WHY NURSES COMMIT SUICIDE
Mobbing in Health Care Institutions
HEINZ LEYMANN AND ANNEUE GUSTAFSSON
,W HY NURSES C OMMIT SUICIDE
Mobbing in Health Care Institutions
,
,WHY NURSES COMMIT SUICIDE
Mobbing in Health Care Institutions
Heinz Leymann
and
Annelie Gustafsson
Translated by
Sue Baxter
With a Preface by
Kenneth Westhues
General Editor, The Leymann Translation Project
The Edwin Mellen Press
Lewiston'"Queenston• Lampeter
, Library of Congress Cataloging-in-Publication Data
Library of Congress Control Number: 2013955670
Leymann, Heinz.
Why nurses commit suicide : mobbing in health care institutions I Heinz
Leymann, Annelie Gustafsson ; translated by Sue Baxter ; with a preface by
Kenneth Westhues.
1. Medical--administration. 2. Medical--nursing--general. 3. Nursing--
issues. 4. Psychology--suicide. 4. Gustafsson, Annelie. 5. Baxter, Sue.
p.cm.
Includes bibliographical references and index.
ISBN-13: 978-0-7734-0068-9 (hardcover)
ISBN- I 0: 0-7734-0068-0 (hardcover)
I. Title.
hors serie.
A CIP catalog record for this book is available from the British Library.
By permission of the authors and publisher of the original Swedish edition:
Sjtilvmordfabriken: om de stora risker sam sjukskoterskor utstittsfor I arbetslivetl
Heinz Leymann, Annelie Gustatlson, ISBN 91-39-10198-3, Stockholm, Sweden. Svenska:
Norstedts juridik, 1998.
Copyright © 2014 Sue Baxter and Noa Zanolli, literary executors,
estate of Heinz Leymann
All rights reserved. For information contact
The Edwin Mellen Press The Edwin Mellen Press
Box450 Box67
Lewiston, New York Queenston, Ontario
USA 14092-0450 CANADA LOS ILO
The Edwin Mellen Press, Ltd.
Lampeter, Ceredigion, Wales
UNITED KINGDOM SA48 8LT
Printed in the United States of America
,
,
, Table of Contents
Preface. The Leymann Translation Project,
by Kenneth Westhues ........................................................................ v
Authors' Note to Readers outside Sweden, and Dedication .............xiv
Introduction ........................................................................................ 1
Chapter 1. Working Life: A Central Manifestation ofLife ............... .4
Chapter 2. Existing Knowledge about Work-Related Suicides .......... 9
Epidemiological Studies .................................................................... 9
Connection Study I : Situations in Working Life
and Suicide .................................................................................. 14
Connection Study 2: Suicidal Thoughts in Nurses .......................... l 6
Qualitative Experiences ................................................................... 18
The Picture ofMental Strain during Rejection ............................... 21
Permanent Personality Changes as
a Consequence of Extreme Stress ................................................ 24
A Summary of the Existing Knowledge .......................................... 27
Chapter 3. A Presentation of the Research ....................................... 29
Method ............................................................................................. 29
Results ............................................................................................. 33
Chapter 4. A Theoretical Background for our Results ..................... 42
A Phase Model of Mobbing and Elimination Processes,
International Research .................................................................. 44
, iv
A Phase Model According to the Whistleblower Research ........... .47
Attribution Research within Psychology,
Blaming the Victim ...................................................................... 48
Work Environmental Studies within Healthcare
and the Swedish Legislation ......................................................... 56
"Should Be" Situations according to Swedish Law ....................... 57
"Are" Inventories about Nurses ...................................................... 64
SHSTF's Response ......................................................................... 74
NSO's Studies ................................................................................ 77
A Summary and Comparison between "Shou ld Be" and "Is" ........ 88
Chapter 5. Case Studies .................................................................... 90
Introduction ..................................................................................... 90
Sarah's Golgatha - An Occupational-Social Anamnesis .............. 92
Union Handling of a Mobbing Case .............................................. 161
Poorly Treated at the Workplace - Hung Out in the Media ........ l 93
A Discussion Based on the Three Case Studies ............................ 204
\Vhy Suicide? ................................................................................. 213
Chapter 6. Suicide Prevention in Working Life-
a Basis for Discussion ................................................................ 22 1
The National Council on Suicide Prevention ................................ 221
Special Possibilities for Suicide Prevention
in Working Life .......................................................................... 223
The Swedish Regulations and their Shortcomings:
Implementation ........................................................................... 225
Suggestions for Suicide Prevention in Working Life .................... 236
A Final Word About Suicide Prevention ...................................... 247
Appendix. An Exemplary Company Policy
for an Anti-Mobbing Agreement ................................................... 250
Literature ........................................................................................ 255
, Preface
The Leymann Translation Project
Kenneth Westhues
General Editor
Mastery of a scientific field requires reading books by the founding
scientists. Subsequent research may have gone beyond the founders ·
ideas. superseded or even disproven some of them. In pursuit of
knowledge. one rightly climbs up on the shoulders of those who have
stood on the shoulders of giants. Even so, the serious student of
evolution has to read Danvin, of psychoanalys is Freud and Jung, or of
IQ Stern and Binet.
For the field of workplace mobbing, a ll paths lead back to a single
scientist. Heinz Leymann conceptualized and named this distinct form
of collective aggression in 1984, when he was 52 years old, and spent
the remaining fifteen years of his life researching it. By now, ten more
years have passed. The number of specialists in the scientific study of
mobbing is in the hundreds, if not thousands. So is the num ber of
published books and research reports. The word mobbing. defined as
the ganging up of peers and managers against a workmate. is lodged
by now in dozens of languages, also in laws, policies, medical
lexicons, and textbooks of human resource management. All this can
be traced in one way or another to Leymann.
That is why publ ication in English of his main books. which he
wrote and published originally in Swedish. is so important an event.
Its effect is to multiply their prospective readership a hundredfold.
Whoever would understand workplace mobbing, its nature, correlates,
