Blog
Why a feminist perspective?
To understand suicidality among women nurses, we must investigate the political, social, and economic conditions that nurses work and live within.
By: Dr Sarah Gillborn
The necessity of using a feminist perspective to study suicidality among nurses.
As Dr Ruth Riley notes, to understand suicidality among women nurses, we must investigate the political, social, and economic conditions that nurses work and live within. The most common ways of investigating suicidality tend to focus on women as distressed and ill individuals. This ignores the oppressive conditions that affect women’s lives. On the other hand, feminist approaches to research focus on the importance of political and structural conditions. Using this approach means that we can explore issues such as violence and discrimination, poor working conditions, race and gender inequalities and other issues that contribute to women nurses’ distress.
Most often, research methods focus on the personal at the expense of the political. Even in interview studies, which are often assumed to be more attuned to wider conditions, suicidality may be seen as being related to an inherent cognitive shortfall or mental illness. Using feminist methods guides researchers to take a wider view rather than be drawn toward the dominant, individualised approach that often takes hold.
We need methods, in nurse suicide research that are based on feminist understandings of the wider political, social, and economic conditions and systems that are relevant. Two such approaches are Foucauldian discourse analysis and feminist relational discourse analysis.
Why study discourses?
Foucauldian discourse analysis draws on philosopher Michel Foucault’s definition of discourses as ‘regimes of truth’ that form and sustain specific power relations. Discourses are ‘ways of talking’ that create a set of ideas about people and phenomena. Using Foucauldian discourse analysis informed by feminist ideas helps us in three ways: it helps us to understand the different ways of speaking about particular ideas or topics to show how these ways of speaking produce and shape knowledge and truth; and reveals what purposes or interests these ideas serve.
For example, in my explanations above and in Dr Ruth Riley’s blog post, we explain how suicidality is often constructed as the result of individual deficits. Understanding suicidality in this way serves to pathologise individual nurses while leaving the contexts, such as violence, discrimination, and poor working conditions, unaddressed. In fact, it is likely to draw on stereotypes – often maintained by men in positions of power - of ‘mad women’ who are prone to hysteria and less likely to handle the usual stresses of work. This victim-blaming paints women’s distress as a disease and maintains the systems that oppress women.
It is, therefore, vital to understand how suicide among nurses is understood by the people who influence public and political thinking in relation to suicide. That way, we can examine who is served by these ideas, and whether they will lead to positive structural change or support the continuation of current mainstream and patriarchal power structures. We can also get a sense of the ideas and stories that are available to nurses themselves who may want to understand nurse suicide. Therefore, we can begin to understand whether suicidality is understood as a structural and political issue or as an indication that something is ‘wrong’ with women. This is important because it will have an impact not only on how nurses seek help, and on their comfort in speaking about this issue more broadly.
Feminist approaches to discourse analysis
Feminist relational discourse analysis offers a more powerful and feminist approach to understanding how ideas around suicidality affect women nurses. First explained by Dr Lucy Thompson and colleagues , from a feminist point of view, Foucauldian discourse analysis can pose problems when seeking to understand individual voices and experiences. While Foucauldian discourse analysis is good at identifying and questioning the ideas that inform policy and public debate on feminist issues, the voices of individual women can be lost; that is, we must be careful not to lose the personal when drawing attention to the political.
Using feminist relational discourse analysis, we can understand the different ways people talk about things, including the main ideas and the alternative viewpoints they use. This approach helps us see the problems with common ideas about suicide, the various challenges women nurses face, and how they can resist these issues. It shows how nurses' experiences and views are shaped by both mainstream ideas and alternative perspectives, and how these ideas about suicide affect them.
Why a feminist perspective?
A feminist perspective is vital for this topic because nurse suicide is a feminist issue. As Dr Ruth Riley highlighted, the suicide rate among women nurses is 23% higher than women in other occupational groups. 89% of nurses are women, and a quarter are from the global ethnic majority. Despite this, the majority of suicide research and policy does not address the topics of gender, race, sexism, and racism.
In April of this year, Unison union published a report revealing that one in 10 NHS health workers reported being subjected to unwanted sexual incidents at work. A further report from the charity BRAP and researchers at Middlesex University revealed that more than 70% of global majority staff who’d been trained in the UK, and 53% who’d been trained abroad, experienced racial discrimination at work. In both reports, this harassment was revealed to be rarely reported due to staff’s concerns about how they would be treated and their lack of confidence that anything would be done. Taken together, these reports reveal everyday environments where racist and sexist behaviours and attitudes are accepted as normal in the NHS. This undoubtably impacts women nurses; yet, these situations are overlooked when discussions and research about suicide focus only on individual women's mental health and ignore the environments they live and work in.
