knowledge and discourse. Foucault believes that there is a relationship between power and knowledge. This relationship appears clearly in the health field, as medical professionals comprise a group of people who have special knowledge (medical knowledge) and they gain the power from this knowledge. Finally, functionalism is a sociological perspective that describes society as a system made up of ‘interconnected and interrelated parts’ and it highlights the relationships between different parts of society In conclusion, the five sociological perspectives provide holistic picture about conceptualization of healthcare systems.
Organisational culture and communication: The introduction of Peer Workers to...Louise Miller Frost
An examination of some of the issues accompanying the introduction of a peer worker program to acute mental health facilities. What works, what doesn't, where are the problems and barriers and who are the drivers of change.
When the cold war was over at the end of 1980th, we expected that the 21st century would be peaceful, progressive, and politically stable. On the contrary, the strong consciousness of ETHNICITY was dramatically emerged in eastern European ethnic groups that were controlled by the old Soviet Union. The worse situation was the case of old Yugoslavia where were divided into three parts with arms. As we know, that war was the terrible genocide as we know.
What is “ Medical Anthropology?
Health and Sickness could be defined as the dynamic studies. Because, the concept of the sickness and health is depended on the indigenous values. It means “dynamics”.
2. Biomedicine and cultural( behavial sciences can be understood reciprocally.
Cultural Diagnosis.
The fact that the past scientific research and analysis gather so many different specialists needs to be stress. No profession can get alone the right perspective to comprehend the destructiveness of violence, we need different points of view to fight against it and hopefully to transfer this knowledge to the policy making body. It is my hope that our policy makers and society will begin to realize the importance of the anthropological aspects which I am going to discuss in this short paper.
Now, I would like to take this opportunity to share the role of Anthropology in this issue with policy makers and anthropologists but, let me first show about the role of anthropology in the process of development and its connection with violence. I believe that the anthropological theory should apply to the practical field. Another word, I would say that anthropologists must put on two hats (theoretical and practical).
The work was presented during the II Workshop on Medical Anthropology in Rome, October 14th - 15th 2011.
The Nature and Scope of Sociology include all the followings:
* The Sociological Perspective
*Seeing the Broader Social Context
*Foundation of Sociology
and many mores :)
Hope that this my Slides will help you to understand all the information :))
Affect of Social Capital on Mental Health OutcomesRuby Med Plus
This research Paper discuss affect of social capital on Mental Health. Psycho social Processes and Social Capital, Empowerment and Social Capital, Social Networks and Social Capital, Measurement of social capital, The Mental Health Index indicators integration, The Social and Mental Well Being Index integration, Health-related Behaviors and Social Capital, Access to Mental Health Services and Amenities, Stressed Problems in Communities affecting social capital and mental health, Model of Overlapping Clusters of Problems, Suicide, Anti-social Behaviour and Social Capital.
Abstract—Theories of sociology of health and illness defy the biomedical model of disease as many of them are ‘concerned with the social origins and influence on disease’ rather than pathological reasons only. There are five sociological perspectives of health and illness: Social Constructionism, Marxism, Feminism, Foucaulian analysis, and Functionalism. These different sociological perspectives were critically analyzed through this article as for better understanding of conceptualize management of health services Social Constructionism is a sociological perspective focus on the sociology of knowledge and reality. Marxism focuses on equity between social classes and emphasizes inequality in capitalist society. According to Marxism inequality of distribution healthcare services in capitalist society arise from the marginalization of some categories of the population who do not contribute to economic system. Feminist theory is to understand and explore the multiple and various reasons for inequalities between the genders. In the healthcare sector, feminists believe that healthcare organizations are hierarchical systems, where doctors (usually men) are at the top level while nurses (usually women) have a lower level of importance. Main areas that Foucault theory emphasizes are power, knowledge and discourse. Foucault believes that there is a relationship between power and knowledge. This relationship appears clearly in the health field, as medical professionals comprise a group of people who have special knowledge (medical knowledge) and they gain the power from this knowledge. Finally, functionalism is a sociological perspective that describes society as a system made up of ‘interconnected and interrelated parts’ and it highlights the relationships between different parts of society In conclusion, the five sociological perspectives provide holistic picture about conceptualization of healthcare systems.
COMMENTARY ‘ What we ’ ve tried, hasn ’ t worked ’ : the politics of assets b...Jim Bloyd
It is a paradox of recent epidemiology that as material inequalities grow, so
the pursuit of non-material explanations for health outcomes proliferates. At
one level, a greater recognition of psycho-social factors has deepened the
understanding of the societal determinants of health, the links between mental
and physical health and the social nature of human need. Too often however,
psycho-social factors are abstracted from the material realities of people
’
s lives
and function as an alternative to addressing questions of economic power and
privilege and their relationship to the distribution of health. The growing in
fl
u-
ence of salutogenesis and asset-based approaches is one example of this trend.
This paper re
fl
ects on the theories of public health that lie behind the dis-
course of assets, together with some of the reasons for, and consequences of,
its popularity and in
fl
uence, notably in Scotland.
Espousal of social capital in Oral Health CareRuby Med Plus
Oral health is projected to be affected by the environment; to provide an understanding to this, the concept of social capital can be used. Social networking appears to be the rational in social capital in which there is ‘connections’ among individuals, a social network guided by a set of values and norms of trustworthiness and reciprocity among peoples’, groups, communities etc of the network. Putnam (1995) defines social capital as “coordination and co- operation for mutual benefit”. Hence it is not only a way of describing social relationships within a group or society, but also adds a social dimension to traditional structural explanations of disease by viewing communities not just as contextual environments, but also as connected groups of individuals.
The theory of social capital emphasizes multiple dimensions inside the concept. For example, social capital can be divided into a behavioral/activity component (for example, participation) and a cognitive/perceptual component (for example, trust). These are respectively being referred to as structural and cognitive social capital. . Structural and cognitive social capital can therefore refer to linkages and perceptions in relation to people who are akin to each other; such as people in one’s own community or people of alike socioeconomic status (referred to as bonding social capital), or to people who are poles apart; such as people outside one’s community or with a different social identity (known as bridging social capital). Social capital relations can also occur in ceremonial institutions such as between community and local government structures (termed linking social capital) .
