Society allows those who fulfill these criteria to assume the sick role, but society loses sympathy for and denies the role to those who appear to like it or those who do not seek treatment. In other cases, family and friends may show sympathy for a while, but lose patience with the victim and assume he or she is seeking attention or is a hypochondriac.
Although many believe that science alone determines illness, this sociological view points out that society determines sickness as well. For example, the culture defines diseases as legitimate if they have a clear “scientific” or laboratory diagnosis, such as cancer or heart disease. In the past, society considered conditions such as chemical dependency, whether drug‐ or alcohol‐based, as character weaknesses, and denied those who suffered from addiction the sick role. Today, drug rehabilitation programs and the broader culture generally recognize addictions as a disease, even though the term “disease” is medically contested. In today's culture, addicts may take on the sick role as long as they seek help and make progress toward getting out of the sick role.
In the past, society first dismissed or judged various ailments, only to later recognize the ailments as legitimate. People now recognize premenstrual syndrome (PMS)—once considered female hypochondria—as a legitimate, treatable hormonal condition. Acquired Immunodeficiency Syndrome, or AIDS, first emerged in the early 1980s in the male homosexual community. Because of the disease's early association with a lifestyle many people considered immoral, society granted those who acquired the disease little to no sympathy and denied them the sick role. People punished these victims for violating the norms and values of the society, rather than recognizing them as legitimately ill. As society became more knowledgeable about the disease, and as the disease affected a broader portion of the population, attitudes toward AIDS and those afflicted changed as well.
Today some conditions still struggle for recognition as legitimate ailments. One controversial condition is chronic fatigue syndrome. Called the “yuppie flu,” chronic fatigue syndrome generally affects middle‐class women, though men have also been diagnosed with it. Flu‐like symptoms, including low‐grade fever, sore throat, extreme fatigue, and emotional malaise, characterize the condition, which is often accompanied by depression. These symptoms may last for years and often result in disability. Sufferers experience difficulty in getting their condition recognized, not only by family and friends, but by insurance companies as well. Because of social hesitancy to accept chronic fatigue syndrome as legitimate, sufferers who are unable to work are often denied disability. Advocates have responded by renaming the disorder chronic fatigue immuno‐deficiency syndrome. This renaming associates the disorder with more scientific, readily recognized diseases. More families, physicians, and employers are now taking the disease seriously, so chronic fatigue sufferers are gaining support.
People with mental illnesses equally struggle for recognition and understanding. Although treatment conditions and understanding of mental illness have drastically improved, critics and mental health providers argue that considerable work remains. Prior to the 1960s, most mentally ill patients were locked away in places referred to as “insane asylums,” in which patients were often sedated for easy control. Because of new drugs that reduce or eliminate many symptoms and changed attitudes toward mental illness brought about by the work of sociologists and psychologists, many asylums closed and thousands of patients were released to community group homes, halfway houses, or independent living. This movement toward community care produced mixed results, with most mental health professionals concluding that the majority of deinstitutionalized patients adapt well with appropriate community placement and follow‐up. Critics point to an increase in homelessness coinciding with deinstitutionalization. They claim many homeless are mentally ill patients who need institutionalization or at least better mental health care.
Communities now face a number of issues due to deinstitutionalization because many localities object to group homes and halfway houses being located in their communities. Many wrongly believe that the mentallly ill are more likely to commit crimes. Because of this misperception, as well as others, recovered mentally ill people, as well as those diagnosed and in treatment, are still stigmatized and discriminated against. In addition, turf wars can exist among mental‐health professionals and over the use of drugs to control problematic behaviors. Psychiatrists and other medical doctors can prescribe drugs, while nonmedical professionals cannot. Insurance companies limit the kind of professional mentally ill patients may see and the length and cost of treatment. All these issues make it more difficult for mentally ill patients to get and remain in treatment.
Some mental illnesses, such as paranoid schizophrenia, require drug treatment for normal functioning. Patients in the community sometimes neglect to take their medication when they start feeling better, opting out of continued treatment and resulting in a relapse. Patients who stop taking their medications are the ones most likely to become homeless or to pose a danger to themselves or others. These are not the majority of patients being treated for a mental illness, however. People with conditions such as depression, panic, bipolar disorder (formerly known as manic depression), and a host of other debilitating conditions can respond well to other therapies in addition to medication. With treatment, they are no different from any other member of society. With increased awareness of mental and emotional disorders, finding cost‐effective ways to meet society's need to appropriately care for these patients and benefit from their many talents will become more critical.
Major health problems in the United States
Over the 20th century, medicine responded to the most common health threats with effective treatments. By the end of the century, the leading causes of death had changed dramatically. According to the national Center for Health Statistics, the top ten causes of death are: heart disease, cancer, blood vessel diseases, accidents, lung diseases (not cancer), pneumonia and flu, diabetes, suicide, liver disease, and homicide. At the beginning of the century, the leading causes of death were tuberculosis, pneumonia, diarrhea, heart disease, nephritis, accidents, blood vessel diseases, cancer, bronchitis, and diphtheria. Discovery and development of vaccines and antibiotics meant that diseases once deadly are curable or nonexistent. People live longer, thus suffering more diseases associated with old age such as heart disease, cancer, and blood vessel diseases. What has also changed is physicians' abilities to recognize and diagnose disease more accurately. In the past a death may have been ascribed to “old age,” when today a physician might diagnose cancer.
What cannot be overlooked is the eleventh cause of death: AIDS, or acquired immune deficiency syndrome. First recognized in 1981, the origin of AIDS is still controversial, though many experts find evidence pointing to African monkeys. In the United States, the disease first appeared in male homosexuals. According to the Centers for Disease Control, the most common transmission of AIDS is through homosexual sex (52 percent). Other means of transmission are drug injection, 25 percent; heterosexual sex, 8 percent; homosexual sex and drug addiction, 7 percent; undetermined, 6 percent; and blood transfusions, 2 percent. The lengthy incubation period, sometimes lasting several years, contributes to its spread. While AIDS is the eleventh cause of death for the overall population, it is the leading cause of death for men age 24–44 in the United States.
Most common drugs: Alcohol and nicotine
The most commonly abused drugs in the United States are alcohol and nicotine. According to the statistical abstract, Americans consume on average 37 gallons of alcohol per year, the majority being beer at an average of 32 gallons per year. The remaining 5 gallons is comprised of 3 gallons of wine and 2 gallons of other distilled alcohol. At this rate, Americans consume more beer than either coffee or milk. Beer consumption has become a major issue on college campuses with recent epidemics of binge drinking, particularly by college males. Many incidents have resulted in injury and death. Although many recent studies have extolled the health benefits of moderate alcohol consumption, the emphasis of these studies is upon moderate consumption or one or fewer glasses of wine per day. Some emerging studies indicate that the health benefits may be the same for grape juice and wine. Alcohol increases the risk of birth defects, and women who are or may become pregnant should not consume alcohol.
In 1964 the surgeon general issued the first warning that smoking could be hazardous to health. Since then the evidence has mounted and the powerful tobacco industry has increasingly found itself on the losing side of lawsuits. Emphysema, lung cancer, heart disease, and other cancers are attributed to smoking. Morbidity experts estimate nicotine kills about 390,000 Americans each year, making it the most deadly recreational drug. Individuals and states have sued for damages in these losses, and for the costs incurred with caring for nicotine‐induced diseases. The role of second‐hand smoke in disease has also been recognized. Although cigarette advertising is limited, it remains a central controversy, especially advertising aimed at teens and youth.