CONTRARY to how modern-day English dictionaries and thesauruses define and provide parallel definitions or synonyms respectively of illness and sickness, the latter both are technically dissimilar in the realm of the social sciences, specifically in sociology and anthropology.

In such disciplines, disease or sickness is defined within the context of biomedical models that cause physical or psychiatric imbalances or disequilibrium of the normal physiology or mentation.

It may be caused by an infectious agent, genetic mutations or acquired through mechanisms that can be traced through pathology or some molecular processes like ageing. Likewise, disease or sickness is supported by laboratory studies like blood chemistry, ultrasound and the likes. Its diagnosis is also legitimized by the International Classification of Diseases for physical ailments or the Diagnostic and Statistical Manual V for psychiatric aberrations.

Lastly, its manifestations (fever, cough, headache for example) can be measured through different instruments like thermometer, spirometer or sphygmomanometer. Corrective interventions are done either through pharmacologic therapeutics or through physical manipulation such as surgery and related therapies with restorative or replacement goals.

In the extreme point, illness is viewed by social scientists in a much broader and complicated sense. As a jump-starter, medical sociologists (professional sociologists who focus their study of health and medicine) refer to “illness” as people’s lay or subjective definition of health problems in contrast to the professional and objective definition of a “disease” or “sickness” by a physician who bases his or her diagnosis on the signs and symptoms.

But such simplistic definition is just the tip of an iceberg: there are many other ways in which illness is defined unlike disease or sickness which tends to have some sense of universality and an established system of identification and classification. Illness is otherwise.

For instance, sociologists have used varied paradigms in defining illness.

One of these paradigms is the structural functionalist: illness is the dysfunction of normative roles caused by disturbances in health. It is anything that interferes with people’s capacity to carry out their prescribed roles in the society as Fernando De Maio put it in “Health and Social Theory.”

Structural-functionalism per se addresses the societal whole with respect to functions of constituting elements of the society, like traditions, institutions, norms, and customs, and much exemplary like organ interactions within the human body to maintain what sociologists call “social homeostasis.”

According to the structural-functionalist perspective, healthcare, a social institution, functions to maintain the well-being of individuals in the society and, consequently, of the social system as a whole.

Medical sociologists using this paradigm believed that illness has dire consequences to society in general. Think what could happen if a significant number of people, let’s say professionals, have fallen ill? Pressing further, think of these people as parts of the society fulfilling roles that serve the needs of humanity.

For example, what could happen if a teacher fails to show up to her class? Sure a substitute teacher could fill in but the point is she failed to execute her function and therefore she is ill. Her absence can cause disruption in the mechanical operations of the academic institution she is serving. Therefore, society must have a social institution or structure to control deviance cloaked in the form of illness.

In fact, William Cockerham noted in his “Medical Sociology” that some mechanisms for legitimizing the illness is required to prevent equating it to deviance. In his writings he argued that it is the social structure of the medical system (specifically the work of the medical profession) to regulate this dysfunction otherwise it interferes with expected social actions and norms. Hence, illness is also viewed as a form of “deviance.”

Consistent to this thought, Talcott Parsons in 1951 generated what he called the “Sick Role Theory”, which states that four things in that the sick person: (1) is exempted from normative societal roles, (2) absolved from personal responsibilities, (3) should try to get well, and (4) should submit self to the expert opinion of the physician.

Parsonian theory, however, had been criticized for five reasons: (1) in contemporary society, the person is held responsible for his illness for failing to follow healthy lifestyle: enough rest, eat nutritious foods, stay away from vice, not practicing safe sex etc… as these are conscious action, (2) it failed to account for those with normal pregnancy experiencing symptoms that are considered abnormal for the non-pregnant person, (3) failed to apply it on chronic diseases like cancer or those with idiopathic or unknown causes, (4) there was no mention of sickness acquired mechanically like accidents or corrective surgery whether successful or gone wrong, and (5)it neglected the contribution of power and conflict as the medical profession has transformed itself to be a social institution of social control using its power to distinguish between normal and deviant as in cases of noncompliant patients.

In sum, the structural functionalist paradigm places emphasis on value consensus, social order and stability of the society at the macro-level perspective.

Ever wonder why a medical certificate is required in such instances as being absent from school or work or when pleading for insanity or some pathology requiring rehabilitation and use of wheelchairs in court litigations?

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The writer is a medical professional and has been writing as a health columnist of this paper since 2008 every Tuesday and Friday. He is an alumnus of Xavier University Ateneo de Cagayan from Elementary to Graduate School. Currently he is a faculty member of the Medical Education Unit for the Doctor of Medicine Program of Southwestern University Phinma, where he is likewise finishing his Master of Public Health.