Social capital is not a magic pill for improving society’s oral health but, it is a useful concept which focuses our attention on an important set of resources, inhering in relationships, networks and associations, which have previously been given insufficient attention in the social sciences and Dental literature. This is probably partly because they are not easy to categories, study and measure their effects quickly. The social capital perspective therefore broadcast us that if we normatively approve of the goal of enhancing population oral health, we cannot achieve this through material inputs alone, or simply through “technological fixes”, whether “forced” or magnanimously “approved” by those with superior resources. Social capital can contribute towards health promotion, in the extent to which it can be used for its strategic value; the concept can be carefully employed within wider health promotion practices which explicitly draw upon social justice, equity and empowerment principles . Social capital draws on solidarity within groups, communities, societies as well.
CHAPTER 5 Law and Social Conrol 241 1In some cases, howeve.docxchristinemaritza
CHAPTER 5 Law and Social Conrol 241 1
In some cases, however. firms that have a monopoly on their products, such as local
gas and electric companies, are not likely to be hurt by adverse publicity. Agencies are, at
times, also reluctant to stigmatize firms. because adverse publicity is considered a form of
informal adjudication, although it is often used and justified by the notion that people
have a righl to knorry-
SUMMARV
This chapter has considered law as a mechanism of formal social control. Law comes into
play whin other forms of social control are weak, ineffective, or unavailable' Individuals
ina g.oupr are led to behave in acceptable ways through the processes of socialization
and ixfernal pressures in the form of sanctions from others. Mechanisms of social control
through external pressures may be formal and informal, and include both tregative and
positive sanctions. Informal social controls are exemplified in the functions of folkways
and mores. Informal sosial controls tend to be effective when there is intense social inter'
action on an intimate face-to-face basis, normative consensus. and surveillance of the be-
havior of members of the community (see, for example, Norris and Wilson, ZOOT)' Formal
social controls are characteristic of more complex societies with a greater division of Ia-
bor and different sets of mores, yalues. and ideologies Formal social controls arise when
informal controls are insufficient to maintain conformity to certain norms. Laws are one
type of formal social control, Other types of formal social controls rely on both penalties
and rewards. whereas conrrol through the law is exercised primarily. but not exclusively,
by the use of punishments to regulate behavior.
The social control of criminal and delinquent behavior represents the most highly
structured formal system used by society to attempt to control deviant behavior (see, for
example. Brudner.2009). The concept legalization describes the process by which norms
are moved from the social to the legal level. It also entails the incorporation of specific
punishments for special kinds of criminal law violators. The goals of punishment are ret-
ribution or social retaliation, incapacitation, and both specific and general deterrence-
Punishment is a deterrent in situations that involve low-commitment individuals who en-
gage in instrumental crimes.The death penalty, as the most severe form of punishment,
remains controversial, and there is no agreement on its deterrent effect.
Formal control of deviant behavior is not limited to criminal sanctions. The use of
civil commitm6nt as a mechanism of legal control is more widespread. In civil commit-
ment, there are no procedural safeguards available for the defendant. Civil commitment
operates through the process of rtefining deviant behavior as a mental disorder. and it in-
cludes the involuntary commitmert of alcoholics, drug addicts, sex offenders, and trou-
blesome tgenagers. It al ...
Presentation by Helen Spandler at Sociology of Mental Health Study Group symposium: What does sociology need to contribute towards or against the wellbeing agenda? on 10 June 2013.
Towards a Critical Health Equity Research Stance: Why Epistemology and Method...Jim Bloyd, DrPH, MPH
Qualitative methods are not intrinsically progressive. Methods are simply tools to conduct research. Epistemology, the justification of knowledge, shapes methodology and methods, and thus is a vital starting point for a critical health equity research stance, regardless of whether the methods are qualitative, quantitative, or mixed. In line with this premise, I address four themes in this commentary. First, I criticize the ubiquitous and uncritical use of the term health disparities in U.S. public health. Next, I advocate for the increased use of qualitative methodologies—namely, photovoice and critical ethnography— that, pursuant to critical approaches, prioritize dismantling social–structural inequities as a prerequisite to health equity. Thereafter, I discuss epistemological stance and its influence on all aspects of the research process. Finally, I highlight my critical discourse analysis HIV prevention research based on individual interviews and focus groups with Black men, as an example of a critical health equity research approach.
11Systems TheoryBRUCE D. FRIEDMAN AND KAREN NEUMAN ALL.docxmoggdede
11
Systems Theory
BRUCE D. FRIEDMAN AND KAREN NEUMAN ALLEN
3
Biopsychosocial assessment and the develop-ment of appropriate intervention strategies for
a particular client require consideration of the indi-
vidual in relation to a larger social context. To
accomplish this, we use principles and concepts
derived from systems theory. Systems theory is a
way of elaborating increasingly complex systems
across a continuum that encompasses the person-in-
environment (Anderson, Carter, & Lowe, 1999).
Systems theory also enables us to understand the
components and dynamics of client systems in order
to interpret problems and develop balanced inter-
vention strategies, with the goal of enhancing the
“goodness of fit” between individuals and their
environments. Systems theory does not specify par-
ticular theoretical frameworks for understanding
problems, and it does not direct the social worker to
specific intervention strategies. Rather, it serves as
an organizing conceptual framework or metatheory
for understanding (Meyer, 1983).
As a profession, social work has struggled to
identify an organizing framework for practice that
captures the nature of what we do. Many have iden-
tified systems theory as that organizing framework
(Goldstein, 1990; Hearn, 1958; Meyer, 1976, 1983;
Siporin, 1980). However, because of the complex
nature of the clinical enterprise, others have chal-
lenged the suitability of systems theory as an orga-
nizing framework for clinical practice (Fook, Ryan,
& Hawkins, 1997; Wakefield, 1996a, 1996b).
The term system emerged from Émile Durkheim’s
early study of social systems (Robbins, Chatterjee,
& Canda, 2006), as well as from the work of
Talcott Parsons. However, within social work, sys-
tems thinking has been more heavily influenced by
the work of the biologist Ludwig von Bertalanffy
and later adaptations by the social psychologist Uri
Bronfenbrenner, who examined human biological
systems within an ecological environment. With
its roots in von Bertalanffy’s systems theory and
Bronfenbrenner’s ecological environment, the
ecosys tems perspective provides a framework that
permits users to draw on theories from different dis-
ciplines in order to analyze the complex nature of
human interactions within a social environment.
