Nursing the Image

Media, Culture and Professional Identity

Julia Hallam

• Publisher: Routledge
• Year: 2012
• ISBN:
  9781134668250
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Ideas of 'nursing' and 'nurses' carry a powerful social charge. The image of the nurse continues to be a symbol of caring and of duty at the same time as it projects a view of femininity, 'stereotypical' in its gender relations.How has this image come to be constructed?An empirical investigation of representations of nursing practices in Britain focusing on publicity and promotional materials and their relationship to popular fictional narratives reveals a strong correlation between what are usually described as discrete forms of signification. Recruitment images, provide an important source of information and inspiration for those considering nurse training. Julia Hallam, draws from a wide range of sources including biographies, marketing and recruitment literature, popular fiction and film to explore this question. In doing so she makes an original contribution to the debates surrounding gender and occupational identity.The book will provide a valuable resource for undergraduate and postgraduate students on courses such as the social history of nursing, the understanding of health and illness, women's studies, gender studies and sociology courses.

1
IMAGES, IDENTITIES AND SELVES

Every woman, or at least almost every woman in England has, at one time or another in her life, charge of the personal health of somebody, whether child or invalid – in other words, every woman is a nurse.

(Florence Nightingale quoted in Poovey 1989: 185)

Since Nightingale’s day, nursing and female identity have been difficult to prise apart. Often identified as the founder of modern nursing, and the only woman to appear on a banknote in modern Britain, Nightingale’s image has entered the realms of popular mythology as one of a very few ‘good and great’ English women. Feminist historians have revealed, however, that Nightingale’s image was mobilised, even in her own time, to serve colonial and nationalistic aspirations. In her ambition to forge a profession for women and rally middle-class women to her cause, Nightingale (re)presented images of the Victorian middle-class mother, the ‘angel in the house’, as nursing’s feminine ideal. But Nightingale also mobilised another now more hidden discourse that has popularly survived in the figure of ‘the battleaxe’; this military image of authoritarian female power served an explicitly colonialist aim of reforming and recreating the home of the sick poor into a facsimile of the female, middle-class home. In her examination of Nightingale’s use of rhetoric, Mary Poovey argues that the Victorian ideal of submission and domesticity always contained an aggressive component. For Nightingale, the role of the nurse was not only to care for the sick, but to become a public agent of moral reform, and through this agency, ultimately to undermine the power of medical men (Poovey 1989: 191–2).

The self-sacrificing ‘angel’ and the ‘battleaxe’ are not necessarily diametrically opposed. The roots of the ‘angel’ image arguably lie in the mid-nineteenth-century promotion of Nightingale as an ‘angel of mercy’, a public relations exercise that aimed to pacify public dissatisfaction with the losses (both military and financial) incurred during the Crimean War (F. Smith 1982: 47).¹ In the aftermath of her return, Nightingale, a consummate strategist, used her heroic public status to reform nursing, drumming up support for her projects through appropriation of the caring characteristics associated with ‘respectable’, middle-class women circulating in nineteenth-century society (Poovey 1989).

Vron Ware argues that, in Britain, although the concept of femininity has been deconstructed by feminist historians as a class-specific phenomenon, it is rarely investigated to reveal the racial meanings attached to being a white woman (Ware 1992). The first section of this chapter argues that the power value of white femininity, with its cultural associations of chastity, purity, cleanliness and spiritual truth, was used by Nightingale in her attempts to persuade the male-dominated Victorian public sphere to support her programme of reform. Nursing’s integral association with the dominant discourse of white middle-class femininity at this time means that it cannot be separated from the racial implications inherent in the reform movements of the day. Nursing was deeply implicated in the colonial and nationalistic ambitions of Victorian society, bequeathing modern nursing an invisible legacy that has permeated the image and identity of professional nursing for much of the twentieth century.²