This is why a feminist perspective is necessary; It helps us to focus on the power imbalances and inequalities that harm nurses and then re-traumatise them through silence and inaction. This approach uses an intersectional, feminist perspective to understand the root causes of nurse suicide and supports real, meaningful changes in how we think about suicide and improve women's workplaces.
If you are a nurse or health worker who is in need of support, we have a range of support links here.
Why is women’s distress classed as an illness?
This blog explores why women’s distress is more likely to be seen as illness and what this means for women, and why this is relevant to women nurses.
By: Dr Ruth Riley, Anna Conolly, Hilary Causer
Women’s mental health
This blog explores why women’s distress is more likely to be seen as illness and what this means for women, and why this is relevant to women nurses. Women in high income countries are three times more likely to be diagnosed with depression and anxiety. For Black, lesbian and/or older women, these numbers are even higher. In the UK, one in five adults are prescribed antidepressants; and women are twice as likely to be prescribed them than men.
Is the medicalisation of women’s distress a modern phenomenon?
Simply put, no. Historically, women’s bodies and minds have been seen and treated differently to men. Women are more likely to be institutionalized, in asylums and hospitals, receive psychosurgery, electroconvulsive therapy and psychotropic medication (e.g. antidepressants, anxiolytics). Such medical interventions can be harmful and come with side effects. Being sectioned, for example, is traumatic and stigmatising for individuals, and exacerbates any pre-existing distress. Medications come with side and/or withdrawal effects which include suicidal thoughts and feelings. To understand why this has happened, we need to understand why and how medical knowledge about mental illness is created and how it is enacted.
The social construction of mental illness in the Western world
“Social constructionism” invites us to question or take a critical perspective towards taken-for-granted knowledge, including medical knowledge. Scientific knowledge, while often viewed as absolute fact, is still the result of social processes and open to interpretation. Sets of ideas, themes and arguments to explain or position or construct knowledge is known as “discourse”. It provides a way of viewing and understanding the world.
Western medicine is underpinned by the biomedical model which draws on ‘scientific’ models and discourses to cure patients through medications and/or surgery. There is an assumption that medical concepts such as depression and anxiety have an underlying pathology or problem, a chemical imbalance, for instance. The solution lies in ‘fixing’ or treating the underlying problem but this overlooks the root causes. Let’s take a look at how distress and its causes are viewed in other cultures and what we can learn from framing the problem differently and more holistically.
How is mental illness or distress constructed in other cultures
The construction of mental illness and distress varies significantly across cultures, shaped by beliefs, values, and socio-historical contexts, including colonial injustices.
Indigenous cultures, such as many Native American groups, often view mental and emotional distress within the context of the spiritual, natural, and ancestral worlds. The mind, body, spirit, and the environment are interconnected. Healing may involve rituals, spiritual ceremonies, and community-based practices to restore harmony.
Aboriginal and Torres Strait Islanders, for instance, view their wellbeing as interconnected to their land, culture, spirituality, ancestry, family and community. The contexts contributing to negative wellbeing include their colonial history and ongoing injustices and oppression linked to grief, loss, racism, discrimination and adversity. Preventing distress involves addressing spiritual, environmental, ideological, political, social, economic forms of oppressions and not the prescription of pills. The problem and the solutions are therefore located beyond the individual and not within.
Women’s distress as a problem within
Scientific models and discourse have given the medical profession the power and control to define and treat illness and disease, including women’s distress. It does this by locating the problem within the woman and not on the root causes such as sexism, racism, violence against women, workplace injustices (gender-pay gap) and other forms of oppression and inequality.
Women are then expected to take responsibility for their distress whether through adherence to prescribed medications (e.g. antidepressants), having to attend counselling or therapy or expectations to be ‘more resilient’ and/or by being gaslighted. Frequently, women are expected to “put up and shut up” or made to feel that they are the problem. Women then internalise the consequences of oppression and injustices contributing to their distress or unhappiness.
Why we need to take a critical feminist perspective on women’s distress
Feminist critics suggest that feelings of distress and unhappiness are understandable responses to the challenges that women face. Blaming these feelings on an internal problem, dismisses women's perspectives and experiences.