RELEVANT HISTORY
Ludwig von Bertalanffy (1901–1972), as mentioned
above, is credited with being the originator of the
form of systems theory used in social work. Von
Bertalanffy, a theoretical biologist born and educated
in Austria, became dis satisfied with the way linear,
cause-and-effect theories explained growth and
change in living organisms. He felt that change might
occur because of the interac tions between the parts
of an organism, a point of view that represented a
dramatic change from the theories of his day.
Existing theories had tended to be reductionis t,
understanding the whole by breaking it into its parts.
Von Bertalanffy’s introduction of systems theory
changed that framework by looki ...
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
1. See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/249686502
Talcott Parsons, the Sick Role and Chronic Illness
Article in Body and Society · July 2010
DOI: 10.1177/1357034X10364766
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2. Matthias Zick Varul, University of Exeter
Talcott Parsons, the Sick Role and Chronic Illness
published in Body & Society vol.16, no.2, pp.72-94
3. 2
Abstract
Parsons sick role concept has become problematic in the face of the increased significance of
chronic illnesses and the growing emphasis on life-style centred health promotion. Both
developments de-limit the medical system so that it extends into the world of health,
fundamentally changing the doctor-patient relationship. But as the sick role is firmly based on the
reciprocities of a resiliently capitalist achievement society it still informs normative expectations
in the field of health and illness. The precarious social position of chronic patients between being
governed by and being consumers of medicine, I will argue, can only be adequately understood if
one involves, as Parsons did, the moral economy surrounding health and illness.
4. 3
Introduction
The sick role still is one of the most frequently invoked of Parsons concepts. It is, however,
mainly used as a negative referent (Shilling, 2002: 625) rather than as an interpretative tool. The
sick role is widely accepted as an historically adequate account of normative expectations around
illness in the middle of the 20th
century (Herzlich, 1973: 9), but the rise of chronic illnesses and
the pathologization of everyday behaviours in health promotion has opened up medical fields
which it no longer seems to cover. Even in the shrinking field of acute illnesses the sick role has
been predicted to disappear soon due to marketization and patient empowerment (Bury, 1997:
106).
This apparent obsolescence, I will argue, can best be understood against the normative
background of reciprocity and recognition at the heart of Parsons thinking. In his medical
sociology, as in his general theory, he was interested not so much in concrete behaviours as in the
normative expectations structuring and structured by ordinary practices in capitalist societies
(Parsons, 1964: 257ff.; Arluke, 1988: 176). Although those practices have changed considerably in
the various transitions described under labels like post-Fordism and the New Economy , both
the success orientation of economic practices and the fundamental patterns of capitalist
reciprocity and recognition (Varul, 2010) have remained intact and may even have become more
accentuated (Gorz, 2005: 6). With this tension between a shrinking field of application and a
persisting moral plausibility in mind, I will suggest that the obsolescence of the Parsonian sick
role is not due to the marginalization of its field of application but to its expansion beyond its
temporal and spatial boundaries. I will try to show that this approach can add to an
understanding of the precarious social position of the chronically ill, and that it also highlights
parallel expectations towards the healthy in what I will call chronic health .
5. 4
Acute illness and health in the capitalist moral economy
Parsons starting point is his understanding of illness as deviance. Illness is the breakdown of the
general capacity for the effective performance of valued tasks (Parsons, 1964: 262). Losing this
capacity disrupts loyalty to particular commitments in specific contexts such as the workplace
and the family. The assumed cause of disloyalties in the case of illness is not disregard of norms
but inability to conform to them, a difference which constitutes the distinction between illness
and immorality or crime (Parsons, 1964: 270). For the effect on the social system, however, it
does not matter if and how deviance is motivated since in any case too low a general level of
health, too high an incidence of illness, is dysfunctional (Parsons, 1951: 430). This renders illness
an undesirable deviance that requires normative rejection.
But system requirements do not translate smoothly into normative expectations in everyday
social relations. It is more informative, therefore, to look at the web of reciprocities of role
performances that make up the social system. Parsons (1951: 430) invokes a social contract in
which society s gift of life is repaid by continued contributions and conformity to social
expectations. As Gerhardt (1989: 17) points out, for Parsons [a]ll social action is seen as
exchange entailing the relentless obligation to conform to others role expectations . A
transgression against a going system of social relationships therefore does not require positive
disruption simple withdrawal is sufficient because it forces role partners to do without the
benefits expected from a person s actions (Parsons, 1951: 30f.). Illness is one of the most
important withdrawal behaviors in our society (Parsons, 1951: 31). As disturbance of the total
person it affects all the person s particular role performances. Failure in all particular roles
amounts to total personal failure since the loss of approvals (for specific role performances)
adds up to a loss of esteem (for the person as a whole) (Parsons, 1964: 266ff.).
The potential consequences of such a loss are severe because approval and esteem function as
fundamental analytical basis of the place of moral sentiments in the institutionalization of the
reward allocation systems of societies (Parsons, 1951: 132). The need for approval by others is
6. 5
built into the personality system s need disposition, reflecting the inescapable dependence on
others reciprocation (Parsons, 1951: 381). King (2009: 281ff), in his reading of The Structure of
Social Action, points out that for Parsons this is more than just a matter of symbolic interaction:
honour and shame accompanying conformity and deviance have consequences for the
allocation of resources and for social membership. In The Social System this insight is watered
down in a shift towards a more psychoanalytical perspective (1951: 38ff.), but it is still echoed in
the norms of loyalty and solidarity which are rewarded by being in a position to count on the
favorable attitudes of alter (1951: 79). Failure to fulfil role expectations, disloyalty, therefore
incurs the risk of social exclusion.
