Talcott Parsons - Wikipedia
Parsons' sick role concept has become problematic in the face of the increased significance of fundamentally changing the doctor-patient relationship. sociology, as in his general theory, he was interested not so much in .. choose treatment – they are not consumers deciding according to their individual preferences. Talcott Parsons (December 13, – May 8, ) was an American sociologist of the . The relationship between Parsons and Sorokin quickly ran sour. .. According to Parsons' own account, it was during his conversations with Elton Mayo Talcott Parsons, "The Sick Role and the Role of the Physician Reconsidered. PDF | This paper argues for a normative conception of medical professionalism based on the work of sociologist Talcott Parsons. Such a professionals, their motivations according to the .. character of the physician-patient relationship.
Physicians' battle-cry of the sacred nature of the doctor-patient relationship sounded hollow in their struggles against universal health insurance. Physicians' high incomes and defense of autonomy appeared to result in both bad medicine and bad health policy, and physician's unaccountable power appeared all the more nefarious because of medicine's intimate invasion of the body, In this context, Eliot Freidson's work,crystallized the notion that professional power was more self-interested than "collectivity-oriented.
Freidson's approach to the sick role was influenced by labeling theory Szasz, ; Scheff,and went beyond Parsons to assert that doctors create the legitimate categories of illness. Professionalization grants physicians a monopoly on the definition of health and illness, and they use this power over diagnosis to extend their control. This control extends beyond the claim to technical proficiency in medicine, to claims of authority over the organization and financing of health care, areas which have little to do with their training.
There are now many studies of the way that professional power has been institutionalized in the structure and language of the doctor-patient relationship. For instance, a recent study of medical students' presentation of cases demonstrated that physicians were being trained to talk about their patients in a way that portrayed the physician as merely the vehicle of an impersonal medicine acting on malfunctioning organs, rather than a potentially fallible human being interacting with another human being.
The more highly regarded presenters were found to 1 separate biological processes from the patient, 2 use the passive voice in describing interventions, 3 treat medical technology as the agent, and 4 mark patients' accounts as subjective the patient "states," "reports," "denies,". These devices make the physician more powerful by emphasizing technology and eliminating the agency of both physician and patient Anspach, Since its publication, Starr's The Social Transformation of American Medicine has quickly become the canonical history of the institutionalization of professional power, its effect on the organization of health care, and the profession's metastasized influence in the political sphere.
Though Starr draws on many theoretical sources, he paints a picture of the American doctor-patient relationship as a successful "collective mobility project" Parry and Parry,whose contours were not at all determined by the functional prerequisites of society.
While Starr does not goes so far as to say that we do not need "doctors" at all, he argues that there are a range of possible structures that medicine could have taken in industrial society, and that American physicians are an extreme within that range.
Marxist and Feminist Approaches Drawing on, and extending the professional power analysts, the growing school of Marxist sociologists interpreted the doctor-patient relationship within the context of capitalism. In the Marxist analysis, the American doctor-patient relationship is conditioned by the "medical-industrial complex" Ehrenreich and Ehrenreich, ; Waitzkin and Waterman, ; McKinlay, ; Waitzkin, ; profit-maximization drives the innovation of technologies and drugs and constrains physician decision-making.
The most orthodox advocate of this analysis, Vincente Navarro,rejects the analyses of those such as IllichFreidson and Starr who see professional power as having some autonomy from, and sometimes being in direct conflict with, capitalism and corporate prerogatives. For Navarro, physicians are both agents and victims of capitalist exploitation, engineers required to fix up the workers and send them back into community and work environments made dangerous and toxic by capitalism.
But the professions are anomalous for traditional Marxist theory; only those who own the means of production are supposed to accrue occupational autonomy and great wealth. Theorists of physician proletarianization point to the rising numbers of salaried physicians, the deskilling of some medical tasks, and the shifting of some tasks from physicians to less skilled technical personnel.
Parallel to, and often included in the Marxist account, has been the growing feminist literature on medicine. In particular, feminists have focused on the patriarchal nature of the male physician-female patient relationship, documenting the history of medical pseudo-science that has portrayed women as congenitally weak and in need of dubious treatments Ehrenreich and English, ; Arms, ; Scully, ; Mendelsohn, ; Shorter, ; Corea, ; Fisher, ; Martin, ; Todd, There is also extensive work done on the history of exclusion of women from medicine Walsh, ; Levitt, ; Achterberg,and the effects of the growing numbers of female doctors on the doctor-patient relationship.
