FAMILY, SOCIETY & SICK ROLE

DR KYI KYI SEIN ASSOCIATE PROFESSOR DEPARTMENT OF COMMUNITY MEDICINE

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SLOs
qExplain the terms family and society. qList types of family. qExplain the functions of a family. qDiscuss the roles of family in relation with health. qDescribe changing family structure in contemporary society. qDifferentiate disease, illness and sickness. qDiscuss Parsons sick role qDescribe the limitations of Parsons sick role model
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What is a society?
Society refers to people who interact in a defined territory and share a culture. n Every society (and, indeed, every social group) can be viewed in this manner. Society, like any system then, is composed of various components. (A social system) n A system an assemblage of parts combined in a complex whole. Each part perform their respective functions. Each part is interconnected either directly or indirectly (interdependent). And create a dynamic, self-sustaining system to maintain a state of equilibrium n these major components of a social system as institutions that constitute patterns of behavior.
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A Diagram of Social System

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Societies have changed over time

Hunting and Gathering Societies Horticultural and pastoral Societies Agrarian Societies Industrial Societies Postindustrial Societies

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FAMILY

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WHAT IS A FAMILY?
be related by blood or marriage? live in the same house? have children? include only male-female couples? include friends? include only individuals you like?

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Defining The Family

Difficult to define. Means different things to different people. Families comes in all shapes and sizes. Families vary across culture and over time. Families are defined by how they are created. Family of Birth (Family of Orientation) Family by marriage (Family of Procreation )

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The family is a social institution found in all societies - the structural & functional unit of the community. - is a social group of two or more people, related by blood, marriage, or adoption, who usually live together. - is a group of people affiliated by consanguinity, affinity, or co-residence.

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How do family form?

Marriage - a legal relationship, usually involving economic cooperation, sexual activity, and childbearing. legal union based on mutual rights and obligations.

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Marriage Patterns
Endogamy: marriage between people of the same social category. Exogamy: marriage between people of different social categories. Monogamy (one union) Polygamy (many unions, more than one marital partners) - polygyny (many women) & polyandry (many men) Serial polygamy

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Family Structures
Nuclear: Family organization usually consisting of a husband, wife, and children who are their offspring. Extended: Family organization combining several generations and a variety of different kinship relations under one roof.

Lone Parent Family: One parent and his or her dependent

children

Childless Families: Commuter Families:

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Nuclear: Family organization usually consisting of a husband, wife, and children who are their offspring.
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Extended: Family organization combining several generations and a variety of different kinship relations under one roof.
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Lone Parent Family: One parent and his or her dependent children
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Blended family (Reconstituted Family)

- The blended family is a family unit in which one or both of

the spouses have been previously married and bring a child or children to the relationship. - A new family that has been created following a divorce and re-marriage, containing step-parents and step-children.

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New Forms of the Family

- Cohabiting couples (with or without children) - Single parent family (because of teen pregnancy, divorce or abandonment) - Blended family - Homosexual couples e.g. Netherlands has legalised homosexual marriages - Singlehood - Commuter families

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Some changes in family composition are also due to a dramatic alteration in societys views of how families should be. e.g. birth outside marriage has become increasingly acceptable

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The Family is Changing

- Changing roles (role = expected behaviour that goes with a social position) - People marry later, have fewer kids, and also have them later - More divorces - Single parent families (these are more likely to be poor) - More working mothers and latchkey kids (empty home, poor or no parental supervision) - Children may be unsupervised and feel neglected and unloved - Working mothers are stressed (Supermom Syndrome and Double Burden of Women)
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American Families in 2000

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The Life Course

Most peoples life has 4 stages: Childhood where we are dependent on others and socialisation takes place Full time employment and adult responsibilities, marriage and family Children are grown up so have less responsibilities but may have to look after parents. Active and independent past own retirement. Old Age dependent on others

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Stages of Family Life

The family is a dynamic institution, with marked changes across the life course. 1. Courtship 2. Marriage

Bride" is an eighteen- month-old squirming in the arms of her mother. The groom? A boy of seven. What would be the ideal age of marriage?
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What are the Functions of the Family? (Family Role in a Society)

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1. Socialization
- Parents help children become well-integrated, contributing

members of society.

