Blog
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.
Don’t give us a sticking plaster
About a month ago I saw an advert about the healthcare workers' mental health crisis in the UK: healthcare scenarios followed by individual shots of healthcare workers being overcome with emotion in various places. I was pleased to see such a successful film had been made and was receiving widespread coverage when the jarring tag lines drifted onto the screen.
by Dr Anna Conolly
About a month ago I was sitting in a packed cinema.
As the pre-film adverts played in front of me, I was distracted and I started to feel guilty about being there on a Sunday afternoon – was all my children’s school uniform ready for Monday morning or had I left some in the washing machine? Then, suddenly my attention was held by the large image of an ambulance, covered with bloody tissues, after treating a trauma, with a member of an ambulance crew, slightly removed, looking at the mess then walking away.
Still from 'Sicker than the patients' by Frontline19, 2024.
This was followed by similar scenarios such as family members on a hospital ward singing happy birthday to their father, supposedly a cancer patient, as a male member of staff watched or a nurse broke bad news to a couple in a side room. These scenarios were followed with individual shots of healthcare workers being overcome with emotion in various places, such as a nurse who broke down in a supermarket. All filmed as if taken by CCTV cameras with loud sound editing which captured the healthcare workers unsteady breathing, the film appeared very realistic and was completely effective in making you feel real empathy for healthcare workers.
I was pleased to see such a successful film had been made and was receiving widespread coverage when the jarring tag lines drifted onto the screen:
With over half suffering from poor mental health many NHS staff are sicker than the patients. Not that they would ever let you see it. Donate now so we can provide the therapy they urgently need.
Sticking Plaster
I almost screamed No! at the cinema audience. The advert, made by Frontline 19, an organization who received backing from Boris Johnson to help healthcare workers during and after the pandemic, positioned mental health support, paid for by charitable donations from the public, as the solution for the healthcare workers mental health crisis in the UK.
I am a researcher, and I have been working on workforce wellbeing for the last 3 and half years. The images that the advert displayed did not surprise me, however, I was more than a little irritated by the messaging used at the end. Because the images shown in the advert were so emotive I was cross that such a powerful film could be used to support an agenda that only represents a ‘sticking plaster’ approach to providing support for healthcare workers in the UK. I believe that chronic underfunding has led to systemic and cultural failings within the NHS. It is the organisation that requires healing, in order for the workforce to have a healthy environment in which to do their jobs.
Social Justice
Social justice has always provided the bedrock of the provision of healthcare in the UK. Founded in 1948 on the principle that healthcare services ‘are free for all at the point of delivery’ the NHS was, for decades, the envy of many countries. However, decades of little or no workforce planning, underfunding of the health service workforce, and massive staffing shortages have led to significant structural challenges.
Even before the pandemic, pressure in the health and care system was taking its toll on staff and was not sustainable. Reports described staff as running on empty and as the shock absorbers in a system lacking resources to meet rising demands. Excessively over-worked staff who suffer from mental distress and trauma due to not being able to provide the care they feel their patients are entitled to does not chime well with the social justice principles the NHS was founded upon.
I would argue that the chronic underfunding has gone too far and sticking plasters are no good to those who work within the NHS. Our government must acknowledge the scale of investment and organisational culture changes that are needed to keep the NHS going and ensure the health of both our healthcare workers and patients.
If you are a nurse or health worker who is in need of support, we have a range of support links here.