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Freidson (1970) incorporated the sick role of the conditions of legitimacy of the gate-
into the new approach to the sociology of keepers to the sick role, the physicians. What
deviance that had been developed during the was the source of their authority to discharge
1970s. As Bosk (2006) points out, this was this responsibility? How effectively did they
the first application of ‘labeling theory’ to ill- do this? Over the course of thirty years, he
ness in general, as opposed to the specific chronicled the changing nature of the rela-
domain of mental illness. Freidson under- tionship between US medicine, its patients,
stood that Parsons had illustrated the sick the state and the corporations of advanced
role through examples from contemporary capitalism. In the process, his views swung
industrial societies, but that it was essentially round from the impassioned critique of the
applicable to any society. The gatekeeping abuses of medical power, with which he
need not necessarily be performed by physi- closed Profession of Medicine (Freidson,
cians; it could be performed by anyone who 1970) to a more appreciative stance in his last
occupied a functionally equivalent role – major work, Professionalism: The Third
shamans, witches, priests, or whatever – and Logic (Freidson, 2001). Here he sees profes-
the conditions attached to its tenancy would sional autonomy and the independent culture
also be locally defined. Co-operating with of professional work as one of the last pro-
recognized advice might mean concordance tections that stand between the sick and the
with a drug regime but could equally mean ruthless calculative logic of neo-liberal
prayer, fasting, sacrifice, self-mortification, market societies. If the professions fall, then
or whatever practices were legitimated in a the trapdoor of the iron cage will indeed
particular social environment. The bound- swing closed with a vengeance.
aries of exemption might be drawn in differ- Goffman’s work, however, inspires a
ent ways, depending on the perceived somewhat more optimistic line of thinking.
seriousness of the condition. Nevertheless, Although not as elaborately formulated as
the core idea of a role available for occupancy Freidson’s approach, Goffman (1969) identi-
by those whose deviance was unintended, fied face-to-face interaction as a crucial site
providing a route for reintegration back into for the analysis of the sick role.
the wider society, remained intact. As both The interesting thing about medical symptoms is
Freidson and Goffman saw, this made a con- how utterly nice, how utterly plucky the patient can
siderable contribution to understanding the be in managing them … He is someone who does
difficulties confronted by those who could not will to be demanding and useless. Tuberculosis
patients, formerly isolated in sanitaria, sent home
not overcome their deviance – people with
progress notes that were fumigated but cheerful.
long-term sickness or disability in an indus- Brave little troops of colostomites and ileostomites
trial society, but equally people who could make their brief appearances disguised as nice,
not shake off a possessive spirit in others. clean people, while stoically concealing the hours
This understanding of the sick role took of hellish toilet work required for each appearance
in public as a normal person. We even have our
Goffman and Freidson in different but com-
Beckett player buried up to his head in an iron lung,
plementary directions. unable to blow his own nose, who yet somehow
Freidson recognized the way in which the expresses by means of his eyebrows that a full-
sick role was a point of convergence between fledged person is present who knows how to
two of the great institutions of any society – behave and would certainly behave that way were
he physically able (Goffman, 1969: 366).
medicine/healing and law. These were the
institutions that were, on the one hand, col- In the same paper, Goffman goes on to
lectively legitimated to manage deviance examine the implications for family interaction
and, on the other, supplied legitimacy to the and the links between a person’s immediate
individuals and organizations that carried caregivers and the medical profession in the
out the practical tasks involved. Much of management of the sick. At the heart of his
Freidson’s work, then, became an exploration paper is an understanding that the sick role is