The process by which individuals are incorporated into society, internalizing its codes, narratives, values, beliefs and symbols. This process begins at birth and usually takes place first in the family. socialization is also the process of developing a personality. Socialization is the lifelong social experience by which people develop their human potential and learn culture.

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Genie
A case of childhood isolation involves a California girl abused by her parents (Curtiss, 1977; Rymer, 1994). From the time she was two, Genie was tied to a potty chair in a dark garage. In 1970, when she was rescued at age thirteen, Genie weighed only fifty-nine pounds and had the mental development of a one-year-old. With intensive treatment, she became physically healthy, but her language ability remains that of a young child. Today, Genie lives in a home for developmentally disabled adults.
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2. Regulation of sexual activity

- incest taboo: a norm forbidding sexual relations or marriage between certain relatives (exactly which relatives cannot marry varies from one culture to another) - reasons for controlling incest? limits sexual competition in families confuse kinship ties and threaten social order - Premarital sex

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3. Reproduction
Addition of new members through procreation or adoption

4. Production, consumption, and distribution of goods and services

A family should be working members of society in order to be able to purchase products/goods that are needed by the family

5. Social placement

Parents pass on their own social identityin terms of race, ethnicity, religion, and social class-to their children at birth. offering physical protection, emotional support, and financial assistance, A family should be a positive environment where Maslows safety and love and belonging needs are met
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6. Material and emotional security

7. Nurturance and Love

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Ascribed Status

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Each member of the family should have their basic needs met

BASIC NEEDS

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FAMILY AND HEALTH

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Effects of Family on Health

1) Effects on Illness Behaviour: Stoic? self-medicate? seek alternative medicine? Effects on medical adherence 2) Effects on patients with long term illness: Quality of care provided by family members (female relatives as care providers for kids, husbands, in-laws and elderly parents) 3) Family and social networks promote health: Socially isolated have poorer mental health; recover slower from sickness

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The Dysfunctional Family

4) Dysfunctional families and poor parenting:

Child abuse neglect, physical abuse, verbal abuse, sexual abuse Overindulgence Domestic violence Alcoholism and substance-abuse in the family Gambling problems

Troubled family that has a negative effect on the physical or psychological well-being of its individual family members
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Effects of Family on Health

5) Learning of health-related behaviour e.g. quality of diet and health (including obesity), smoking and passive smoking, alcohol (religion & alcohol consumption), risk-taking behaviour, values and behaviour (including sexual behaviour) 6) Family changes can affect health Stressful life events such as marital breakdown and divorce, death of spouse etc. increase risk of sickness for other family members Large families: can affect health of kids in a negative manner

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Effect of Sickness on the Family

1) Effect of chronic disease or death Role changes: if the wife gets sick or dies, the husband has to adjust (or vice-versa) Economic pressures: family member stops work to care for the sick, patient is unable to work, medical bills become high 2) Stress from taking care of sick family member e.g. Alzheimers disease, serious mental illness, relative who is bedridden or incontinent 3) Stigmatizing diseases such as HIV/AIDS e.g. hostility from neighbours, abandonment by own family
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The majority of informal care, especially long-term care, is provided by family rather than the wider community. e.g. majority of help for elderly or disabled people friends? Neighbours? Women or men?

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the nature of informal care has a vital impact on the wellbeing of the receiver of care. certain factors associated with relapse in schizophrenia cases: - critical comments made by family members, - expression of hostility towards the patient, - expression of warmth towards the patient - level of emotional involvement with the patient.