Women physicians tend to choose poorly paid primary care fields over the more lucrative, male-oriented surgical specialties, are more likely to be employed as opposed to in private practice, and are less likely to be in positions of authority Martin, Women providers are also better communicators Weisman and Teitelbaum, ; Shapiro, Economic Approaches The growth of studies on cost-containment, and the economistic trend of 's social science, led to the rise of methodologically individualistic "rational choice" studies of the doctor-patient relationship.
These studies usually ignored the functionalists' interest in norms and roles, as well as the critical theorists' interest in power and exploitation. Instead, the economists' model starts from the assumption of a mutual "utility-maximizing" agency contract between the doctor and patient Dranove and White, ; Buchanan, The patient is interested in maximizing consumption of health, and the physician is interested in maximizing income. The studies then focus on the effects of insurance, reimbursement and utilization control structures on doctor behavior, the doctor-patient relationship and the success of medical agency Eisenberg, ; Salmon and Feinglass, For instance, a number of studies have documented that patients without health insurance have less access to doctors, and receive less care from them when they have access Hadley, Steinberg and Feder, ; Kerr and Siu, Research has also demonstrated that different payment structures affect physician behavior Moreno, ; Rodwin, For instance, a recent study of Medicaid case-management found that pediatricians who received augmented Medicaid fees provided a higher volume of services to children than either a group receiving fees-for-service, or a group covered by capitation Hohlen, et al.
Another strain of economistic research picks up on the Freidson observation of physicians' power to define illness, and explores the degree to which physicians "induce demand. Communication and Outcomes Two trends led to the rapid growth of research on doctor-patient communication. The first trend was the interest of physicians and medical educators in improving their ability to elicit patient histories and concerns, and inform patients of their conditions and treatment needs, and thereby achieve successful diagnosis and treatment compliance.
Literally thousands of analyses of consultations have been done since the s to develop methods to teach and improve physician communication skills Stewart and Roter, A second trend, the rise of health consumerism, has encouraged more contractual and conflictual relationships between patient and doctor.
An increasingly well-educated population has begun to challenge medical authority, and treat the doctor-patient relationship as another provider-consumer relationship rather than as a sacred trust requiring awe and deference Reeder, ; Haug and Lavin, Opinion polls indicate a steadily declining faith in physicians, and in the American medical system in general Blendon, The consumer, women's health Ruzek,the holistic health movements, and the perception of physician indifference and greed, have also encouraged patients to distrust physicians.
These trends were often portrayed by medical sociologists as democratizing Haug, ; Haug and Lavin, but perceived by physicians with alarm, especially in light of the rise of malpractice litigation. Encouraged by these two trends, symbolic interactionists Anderson and Helm, ; Strauss, and discourse analysts began detailed analyses of doctor-patient communication to tease apart the workings of power and authority within them.
In particular, Howard Waitzkin,has drawn attention to the way that American medical communication reinforces individualistic, bio-medical interpretations of problems with social origins and social solutions, and thus reflects and reproduces social inequality and disenfranchisement.
Another example is the work of Hayes-Bautista who studied the bargaining between the patient and the doctor over treatment. I do not want to be a philosopher — I shy away from the philosophical problems underlying my scientific work. By the same token I don't think he wants to be a scientist as I understand the term until he has settled all the underlying philosophical difficulties.
If the physicists of the 17th century had been Schuetzes there might well have been no Newtonian system. Dodd published a major work, Dimensions of society,  which attempted to build a general theory of society on the foundation of a mathematical and quantitative systematization of social sciences.
Dodd advanced a particular approach, known as a "S-theory. In AprilParsons participated in a conference, "On Germany after the War," of psychoanalytical oriented psychiatrists and a few social scientists analyze the causes of Nazism and to discuss the principles for the coming occupation.
Kubie was a psychoanalyst, who strongly argued that the German national character was completely "destructive" and that it would be necessary for a special agency of the United Nations to control the German educational system directly.
Parsons and many others at the conference were strongly opposed to Kubie's idea. Parsons argued that it would fail and suggested that Kubie was viewing the question of German's reorientation "too exclusively in psychiatric terms. Harvard reacted to the offer from Northwestern by appointing Parsons as the chairman of the department, promoting him to the rank of full professor and accepting the process of reorganization, which could lead to the establishment of the new department of Social Relations.
Parsons' letter to Dean Paul Buckon April 3,reveals the high point of this moment. Langer proposed for Parsons to follow the American army in its march into Germany and to function as a political adviser to the administration of the occupied territories.
Late inunder the auspices of the Cambridge Community Council, Parsons directed a project together with Elizabeth Schlesinger. They investigated ethnic and racial tensions in the Boston area between students from Radcliffe College and Wellesley College.