Parsons has tailored the sick role to US American achievement values, but it also applies to other
capitalist societies to the extent that liberal labour and consumer markets are the central loci of
social exchange. In these societies the absence of a definitive goal for the system as a whole
means that economic productivity becomes the most significant field of contribution to the
common good (Parsons, 1964: 278). In this context health is crucial because it underlies the
capacity for economic achievement. Defined as the ability to perform health is synonymous with
what Marx called abstract labour power : the unspecified capacity to produce (Blane, 1987; Varul,
2004: 207ff.). In a later reflection Parsons (1978: 80) suggested a parallel between health and
money. He may not have had this in mind, but if money is the socially recognized incarnation of
human labour (Marx, 1996: 107) and health the basic ability to work, money and health are
convertible through the working body. Williams (2003: 38) relates this money-like health to
Bourdieu s notion of physical capital , which is economically relevant in every occupation as all
work is embodied (Shilling, 2005: 28ff., 73ff.; Hall, 1999: 607). In tune with the gendered
division of labour of the 1950s, the body in Parsons sick role is a male one, defined as controlled
by a rational, purposive mind and oriented by it towards an income-generating performance. The
female body here counts only in its biologically and emotionally reproductive role within the
family (Parsons, 1956: 12ff.), which gains legitimacy only indirectly through the performance of
7. 6
the reproduced male body. While the mind/body dualism and the requirement to control
emotions must not be essentialized as masculine, and the emotional body not as feminine
(Witz, 2000), it is the health of the rational producer whatever the gender that the Parsonian
sick role seeks to restore. Ignoring much of the lived illness experience that often cannot be
subsumed under the notion of incapacity , it nevertheless adequately reflects social legitimacies
which until today privilege paid work.
The use of money as symbolic recognition and as material realisation of that recognition (Varul,
2010) enforces the existential nature of the anomie constituted by illness. In a society
championing universalistic achievement values , tokens of approval for specific performances are
the central element in the social reward system. Desisting from a holistic evaluation of the
person, approval has an affinity to money which in turn very often is used to express the degree
of approval and the importance of the valued action (Parsons, 1951: 132). In an achievement
society esteem as more diffuse social recognition of the whole person is largely linked to general
capacity, evidenced in its particular approved actualizations. Illness as a breakdown of capacity
interrupts performance worthy of approval, most significantly in economic roles, and thereby
threatens general esteem, which is largely (although not exclusively) expressed in financial
resources. And because financial resources are the basis of the availability of facilities for
attaining whatever goals may seem most worthwhile (Parsons, 1964: 278) illness is not only a
threat to social status in terms of respect ( honour ) but simultaneously a threat to material status
in a very immediate sense.
Being largely beyond the individual s rational control (Gerhardt, 1989: 23) illness thus poses an
unbearable prospect of abandonment and deprivation. The provision of an institutionalized
bridge over periods of illness is therefore essential if mass loyalty in a modern capitalist society is
to be maintained (Behrens, 1997). Because health is the fundamental condition of achievement ,
access to health services becomes a central focus of the problem of justice (Parsons, 1964: 279),
a cornerstone of the capitalist moral economy.
8. 7
The sick role
The sick role is, for Parsons, one of the most important mechanisms of social control in capitalist
societies. Yet, while health is vital for the economic system, the anomie of illness is controlled by
non-economic means: The profit motive is supposed to be drastically excluded from the
medical world (Parsons, 1951: 435). In Durkheimian tradition Parsons sees the capitalist
economy as an institutionally established field where interaction based on utilitarian motives is
enabled by social arrangements that cannot themselves be utilitarian (Durkheim, 1933). The case
of medicine has such a prominent place in his theoretical work because it excellently
demonstrates this point. It is an institution that is oriented towards enabling individualistically
calculated social action, but is in itself collectivity-oriented.
Substituting the multiplicity of everyday roles, the sick role bridges periods of incapability by
establishing a single role that enables conformity within the deviance of illness. Loyalty to and
efficient performance in the particular commitment of the sick role compensates temporarily for
general incapacity. In what is best termed a moratorium of reciprocity (to extend the application
of Gerhardt s [1987: 117] apt expression), the individual s everyday obligations and also their
everyday rights are suspended and replaced by a set of sick-role specific rights and obligations.
The exemption from normal role expectations itself obviously is the most fundamental right.
Other rights are the assumption of innocence and access to professional help. These rights are
matched by complementary obligations.
The right to exemption is matched by an obligation to retreat from normal everyday life, both
work and leisure, to isolate oneself from the world of the healthy. Parsons (1951: 437) points out
that this obligation is often enforced by role partners (domestic, occupational etc.). The ill are to
be insulated as disturbing element in the system (Parsons, 1964: 259). The system needs to be
protected not only from biological infection but also from motivational contagion (Parsons,
1964: 275f.) as without such protection the presence of people who receive sustenance and care
9. 8
without making a productive contribution would destabilize the motivation of the healthy not to
fall ill.
This concern with illness motivation originates from Parsons premise that illness is not just
situational incapacity (1964: 269) but also normative deviance (cf. Gerhardt, 1989). Although
Parsons put a strong emphasis on the physical organism (Shilling, 2002: 625, Howson, 2005: 16)
the body remains secondary, a mere object ultimately to be controlled by the rational mind.
Illness in most cases is the failure of such control (Shilling, 2002: 626). In a Parsonian
perspective, therefore, most illness, if not all, could be considered to be psychosomatic (Lupton,
1997c: 567).
The assumption of innocence still makes sense, as the unavailability of motives makes an appeal
to the sufferer s morale or even punishment dysfunctional. Part of the predicament of the ill
person is that they cannot control those motives. Further, the motivational component of illness
always exists alongside a conditional one the body refusing to follow the mind which cannot
be tackled by a merely social control (Parsons, 1964: 335). In his reconsideration of the sick role
(1978: 19) Parsons limits the notion of illness as deviance to the motivational component. Given
the way the sick role is embedded in a capitalist moral economy it seems nonetheless appropriate
to retain the notion of even purely physiological incapacity as deviant. Valuing contribution here
is based neither just on one s potential (capacity), nor just on its motivated realization the value
of actualized labour power is qualified by what is socially defined as its relevant skill (Varul, 2010)
and so, too, are individual healths as different capacities.
Controlling the motivational side of illness is crucial in preventing sufferers from accepting their
illness as a liberator from the burdens of a stressful modern life (Herzlich, 1973: 130). The
secondary gains (exemption, attention and care) of the sick role must not be obtained without a
price. In order to uphold commitment to social reciprocities while unable to fully take part in
them, a secondary reciprocity is introduced. The weakened motivation to fulfil normal role
obligations is replaced by a motivation towards recovering lost motivational energy. The
10. 9
assumption of innocence can only be upheld if the sick person is seen to comply to the second
obligation that comes with the sick role: the obligation to want to get well (Parsons, 1951:
437). Compliance to this imperative is demonstrated by compliance to the obligations matching
the right to professional help and social support: to actively seek professional help, to trust the
physician and to follow medical advice. The doctor-patient relationship is set up to enable
legitimacy-providing conformity within the deviance of illness.
The sick person may be allowed, to an extent and for a time, to regress into childlike dependency
but this permission comes with an equally childlike loss of autonomy (Gerhardt, 1991: 171f.).
In order to achieve the collective goal of re-establishing health, the patient has to accept
violations of personal and bodily integrity, treatments that come with discomfort and sometimes
even considerable pain the burdens the physician asks his patients and their families to assume
on his advice are often very severe. (Parsons, 1951: 442) The ill are not allowed to pick and
choose treatment they are not consumers deciding according to their individual preferences.
Shopping around is not an option (Parsons, 1951: 438f.).
The loss of autonomy is, paradoxically, informed by the high value placed on autonomy,
compulsive independence (Parsons, 1958: 345), in modern societies. Disease is a threat to
autonomy as it disables social contributions which legitimize individual freedoms; and, of course,
it impacts directly on autonomy by way of incapacitation. The renunciation of individual
autonomy in the sick role is only tolerable because it is relinquished solely in order to fully regain
it. As a strictly transitional role the sick role defines a spatially and temporally delineated world of
illness (Parsons, 1978: 32).
Chronic Illness
Chronic illnesses from the 1970s onwards more significant than acute illnesses - by definition
exclude recovery. In this situation the sick role s spatial and temporal containment of illness
becomes untenable (e.g. Freidson, 1970: 234f.; Segall, 1976: 165). Parsons defended his concept
11. 10
against such charges by stating that despite the failure to recover completely the sick role still
makes sense as:
recovery is the obverse of the process of deterioration of health, that is, level of capacities,
and in many of these chronic situations tendencies to such deterioration can be held in
check by the proper medically prescribed measures based on sound diagnostic knowledge.
(Parsons, 1978: 19)
He ignores, however, the implications of the achieved normality under the Damocles sword of
impending crises and the effects of a regimen structuring everyday life with disciplines holding in
check, but thereby also holding present, those recurring crises. For the chronically ill their
illnesses are either always with them or, if quiescent, potentially lurking just round the corner
(Strauss and Glaser, 1975: 9).
For chronic patients the doctor-patient relation therefore never really ends; they remain
dependent on, and therefore under the authority of, the medical system. Even in the case Parsons
quotes as relatively easy to control (mild diabetes) the regimen has an infantilizing aspect: being
told what and what not to eat (Cohn, 1997).
The indefinite extension of medical control and diminished autonomy follows the logic of the
sick role concept under changed circumstances. Full capacity cannot be recovered however well
the motivational component is controlled. The dys-appearing body (Leder, 1990: 69ff.) refuses
to disappear and gets in the way of daily routines, permanently disabling reciprocities that require
a social competence [...] informed and coded by non-impaired carnality (Paterson and
Hughes, 1999: 607). If health is understood as elasticity as a resource that enables adaptation to
and absorption of new challenges (Canguilhem, 1988), an exhaustion of this reserve is the more
disruptive the more fluid and flexible the world of work becomes.
There therefore is a strong incentive for normalization , a return to normal role performances in
spite of persisting illness. In a society oriented toward universalistic achievement values the
permanent removal of members from relations of reciprocal efficiencies/loyalties is not an
12. 11
option neither would it be a tolerable prospect for the sufferers themselves. The sick role does
provide specific approval confirming that the ill person is attestably doing the right thing ; but
being only one particular role, and one that includes the obligation not to perform in any other
roles, it thwarts the acquisition of multiple approvals in diverse contexts which could add up to
esteem. Continued inability to accrue esteem, in turn, will contribute to the erosion of socially
embedded personhood, a loss of self (Charmaz, 1983). Regaining the desired status as valid
adult (Charmaz, 2000: 282) requires, in capitalist societies, the acquisition of esteem through
direct or indirect participation in the generalized reciprocity of economic exchange. Both the
moral order of the social system and individual need-dispositions geared to autonomy and
recognition lead to a
commitment to the attempt to recover a state of health or in the case of chronic illnesses
or threats of illness to accept regimens of management that will minimize the current
impairment of teleonomic capacity and future risks that the actual or presumptive illness
may entail. (Parsons, 1978: 76)
Without the prospect of regaining full capacity, the job of recovery becomes a life-time
employment. The discipline of the sick role is partly replaced by self-disciplines of the chronic
patient, a regimen consisting of treatments, diets and/or exercise which often is so demanding
that it requires the reorganization of the entirety of everyday life towards it (Strauss and Glaser,
1975: 21ff.).
On re-entering social reciprocities the chronically ill are confronted with the competing
expectations of an ongoing sick role and of normal everyday roles. On the one hand continued
compliance to sick role expectations is essential in order to avoid sanctions both from a
disapproving environment and, above all, one s own body. Regained capacity often remains
fragile and complete control is rarely won back. The very ability to engage in social relations is
13. 12
put in question by a body that may no longer behave according to social expectations (e.g.
Radley, 1994: 151).
By normalizing, the chronically ill become dual citizens in the world of illness and the world of
health (Radley, 1994: 136). If illness is to be re-admitted, the danger of moral contagion must be
minimized: The healthy public needs constant reassurance that it is not nice to be ill, that ill
people carry a burden. Their narratives represent the abhorred (Radley, 1999), the unhealthy non-
self (Crawford, 1994). Re-entering the world of health while still being ill therefore means that
even where the ability to specific performances is regained, these are indexed as performed by a
sick person. As Charmaz (2000: 284) points out a woman who uses a wheelchair because of
multiple sclerosis becomes a disabled mother, handicapped driver, disabled worker, and
wheelchair dancer. This limits what can be achieved in normalization as already the effort to
regain and maintain normal capacity makes one stand out. The membership in self-help groups,
for example, may on the one hand facilitate normalization but it can also entail engulfment in a
community of illness (e.g. Crossley, 1998: 525).