When we give centre-stage to women’s experiences and their voices, we are more likely to understand why they may be experiencing distress. A feminist perspective allows us to see how social structures, such as gender inequality, unpaid caring roles, and the emotional weight of caregiving, contribute to women’s emotional and psychological struggles. It also highlights how their distress is not a personal or individual issue, but one rooted in systemic and historical oppression. By acknowledging these factors, we can begin to challenge the pathologisation of women's emotions and instead advocate for changes that address the root causes of women’s suffering.
Why is this relevant to nurses
The NHS is the largest employer of women and nurses in Europe. Nurses, in particular, are on the front line of healthcare. The NHS can be viewed as a microcosm of society, reflecting broader social structures, inequalities, and dynamics, such as those related to gender, race, and class. Thus, the NHS encapsulates the challenges faced by women in the workforce, such as the gender pay gap, work-life balance issues, and workplace discrimination. Women nurses experience these inequalities first-hand, with staff from the global majority reporting higher rates of discrimination, lower promotion rates, and fewer leadership opportunities.
The pressures nurses face in the NHS such as chronic understaffing and long and disruptive shift patterns intensify the stress of the emotional burden of caring for patients with complex needs with limited resources. The role of nurses in the NHS reflects traditional gender roles associated with caregiving and emotional labour, roles that are disproportionately occupied by women in both professional and personal contexts. Unpaid caregiving tasks often fall upon women, and nurses frequently deal with expectations of nurturing and providing emotional support on top of their clinical duties. Perhaps, it is unsurprising, therefore, that women nurses are experiencing higher rates of distress. Maybe we can learn from indigenous societies’, older than Western medicine, that the solutions lie beyond the individual.
We will continue elements of this blog which we’ve touched on in our next editions. In our November blog, Dr. Lucy Thompson will discuss violence against nurses and institutional trauma. In our December blog, Dr. Sarah Gillborn, talks in more detail about the power of discourse and its effects, particularly on women’s mental health.
If you are a nurse or health worker who is in need of support, we have a range of support links here.
What feminism means to me
Welcome to the first blog of our series, ‘What feminism means to me’. We will be inviting a range of contributors to share their thoughts, ideas and experiences on this topic.
Our first contributor is Leo Conolly.
Welcome to the first blog of our series, ‘What feminism means to me’. We will be inviting a range of contributors to share their thoughts, ideas and experiences on this topic. A feminist ethos sits at the heart of our research and the ways that we work within our team and with our collaborators and participants. Using our blog to explore this question is one way that we are hoping to contribute to feminist narratives.
Our first contributor is Leo Conolly..
I am a Year 10 student. I often think deeply about social issues and why the world is the way it is. I am a boy who lives alone with my mum and my two brothers, but I have always had girls as friends who I spend lots of time with. Growing up I have considered myself to be a role model for my two brothers. Because of this I am careful of how I behave because I want them to behave in a similar manner. I now go to a boys’ school, and this has made it even more important to me that women are treated respectfully. I think the world needs to be fairer, with the government putting laws into place to help women achieve equality. For example, lots of women, like my mum, are carers. I know my mum had to give up work for a long time because of this and her life can sometimes be difficult. I think feminism is really useful because it helps people to think about the issues that might overly affect women, and it can help us to think about how to make things better.
Last year, in History I learnt about the suffragettes and the actions of women such as Emily Davidson at the Epsom Derby. Through direct action the suffragettes were able to raise awareness of the issues they believed in so strongly which eventually led to women being given the vote. For me this shows the powerful effect that thinking about issues, then acting, can have. Having a more equal society, with equality between men and women will benefit everyone in the country. For example, making sure women get equal pay would make everyone richer! I know that feminism is about creating a fairer world for all, and I think everyone should be happy to get involved with that.
By Leo Conolly. September 2024.
If you would like to write for us about your thoughts on feminism, you can get in touch here: info@nursesuicidestudy.com
How our understanding of context informs our understanding of nurse suicide; and why we need change.
There are 30 million nurses world-wide and the NHS, the largest employer in Europe, employs more women than any other organisation. It is also the principal employer of nurses of whom, 89% are women and one in four are from the global ethnic majority. Yet, the majority of suicide research and policy is gender- and colour-blind.
by Dr Ruth Riley
There are 30 million nurses world-wide and the NHS, the largest employer in Europe, employs more women than any other organisation. It is also the principal employer of nurses of whom, 89% are women and one in four are from the global ethnic majority. Yet, the majority of suicide research and policy is gender- and colour-blind.
The suicide rate among women nurses is 23% higher than women in other occupational groups.
These numbers are more than just statistics but speak of human stories of distress and suffering in women nurses across continents. Yet their voices, experiences, and stories are largely unaccounted for in dominant suicidology approaches and suicide prevention policies.
