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  Functionalists such as Parsons argue that being sick has potentially disruptive effects on society. Sickness is a form of deviance that needs to be controlled. Otherwise, the behaviour associated with it, such as dependency, apathy and incapacity, could become widespread and threaten the smooth functioning of society. It is therefore important to restrict access to the sick role to those who are genuinely sick. This is the function of the doctor, whose authority is maintained by his or her objective scientific knowledge and high status.

The sick role involves both rights and obligations: the right to be exempted from normal role obligations (such as work) and to be looked after, and the obligation to want to get better, to seek help and to obey doctor’s orders.

Access to the sick role has to be legitimised by the medical profession. Failure to comply with its obligations may result in society withdrawing from the individual the right to be considered sick and/or imposing sanctions. The function of the medical profession is one of social control: it polices the sick role, ensuring that only the genuinely sick gain access to it.

Parsons recognises that medicine and sickness have social as well as biological dimensions. However, he assumes that medicine is a ‘good thing’ and that the medical profession works for the interest of society. His explanation also fits short-term, curable illnesses better than long-term, chronic illnesses.

Health, illness and disability can all be seen as socially defined or constructed. That is, they are created by the labels, definitions or meetings that we attach to ourselves and others, and by the way we act upon these meanings. One example of social construction is mental illness, which is covered in the next section. Here we shall look at physical illness and disability.

Interactionists are interested in how individuals come to acquire illness labels, and the effects these labels have on them and those around them. They are interested in how doctor-patient interactions create such labels.

But how do people decide they are ‘ill enough’ to go to the doctor in the first place? Zola argues that friends and relatives are often important in interpreting something as a ‘symptom’ worthy of the doctor’s attention. He also argues that patients’ reasons for seeking medical help are affected by cultural background. His study in the USA found that Italians often sought help because symptoms interfered with personal relationships. Anglo-Saxons were more likely to seek help if symptoms affected their work, while the Irish were likely to present symptoms because of pressure from others to seek help.

Interactionists are interested in how doctors and patients negotiate a diagnosis (ie a sickness label). Byrne and Long found that there is a conflict between doctors’ and patients’ views of the ideal consultation (not surprisingly, doctors prefer short, doctor-centred consultations).

Doctors generally have more power in these interactions, but patients are not always passive and may try to create their own diagnosis and get the doctor to agree to it.

While the medical model equates disability with illness, sociologists generally see disability as socially constructed. We can distinguish between impairment, which involves loss of physical, sensory or intellectual functioning, for example, being partially sighted or lacking a limb, and disability, which refers to the restrictions society places on people who have impairments.

Using this distinction, Shakespeare argues that disability is a social and not a medical problem, stemming from society’s failure to address the needs of people with impairments. In this view, disability is the result of discrimination. Social and environmental barriers exclude people with impairments from participation in mainstream society. Society has disabling effects when its buildings, education, employment and transport systems fail to meet the needs of people with impairments.

Impairment may have social causes. For example, accidents at work, poor quality housing, etc can cause injury and disease. In general manual workers and their families are at greater risk of impairment.

There are two main sociological approaches to the study of mental illness: the positivist approach and the interactionist approach.

    The positivist (functionalist) approach tends to accept medical definitions and assumes that mental illness is an objective ‘thing’ or disease. This approach examines the distribution of mental illness among different groups in society and seeks to discover its causes.

For example, Hollingshead and Redlich show that members of class V were over six times more likely than members of class 1 suffer from mental illness. Faris and Dunham found rates of mental illness were highest in areas of Chicago that had high levels of social disorganisation. This approach traces mental illness to the way society is organised and the position of the individual in the social structure.

Feminists argue that the higher rates of mental illness among women are caused by their position in the social structure, for example, as a result of the stress factors associated with their domestic roles. Similarly, racial discrimination and disadvantage faced by ethnic minorities create stress and may result in higher rates of mental illness.

     The interactionist approach sees mental illness not as a disease or medical condition, but as a social construct: a label or social status conferred on some individuals by others (eg psychiatrists) who have the power to do so. Interactionists focus on the labelling process when someone is defined as mentally ill. For example, in Rosenham’s pseudo-patient experiment, the researchers gained admission to mental hospitals by claiming (falsely) to hear voices. Once admitted, they found that staff interpreted all their behaviour as symptoms of mental illness.

Such labelling can create a self-fulfilling prophecy: once defined and treated as ‘mentally ill’, a person may begin to see themselves, and act, as mentally ill. Goffman describes how an individual’s identity changes once admitted to a total institution such as a mental hospital. On admission, the individual’s old identity is destroyed, and they are given the new identity of ‘inmate’. Similarly, Lemert describes how labelling a person as paranoid creates a vicious circle where other people begin to avoid them; this isolates the person, increasing their paranoia.

       Szasz argues that mental illness is not really illness at all, but a label attached to individuals whose behaviour does not conform. In his view, psychiatry is a form of social control. Scheff sees differences in status and power as central to this labelling process: those who have least power are most likely to be labelled as mentally ill.

      Women are more likely than men to be admitted to a mental hospital for almost all the major mental illnesses. This is partly because women are more likely to admit distress and define their problems in mental health terms. However, feminists argue that doctors tend to see female patients as hysterical and interpret women’s physical symptoms as having psychological causes.

Pilgram and Rogers describe how social judgements about deviance are influenced by gender stereotypes. Women are stereotyped as vulnerable and passive, so that when they are deviant (eg behaving aggressively), this is more likely to be seen as irrational and needing psychiatric treatment. Men’s deviance is more likely to be seen as intentional and dangerous, and so they are more likely to be seen as intentional and dangerous, and so they are more likely to be regarded as criminal than mentally ill.

Pilgram and Rogers see stereotyping as the reason for the higher rate of mental illness among Afro-Caribbeans, especially young men. They are much more likely than their white counterparts to be labelled as dangerous by the police and courts and referred much more frequently for psychiatric assessments.