Past and Present ‘sick roles’

It always amazes me how readily people are prepared to tell complete strangers about their symptoms and maladies. Sitting in the waiting room of a the doctor’s surgery, I have overheard people telling someone they’ve never met some of the most intimate details about about this or that operation, favourite doctor or some related tale of misery.

And it isn’t just in the context of medical institutions. Wherever two people strike up a conversation, it seems to me that, like the weather, the topic of health is somehow (and rather counterintuitively) an accepted topic for discussion. It might be recovery from recent illness; it might be waiting for a forthcoming treatment; it might be. especially among friends or acquaintances, the opportunity to share the latest miracle cure for arthritis, whether Royal Jelly in the 80s, or Glucosamine in the last few years.

This readiness to share information about our health, though, is certainly nothing new. Sickness has always been a social event in some measure. As part of the research for my book, I explored the ways in which early-modern patients experienced sickness and constructed the role of sufferer. What it consistently showed was that sick people in the past – both consciously and unconsciously – adopted and deployed certain language and behaviours to fit with social expectations of the sufferer on the one hand, and in some measure to try and garner help and support for themselves.

In the seventeenth century, for example, the parameters of sickness were somewhat different. It has even been argued that most people felt some degree of illness for most of the time. This is because of the vast range of minor ailments that today would be treated easily by a trip to the chemist, but then were less simple to get rid of. If this is true, then the whole concept of feeling ‘well’ in the first place is shifted. It is probably true to say that people’s expectations of health were lower; through Galenic humoural beliefs of the time, good health was almost an unattainable ideal anyway.

In fact, in the early modern period, there were clear levels of sickness. At the basic level were minor ailments – troubling and worrisome yes, but not considered dangerous. With these sorts of ailments, people essentially carried on with their daily business as best they could. If things got worse, they might stay within doors, doubtless self-dosing with some favoured remedy or, if they could afford it, consulting with the local practitioner. Communities were adept at knowing when a member was ill, and word spread extremely quickly, kicking off a likely stream of concerned visitors. At this level, the sick person might still function in some respects as a member of the household. A woman, for example, might still carry out some domestic tasks if she were able, while many handicrafts were also carried out within doors.

At the more serious end, though, was sickness that required the sufferer to take to their beds. When this occurred, the patient was effectively considered to be seriously ill. Here, medical intervention was likely to be sought, and copious amounts of medication administered. It is worth remembering that early modern medicine worked on the basis that it had to be seen to ‘do’ something, even if that something was to make the patient violently ill. On one level, taking to one’s bed was an obvious reaction to sickness, but it was also a conscious signal to others. There were even some treatment regimes which required the time at which the patient lay down to be recorded as this had a bearing on what medicine could be administered and when.

The words and conduct of the sick were extremely important, not least to their families. The sick person was expected in some measure to take the medicine and advice proffered to them, but in effect to ‘act’ like a sick person. This might include what they said. The wife of the Flintshire diarist Philip Henry, for example, when she was sufferering from a recurrent ague, repeated the same phrase ‘sick, sick, never so sick’, as if to reinforce the point to her family.

This was also a period when medicine, and in particular medical remedies, were part of a common and shared knowledge bank. People at all levels of society shared their favourite remedies and treatments, and this transcended social status. In other words, a servant might offer her master a favourite remedy, which was then duly noted down in a domestic remedy collection. People sent medical advice to friends by post, and sometimes fired off letters describing symptoms and seeking cures. Indeed, sickness was an extremely common theme in early modern correspondence, and sometimes the only reason for writing at all.

For those who couldn’t write, there was a strong verbal culture; people simply knew many remedies and, as the historian Adam Fox has admirably noted, were far more adept at committing large amounts of information to memory.

But by the eighteenth century, interesting changes were afoot, and the figure of the ‘heroic sufferer’ emerged. This was the era of fashionable maladies like gout, nervousness and melancholia. Rather than deploring your sickness, many Georgian society figures embraced it as a sign of their status and also of their romantic duty to suffer. Gout, for example, suggested a rich diet and fast living; in this sense, it was a visible status symbol – despite being incredibly painful as satires by Cruickshank and others suggest.

But the literate sick used letters to construct a whole new persona, telling friends in martyred tones that they were suffering in various unimaginable ways, and would write again if they survived, only to resurface in a fresh missive, much recovered, a week or two later.

The fact is that sickness has always been a topic of conversation, and the similarities between us and our early modern contemporaries continues to astonish me. We still have a lively culture of sharing and discussing medicine – in fact never more so than at a time when the whole structure of the NHS is under question. We still have our own favourite remedies, and self-medicate when we can. But, we also still visit a vast range of practitioners, from faith-healers to accupuncturists and Chinese herbalists.

However far we’ve come in terms of treatments, it’s worth considering the constancy of the human response to feeling, and being, ill.


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