High suicide rates in women nurses have been documented for over 20 years in the UK and in other high-income countries too. Yet workplace practices, policies and research have failed to address the realities and contexts of nurses’ lives.
Current approaches and why they are failing women nurses
Deaths by suicide are often what we see or hear about but hidden beneath the surface are the diverse contexts that contribute to distress and suicidality. Our studies will argue that mainstream research approaches are not only gender- and colour-blind, but also focus on individual-level characteristics and the mental health of individual nurses and rely on methods which fail to account for wider contexts.
In North America, there is a trend which advocates screening for mental illness in nurses which may further label and individualise women’s (and others’) distress. This may compound stigma and increase shame, leading to the concealment and non-disclosure of feelings and distress and presenteeism, particularly in healthcare cultures which lack compassionate leadership and psychological safety.
Why we need to revision our understanding of distress and suicidality in women nurses
In contrast to these approaches, the ambition of our project is to address these under-researched contexts using critical suicidology which questions the mainstream approaches that locate ‘the problem’ within the individual. Our position argues that by individualising distress, attention is distracted from the political, social and economic contexts and systems within which nurses work and live. Solutions aimed at addressing these wider contexts and systemic problems – which include deep-rooted violence against women, both inside and outside the workplace, discrimination, poor working conditions, and other workplace injustices, are overlooked. Employing a feminist approach will enable us to better understand the patriarchal, social and structural systems which impact women nurses, nurses from the global majority, and othered communities. This is a timely project as we witness continued distress compounded by ongoing injustices, the pandemic and workforce and resource shortages.
Joining the dots – politics, mental health, and women.
Individualising distress and labelling distressed women as unwell goes hand in hand with current – neoliberal – political mindsets. For example, we are expected to maintain ‘good’ mental health despite changes in political and organisational systems which contribute to and sustain inequality and injustices for women and othered communities.
Messages about self-care, help-seeking and individual resilience are all examples of the drive toward individual responsibility for mental wellbeing. Therefore, the unjust systems that oppress and disadvantage women and others are excused any responsibility.
A feminist understanding of ‘mental illness’
Mainstream approaches to treating distress or ‘mental illness’ and the messages surrounding it are largely uncritical – relying on taken-for granted knowledge. Such approaches, as above, are underpinned by biological and medical models and are predominantly understood from a medical and male viewpoint. This poses a problem for women and for marginalized and minoritised communities.
In the UK and other high-income countries, women are three times more likely than men to be diagnosed with depression and anxiety. This proportion increases when women are also Black, lesbian and/or older. Historically, women are more likely to be institutionalized, in asylums and hospitals, receive psychosurgery, electroconvulsive therapy and psychotropic medication (particularly antidepressants), which can be accompanied by harmful side and withdrawal effects, including suicidal thoughts.
Medicalizing women’s distress and focusing on the individual is a form of institutionalized gaslighting, as their distress symptoms are reduced to a diagnosis yet their voices, experiences and the contexts contributing to their suffering are overlooked. In feminist research, women participants often resisted a medicalized diagnosis of depression as they attributed the cause of their misery to structural factors, including poverty and violence.
We argue that focusing on the personal, overlooks the political, and fails to hold to account those systems, structures and cultures which contribute to and sustain social, colonial and economic injustices, gender-based violence or the impact of work cultures and working conditions on women. This includes women nurses and ethnically diverse nurses and will apply to women working in other occupations, including doctors.
What is the ambition of this project?
This ground-breaking project has five different studies which will capture the diverse experiences and accounts of a range of women nurses and those from the global majority. We will also be capturing the views of the public, including friends and families of nurses to explore their understanding of what contributes to nurse distress and suicidality. In providing space and opportunities for new perspectives, we will gain a more nuanced understanding of relevant contexts while providing a voice and platform for under-represented nurses.
The project aims to transform research approaches, and trends in suicidology and significantly shift our understanding of the contexts that contribute to distress and suicidality within the nursing population. This research may also have direct implications for women working in other occupational groups. We wish to launch a more nuanced approach and debate about the contexts that impact women inside and outside the workplace.
The project will lead to societal benefits too by increasing public understanding of these issues. We want to change hearts and minds so that suicide is no longer viewed as an individual problem and its contexts are more widely understood.
I am proud to be leading this ambitious project with a passionate and experienced team, who include international experts, award-winning creative artists and, crucially, nurses themselves, who have shaped the project and research priorities. Over the next 5+ years, we will be working with nurses, for nurses, to radically revision our understanding of distress and suicidality within the nursing community.