This study was a reaction to the upsurge of anti-Semicism in the Boston area, which began in late and continued into The background was a controversy over whether the social sciences should be incorporated into the National Science Foundation.
Parsons' report was in form of a large memorandum, "Social Science: A Basic National Resource," became available in July and remains a powerful historical statement about how he saw the role of modern social sciences.
II. SOCIOLOGICAL PERSPECTIVES
Parsons went to Allied-occupied Germany in the summer ofwas a contact person for the RRC, and was interested in the Russian refugees who were stranded in Germany. He happened to interview in Germany a few members of the Vlasov Army, a Russian Liberation Army that had collaborated with the Germans during the war.
The Vlasov movement's ideology was a hybrid of elements and has been called "communism without Stalin," but in the Prague Manifestoit had moved toward the framework of a constitutional liberal state. Anticommunism[ edit ] Parsons' fight against communism was a natural extension of his fight against fascism in the s and the s.
For Parsons, communism and fascism were two aspects of the same problem; his posthumous article "A Tentative Outline of American Values" was published in  and called both collectivistic types "empirical finalism," which he believed was a secular "mirror" of religious types of "salvationalism".
In contrast, Parsons highlighted that American values generally were based on the principle of "instrumental activism," which he believed was the outcome of Puritanism as a historical process. It representing what Parsons called "worldly asceticism " and represented the absolute opposite principle of empirical finalism. One can thus understand Parsons' statement late in life that the greatest threat to humanity is every type of " fundamentalism ".
For example, the Jacobins ' behavior during the French Revolution would be a typical example. Parsons' rejection of communist and fascist totalitarianism was theoretically and intellectually an integral part of his theory of world history, and he tended to regard the European Reformation as the most crucial event in "modern" world history.
Professional–Patient Relationship: II. Sociological Perspectives | kinenbicounter.info
Like Weber,  he tended to highlight the crucial impact of Calvinist religiosity in the socio-political and socio-economic processes that followed. The Calvinist faith system, authoritarian in the beginning, eventually released in its accidental long-term institutional effects a fundamental democratic revolution in the world.
Puritan, essentially Calvinist, value patterns had become institutionalized in the Britain's internal situation. The outcome was that Puritan radicalism was reflected in the religious radicalism of the Puritan sects, in the poetry of John Miltonin the English Civil Warand in the process leading to the Glorious Revolution of It was the radical fling of the Puritan Revolution that provided settlers in early 17th-century Colonial Americaand the Puritans who settled in America represented radical views on individuality, egalitarianismskepticism to state power, and the zeal of the religious calling.
The settlers established something unique in the world that was under the religious zeal of Calvinist values.
The Doctor-Patient Relationship: A Review
Therefore, a new kind of nation was born, the character of which became clear by the time of the American Revolution and in the US constitution And its dynamics later were studied by Alexis de Tocqueville. Although America has changed in its social composition sinceParsons maintained that it preserves the basic revolutionary Calvinist value pattern.
That has been further revealed in the pluralist and highly individualized America, with its thick, network-oriented civil societywhich is of crucial importance to its success and the factors have provided it with its historical lead in the industrialized process.
Parsons maintained has continued to place it in the leading position in the world but as a historical process and not in "the nature of thing. He acknowledged that the future had no inherent guarantees, but as sociologists Robert Holton and Bryan Turner said that Parsons was not nostalgic  and that he did not believe in the past as a lost "golden age" but that he maintained that modernity generally had improved conditions, admittedly often in troublesome and painful ways but usually positively.
When asked at the Brown Seminary in if he was optimistic about the future, he answered, "Oh, I think I'm basically optimistic about the human prospects in the long run.
Well, its more than 50 years later now, and I don't think the West has just simply declined. He was wrong in thinking it was the end. The new department was officially created in January with him as the chairman and with prominent figures at the faculty, such as Stouffer, Kluckhohn, Henry Murray and Gordon Allport.
An appointment for Hartshorne was considered but he was killed in Germany by an unknown gunman as he driving on the highway. His position went instead to George C. The new department was galvanized by Parsons idea of creating a theoretical and institutional base for a unified social science. Parsons also became strongly interested in systems theory and cybernetics and began to adopt their basic ideas and concepts to the realm of social science, especially the work of Norbert Wiener — had his attention.
Renee Foxwho arrived at Harvard inwould become a very close friend of the Parsons family. Joseph Berger, who also arrived at Harvard in after finishing his B. According to Parsons' own account, it was during his conversations with Elton Mayo — that he realized it was necessary for him to take a serious look at the work of Freud.