Since the mid-1970s, nursing commentators have become increasingly critical of images of professional identity circulating in the mass media, claiming that nursing is misrepresented and poorly understood by producers, writers and visual image makers. Content analysis, the methodological approach favoured by many researchers of nursing’s occupational identity and public image, yields useful and necessary information on how nurses are represented across a range of media sites, but it often fails to reveal the implicit nature of the social relations on which these explicit meanings are fabricated. Analyses of nursing’s public image can be usefully developed using the theories and methods of feminist cultural studies, which argues that knowledge is always situated and located in particular schools of thought or epistemes which feminist academics aim to challenge and subvert. Feminist nursing historians and academics can assist this process through their analyses of the public image and identity of nursing as a discourse mediated through conceptions of white middle-class femininity. If this image, with its associative elements of class and colonial subjugation, is to be dislodged from its hegemonic mediation of nursing’s occupational identity, differences within nursing and between nurses have to be recognised and treated with respect. It is not only the attitudes of image makers and producers that need to be swayed; there is no place for complacency in nursing’s professional associations. In April 1999, in the wake of the controversial judgement of institutional racism within the Metropolitan Police following a public inquiry into the racially motivated murder of Stephen Lawrence, the Royal College of Nursing (RCN) voted against instituting a policy of positive discrimination to tackle racism in the profession.³ The result generated despair and despondency amongst black nurses and a fierce debate that culminated in a second vote with a more positive outcome.⁴ The incident underlines the fact that stereotypes often contain within them implicit truths; nursing’s discursive formations will be unable to mediate a fresh identity for the profession until the majority of nurses can envisage a different and more diverse image of their professional selves.⁵

Images: nursing and femininity

The contemporary dilemma faced by nursing historians and feminists in any attempt to account for the gendered identity of health care professionalism is posed acutely in terms of how the image of Florence Nightingale is situated in what Dorothy Smith terms the discourse of femininity (Smith 1988b). Smith argues that femininity can be examined as an actual practice, as a social form of consciousness that takes place in real time, in real places within a defined set of material circumstances. Her focus ‘investigates a lived world of on-going social action organised textually’ through the production, distribution and consumption of all forms of texts (Smith 1988b: 39). For Smith, femininity is an active enterprise; women construct their feminine identities (or not) through their daily interaction with magazines, books, television and films (to name but a few examples) and the purchase of the products they promote. Textually mediated discourse is a distinctive feature of everyday life in contemporary Western societies that has its roots in the development of mass communications and literacy in the nineteenth century.⁶ The consumption and interpretation of texts such as photographs, newspapers, books, magazines and, more recently, radio, film and television are an integral aspect of everyday life. These texts contribute to the organisation of individual choice and the understanding of personal and social experiences as well as mediating the social relations of the political process and the economy (Hermes 1995, Silverstone 1994). Phenomenologists, in their quest to elucidate the relations between experience and knowledge, argue that lived experience consists of interpreted realities; meaning is the relationship established between the self and its everyday experiences.⁷ For Smith, women are not passive products of social and economic organisation: they actively create themselves through interactions with their everyday worlds (1988a). In this context, femininity is a set of texts and practices that socialise and teach women how to live our lives as gendered individuals, enabling us to select and reject those aspects of feminine appearance, behaviour and attitudes that suit (or not) our individual needs, attitudes and circumstances. Femininity is a ‘textually mediated discourse’, a dialectical process between active, creative individuals and the organisation of their behaviour in and through texts that co-ordinate their activities with the market in goods and services. The emphasis here is not on the text itself (as in much conventional literary study) or its content and effects (as in some media and communications sociology and psychology) but on the social relations that are implicated in and through the textual construction of practices.

Smith’s analysis of femininity as a practice mediated by the social relations of different kinds of texts is usefully enlarged by Beverly Skeggs, who argues that femininity is a form of cultural capital that women are encouraged to inhabit and practise. The texts and practices of femininity are taken up and used variously by women, whose choices are informed by the network of social relations they inhabit. Positions of class, gender, sexuality, race, religion, region and age, for example, ensure that the discourses of femininity are taken up (and resisted) in different ways. Skeggs’ longitudinal study of a group of young women who returned to further education to study courses in community care demonstrates how the group were encouraged to convert their everyday skills (of caring for children and tending to the needs of others) into marketable skills. Femininity is a form of cultural capital that can be transformed into economic capital but it is a limited resource in that it only provides restricted access to potential forms of power, whereas it is possible to trade masculinity more readily and for greater reward in the labour market (Skeggs 1997: 10).