Normalization further means that the ill person needs to be seen as not giving in to illness. Even
where treatment evidently does not make any difference whatsoever, the normative expectation
to comply remains (Freidson, 1970: 235; Jobling, 1988). If, as in the case of chronic back pain, it
is difficult to get a regimen prescribed, this creates anxieties that this lack of treatment could be
seen as a sign that they were not really trying to get back to work (Glenton, 2003: 2247). Just as
in the sick role of old, here too the motivation of wanting to get well in the sense of wanting to re-
enter normal reciprocities is central. The unhealthy body must be shown to be driven by a
healthy mind.
Welfare-to-work agendas such as the British New Deal programme (e.g. Roulstone, 2000)
confirm such a continued hierarchical mind/body dualism by linking benefits to motivation.
Motivation is also central in the Expert Patient Programmes (EPPs) with their emphasis on the
14. 13
enhancement of self-efficacy , a psycho-therapeutic strategy to induce behavioural changes
despite remaining limits set by an impaired body (Taylor and Bury, 2007: 32).
While compliance to sick role expectations is still required, it no longer offsets diminished
contributions in normal roles. This is manifestly expressed in the loss of income that many
chronically ill experience. Diminished capacity translates into less valued jobs and thus less
approved specific role performances. The sick role is an institutional arrangement to bridge
discontinuities if there is no end in side, it turns into a slide down to whatever level of
contributions can be expected in the future (Behrens and Dreyer-Tümmel, 1996: 195). The
parallel between health as capacity and abstract labour power helps to understand this. Wage
differentials for what is socially defined as different capabilities do not just show the extent of the
realization of those capacities capacity itself is the object of an indirect moral evaluation. The
everyday meritocratic interpretation of economic rewards does not make a difference between
effort, skills and talent as factors in achievement. Different capacities are reflected in different
levels of reward, so that permanently diminished capacity is morally and materially sanctioned by
diminished rewards.
Approval is then to be earned under the same or similar conditions as apply to the healthy
population and, subsequently, the chronically ill feel themselves to be subject to the same
normative judgments as the healthy (Radley, 1994: 157). The co-occurrence of sick role and
normal roles in chronic illness means that
balances must continually be struck between doing too little and doing too much. If
sufferers ignore symptoms and press on as normal, they risk being perceived as reckless .
If they take great care of themselves, they run the risk of being seen as invalids or as
malingerers . (Radley, 1994: 157)
Over-compliance on either side results in deviance on the other. To achieve normalization in the
face of the permanent loss of normality, conformity to medical regimens must be oriented
15. 14
towards enabling normal role performances. The classical sick role requires patients to dedicate
all their efforts and time to prepare for normality after the sick role full sick role compliance
hence disables normalization during illness. For the chronically ill person, therefore, full sick role
compliance turns into what Merton (1968: 238) described as ritualism in the response to anomie:
a response in which one continues to abide almost compulsively by institutional norms but in
doing so abandons the culturally defined aspirations behind those institutional norms. Illness as
occupation (Herzlich, 1973: 130), is as detrimental to normalization as illness as a liberator .
The normative background of the Parsonian sick role thus contributes substantially to an
explanation of the double expectations of conformity in normalization: the routine observance of
a regimen, self-monitoring, crisis management as prolonged compliance on the one hand and the
expectation to perform as far as possible in normal roles on the other. Regaining legitimacy by
minimizing unreciprocated dependency (Charmaz, 1983: 188; S. J. Williams, 1993: 93) is a central
motive in the reorganizing efforts towards a new normality.
Successful normalization leads to an erosion of the medical authority under whose extended
influence it is performed. This erosion is commonly seen as an effect of the illness knowledge the
chronic patient acquires by playing a greater part in managing their illness, being a participant in,
rather than a mere object of, medical decision making (Bury, 1997: 100; Frank, 1995: 12ff.) not
to mention the obvious fact that the prolonged experience of illness in itself creates practical
knowledge of it. For Parsons, medical authority is first and foremost based on, and justified by,
the doctor s exclusive access to expert knowledge. Consequently, Young (2004: 6f.) observes, as
the patient s knowledge of medicine increases, the power differential between patient and doctor
decreases, as does the dominance of physicians in the sick role relationship. While the internet is
often presented as the major challenge to the knowledge-based authority of medicine (e.g.
Shilling, 2002: 630) acute patients appear to be reluctant to educate themselves into competent
rational consumers of medical services (e.g. Lupton, 1997b, Henwood et al., 2003). It takes
16. 15
considerable time and skills to access, assess, and apply online medical information (Hardey,
1999), which is why online forums and patient online communities (Josefsson, 2005) only
unfold their potential as sites of exchange and production of knowledge in the long term, by
chronic involvement.
Once actualized this potential minimizes a central characteristic of the sick role: the anomic
helplessness of the ill and the insurmountable knowledge gap between physician and patient.
Apparently, therefore, the applicability of the sick role concept ends here. Yet the patient s
helplessness is not in itself an essential element of the normative setup of the sick role. Rather,
what is required is the recognition of this helplessness, which is to be proven by seeking
professional help. Therefore, as soon as it becomes possible at least partly to overcome this
helplessness, the sick role occupant must reject total dependence on the doctor, actively search
for information and engage in self help. The shift in the power balance between doctors and
patients follows from a sick role requirement conformed to over a longer period of time and thus
is not at all at odds with its normative background. To regain autonomy is one of its aims, and
informed, knowledgeable patients are sharing it.
The emancipation from medical power, however, will always be incomplete. While the
knowledge-based authority of the doctor over the chronic patient erodes, that of science-based
medicine itself remains largely untouched. Much of patient organizations energy is spent on
campaigns to increase funding for bio-medical research and to make newly developed drugs
available. As Crossley (1998: 524) puts it, they remain tied in the most fundamental fashion to
the progress of medical knowledge .
From a governmentality point of view one could say that this is a case of progression from direct
power, from surveillance and punishment, to governing indirectly at a distance (Rose and Miller,
1992: 180) a shift from control to self-control, from discipline to the self-discipline of subjects
into whose subjectivity the knowledge/power of the medical gaze has been inscribed (Lupton,
17. 16
1997a: 99). The subject in this indirect regime makes free choices and is governed through the
entailing accountability and responsibility for these autonomous decisions within the parameters
of the facts about risks provided by governments, policymakers and institutions (Nettleton,
1997: 266). In capturing this shift towards knowledge-instilled autonomous conformities
governmentality studies develop on Parsons (1958: 345) notion of compulsive independence .
