A strange combination indeed! What interest would nurses have in philosophy, which is, after all, something usually seen as the province of bespectacled professors locked away in their ivory towers? Undoubtedly though, philosophy in many guises has informed nursing from its very beginnings, but sometimes without our consent or complete understanding of the consequences. Therefore, it is for me a fascinating challenge to explore the most significant philosophical positions that have shaped—and continue to inform—our profession in order to better understand why contemporary nurses might think and act the way they do. This is the cut and thrust of this chapter: a journey into philosophy out of nursing, but simultaneously a journey into nursing out of philosophy.

My history as a nurse is tightly bound up with a life as someone who has always asked difficult questions of the world and who, consequently, has spent more years than he cares to remember struggling with seemingly countless contradictions and inconsistencies lived out between articulating philosophies of nursing and engaging in it as a practice (Walker 1993). In living through and finding ways to better understand these things, I have journeyed through diverse and often complex philosophical territories—journeys, it could be argued, that have provided me with the credentials to contribute to this text.

Therefore, in this chapter, I want to explore with you the ways many different philosophies—each with their own histories and effects—have variously enabled and disabled what passes for the ‘truth’ of nursing. And this is why philosophy is perhaps best thought of as ‘a way of reflecting not so much on what is true and false but on our relationship to the truth’ (Foucault, cited in Lotringer 1989:201, emphasis added). Throughout, I attempt to show how certain truths about what it is to be a nurse and ‘do’ nursing have been decided for us, but not necessarily by us. These truths have generally made it difficult for nursing to position itself as a serious discipline (in terms of its ‘body of knowledge’) and authoritative profession (in terms of nurses’ capacity to make decisions on their own behalf and be recognised for their contribution to the wellbeing of humankind). But it is our relationship to these truths and the effects they create in the minds and actions of ourselves and others that we need most to interrogate. Let me begin this work by putting forward a couple of truths to which I subscribe.

Nursing first and foremost is a practice; it only comes to true (or material) expression in action. Moreover, nursing, as an intractably social and relational activity, is bound up in and manifests itself by way of ceaseless acts of communication and interaction with others. Language, history and culture are at the core of this activity and they are the most significant phenomena through which we construct and interpret our worlds. Philosophy is primarily a linguistic and cultural phenomenon in the sense that it is about words and ideas shared by certain people in specific circumstances. There is no other place to start thinking philosophically about nursing than nursing’s origins in history, culture and language. This discussion will lead us nicely towards a more sophisticated analysis of how philosophy might be embedded in nurses’ everyday talking and moving-about-in-the-world as active agents in that world’s creation. With luck, it will encourage you to read more on this fascinating topic, and, if that is the case, then I have achieved more than I could hope for!

As exemplified in Nightingale’s definition, to be a nurse is to be a woman first. This idea reinforces both the necessity and centrality of nursing as a human caring activity that has always fallen to women. But it also seriously disables the potential for nursing to be anything but merely women’s work (in a world that even today values men’s work in every way more than women’s). This is a double bind—the grip of which will likely never relent in its capacity to constrain the possibilities for nurses to exercise power in any way commensurate with, for example, medicine’s capacity to do so.

Embedded within the discussion above are the manifestations of a particular philosophical position, namely essentialism. This philosophy allows someone to claim the ‘truth’ that ‘a man is a man down to his very thumbs, and a woman is a woman down to her little toes’ (Thomson & Thomson 1911:4); or that women are ‘longer lived’ than men because ‘their constitution has staying powers, probably wrapped up with femaleness’ (Thomson & Thomson 1911:7). In other words, there is something inherently or essentially female about women and equally something inherently or essentially male about men; this is what is called an ‘essence’ and it is self-evident, irreducible to any other form and is permanent and incontestable. Clearly, essentialism is a very politically conservative posture and this has been significant for nursing because it has relegated nurses to an inferior position in the order of things in what is a still overtly patriarchal society in the developing and developed worlds.

Essentialism has a close cousin in another philosophical viewpoint: biological determinism (anatomy and physiology exclusively determine whether we are male or female; boys/men have a penis; girls/women have vaginas; function follows form). Essentialism draws on this determinism very strongly to posit an essence—or a universal, immutable and sex-specific set of qualities and behaviours—of maleness and femaleness, as I suggested above.

