Social Sources of Pregnancy as Illness or Normality

Expectant mothers who manifested high degrees of social-personal instability tended to regard themselves as more "sick" during pregnancy than did socially more stable women. Motivations to enact a sick role during pregnancy are viewed in relation to objective social status, dissatisfactions with current round of life, and with both upward and downward mobility. C ENTRAL to Parsons' discussion of modern medical practice is the contention that illness is something more than a 'natural phenomenon' which simply happens to people.' It involves, in addition, reciprocal motivations of persons-particularly those of the patient and of his significant others. Considering the joint social-biological nature of illness, motivations to become 'ill' may be directed toward one or the other of these two aspects. First, one may be motivated to become ill in the biological sense* This investigation is supported by a grant from the Association for the Aid of Crippled Children, New York, and facilitated by the collaboration of the Institute for Health Sciences, Brown University, Glidden L. Brooks, M.D., Director. 1 Talcott Parsons, The Social System (Glencoe, Illinois: The Free Press, 1951), chap. X. This content downloaded from 157.55.39.250 on Sat, 23 Apr 2016 06:38:30 UTC All use subject to http://about.jstor.org/terms PREGNANCY AS ILLNESS OR NORMALITY 261 to injure oneself, to become infected, and the like. This kind of motivated biological illness is that which interests students of psychosomatic illness and leads, most frequently, to a consideration of individual psychodynamics. Second, one may be motivated to enact a sick role with relative disregard for the kind and extent of organic impairment involved. The first, in its extreme, is exemplified by the masochist-sick but acting 'as-if' he were not. The second is most dramatically represented by the chronic hypochondriac-not sick but acting 'as-if' he were. The latter more frequently evokes questions of status, of role, and of social structure. Important in this context is the proposition that the sick role is a contingent role insofar as it is ordinarily reserved for organically 'abnormal' persons. As such, it legitimizes the presence of persons who are unable to enact their more normal roles because of something that has 'happened to' them. The role of the sick, then, serves functions of equilibrium which are potentially both functional and dysfunctional. It is potentially functional to the extent of providing a sanctioned role for those who would otherwise be 'roleless' and without legitimate status. On the other hand, it is potentially dysfunctional insofar as it offers a normatively defined deviation by means of which one might evade and escape his traditional roles and responsibilities. Illness in this dual sense has been defined by Parsons as "a state of disturbance in the 'normal' functioning of the total human individual, including both the state of the organism as a biological system and of his personal and social adjustment."2 If the enactment of the sick role does reflect a condition of social-biological disturbance, then one might also expect that the motivation for the sick role has its sources in personal-social disturbance as well as in disorders of the biological system. Furthermore, in those instances in which the biological disturbance is least severe, one might expect that the motivations stemming from personal-social disturbance are correspondingly greater. The purpose of this research was to examine some selected social attributes of women who regard pregnancy as a 'sick role' as compared with those of women who do not regard pregnancy as a social-biological illness. Pregnancy has been chosen as the 'ill constant' because there seems to be considerable ambivalence as to the appropriateness of the sick role in regard to it. In other words, while the posture of the 'Victorian lady-in-waiting' may be largely absent, her image is still present. A second reason for focussing upon pregnancy was the attempt to maximize the possibility of determining factors reflecting 'personal-social adjustment' insofar as they may serve to motivate persons to assume the sick role. In view of the relative organic normality Qf pregnancy, it was expected that those women who are most motivated to enact the sick role while pregnant would be those among whom could be found the greater incidence of personalsocial disturbance. The chief proposition underlying the measures and procedures of this study was: personal and social disturbance are major sources of motivations to enact a sick role in connection with a relatively normal organic condition. If differentials in personal-social adjustment are related to differentials in the motivation toward the sick role, then one might expect that differences in objective social status, in current satisfactions with one's round of life, and in the extent and direction of social mobility might be important correlates of the extent of motivation to shed traditional roles in favor of the contingent role of the sick. This paper, therefore, focuses upon three major indices of personal-social adjustment: (1) objective social status as determined by traditional status determinants, (2) kinds and extent of social aspirations, and (3) kind and direction of social mobility.