Functionalist views on illness and the role of doctors

Functionalists argue that illness disrupts the smooth functioning of society by preventing individuals from fulfilling their usual roles. Doctors play a crucial role in managing this disruption and maintaining social order.

The concept of the sick role

• Illness as deviant behaviour - Illness is seen as a form of deviance because it stops people from contributing to work and family responsibilities.
• Temporary exemption - According to Talcott Parsons (1951), sick individuals adopt a 'sick role', which temporarily excuses them from normal duties.
• Obligations of the sick role - While in this role, individuals are not held responsible for their condition but are expected to seek recovery and follow medical advice.
• Doctors' authority - Doctors have the power to validate illness, granting limited time off work or other duties, and use their expertise to facilitate recovery.

Criticisms of functionalist views

• Self-interest in medicine - Critics argue that doctors do not always prioritise patients' needs, pointing to private medicine as evidence of self-interested behaviour.
• Validation role acknowledged - Despite criticisms, it is widely accepted that doctors do provide sick notes, enabling legitimate time away from responsibilities.

Interactionist perspectives on doctor-patient relationships

Interactionists, also known as interpretivists, focus on the dynamics of social interactions between individuals. They explore how relationships between doctors and patients vary, challenging the uniform 'sick role' concept proposed by functionalists.

Types of doctor-patient interactions

Research by Szasz and Hollender (1956) identified three distinct models of interaction between doctors and patients, each reflecting different levels of patient involvement.

These models were:

1. Activity/passivity - The doctor takes full control, acting on the patient without their input (e.g., complex surgery like a kidney transplant).
2. Guidance/co-operation - The doctor directs the patient, who follows instructions willingly (e.g., acute illness like bronchitis).
3. Mutual participation - The doctor and patient collaborate, with the patient taking an active role in their care (e.g., chronic condition like diabetes).

Marxist critiques of medicine and capitalism

Marxists view the medical profession as a tool that upholds capitalist interests, perpetuating social inequalities by prioritising the needs of the ruling class over others.

How medicine supports capitalism

• Maintaining workforce productivity - Doctors ensure workers remain healthy and able to work, maximising profits for capitalists by reducing absenteeism.
• Monitoring sick leave - They regulate the duration of time workers spend off sick, preventing excessive disruption to capitalist production.
• Masking social causes of illness - Marxists argue that doctors focus on individual symptoms rather than addressing broader social issues like poverty or inequality, which are often the root causes of health problems.

Feminist views on medicine and patriarchal interests

Feminists argue that the medical profession often reinforces patriarchal structures, prioritising male interests and exerting control over women's bodies and roles within healthcare.

Areas of patriarchal influence in medicine

• Contraceptive risks - Many contraceptives, such as the pill or intrauterine devices (IUDs), carry health risks for women, which feminists argue reflect a bias towards male convenience rather than female well-being.
• Medicalisation of childbirth - Ann Oakley (1984) highlighted how childbirth has been turned into a medical condition, stripping control from women and placing it in the hands of predominantly male doctors rather than midwives or the mothers themselves.
• Gender hierarchy in healthcare - Women often occupy lower-status roles like nurses or auxiliaries, while men dominate higher positions such as consultants, reinforcing the image of nurses as subordinate to male doctors.
• Medicalisation of beauty - Cosmetic surgery is critiqued as a form of social control over women, pushing societal beauty standards through medical intervention.
• Control through mental health diagnoses - Feminists point out that diagnoses like depression in women are sometimes used to control and pathologise normal emotional responses.

Weberian and postmodernist perspectives on the medical profession

Weberian and postmodernist approaches offer contrasting views on the power and role of the medical profession, focusing on self-interest and societal shifts respectively.

Weberian views on medical power

• Self-serving profession - Weberians argue that doctors maintain their high status and power by creating a monopoly over healthcare, excluding alternative practices like homeopathy or aromatherapy.
• Control over healing - By marginalising other forms of treatment, the medical profession ensures its dominance and influence in society.

Postmodernist views on changing medical authority

• Shift in knowledge power - Traditionally, doctors held exclusive medical knowledge, but postmodernists note that the internet allows individuals to research and self-diagnose, reducing doctors' authority. However, this can lead to misinformation and inappropriate treatment demands.
• Consumerism in healthcare - Health services are now part of a consumer culture, with patients choosing treatments or hospitals based on performance data, and exploring alternative therapies like acupuncture, though not always funded publicly.
• Medicalisation of everyday life - Postmodernists observe that normal life stages, such as ageing or menopause, are increasingly treated as medical issues, shifting power to pharmaceutical companies promoting solutions and to patients as active consumers.