The Florence Nightingale Effect - Lovesick, or in love with sick?

Updated on 20th October, 2022

Definition of The Florence Nightingale Effect

The Florence Nightingale Effect is a trope in pop culture where a caregiver develops romantic affection for an individual under their care. Many people know it because it's mentioned in the 11065 flick Back to the Future.

In this movie, Dr. Emmet Brown tells Marty McFly and his mother that her infatuation with Marty’s father likely originates from the care she offered after he fell from a tree. It could be considered the opposite of Stockholm Syndrome – another psychological effect making a captive person fall in love with their captor. In this case, a caregiver is falling for the person they are nurturing back to health. It is important to note that the Florence Nightingale Effect is not a medically recognized syndrome, but a circumstance frequently observed in pop culture and real life.

The nurse with feelings
The nurse with feelings

With this said, there is psychological evidence of its existence. The question remains whether this is a psychological phenomenon or simply a trend that has been blown out of proportion by its use as a plot point in various films and books.

What is the Florence Nightingale Effect?

Outside of pop culture, psychologists have, since the late 19th century, noticed a regularly occurring dynamic involving caregivers developing feelings for those under their care, with these feelings often manifesting after the care has been concluded. It does make some sense – it is easy to see how the attention a caregiver gives to a dependent person could develop over time into something more than a desire to see them well again. It is not controversial to say that a wide range of deep feelings can arise when genuinely caring for someone. Considering this, is it a surprise for those feelings to develop into lust and romance?

The doctor who loves you until you are fine
The doctor who loves you until you are fine

Another common factor observed with the effect is that the attraction tends to disappear once the patient improves. This gives some insight into how and why the attraction develops – telling us that it might be less to do with the patient’s personality or attractiveness, but rather the dynamic between the dependent person and the caregiver. We must now ask ourselves, what elements within this intimate relationship cause these feelings to arise if not from personality or attractiveness?

When this scenario arises, it is essential to consider whether it is ethical for a nurse to lust for a patient. Would you act on it if you had someone under your care who was sick or wounded and noticed you were developing romantic or erotic feelings for them? The answer for most people is: certainly not. That romance might negatively impact the quality of care given to the patient, and there can be questions raised about consent when one of the parties is injured and not in a healthy state of mind. Is it the vulnerability of the patient that causes these feelings to emerge?

Attention of a caregiver develops over time
Attention of a caregiver develops over time

However, there is certainly room for a more lenient interpretation of the Nightingale Effect. In the words of Aristotle:

"With true friendship, friends love each other for their own sake, and they wish good things for each other."

People certainly can’t be blamed for feeling affection towards somebody; it is, after all, something that is typically out of our control. Furthermore, feelings that arise in this circumstance can be explained and empathized with fairly easily. A caregiver who sees their patient being without the skills necessary to take care of themselves might form a deep emotional connection to that individual’s wellbeing and a desire to see them get better. This wish could extend further into a romantic desire as they seek an emotional connection with them. While the ethics of pursuing a relationship with a sick patient is questionable, a person experiencing the effect itself should not be blamed or criticized for harboring such feelings.

Medical professionals have provided these five features that should be present when engaging in a doctor-patient relationship:

1. Communication
If avenues are open for honest discourse, partners will not be inhibited in raising medical concerns, lowering the risk of medical misconduct.

2. Doctor Empathy
The doctor must be able to put themselves in the patient’s shoes to understand their needs and symptoms.

3. Trust
The patient will not feel pressured to raise medical concerns if trust is present.

4. Consent
Informed consent should always be provided, and the patient should be in sound mind when delivering it.

5. Boundaries
The couple must be capable of setting boundaries between their professional and romantic lives.

History of the Florence Nightingale Effect - From Platonic Caregiver to Erotic Namesake Holder

Florence Nightingale (1820 – 1920) is perhaps the most famous nurse in history. Known as “the Lady with the Lamp,” Nightingale was a British aristocrat who traveled to the frontlines of the Crimean War in the 1850s. When she arrived, she was shocked at the lack of hygiene, prevalence of disease, absence of hospice care, and the number of preventable deaths from treatable afflictions. Turning her disgust into action, Nightingale pushed for widescale reforms in the British military – encouraging the use of hygienic waste disposal and clean water provisions.

She also established a network of field hospitals in Crimea to treat injured and sick troops. With all this in mind, why has Nightingale’s name been used for such an effect as romantic and erotic thoughts toward a patient? As far as we know, Nightingale never developed or engaged in romantic relationships with her patients, but it seems the name has stuck. Some observers have argued that her name is used because Nightingale was known for the compassion and (platonic) affection she expressed towards her patients. We will never know whether she would approve of her name being associated with such a salacious phenomenon.

