The Obligation to Remain Sick

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Abstract
AS THE SCOPE of psychiatry has broadened, the psychiatric consultant has been requested by his colleagues in internal medicine and surgery to offer assistance with an increasing variety of problems.2,3,16 Prominent among these is management of "difficult" and "uncooperative" patients on medical and surgical wards, and psychiatrists have increasingly become aware that these patients may be responding not only to their individual psychopathology but also to the milieu within which they find themselves. It is the purpose of this paper to discuss and illustrate one aspect of the patient's milieu which may contribute to his illness behavior,11 and which may lead to the request for psychiatric assistance. This feature of the patient's environment shall be called "the obligation to remain sick." The focus for this discussion derives from the concept of the sick role which has been defined by Parsons.14,15 He has pointed out that "being sick" constitutes a role in society for which there

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