Textually mediated discourse does more than communicate popular sentiments and values: it connects the production and distribution of, for example, clothes, furnishings, and education with the skills and work (paid and unpaid) of women, and the norms and images that both construct and regulate the public presentation of the self in the social realm. Within the discourse of femininity, women are situated as objects not only of a male desiring gaze, but also of their own self-disciplining gaze. Smith describes the structure of the relationship of the subject to herself as tripartite: ‘the distance between herself as a subject and her body, which becomes the object of her work, is created by the textual image through which she becomes conscious of its defects’ (Smith 1988b: 50). This relationship is often foregrounded in accounts of anorexia which Chenin (1983, quoted in Smith) has suggested is a conflict in which some women cannot resolve the relations between mind and body. Smith sees this conflict as an over-intensification of an already existing tension between the subject, textual images and the ‘body-as-object-of-work’; participation in the discourse of femininity situates the body as an object of the work involved in trying to achieve the unchanging perfection of the image in the text. Thus Toni Morrison’s heroine Pecola in her novel The Bluest Eye (1970) sees herself as black and ugly, her body as the object of work involved in trying to achieve the textually mediated norm of white feminine beauty. Unable to create a transformation through the consumption of products aimed at young white women, she seeks a magical solution from a black soothsayer that will make her dream come true. Finally, she goes mad because she cannot make her body conform to the idealised images of white femininity that are consuming her sense of self – in the magazines, advertisements and movies that surround her (Smith 1988b).

Poovey (1984) has mapped the genealogy of femininity’s discursive development, tracing its emergence to the eighteenth-century production of magazines and conduct books addressed to leisured upper-class women. This situates femininity as a class discourse, one that places women in a social hierarchy in which economic wealth and social relations are productive of certain forms of female conduct and appearance. In the nineteenth century, books and articles in magazines as well as advertisements created a common code among readers, vested in languages and images which could be referenced in conversation and in interpreting behaviour and events. Conduct books provided instruction on how to become a ‘lady’ for growing numbers of socially aspirant women, the wives and daughters of (newly) wealthy entrepreneurs, industrialists, merchants and emerging professionals eager to join upper- and upper middle-class society. The development of textual and visual technologies, such as printing and photography, emphasised the construction of appearance as a sign of female conduct that implied social respectability. By the end of the century, appearance became a signifier of conduct with hair styles and clothes the predominant means through which middle-class women could define themselves and place others. Femininity was established as a certain kind of womanhood, a middle-classed sign that connoted the particular forms of conduct deemed ‘respectable’. Investments in the social trappings of this idealised form of femininity enabled women to gain access to limited status and moral superiority. Donning the accoutrements of their social positioning and displaying them through appearance enabled white middle-class women to judge those who were lacking in ‘femininity’ (feminine class capital) as inferior. Hence ‘respectability’ became not only an indication of social status but also of moral value and social worth (Skeggs 1997: 100–1).

Skeggs argues that white middle-class femininity was defined as the ideal but also as the most passive and dependent of femininities. Working-class women were paradoxically coded: on the one hand, they were depicted as inherently healthy, hardy and robust in contrast to the frail physical bodies and ‘delicate’ temperaments of middle-class women; on the other hand, they were seen as a source of infection and disease, in part the result of their ‘dangerous’ sexual appetites. Working-class women’s relationship to femininity has historically been predicated on a class-based relationship to the vulgar, the pathological and the sexual; they are distanced from ‘taste’, from the static, silent, invisible and composed forms of conduct and behaviour which are the marks of respectability (Davidoff 1983, Stanley 1984, Skeggs 1997).

