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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.
Why ‘only’ women nurses?
We have been asked why our research focuses solely on women nurses.
We have given a great deal of consideration to the design of the studies within this project, including consulting with nurses and our project stakeholders. We made the decision to focus specifically on women nurses for a range of reasons and in this blog I will focus on three of these.
by Dr Hilary Causer
We have been asked why our research focuses solely on women nurses.
Firstly, let me clarify that when we talk about women in the context of our research, we are referring to anyone who identifies as a woman. This definition has been developed in collaboration with nurses who have experience of suicidality, and we will use it when recruiting nurse participants into our studies.
We made the decision to focus specifically on women nurses for a range of reasons:
In response to the statistics regarding suicide rates by women nurses
Because women’s and men’s experiences of being a nurse are different
Because suicide is a gendered experience and there is a notable lack of research that specifically explores women’s experiences.
Because historically, women’s experiences and distress are more likely to be understood as medical problems.
Solutions and interventions to address women’s distress and suicidality have been individualised. This suggests that women are seen as being responsible for their own problems, whereas the root cause may lie in the ways that society and the workplace are organised.
In this blog I will focus on the first three.
Women nurses have a heightened rate of dying by suicide
This project came to fruition in response to the heightened rate of suicide among women nurses who have a 23% greater risk of dying by suicide than women in other professions. This statistic is echoed in other western countries such as Australia and the USA. However, male nurses, health care assistants, or midwives do not demonstrate a similarly heightened rate.
“women nurses have a 23% greater risk of dying by suicide than women in other professions”
Whilst the statistics tell us ‘what’ is happening, we don’t currently understand ‘why’ it is happening. Therefore, we are undertaking five distinct studies, using qualitative and mixed research methods, that focus on the experiences of women nurses. Our research findings will not only add to current knowledge, but also identify necessary changes to the working lives and environments of women nurses to address this longstanding anomaly.
Gendered experiences of being a nurse
Research tells us that there are distinct differences in the experience of being a nurse according to gender. Almost 90% of UK nurses are women, thus nursing is a female majority profession. Despite this, women nurses are less likely to progress to senior roles than male nurses and are paid less on average than male nurses.
They are also more likely than their male counterparts to experience discrimination, bullying, and harassment at work and are significantly more likely to experience gender-based violence inside the workplace and intimate partner violence, a known risk factor for suicide outside the workplace. Women health staff, including nurses, were also more likely to experience anxiety, depression, and sleep disorders after working through the Covid-19 pandemic. A recent report on suicide in female nurses in England states that of nurses who were in contact with mental health services 18% percent reported problems at work compared with 6% of women in other occupations.
“Almost 90% of UK nurses are women”
For some women nurses these gendered experiences occur at the intersection with other factors, which further complicate their experiences. For instance, 40% of the NHS workforce, and 60% in social care, are workers from the global majority, many of whom gained their nursing qualifications before migrating to work in the UK. Nurses who identify as Black are disproportionately referred to the nursing regulator.
It is clear, that while the experiences of male nurses are valid and important, they will not helpfully contribute toward growing our understanding of what is happening for women nurses.
Gendered experiences of suicide and gendered suicide research
There are also gendered differences in suicidal experience. The most significant being that nearly three quarters of all people who die by suicide are men. Paradoxically, incidents of self-harm and suicidal thoughts and attempts are more frequent for women. The means by which people die by suicide also differ between men and women, as do the most likely age at which people die by suicide.
These differences have shaped the research agenda. Specifically, as most deaths by suicide are men, research has focused on seeking to understand risk factors and preventative factors that pertain to men. This has resulted in a dearth of research into women’s suicide in any cohort.
“suicide research has focussed on risk factors and preventative factors that pertain to men”
This is problematic as it means that certain contexts or life events which are specific to women remain unexplored. These include the care burden and the ‘second shift’; menstruation, pregnancy/infertility and menopause; dominance of patriarchal messaging and systems in society and workplaces; sexual and domestic violence and coercive control; violence in the workplace; and experiences of working in female majority professions.
Our research, by focusing on women nurses, will provide novel and valuable evidence that will grow our collective understanding about how suicide might be experienced differently for women.
Our answer to your question
We have given a great deal of consideration to the design of the studies within this project, including consulting with nurses and our project stakeholders. Our answer to your question, ‘why only women nurses?’, is, because they face greater risk of dying by suicide, and have distinctly different experiences to men nurses, and because women’s experiences around suicide are currently under-researched and poorly understood.
To learn more about the approach that we will be taking in our research, and the feminist and critical arguments that underpin our approach, take a look at our previous blog post by our Principal Investigator Dr Ruth Riley.