The governmentality approach does not, however, tell us how such an infusion with
independence through knowledge can produce socially conforming performances. Here Parsons
approach from the reciprocities of the sick role and its links to the recognition to be had from
normal role performances is still relevant even after the sick role s alleged obsolescence.
Governmentality studies do acknowledge that governing agencies tap into this need for
recognition and inclusion in order to mobilize them for their own programmatic aims. But while
taking parameters like self-esteem and recognition into account (Cruikshank, 1996), to account
for them remains beyond the theoretical remit of a Foucauldian perspective that denies the role of
legitimacy in the construction of social reality (Fraser, 1993). Yet, legitimacy and recognition play
a crucial part in another important transformation through chronic illness.
There are two reciprocity arrangements providing legitimacy in the doctor-patient relationship.
The first is the expectation that the doctor directs all efforts towards the patient s recovery, which
is to be reciprocated by the patient s equally uncompromising success orientation translated into
and expressed by compliance and trust. The second is a reciprocity of reciprocity moratoria: The
patient is exempt from sanctions that would normally apply to those not conforming to everyday
social roles. In return the patient desists from reciprocating violations of their psychological and
physiological integrity that come with diagnosis and treatment (Gerhardt, 1987: 117). Both these
reciprocities do no longer fully work in chronic illness: The doctor cannot promise full recovery
and the total exemption from social roles is no longer sustainable.
In the absence of the prospect of full recovery it is now often for the patients themselves to
decide what, in the end, is a desirable state to achieve because such states will always be trade-offs
18. 17
between only relative gains in well-being and further suffering incurred by the treatment itself
(e.g. Low, 2004). Without a perspective beyond illness the negotiation of, for example, side
effects becomes much more significant in the fine judgment about the costs and benefits (social
as much as economic) of treatment (Bury, 1997: 126). In the face of the ineffectiveness of
medicine in treating chronic illness the patient can indeed become more of a sovereign consumer
who is making judicious use of doctors and their drugs (Williams, 1993: 102). As medicine
cannot keep its side of the bargain, patients are no longer bound to theirs and can begin to shop
around .
The reciprocity of reciprocity moratoria, too, is thrown off balance. If a chronically ill person
goes back to performing in normal roles, he/she thereby terminates the exemption and exposes
her/himself to the same sanctions and rewards as a healthy person. As a consequence the
doctor s unquestioned exemption from scrutiny regarding physical and psychological injuries
inflicted in the course of treatment is also terminated. Back in a role that is recognized as
contributing in social exchange the normalized chronic patient is in a more empowered
position vis-à-vis medical personnel whose right to order and prescribe can no longer be taken
for granted. The power balance within the doctor-patient relationship is shifted as the patient
regains the status of autonomous adulthood that had been suspended in the Parsonian sick role,
which is thus obsolete. But its spirit survives as driving force behind this very obsolescence.
This survival seems to indicate, as Charmaz (1983: 169) maintains, that the traditional American
emphasis on independence, privacy and family autonomy is still evident in the management of
chronic illness. My argument so far would suggest that the moral economies of capitalist
societies play a major part in the continuation of such normative expectations.1
Chronic Health
There are striking parallels between what is promoted as healthy lifestyles and what is prescribed
to chronic patients. Like them, the chronically healthy follow a regimen consisting in dietary
19. 18
requirements (low fat, high fibre, five-a-day etc.), quasi-medication (vitamin supplements, herbal
infusions etc.), exercise of an ascetic or gymnastic (Bourdieu, 1978: 838f.) nature (yoga, jogging,
etc.), and self-observation based on health knowledge (BMI, blood pressure, emotional balance
etc.). Again, neo-Foucauldian approaches to health promotion, like those of Lupton (1995) and
Nettleton (1997), capture the governmental inscription of such self-surveillance and self-
disciplines into subjects. And again what they do not do, but what a Parsonian perspective does,
is to acknowledge the embeddedness of those subjects in the moral economy surrounding health
and illness.2
Parsons, of course, did not address lifestyle-centred health promotion which was only emerging
in the 1970s, and at first sight he therefore seems to have relatively little in store to approach it.
But, as Shilling (2002: 627) points out, the productivity ethos so central for Parsons is still behind
much of contemporary health seeking only that it is now joined by a consumerist ethos
emphasizing the additional capacities of maintaining self-images and achieving pleasure (also cf.
Crawford, 2000: 221). As Lupton (1994: 31) puts it, self control and self-discipline over the body
within and without the workplace have become the new work ethic .
Parsons persistent relevance is particularly evident in the current promotion and pursuit of
health as related to the significance of chronic illness. The most obvious link is the causal
connection that is made between lifestyles and chronic diseases, since
the prevalence of chronic diseases has meant that there has been an increased effort to
find the risk-factors that lead to onset and, where possible, to persuade people to modify
their lives to minimize the risk. (Radley, 1994: 137)
Once such a causal link is established, the sick role expectation of working towards recovery is
extended to include working towards preserving health before illness occurs. As Greco (1993:
370) puts it, the moral responsibility [that] has become associated with prevention [ ]
represents an extension of the duties Parsons described as those incumbent upon the sick-role.
20. 19
Parsons (1978: 76) already saw the social control of motivational deviance reaching into the
behaviour of the still healthy, e.g. requiring them to avoid exposure to the risk of infection. Such
quasi sick role expectations towards the healthy have now been extended much further.
Mobilizing citizens to combat potential disease is a governmental reaction against the rising costs
of health care provision. But the obligation to avoid risks does not directly follow from their
attestation. Health promotion to a large part consists in appeals appeals to individual rational
self-interest but increasingly also to individual responsibility towards others. The recent NHS
anti-smoking campaigns are indicative of this: Not the fear of suffering in disease and dying is
central but the guilt anxiety of letting down dependent family members. Appeals cannot create
what they appeal to, in this case the moral economy behind the sick role: preserving health as
general capacity is part of the social imperative of self-reproduction in the Durkheimian (1933:
399) sense that the duties of the individual towards himself are, in reality, duties towards society.