It is sad leaving the patient once cured
It is sad leaving the patient once cured

Case Examples of the Florence Nightingale Effect

Case 1:
Dr. Simon Holmes was a family doctor based in London, UK. Typically, Holmes would only see patients for a short window, whereafter he would prescribe medicine or refer them to a specialist. This small window of opportunity does not afford the time for any such romantic feelings to develop. Rather than developing the effect while practicing at his GP, Holmes took up counseling part-time and took on various patients in this capacity. One of Holmes’ patients was a woman who had recently gone through a divorce. Holmes developed feelings for this woman and acted upon them, with the two getting married shortly after the meeting.

The story of the doctor
The story of the doctor

However, the two did not live happily ever after. It seems that the Florence Nightingale Effect struck Holmes again – this time with a businesswoman who was also a counseling patient. The two began an affair while Holmes was still married, though Holmes shortly divorced the first patient and married the businesswoman six months later. The first patient (Patient A) has recently spoken out against Holmes. She described herself as “clearly vulnerable” and insisted that Holmes had targeted her because of this vulnerability, as she was “ripe for the picking.” However, Holmes defended his actions: "I admit I started a relationship with Patient A when she was a patient, and she left my list, and we continued that relationship. That progressed to marriage over two years, which continued for a further 13 years."

Holmes is arguing that there was no unprofessionalism on his part as he had concluded the medical relationship once the romantic one began. He seems to believe that because the marriage has lasted so long, he is not someone who targets vulnerable women, but rather just a person who developed feelings for people he came across who happened to be patients. However, the fact that Holmes entered relationships with not one, but two of his patients does raise some questions. What do you think?

Case 2:
A doctor who wished to remain anonymous provided his experience of the Florence Nightingale Effect to Medscape. The doctor recounts how, after only seeing the patient on two occasions, he developed strong feelings for her. The doctor was aware of the issues surrounding medical ethics when engaging in such a relationship.

He felt too guilty to say anything to her and decided to cut off the relationship. "I told her she'd have to find another PCP," recalls the doctor. However, the two managed to get back in touch. As of today, they are happily married. In this case, the doctor had a solid moral compass and was aware of the pitfalls that can come with this sort of romance. He acted professionally and selflessly and valued the patient’s wellness over his desires. It seems he need not have taken these precautions, as the feelings were ultimately reciprocated by the patient. Regardless, the doctor made sure not to abuse his position and was karmically rewarded when the two of them reconnected and married.

Case 3:
As the Florence Nightingale Effect is primarily a trope found in pop culture, it would be amiss not to give an example of such. In Edward Scissorhands, Edward is a decrepit loner with no friends who is functionally disabled, as the inventor that made him neglected to give him hands before passing away. As a result, he is left with scissors for hands. Edward is found by Kim’s mother and brought home with her, after which Edward meets Kim. Despite a rocky beginning, Kim begins to warm up to Edward and helps habilitate him into suburban society. She helps him with his everyday tasks and finds avenues for him to succeed with scissors for hands – such as by grooming dogs and cutting bushes.

Kim develops feelings for Edward and ultimately breaks up with her boyfriend, Jim, to be with him. However, this causes a fight between Edward and Jim, wherein Edward accidentally kills Jim. Kim tells the townsfolk that Edward and Jim killed each other, thereby saving Edward from punishment for the crime. Kim never sees Edward again, but it is implied that both continue to love each other. The doomed fate of the relationship could be interpreted as a metaphor for the impossibility of this relationship dynamic. For many reasons, the two partners' differences in power and mindset lead to the destruction of the relationship. Whether this was a point intended by the director is uncertain, but it is certainly interesting to ponder.

Scissor Hands
Scissor Hands

A Beautiful Quote

“Attraction is beyond our will or ideas sometimes.”

- Juliette Binoche

Questions and Answers

What are the top Florence Nightingale quotes?

Florence Nightingale quote 1: I attribute my success to this - I never gave or took any excuse.

Florence Nightingale quote 2: How very little can be done under the spirit of fear.

Florence Nightingale quote 3: The wise and humane management of the patient is the best safeguard against infection.

Florence Nightingale quote 4: I think one's feelings waste themselves in words; they ought all to be distilled into actions which bring results.

Florence Nightingale quote 5: Every nurse ought to be careful to wash her hands very frequently during the day. If her face, too, so much the better.

What is the Florence Nightingale pledge?

I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug.

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