African Americans and the Sick Role
The sick role may not be easily available to poor African Americans. A lack of resources for medical care and a fatalistic acceptance of conditions may preclude active intervention or preventive efforts and contribute to a tendency to endure discomfort. Utilization of self-care practices, prayer for religious intervention, lack of resources for health care, and fear of racist treatment in health care institutions often lead to delays in seeking treatment. Consequently, medical care is more commonly sought in emergency departments when crises occur. Even African Americans not actively involved in religious organizations may rely on religious coping in times of stress. Religion may give hope and positive expectations or may "spiritualize" difficulties, viewing problems as part of God's plan and passively trusting God to take care of them. Seeking psychotherapy departs from African Americans' traditional reliance on coping and management of difficulties within one's family. Consequently, entering into therapy and accepting the sick role as a psychiatric patient is a strong statement about perceived needs for help.
for resources is not with biomedicine but with family or ethnomedical traditions (see Chapter Five).
Dependent-Patient Stage Once under the care of a provider, patients enter a dependent stage in which they are expected to comply with recommendations and treatment. Whether the condition is remediable or terminal determines whether the patient role is a temporary condition or a permanent condition of the self. The social consequences of diagnoses have effects on the experience of the condition.
Recovery or Rehabilitation Stage In remediable illness, the patient role is to be relinquished on recovery and rehabilitation. Societies have rituals, ceremonies, and activities that indicate termination of the patient role. However, in some cultures, particular illnesses carry a social stigma that a person cannot escape (e.g., mental illness, cancer, and addiction).
The concept of the sickness career recognizes that a series of interactions with others occurs over time and in definable stages (Twaddle, 1981). Becoming sick is a social process, one in which perceptions of and responses to impaired well-being are shaped by the behavior of significant others. Although physicians may be official arbitrators regarding the sick role, it is generally family, friends, and employers who legitimate the sick role, validate changes in an individual's status, and accommodate to their implications.
Cultural, social, and personal factors affect people's willingness to accept the sick role. Some do not want to adopt the sick role, and others liberally use it for sympathy, release from obligations, and assistance. The social benefits of the sick role may make patients ambivalent, wanting to maintain their sickness rather than eliminate it because of beneficial effects such as
- Primary gains, beginning with the relief of symptoms and associated unpleasant feelings, including diverting attention from other problems. The sick role may serve psychosocial needs, providing attention and concern from others, a use employed by those of marginal status and with weak social support.
- Secondary gains of exemption from responsibility, including work, and special consideration from others. The sick role may relieve individuals from ordinary responsibilities and provide an excuse for personal failure and not meeting social expectations. The sick role can alleviate blame for personal shortcomings, placing responsibility on the malady.
- Tertiary gains, benefits others receive from a patient's sickness (e.g., being a helper).
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