Where lifestyle choices are identified as pathogenic or salutogenic , making the right choices
and being persistent in them becomes maintenance of status-securing capacity. Advertising for
health preserving or enhancing products hence often plays to anxieties about losing the ability to
meet role expectations (Varul, 2004: 164ff.). As Crawford (1980: 382) notes:
Not only do we experience the insecurity of imagined, future illness, the
anxiety of worrisome prognosis, but also the insecurity of the deviant, the
anxiety of not fitting in.
While this applies to domestic as well as to public roles, the paradigmatic case (given the central
role of money for approval in contemporary capitalism) remains the reproduction of labour
power. So it is not surprising that some employers are tempted to arrogate the right to regulate,
under the banner of a new corporate health ethic , into their employees private lives (Conrad
and Walsh, 1992).
Beyond the mere obligation to maintain or even enhance capacity, health practices testify to the
motivation to stay healthy. This, too, can be related to the increased significance of chronic illness
21. 20
and its normalization. As Crawford (1987: 104) points out, the meaning of health shifts from the
results of a healthy lifestyle to the lifestyle itself because the more the achievement of health is
defined as a moral project, the more people are likely to confuse means with ends . This also
works as a statement of immunity against motivational infection by the presence of chronic
illness a means of maintaining one s identity as fully contributing and hence recognized
member of society (Varul, 2004: 258ff.). The toleration of chronic illness and disability within the
world of health is balanced out by a rejection of behaviours and attitudes that are suspected of
being part of their aetiology which in turn keeps reminding those who do not have full health
of their otherness (e.g. Marks, 1999: 28)
Against this background, the similarity of regimens in illness management and health
maintenance does not seem to be a mere coincidence. While the chronically ill have to display
their refusal to give in to illness, engaging through such disciplines in constant rehabilitation not
only in a physiological but also a moral sense, the chronically healthy engage in a similar display
of motivation moral prehabilitation as it were.
Further, a Parsonian perspective also can help to shed light on the limitations of the current
lifestyle-centred health promotion. Like the chronically ill, the chronically healthy do not obtain
any of the secondary gains of the sick role (Horn et al., 1984: 18), leading into an unbalanced
reciprocity with no tangible reward for conformity except perhaps a reduction in guilt anxiety.
This also exposes the weakness of employers claims to a right to govern the health maintenance
of their employees on the basis that this capacity is the foundation of the efficiency/loyalty that
workers owe them in exchange for the material/symbolic approval which is the wage. As
employees normally do deliver on the labour contract their capacity is proven by its actualization.
Autonomy in social reciprocity is thus safeguarded, which prohibits control beyond this
reciprocity so that there is no legitimacy for any attempt to govern reproduction. This also puts
limits to the extent that government agencies can motivate and expect compliance.
22. 21
Finally, just as illness as an occupation constitutes deviant behaviour, so does health as an
occupation. It focuses entirely on the maintenance of the capacity that is the basis of the
acquisition of esteem but capacity must be realized in concrete performances in order to earn
approvals, which in aggregate build up esteem. Extreme healthism (Crawford, 1980) celebrates
capacity and refuses its actualization. Parsons enigmatic money/health parallel aims at this
dilemma. Georg Simmel (1990: 218) understands money as a universal capacity, as encircled by
innumerable possibilities of use, as though by an astral body . Like money good health is an
endowment of the individual that can be used to mobilize and acquire essential resources for
satisfactory functioning as organism and personality (Parsons, 1978: 80). Without a physically,
emotionally and mentally working (i.e. healthy ) real body the astral body of financial
resources is not only less freely deployable this astral body tends to collapse with an
incapacitation of the real body that sustains it. Like money or capital, health in this meaning,
would function only if it is used and not hoarded (Parsons, 1978: 80f.). The hoarder of
health, like Simmel s miser (1990: 242), relishes in the endless possibilities, the infinite potential
that is implied in capacity, but is fearful of destroying this potentiality by its realization and thus
renders it worthless. Capacity (and therefore health) in itself does not yield any recognition
(approval/esteem), it has to be actualized in specific and particular role performances
(efficiency/loyalty). Not only does the astral body depend on the real body s working that
working is only recognized through the accumulated approval money - that is the substance of
the astral body.
Conclusion
It is an intriguing question why Parsons special sociologies and prominently his medical
sociology have proved to be so much more resilient than the general theory which they were
supposed to illustrate. I would suggest that this is mainly because this illustration is firmly based
on a much neglected current in Parsons thought: the attention given to reciprocity, recognition
and its allocative consequences. His theorization of the sick role is rooted in needs for
23. 22
recognition as they emerge from the exchanges (economic and non-economic alike) of ordinary
life in capitalist societies, which links back to an everyday moral economy that is largely ignored
in contemporary approaches. It is therefore better equipped to relate to empirical accounts of
practices of living with chronic illness and of health consumerism than approaches that argue
from the systemic needs of consumer capitalism, or approaches that focus on programmes rather
than actual practices. Parsons acknowledges the emergence of role expectations in ordinary
reciprocities and the need for recognition in a much more material sense than more recent re-
visitors (Honneth, 1995; Fraser, 2000). Rediscovering an earlier Parsons of reciprocity and
recognition may add substantially to the debate on symbolism and materiality in relations of
recognition and thus may prove to be of an ongoing relevance, a relevance that the structural-
functionalist Parsons of the sociology textbooks seems to have lost.
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1 To the extent that those moral economies are relevant, they should generally apply beyond a US context. There are
strong indications that the proposed perspective is one that is broadly applicable throughout advanced capitalist
economies. Where welfare to work means that incapacity benefits are linked to proven efforts to regain
employability, one can speak of a sick role writ large. Such moves have been made in countries with very distinct
welfare cultures and health care systems (e.g. Dahl/Drøpping, 2001 for the Norwegian case and Barbier/Théret,
2001 for the French case). It is less applicable where the societal regimes of responsibility for the disabled and
chronically ill remain with family networks and hence outside capitalist moral economies. Italy would be such a case
and the issue of health is conspicuously absent in the Italian version of welfare to work (cf. Boeri et al., 2000,
Fargion, 2001).
2 Again, there are indications that these patterns seem to be surprisingly similar across countries with otherwise
distinctive healthcare systems (cf. e.g. Freeman, 2000: 74).
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