National Pain Posted on August 10, 2019 By Liza Zoellick
“Patients have figured out that by adopting the sick role and signing up for disability, they can pay their bills and yet in order to validate the sick role status, they have to participate in the healthcare system, which means taking certain types of pills.” – Dr. Anna Lembke Associate Professor of Psychiatry and Behavioral Sciences. (General Psychiatry and Psychology-adult)
Straight out of the gate, lets get one thing clear, patients do not adopt a sick role to gain disability. No one looks at SSDI and thought, “hmmm…jackpot! This is like winning the bloody Mega Millions! I’m going to fake an illness so I can hop on that gravy train.” Most SSDI recipients receive between $800 – $1,800 per month with $1,234 being the average for 2019. Now, if you have a spouse who is working and is not also on SSDI, this can leave you comfortable and able to pay the bills. However, if you don’t have a spouse who is working and are on your own, or your spouse doesn’t make enough or you have kids and his paycheck is being spread to cover a multitude of things, then you are most likely living from paycheck to paycheck and praying you have enough and skimping where you can to get buy. This does not validate your sick role status. It makes being sick about a thousand times worse.
Initially, I was going to write this on pure emotion. But I am a student at heart and the term “sick role” and the fact that Dr. Lembke is a Psychiatrist had me wondering if there was more to this than a snide comment. So, after I had finished the article, I Googled the term and what do you know, “sick role” means exactly what you think it means and exactly what she implies. I don’t want to give a sociology lesson, as that is where the term is derived from, but let me give you the definition here so that you might read it as it was explained by the man himself. “ The “sick role” is a theory in medical sociology that was developed by Talcott Parsons. His theory of the sick role was developed in association with psychoanalysis. The sick role is a concept that concerns the social aspects of becoming ill and the privileges and obligations that come with it. Essentially, Parsons argued, a sick individual is not a productive member of society and therefore this type of deviance needs to be policed by the medical profession. Parsons argued that the best way to understand illness sociologically is to view it as a form of deviance, which disturbs the social function of the society. The general idea is that the individual who has fallen ill is not only physically sick, but now adheres to the specifically patterned social role of being sick. Now, I still don’t agree with Dr. Lembke but I understand where her school of thought comes from. I’m still going to decimate it starting with why not working doesn’t validate us in our “sick role.”
Part of who we are is what we do as a job. It’s where we derive our self-worth from. When we work, we earn money and we are able to take care of ourselves and our families (which would include our spouse or children, if any). When we can’t work, and we’re reliant on our spouse, or family to help us, or the government to help us, we become a burden. We do not live in a society any longer where we are close-knit with extended family where everyone sort of helps one another and if one is having a bad time of it everyone pitches in to help. So, when you find yourself in dire straits, you are on your own and if you aren’t in a good, financial place where you can support yourselves on one income you are typically looking at a spouse or SSDI. This leaves the patient who is sick in a place where they are feeling a great deal of guilt and sadness. They have lost their source of income, they have lost their health, they are progressively having feelings of low self-worth and with the strain of income it is likely to put a strain on the relationship. No one wants to feel like they are the cause of everything falling apart. No wants to feel like they are a burden. People outside the relationship don’t understand why you can’t work. They think you’re just at home watching movies and eating bon-bons. Instead, you’re feeling miserable. So, no, this does not validate the sick role. And no one would want to validate the sick role in a way that could jeopardize their happiness and their marriage.
Here we come to my favorite part of this whole ridiculous statement: “they have to participate in the healthcare system, which means taking certain types of pills.” You began by talking about us patients signing up for disability and end with us having to participate in the healthcare care system by taking certain pills. Which to me, is putting the cart before the horse. Patients begin going to the doctor and seeing specialists and taking pills long before the make the decision to file SSDI. I’m not sure who you’ve been talking to. We don’t decide to participate in the healthcare system. We participate in the healthcare system because we are sick. We take medicine because without it we would be in pain. It angers me that you are so quick to judge those of us who are sick and fighting to pursue what is ours, making a mockery of illness by calling it a “sick role.” How dare you. Do you have any idea how long it takes for many of us to finally receive the benefits we need? You should be ashamed of yourself. Patients need an advocate on their behalf to fight for them not against them. As a doctor this is what you should be doing. Of course, now I understand where this term of the “sick role” comes from, I understand that you perceive those of us who are sick not to be productive and therefore, to be deviant from “normal” society. I could write a ten-page paper on how I feel about you and Talcott Parsons and this “sick role,” but I prefer to spend my time advocating for those of in chronic pain and who are chronically ill.
As for the “certain pills,” which was ambiguous, to say the least, many of us do take opioids. Many of us have taken opioids for years and the range of prescriptions varies between all of us and dosages vary as well. The ambiguity of which you express us taking these “certain types of pills,” just to fulfill our “sick roles” makes us seem little more than junkies getting our fix. That might not make much difference to you but it does to me- on behalf of everyone within this chronic illness and chronic pain community. We may be little more than deviants who don’t fit the productive society mold, but we all have valuable insights yet to offer and contribute even though we may not be able to work. We’re advocates and we support one another, and we will continue to shout to those who make the rules regarding our health that we’re here and we want to be heard.