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ROLE
behavior expected of someone who holds a particular status. E.g. status of student - leads you to perform the role of attending classes and completing assignments

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Disease illness - sickness

Disease without ease (uneasiness) or opposite of ease when something is wrong with bodily function A physiological or psychological dysfunction Illness not only to the presence of a specific disease, but also to the individuals perceptions and behaviour in response to the disease, as well as the impact of that disease on the psychosocial environment: a subjective state of the person who feels aware of not being well Sickness refers to the state of social dysfunction i.e. a role that the individual assumes when ill (Sickness role)
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SICK ROLE
The sick role any activity undertaken for the purpose of getting well by those who consider themselves ill

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Parsons sick role (Talcott Parson 1951)

It focuses on the social role of being sick. It distinguishes: Rights: Duties / Obligations:

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Four major characteristics of the sick role

Rights: The sick person is exempt from normal social roles and obligations The sick person is not responsible for their condition Obligations: The sick person should try to get well (want to recover) The sick person should seek technically competent help and cooperate with the medical professional

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Two major components of the doctor role

qEvaluate peoples claim of sickness, assessing whether they are really sick and, if so, determine the source of illness (technically competent, neutral) qPrescribe medication and cure the sick so that they are able to resume their normal social roles (professional practitioners - right to treat, right to access to tabooed areas)

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The Sick Role is a temporary role we take on when we are ill. We are not held responsible for the fact that we are ill and/or unable to do what we normally do (Illness is beyond your control, Malfunction that needs to be fixed) (no victim blaming)

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Looked at illness as a social phenomenon Illness is a deviation from expected behavior and prevents individuals from fulfilling their normal role responsibilities the sick role sees sickness as social deviance (*) expected social roles become visible, such as appropriate behaviour in doctor/patient encounters see the doctor/patient relationship as analogous to that of the parent and child.(*) If not - labelled as weak, a malingerer or a difficult patient not all illness lead to adoption of sick role.(*)
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Health institution serves an important social function that keeps members of society healthy So that they can perform the social roles necessary for a well-functioning society.

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Good patients seek medical care and follow doctors orders. Good doctors direct and help their patients to follow their guidance.

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CRITICISMS
qthe inequalities of power in sick-role encounters. qthe power that biomedicine has, for example, in effectively controlling entry to the sick role, can profoundly influence and control subsequent medical and social relationships. (asymmetrical dr- patient relationship) qthe sick role cannot adequately deal with social roles which are not easy to define, such as chronic illness or mental ill health. (*) q Behavioural alcoholism, drug addicts, obesity, sexually transmitted infections qHealth care system profit motive
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Think of your most recent experience of illness. What did you do? Does it fit with Parsons sick role model?

Common cold Childhood diabetes AIDS/leprosy

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Points to Ponder
qAre all illnesses temporary? qAre all illnesses completely not the individuals fault? qDoes every sick person seek professional help? Do people accept the sick role voluntarily? qDo people accept passive patient role? qDoes seeking health care mean the person is sick?

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qlevel of visibility qcontext dependent qits obtrusiveness, or the extent to which the attribute disrupts normal social interaction

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qmay not give up social obligations qmay resist dependency (Chronically ill patients are often encouraged to be independent) q may avoid public sick role if their illness is stigmatised.

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qMany illnesses, diseases and handicaps attract social reactions that evoke negative attitudes. qimportant for health professionals to have an understanding of the social processes involved in the acquisition of such negative societal reaction or stigma. qE.g. epilepsy, sexually transmitted diseases or HIV and AIDS. qsocietys reactions to them can affect a persons life and social circumstances

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Stigma
qdescribed stigma in terms of spoiled identity (Erving Goffman 1963) qdefined as a negative social reaction. It also reflects social devaluation and negative labelling of individuals.

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The bearer of the label is frequently viewed as morally inferior. in society this means that the person with the stigma is seen as not quite human (Gofrman 1968: 15) a courtesy stigma that spreads out in waves from the stigmatised individual to friends and family, through their close association with the stigmatised individual.
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Covering, or attempting to reduce the significance of a stigmatising condition information control the social processes involved in the acquisition of a deviant identity is useful for health professionals as they often work closely with stigmatised people, helping them to accept their problem or make a good adjustment to new circumstances or a new body image.

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