Women and caring have strong cultural associations in Western culture, which can lead to assumptions that caring is a natural or essential attribute of those born female, a genetic inheritance rather than a socially learnt pattern of behaviour. But many feminists have challenged the supposition that females are ‘naturally’ more caring than males, arguing that caring is a socially acquired attribute, part of the process of gendering female identity in Western cultures through the discourse of femininity.⁸ An important theme of early nineteenth-century women’s history is the philanthropic, caring role often assigned to women of the emerging middle classes. Nightingale’s relationship to the Victorian feminist movement has been a source of considerable interest and debate amongst feminist nursing scholars and historians: her association with Victorian philanthropic movements and British imperial power is well documented although it has not been subjected to a sustained critique of its racial implications.⁹ Feminine discourse ascribed special qualities of a moral and ethical nature to middle-class women which defined the domestic realm as their principal area of responsibility and operation. This is sometimes referred to as ‘woman’s mission’: women were expected to use their special qualities as a reforming influence on family and friends and to donate their leisure time and energy to societies engaged in social and moral reform.

One of the contradictions of ‘woman’s mission’ is that it helped to regulate the distance between women of different social classes. Linda Nead discusses the way the phrase was used to describe the role of the respectable woman in the reclamation of ‘the fallen’ (prostitutes and other women of dubious morality), and the way that it differentiated between the ‘deserving’ and ‘undeserving’ poor (Nead 1988: 196–7). Philanthropic work also constructed hierarchical relationships between white women and those of different races. Vron Ware argues that it was a short step from bestowing charity on poor women to applying the same principles of compassion to assist and plead for those who were enslaved, a more abstract group of poor with whom white middle-class women had little physical contact.¹⁰ The urban poor belonged to a social hierarchy that was familiar to middle-class women; their condition could be addressed by Bible readings or education in home economics, but not by campaigning for their emancipation or their equality. The abolition of slavery was a political struggle aimed at changing hearts, minds and laws; it could be read as merely sentimental philanthropy but it could also signify an assault on racism itself (Ware 1992). The abolitionist movement allowed women to use their image of respectability in the public sphere, but the success of the campaign was followed, paradoxically, by an increase in British imperial control of many areas of the world. The relationship between white women and those of different races continued to evolve during the nineteenth century through their participation in the British colonising project (Ware 1992: 109); missionary work, nursing, teaching and marriage to colonial officials expanded the reach of ‘woman’s mission’ way beyond their own ‘urban jungles’.¹¹ Wendy Webster points out that the analogy between British colonial and urban English missionary work was often made explicit; William Booth, founder of the Salvation Army, described the urban poor as ‘colonies of heathen savages in the heart of our capital’, arguing that: ‘As there is a darkest Africa is there not also a darkest England?’¹² (quoted in Webster 1998: 62).

The 1850s were something of a watershed in women’s history, for it was in this decade that discursive formations of femininity became distinctly allied to various reform movements, creating discrete and separate identities for groups of middle-class women that were predicated on their religious and political attitudes and beliefs. Nightingale’s reforming mission, which culminated in the opening of her School of Nursing, is perhaps the most well-known and publicly acclaimed activity of this type during the decade, but her projects were accompanied by two other significant interventions. In 1858 one of the first feminist publications, The Englishwoman’s Journal, started publishing with the explicit aims of generating support for the opening up of skilled occupations to women and of raising the status of acceptable female occupations such as nursing and teaching (Simnett 1986). In the following year, 1859, the Ladies Association for the Diffusion of Sanitary Knowledge (LADSK) was founded by evangelical middle-class women who saw it as their moral duty to visit the poor and teach them about the virtues of fresh air, good diet, clean clothes and houses and clean living. These middle- and upper-class women, in a manner that forecasts the development of the Health Visiting movement some fifty years later, visited the houses of the poor in an attempt to redeem working-class women from themselves, that is from themselves as a sign of dangerous, disruptive sexual women (Hall 1979 in Skeggs 1997: 99). At the inaugural ceremony of LADSK the celebrated novelist Charles Kingsley urged women to recognise that ‘...

Table of contents

• Cover
• Title
• Copyright
• Contents
• List of illustrations
• Acknowledgements
• Illustration Acknowledgements
• Introduction: (Auto)biography, research and feminist cultural studies
• 1. Images, identities and selves
• 2. The popular imagination
• 3. The professional imagination
• 4. The personal imagination
• 5. The contemporary imagination
• Notes
• References and Bibliography
• Index