In the fall ofParsons began to offer a series of non-credit evening courses on Freud. As time passed, Parsons developed a strong interest in psychoanalysis. He volunteered to participate in nontherapeutic training at the Boston Psychoanalytic Institutewhere he began a didactic analysis with Dr. Grete Bibring in September Insight into psychoanalysis is significantly reflected in his later work, especially reflected in The Social System and his general writing on psychological issues and on the theory of socialization.
That influence was also to some extent apparent in his empirical analysis of fascism during the war. The Social System and Toward a General Theory of Action[ edit ] During the late s and the early s, he worked very hard on producing some major theoretical statements.
The former work was Parsons' first major attempt to present his basic outline of a general theory of society since The Structure of Social Action He discusses the basic methodological and metatheoretical principles for such a theory. He attempts to present a general social system theory that is built systematically from most basic premises and so he featured the idea of an interaction situation based on need-dispositions and facilitated through the basic concepts of cognitive, cathectic, and evaluative orientation.
The work also became known for introducing his famous pattern variables, which in reality represented choices distributed along a Gemeinschaft vs. However, the details of how Parsons thought about the outline of the social system went through a rapid series of changes in the following years but the basics remained. According to Parsons, its key idea was sparked during his work with Bales on motivational processes in small groups.
It reorganized the basic concepts of the pattern variables in a new way and presented the solution within a system-theoretical approach by using the idea of a cybernetic hierarchy as an organizing principle.
The real innovation in the model was the concept of the "latent function" or the pattern maintenance function, which became the crucial key to the whole cybernetic hierarchy. During its theoretical development, Parsons showed a persistent interest in symbolism. An important statement is Parsons' "The theory of symbolism in relation to action. The paper can be regarded as the main statement of his own interpretation of Freud  but also as a statement of how Parsons tried to use Freud's pattern of symbolization to structure the theory of social system and eventually to codify the cybernetic hierarchy of the AGIL system within the parameter of a system of symbolic differentiation.
His discussion of Freud also contains several layers of criticism that reveal that Parsons's use of Freud was selective, rather than orthodox.
In particular, he claimed that Freud that "introduced an unreal separation between the superego and the ego. Parsons had early been fascinated by the writing of Walter B. This social institution in the United States is vast, to put it mildly, and involves more than 11 million people physicians, nurses, dentists, therapists, medical records technicians, and many other occupations.
Finally, health care The provision of medical services to prevent, diagnose, and treat health problems. With these definitions in mind, we now turn to sociological explanations of health and health care.
As usual, the major sociological perspectives that we have discussed throughout this book offer different types of explanations, but together they provide us with a more comprehensive understanding than any one approach can do by itself.
The physician-patient relationship is hierarchical: The physician provides instructions, and the patient needs to follow them.
Conflict theory Social inequality characterizes the quality of health and the quality of health care. People from disadvantaged social backgrounds are more likely to become ill and to receive inadequate health care. Partly to increase their incomes, physicians have tried to control the practice of medicine and to define social problems as medical problems.
Symbolic interactionism Health and illness are social constructions: Physical and mental conditions have little or no objective reality but instead are considered healthy or ill conditions only if they are defined as such by a society. Poor medical care is likewise dysfunctional for society, as people who are ill face greater difficulty in becoming healthy and people who are healthy are more likely to become ill. For a person to be considered legitimately sick, said Parsons, several expectations must be met.
He referred to these expectations as the sick role Expectations of how people are supposed to think and act when they are ill. First, sick people should not be perceived as having caused their own health problem.
If we eat high-fat food, become obese, and have a heart attack, we evoke less sympathy than if we had practiced good nutrition and maintained a proper weight. If someone is driving drunk and smashes into a tree, there is much less sympathy than if the driver had been sober and skidded off the road in icy weather. Second, sick people must want to get well.
If they do not want to get well or, worse yet, are perceived as faking their illness or malingering after becoming healthier, they are no longer considered legitimately ill by the people who know them or, more generally, by society itself. If a sick person fails to do so, she or he again loses the right to perform the sick role.
Talcott Parsons wrote that for a person to be perceived as legitimately ill, several expectations, called the sick role, must be met. These expectations include the perception that the person did not cause her or his own health problem.parsons sick
Sometimes they are even told to stay in bed when they want to remain active. Physicians also have a role to perform, said Parsons. Parsons thus viewed the physician-patient relationship as hierarchical: First, his idea of the sick role applies more to acute short-term illness than to chronic long-term illness.