Lay concepts of the sick-role: An examination of the professionalist bias in parsons' model

The sick-role model of Parsons, with its professionalist bias, and with its underlying notion of illness as deviance, has been vulnerable to sustained criticism for its failure to take into account the lay's participation in the illness process. Accordingly, the model does not really apply to situations of the chronically ill and the permanently handicapped, in which the resumption of the patient's independence depends more on the resources at his/her disposal than on medical intervention. This study of 430 women affiliated with Israel's largest comprehensive health care deals with variations between the sick-roles in acute and chronic conditions, focusing on those behavioral expectations of Parsons' model which have implications for the extent of dependency granted to the ill. As expected, the extent of dependency which the respondents would allow, was indeed found to rest largely upon the prospects implied by medical diagnosis. But Parsons' supposition that the professionals would have a dominant role in caring for the ill and in defining their sick-role expectations has not been confirmed. A sequence of cluster analyses revealed two distinct sets of expectations corresponding to the sick-roles for acutely and for chronically ill. Although the chronically ill were allowed less dependency than the acutely ill, a more crucial role in their treatment was assigned to the lay significant others than to professionals. Moreover, the contribution of the lay was found to be the most prominent dimension in the cognitive process by which the lay respondents formed the behavioral expectations of the ill. Accordingly, it was the concern about the care and support of lay others rather than about medical care which was found to provide the best criterion for differentiating between the revealed clusters.