Furthermore, these authors justify their remarks:

Naturalism also posits a timeless and universal femaleness and maleness inherited since the origin of the species and it is simply ‘God-given’ in the great order of beings (reflect, for example, on the concept of ‘human nature’ and how much of human behaviour we rationalise by this concept without giving it another thought). Indeed, naturalism still exerts enormous influence in the ways the world of work is carved into hierarchies of who is ‘naturally’ better equipped to do certain types of work and who not; consider that it was only in the last couple of decades that women were able to become airline pilots because of the fear that their hormonal fluctuations might render them temporarily unable to be in command of their emotions and therefore endanger the lives of their passengers. The very idea of a woman in charge of an airplane was for a very long time anathema to the airline industry (not to mention the travelling public) and probably still is to many.

If we examine nursing education texts throughout the last century, we can see the significance of essentialism, naturalism and biological determinism in the ways nursing has been inextricably linked to the female of the species and how this has shaped the form and content of nursing education and, ultimately, what a nurse is and does (e.g. Brackman Keane 1969, Burbridge 1935, Cuff & Gordon Pugh 1924, Hansen 1958, Nixon & Wakeley 1948, Watson 1908). This reality explains why even in the early twenty-first century only about 10% of the world’s nurses are men. And by now you should be better able to appreciate how—as Nietzsche (cited in Hayman 1997:38) puts it: ‘Every philosophy conceals another philosophy’.

By way of advancing the analysis of how philosophies insert themselves into nursing, I draw on the work of a very significant thinker whose philosophical writing has deeply influenced my own, namely Michel Foucault (1926–84). Much of Foucault’s early intellectual project was to explore how ‘knowledge’ (and philosophy as a form of knowledge) came to be constructed in specific forms for equally particular circumstances (e.g. the law, science, psychiatry) (Foucault, 1970 and Foucault, 1972). In his work he analysed the various forces and structures at play in the development of the modern or civilised Western world, and advanced the still quite radical notion that truth and its effects is intimately connected to knowledge production, which in turn is bound up in the exercise of power (Foucault, 1980 and Foucault, 1984).

These three things—knowledge, truth and power—all interact with and through language in such a way so as to produce certain disciplines (such as science and the law). These disciplines, in turn, generate an authority for themselves by enabling those subscribing to the discipline to speak of and define the disciplines’ territory, address specific audiences and, in so doing, compete for supremacy of position among the various disciplines. In the process, the disciplines’ disciples would have us believe that certain truths are more significant than others; indeed, how some are absolute.

This is how science as a discipline (or specific body of knowledge and practices), for example, has come to dominate our contemporary times as the most revered form of knowledge. Indeed, it is held to be the truth of all things for many communities of professionals. Nursing too has been seduced by the authority of science and has been very concerned to define itself as a science in order to augment its authority and prestige. There is also a chapter in this text dedicated to exploring this notion of nursing as a science (Ch 3), and I will not enter this debate directly (although as you read into this chapter you will discover how certain philosophies closely linked with science have influenced and expedited nursing’s development as a science).

Undoubtedly, given the historical epoch in which modern nursing was conceived, much of nursing’s theory and philosophical development has been strongly humanist in orientation. Humanism is perhaps the most influential philosophy of the last 400 years because of the ways it has shaped government, religion, politics and much else besides. Humanism, in a word, posits that human beings are the sovereigns of their kingdom, which is to say, the world as we know it. Human beings are able to claim sovereignty because they, unlike any other member of the animal kingdom, are possessed of an intelligence, which provides the higher order functions such as language and the capacity for rational thought. Unequivocally, humanism posits that the human beings are the rational authors of their own lives because they possess a stable, coherent and self-same identity, which enables their capacity to act purposefully on the world around them to their own benefit (see Johnson, 1994, Lather, 1991, McLaren, 1988, Rogers, 1980 and Weedon, 1997).

Humanism is especially attractive to a profession such as nursing, which clearly has human beings and their interests, needs and wants as the main focus of, and reason for, its very existence. However, humanism is also a gendered philosophy, which again creates problems for nursing’s unproblematic appropriation of it as a defining force in curriculum and practice. Reflect for a moment on the concept of ‘mankind’: why is it that the term for the collective of men and women, of humanity, is gendered male? Why wasn’t humanity collectively called ‘womankind’, for example. Consider how strange to the ear it sounds, and also how unusual it is that ‘mankind’ sounds so seemingly natural. (Wouldn’t ‘humankind’ be so much more appropriate?) As Irigaray reminds us: