Symbolic and systemic violence in media representations of aggression towards ambulance personnel in the Netherlands

Symbolic and systemic violence in media representations of aggression towards ambulance personnel in the Netherlands

Nicole Cuijpers and Patrick R. Brown*

Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands


Violence towards public sector employees is perceived as a growing problem in a number of societies, attracting the attention of mass media, politicians and social scientists alike. In this article we discuss how national newspapers have reported aggression towards ambulance workers in the Netherlands. Our analysis is informed by Žižek’s conceptualisations of less visible yet fundamental formats of violence, which he posits as vital for analysing narratives of subjective experiences of aggression. Based on quantitative analysis of newspaper articles describing such incidents between 2000 and 2010, we first provide insight into trends in media coverage. Following this, 121 news stories referring to the six most reported incidents are analysed using a critical discourse framework, paying particular attention to discursive constructs by which certain hegemonic explanations of the events were created and reinforced. Our findings denote a dramatic increase in reporting in the latter half of the decade, with large spikes of media interest around the key incidents. Analysis of central themes in the reporting of these key incidents, especially in terms of explanations and attributions of blame, notes the disproportionate influence of professionals’ narratives, in contrast to those of often-marginalised individuals and groups who were depicted as the perpetrators of violence. This inequality in power is analysed as leading to particular (mis)representations of incidents and the related reproduction of stigmatising and othering discourses within newspaper coverage. Such tendencies in reporting came to centre upon discourses of ethnicity towards the latter part of the decade, reflecting more general tendencies within the Dutch public sphere at this time. We then apply our Žižekian framework to illuminate how subjective narratives of violence are embedded within the reproduction of symbolic and systemic violence. Such understandings of violence have vital implications for policy interventions.

Keywords: Ambulance workers; media discourse; symbolic violence; systemic violence; the Netherlands; Žižekian theory

Citation: Society, Health & Vulnerability.

Copyright: © 2016. Nicole Cuijpers and Patrick R. Brown. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license.

Published: 14 March 2016

Competing interests and funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

*Correspondence to: Patrick R. Brown, University of Amsterdam, Amsterdam, The Netherlands. Email:


In recent years, attention towards aggression1 against public sector employees has increased considerably within mass media reporting, political debate, and indeed in social scientific research. In the Netherlands such violence has become increasingly visible over the past decade, in particular when directed at ambulance nurses (Jacobs, Jans, & Roman, 2009). A large-scale study in 2007 found that 89% of Dutch ambulance workers had been victims of “undesirable behaviour”2 and stated that “there is not much that can be done about it as such incidents to a large extent happen by chance” (Sikkema, Abraham, & Flight, 2007, p. 8). In follow-up investigations, a comparable prevalence was found, alongside a heightened awareness of the issue amongst professionals (Abraham, Flight, & Roorda, 2011; Jacobs et al., 2009). To manage safety under potentially harmful circumstances, early detection and de-escalation strategies have generally been considered vital (Ryan & Maguire, 2006; Wand & Coulson, 2006), while zero tolerance policies have increasingly been advocated as a “quick fix” to restore order (Gabe & Elston, 2008). The Dutch government accordingly launched a national programme in 2007 through which policy-makers called upon public service organisations to take responsibility in limiting such violence and the connected financial and social costs, and to “regain respect” by a stricter enforcement of norms and rules (Rijksoverheid, 2007, p. 1).

Concerning the wider context of this latter policy appeal, it is essential to note that the Dutch government had been striving to instigate a national discussion on “norms and values” since 2002. This topic was put on the political agenda by two new coalition parties, whereby the Christian Democrats (CDA) were keen to (re)establish Christian principles within society, while the more right wing List Pim Fortuyn (LPF) predominantly linked these concerns to perceived failures in creating a multicultural society in the Netherlands (WRR, 2003, p. 19). Because of a widely shared “feeling that social cohesion in […] society was diminishing, [and] trust between citizens mutually and between citizens and the government was declining” (WRR, 2003, p. 19) the Scientific Council for Government Policy (WRR) was consulted for advice on how to recover a nationwide basis of commonly shared values, “amongst other things against the backdrop of cultural differences” (WRR, 2003, p. 9).

Although the intended public debate did not exactly take off as envisioned, Dutch society was increasingly described as troubled and in a state of moral decay, whereby a national investigation in 2008 showed that “norms and values” was the topic Dutch citizens were most concerned about (Dekker, Van der Meer, Schyns, & Steenvoorden, 2009). A common argument was that the national government should take responsibility for resolving this problem by imposing stronger, more restrictive measures and intervening earlier in private affairs such as appropriate parenting (Bijl, Boelhouwer, & Pommer, 2007, p. 304, 305). These debates came to shape news media reporting and sensitivities to particular types of story (Kitzinger, 2004), helping to explain the numerous reports on violent acts against ambulance nurses over the past decade, as will be discussed in later sections of this article.

Most news reports and policy statements regarding these occurrences focus almost exclusively upon the aggressive actions, though often supplementing this with displays of incomprehension and moral condemnation of the unjust actions perpetrated against innocent professionals doing their utmost to provide assistance in emergency situations. However, in order to develop an understanding of such seemingly inexplicable incidents, Žižek argues that “we should learn to step back, to disentangle ourselves from the fascinating lure of this directly visible ‘subjective’ violence, performed by a clearly identifiable agent. We need to perceive the contours of the background which generates such outbursts” (2008, p. 1).

Sensitive to these “background contours,” we consider the representation of violence towards ambulance workers in the main Dutch newspapers from 2000 to 2010 by means of a critical discourse analysis (CDA). CDA is particularly suitable for this purpose as it scrutinizes “dialectical relations between discourse and power, and their effects on other relations within the social process and their elements” (Fairclough, 2010, p. 8). Special attention will be paid to key foci arising within coverage of the topic, discursive constructions used to implicitly strengthen certain explanations, and disparities between different groups’ accounts. We latterly connect this with Žižek’s (2008) three-dimensional conceptualisation of violence, in exploring how the mediatised portrayals of violence are linked to ideology and tend to obfuscate and reproduce existing inequalities in Dutch society.


Both CDA and Žižekian approaches revolve around a critique of ideology, with the aim of raising awareness and creating opportunities for empowerment and change (Fairclough, 1989, 2010, p. 68; Jørgensen & Phillips, 2002; Richardson, 2007; Žižek, 1989). Scrutiny of discursive processes through which inequalities are affirmed and normalised generates knowledge that may be employed for concrete action (Fairclough, 2010; Richardson, 2007; Žižek, 1989). Rationales behind this analytical approach point towards discourse and society being entangled in a dialectical relationship; narratives are influenced by the social contexts in which they are produced, and in turn “influence society via shaping the viewpoint of those who read or otherwise consume them” (Richardson, 2007, p. 37).

Major actors in this regard are the news media, as they supply their consumers with “information, practices, and values […] which transcend their unmediated experience” (Fairclough, 2010, p. 471; Kitzinger, 2004) and have the capacity to affect public opinion as well as political agendas (Richardson, 2007, p. 13). News media not only determine the “newsworthiness” of events, but also influence how they are defined by emphasising or downplaying certain elements (Richardson, 2007), consequentially suggesting directions of explanation and accountability (Alaszewski & Brown, 2012, p. 224–226). This influence is not unidirectional however, but part of an intricate web of actors that mutually influence each other (Fairclough, 1995).

Although news is often presented as neutral, objective information, it “is not a natural phenomenon emerging straight from ‘reality’, but a product” (Richardson, 2007, p. 222) that is usually communicated in a way that appeals to the sentiments and anxieties of a target audience in order to enhance sales in an increasingly competitive market (Richardson, 2007; Van de Donk, Broeders, & Hoefnagel, 2005). To procure attention and justify continuation of media coverage, references are often made between different incidents or news reports (Fairclough, 2010, p. 469), thus simultaneously creating the impression of ever-increasing problems (Best, 1999; Vasterman, 2005). Since more powerful groups in society have better access to the media and are their main public, it is generally their ideologically-hegemonic perspective that is reflected in these “problems” (Van Dijk, 1996): “The under-acknowledged ideological role of the media is the manner in which it serves as a system […] that presents [existing forms of social organisation] […] as society’s natural backdrop” (Taylor, 2010, p. 57).

Grounded in a different ontological framework, Žižek goes further to argue that “it is […] reality itself which is to be conceived as ideological” (Žižek, 1989, p. 21). From this perspective he argues that the influence of media on consciousness is so pervasive that it comes to “render reality indistinguishable from the ‘aestheticized’ image of it” (Žižek, 1994, p. 15). The methodological and analytical implications of this understanding are that we not only need to interrogate the ways in which social phenomena, such as violence, are narrated but to develop deeper analyses of the dynamics by which such phenomena arise (1989, p. 125). Hence the utility of Žižek’s (2008) three-dimensional approach to violence.

In the analysis below our main emphasis is on discourse analysis—which CDA and Žižek both acknowledge as a crucial component of ideological critique (Fairclough, 2010, p. 78, 79; Žižek, 1989, p. 125). In the discussion we develop the understandings emerging from this towards a consideration of the broader socio-political context and the ideological structures in which diverse formats of violence may be detected in various degrees of explicitness.


A range of contrasting perspectives towards violence is invoked across different academic disciplines, though a tendency exists towards narrow foci rather than broader interdisciplinary debate (Schinkel, 2010, p. 3, 4). Divergent understandings are apparent regarding which behaviours might be bracketed as aggression or violence, resulting in differing accounts of how acts defined as such are politicised (Stanko, 2003; Waddington, Badger, & Bull, 2005). In order to make sense of the ostensibly senseless violence that often prevails in media coverage (Taylor, 2010; Žižek, 2008), Žižek argues that attention should not be limited to the more tangible subjective violence, which refers to harmful acts carried out by a clearly identifiable agent (Žižek, 2008, p. 1). Such “explosions of ontic violence” (Žižek, 2008, p. 60) are inextricably linked to other formats of violence which are intrinsic to the state of affairs when society is perceived as normal and peaceful (Žižek, 2008, p. 2). These other dimensions of violence, however, are usually overlooked as they are “largely invisible to the ideologically acclimatized eye” (Taylor, 2010, p. 122).

One of these key formats—symbolic violence—denotes the “imposition of a certain universe of meaning” (Žižek, 2008, p. 1) via communicative acts, which inevitably result in incomplete representations of reality, and which always carry particular connotations in various degrees of explicitness (Žižek, 2008, p. 51). The other key format—systemic violence—(Žižek, 2008, p. 1) takes shape through coercive and oppressive structural inequalities connected to the functioning of economic and political systems (Taylor, 2010, p. 121, 122; Žižek, 2008, p. 1). As a consequence of the unequal distribution of resources and opportunities, (often latent) tensions arise between peoples’ membership of a universal humanity on the one hand and of more privileged or marginalised groups on the other (Žižek, 2008, p. 134). The insidious pervasiveness of both symbolic and systemic violence necessitates a heightened awareness towards such figurative undercurrents in society, of which the more perceptible subjective violence is merely the symptomatic manifestation (Taylor, 2012; Žižek, 2008).

Žižek draws our attention not only to these other dimensions of violence, but also to the public expressions of outrage which regularly accompany mediated images of subjective aggression and often culminate in moral demands for immediate action. This is treacherous, he states, because those in advantaged positions often use such situations as a chance to profile themselves positively, while further obscuring the background contours of such incidents and ignoring their role in sustaining the harsh, unequal reality outside their secluded worlds (Taylor, 2010, p. 131; Žižek, 2008). In order to avoid ignoring the fundamental roots of aggressive outbursts, Žižek pleads for a slower, more critical analysis instead of knee-jerk reactions and policy-making (2008, p. 5–7; see also Lodge & Hood, 2002). The study presented below aims at such an analysis.


Within our study we have specifically scrutinised conceptualisations within the printed media, and focused on the six principal national newspapers in the Netherlands: AD/Algemeen Dagblad, NRC Handelsblad, Het Parool, De Telegraaf, Trouw and de Volkskrant, thus covering a range of influential perspectives. To consider fluctuations in attention to aggression against ambulance nurses, our overall selection included all relevant articles that appeared in the period 1 January 2000 to 31 December 2010. By using both quantitative and qualitative approaches we sought to enhance internal validity of our analysis, while the resulting combination of methods also enabled the different “standpoints” necessary to analyse violence across Žižek’s three formats (2008, p. 2).

First, to develop insights into trends in reporting, the online database LexisNexis was used to retrieve all newspaper articles in which mention was made of aggression against ambulance workers. Search terms were designed to include diverse wordings denoting ambulance personnel and aggressive acts, in various compositions and conjugations. The resulting sample consisted of 749 articles which were coded numerically and entered into SPSS under the following variables: newspaper; date; page; number of words; incident to which the article was connected (if relevant); main theme; subtheme(s); voice(s) represented; kind of violence reported; reference(s) made to other articles or incidents (if relevant).

These quantifications then formed the basis for the qualitative analysis which was focused on a subsample of newspaper articles. To this end we established which incidents have been used as “narrative schemas” or “templates” (Fairclough, 2010) by comparing them in terms of the number of articles they evoked and the number of references made to them. Of the six incidents that accordingly emerged as most prominent, we collected all newspaper articles that reported on them. The resulting subsample, consisting of 121 articles (see Table I below), was individually scrutinised and coded in Atlas.ti (qualitative data analysis software) utilising a CDA framework. Within these articles, text fragments and words used to describe victims, perpetrators, actions, or to offer explanations or references were marked and assigned codes. These were compared to discern core themes and then categorised and connected in network schemes concerning content and discourse, so that not only their literal messages were grasped but also more implicit meanings.

Table I.  Salient events, date of occurrence, number of articles, references, and average number of words.
Date of incident Incident Articles focusing on incident Articles considering incident alongside other topics Later articles making retrospective references Average number of words of articles focusing on incident
07-12-2003 I 12 2 9 301
30-04-2006 II 6 10 8 187
12-06-2006 III 5 12 31 215
02-07-2006 IV 7 1 11 246
01-10-2006 V 18 9 19 269
03-09-2008 VI 22 17 46 461

We developed an initial linguistic analysis (Fairclough, 1995, p. 53–68) to discern which suggestions were made concerning reason(s) for the subjective violence, either explicitly or by calling attention to particular aspects through composition of the text and/or (repeatedly) using certain wording. We then progressed to analyse how these suggestions were (implicitly) reinforced by the use of particular rhetoric and/or the creation of linkages to other incidents or articles. With this last step we have supplemented the more descriptive part of our study with an intertextual analysis (Fairclough, 1995, p. 53–68). This also formed the basis for the final part of our study, in which we established which actors were granted a voice in the articles, either by illuminating the occurrences from their point of view, or by quoting them, and whose “claims” were thus communicated (Best, 1999). Before discussing the findings of our discourse analysis, and eventually linking them with ideology and the wider socio-political context, the broad dimensions of our descriptive statistical analysis of media attention for the topic will be described.


Growing media attention over the decade

The descriptive statistical analysis of our quantitative data underpins our wider analysis. Thematic analyses on their own would tell us little about the relative concern or neglect of this phenomenon within media reporting, especially as this varied over time. This broader context leads us to focus on certain peaks of heightened media attention on specific incidents within our sampling approach for the latter thematic and discourse analyses.

Between January 2000 and December 2010 the mainstream newspapers in the Netherlands published a total of 749 newspaper articles that referred to aggressive behaviour against ambulance personnel.3 Figure 1 helps visualise fluctuations in attention during this period. What is immediately evident from this overview is the large variation in coverage; only 55 articles (7.3%) were published during the first half of the decade. As time passed, newspapers increasingly reported on occurrences of aggression against ambulance workers and regularly suggested that such incidents were getting more frequent and severe. Although questions may be raised as to whether such statements reflected the actual experiences of ambulance nurses (Bakhuys Roozeboom, Koningsveld, & Van den Bossche, 2010; Dekker et al., 2009, p. 180), it is indisputable that media attention for the topic rose considerably.

Fig 1
Figure 1.  Coverage of aggression against ambulance personnel by the six main Dutch newspapers: Number of articles per quarter, 2000–2010 (letters and roman numerals refer to specific incidents—see main text for more information).

Figure 1 depicts articles that covered specific occurrences of aggression, but also those that were more generally related to aggression against ambulance personnel. Yet most peaks in the frequency polygon can be traced to six particular incidents: to an aggressive situation after an infant girl choked on a peanut (I); to an assault on ambulance workers on their way to attend an injured person (II); to an event that occurred after a young man had lost consciousness in a swimming pool (III); and to one that took place when a man suffered a heart attack (IV). The next occurrence (V), where a crowd was said to have blocked and attacked an ambulance, was emphatically referred to as representing the nadir of societal decay. The event which aroused most media attention however took place in September 2008, when ambulance nurses were reported to have had their lives threatened when they tried to assist a young man who had been stabbed (VI).

Additionally, from January 2007 onwards a peak can be observed every first month of the year, which signifies a recurrent array of articles around the celebration of New Year’s Eve (A, B, C, D). By broadening the problem definition (Best, 1999; Vasterman, 2005), aggressive behaviour against ambulance nurses was homogenised with aggression encountered by other public sector employees on New Year’s Eve, such as policemen and fire fighters. This not only resulted in increased attention before and after each subsequent New Year, but also caused general coverage on the topic in 2009 and 2010 to remain higher than before, which was further elevated by increased reporting on prosecutions following such incidents.

Dominant explanations of the aggressive occurrences within newspaper accounts

The 121 articles that covered the six most often-reported incidents—see Table I—have been further analysed concerning content and rhetoric.

Many articles on the events in our subsample contained clear attributions, with certain causal connections receiving particular emphasis. Of those reports where causality was inferred (64% presented an explanation or strongly implied one), commonly recurring themes are described below:


Newspaper accounts of event I, involving an infant choking on a peanut, predominantly portrayed aggressive behaviour as having been caused by unjust demands for faster support:

The fifteen month old Yasemin Sak choked on a peanut on Sunday evening. At 20.30 the emergency number 112 was called. The call reached patient transport service VZA at 20.33. The first ambulance arrived nine minutes later, at 20.42, another one followed two minutes later […] The norm is that ambulances must be present within thirteen minutes […] The ambulances were being waited for by a furious multitude of some hundred residents. They considered the ambulances to be too late [in arriving]4 (NRC, 15 December 2003—emphasis added).

Similarly regarding incident IV, the aggression which ambulance personnel experienced when they tried to help a “Turkish”5 man who had suffered a heart attack, was portrayed as predominantly stemming from impatience. “Seven minutes waiting appeared too long; Family threatens ambulance” (Het Parool, 3 July 2006—emphasis added) ran the headline of the first article reporting the event, and coverage denoted:

The family members were aggressive against the GGD-personnel because they had the opinion that the ambulance made them wait too long. There were also threats uttered and the ambulance was damaged. The ambulance arrived in seven minutes. This is amply within the norm (Het Parool, 3 July 2006—emphasis added).


In articles referring to event II no causal attribution was established and in most cases emphasis was placed upon the arbitrariness of the incident:

Ambulance nurses who were […] on their way to a wounded patient, have been threatened and abused by a group of men whom the healthcare workers randomly encountered on their route. The five still unknown men lunged towards the ambulance from out of nowhere and for no reason, and forced it to stop. Immediately they started to pound the car while scolding (De Telegraaf, 1 May 2006—emphasis added).

About 6 months later, some articles reporting the prosecutions of the aggressors contained further information; that of a person’s foot having been reversed over by the back wheel of the ambulance, hence why some men had banged on the side of the vehicle. Due to the general absence of these details however, the occurrence was commonly described as an example of “senseless public aggression.”

Alcohol intoxication

Most articles on event III in June 2006 drew attention to excessive drinking as an explanation: The influence of alcohol was emphasised by recurrent references to the aggressors as either “drunken youth” or “drunken boys.”

On Monday afternoon a group of twenty drunken boys threatened a doctor and ambulance personnel in the De Miranda swimming pool in Amsterdam. They also damaged an ambulance. […] As soon as the ambulance arrived an aggressive atmosphere arose. The boys tried to prevent their friend being helped […] (de Volkskrant, 14 June 2006—emphasis added).

In October of that same year, ambulance personnel were reported as having been attacked again (event V). Most of the newspapers described the environment where the incident had occurred as a “nightlife area,” also referred to as a “high-risk-area” where the potential for danger was suggested to be significantly higher than in other locales because of excessive alcohol consumption. Besides this, some articles defined the aggressors as “pub-goers.”

In the course of Saturday night […] two police officers were injured in a nightlife area in Vlaardingen, after ambulance workers had called upon the police because they felt threatened. […] For still unknown reasons the nurses were entrapped by angry bystanders and had the windows of their ambulance kicked in (Trouw, 2 October 2006—emphasis added).

Lack of respect

Two years later a further incident unfolded (VI): When ambulance workers arrived at the scene where a young man had been stabbed, they were reported to have been threatened by “Moroccan boys” who said that they would kill them if he did not survive. In relation to this incident a nurse was quoted as saying:

We can handle aggressive behaviour, but this is simply indecent. We can no longer go to that neighbourhood to do our job. A small group in Amsterdam-West think they can do whatever they want. They no longer have any respect for healthcare workers (de Volkskrant, 5 September 2008—emphasis added).

This statement was typical of many of the causal connections attributed through newspaper coverage around this incident.

Discursive patterns employed to strengthen particular suggestions

The more general explanatory themes as outlined above were, of course, far from essential characteristics of the incidents. They were put forward and strengthened by employing specific rhetoric, thus strategically steering moral judgements on the issue (Fairclough, 2010, p. 389). Below we move to explore how the aforementioned themes were constructed and—largely implicitly—applied as fundamental frames within the newspaper coverage.

Impatience portrayed as stemming from an inappropriate attitude

In the reporting on event I, the aggressors were repeatedly described as “angry,” “furious,” or “enraged.” These depictions involved suggestions that those described as the perpetrators “had the idea,” “thought,” or “had the opinion” that the ambulance arrived too late. While the newspapers might equally have mentioned feelings experienced by the little girl’s family (e.g. despair), the aggressors’ actions were instead usually suggested to have been rooted in inappropriate attitudes. In order to prevent such occurrences in the future, it was suggested that a meeting would be organised by the district council “to inform people with strange ideas in their heads and inferior knowledge” (Het Parool, 7 April 2004—emphasis added) about the procedures of the ambulance services.

Also regarding incident IV, the actions of the perpetrators were associated with unjust demands. One article for instance stated: “A patient dies because the doctor arrives too late to the taste of the family” (De Telegraaf, 4 July 2006—emphasis added). Only one report mentioned how panic and language-barriers had hampered the emergency call, which caused the ambulance to be dispatched later than usual. Moreover newspaper articles tended not to explain that the response time was calculated from the moment of dispatch, hence understandings of the aggressive happenings were reduced to the misguided impatience of a “Turkish” family.

Misbehaviour defined through ethnicity

The white-Dutch aggressors involved in incidents II and V were often depicted in terms such as “vandals,” “ambulance-vandals,” “troublemakers,” or “rioters”; with their acts described as “rebellion,” “riots,” or more specifically as an “ambulance-riot.” The use of such phrasings implied that these actors transgressed social rules in a state of anomie, as generally associated with aggression enacted for thrill and entertainment (Collins, 2008, p. 242–281). Specific characteristics of these groups were not problematised, instead attributing the occurrences to broader considerations of decadent society and human nature.

In contrast, the first article that reported on event III, which involved “Moroccan” aggressors, incorporated the term “terror” in its headline (Het Parool, 13 June 2006) and most newspaper accounts attributed the aggression to their specific community and background, implying that “Moroccan boys” often behaved badly. This was, for instance, hinted at by references to these young men being “problem boys of Moroccan descent,” “tormentors,” “a difficult group,” alongside broader references to “problem-youth,” “anti-social,” “the neighbourhood-gang,” “a rabble.”

In media coverage around event VI the “Moroccan” identity of the aggressors was presented as a defining topic, which was given extra impetus when several newspapers reported that the Amsterdam mayor had declared that “it is mainly about our Moroccan fellow citizens” (Trouw, 5 September 2008), also reproduced as; “in many cases it is about Moroccan youngsters” (NRC and De Telegraaf, 5 September 2008) or; “in many cases Moroccans are involved” (de Volkskrant 9 September 2008). Whereas “our Moroccan fellow citizens” seemed to imply that “although they are misbehaving, they are part of our in-group,” there is a more emphatic suggestion of “outsiders” in the other two quotations, due to the emphasis on non-Dutch ethnicity and the omission of references to membership of Dutch society.

Several articles covering other topics referred back to these incidents of aggression against ambulance nurses as part of a wider emphasis of repeated displays of bad behaviour by young “Moroccans” and employed headings such as: “Keep addressing anti-socials on their behaviour” (Trouw, 9 September 2008); “Approach for Moroccan criminals has to hurt” (de Volkskrant, 16 September 2008); “The problem is called Moroccan youth” (de Volkskrant, 26 September 2008); “Problem-Moroccans: Time for solutions” (Het Parool, 17 October 2008). These phrases seem relatively unambiguous: young “Moroccans” were not only regularly referred to as causing problems, they were moreover suggested to be the problem, for which their cultural background was the suggested explanation.

Contrasting legitimations of different accounts

Quotes and indirect speech reproductions are an essential ingredient of newspaper reports and are often utilised to strengthen and enliven media narratives (Fairclough, 1995). Below we discuss how this was employed in the articles in our subsample.

Dominant voices increasingly making demands for tougher measures

In order to support suggestions that aggression against ambulance nurses was an ever-increasing problem, many articles referred back to previous incidents or specific newspaper articles. That this tendency was highly influential became particularly clear in the coverage of incident V. An investigation into the incident was ordered by the mayor and retrospectively concluded that the ambulance workers had not really been threatened: “Incorrect police report cause of hype: Anxiety around molestation of ambulance personnel based on misunderstanding” (de Volkskrant headline, 1 November 2006). Yet despite these findings, later articles continued to refer to this event to support claims that aggression against care workers was on the rise (De Telegraaf, 30 November 2007; AD, January 2008; NRC, 5 September 2008). Further legitimation of such statements was gained by incorporating numerous quotes from managers and other spokespersons of the ambulance services, affirming the impact of this detrimental development on ambulance workers.

Linked to the suggestion of a growing problem, several reports suggested that the perpetrators were acting with impunity because the police were not firm enough and the government was not taking sufficient action. This was predominantly substantiated by the publication of letters to the editor, which often held such incidents as indicative for the moral demise of Dutch society and claimed that the public authorities were too “soft” in countering the problem. In further stating the case for a more punitive approach, several articles on incident IV, for instance, reported that the mayor intended to personally visit the ambulance nurses in order to persuade them to report the incident to the police. It was suggested they did not dare to do this out of fear for reprisals, thus accentuating the potentially violent nature of the aggressors.

This line of argumentation came to a climax in the coverage around event V, in reaction to quotes in which a representative of the trade union demanded that ambulance workers should be better protected. Whereas national politicians had previously been absent in newspaper reports on the issue, several were now quoted condemning the aggressive behaviour with decisive pronouncements such as; “severe measures are needed” (member of parliament; AD, 2 October 2006), “the first blow is half the battle” (member of parliament; De Telegraaf, 3 October 2006), “violence against ambulance personnel is unacceptable” (Minister of Internal Affairs; AD, 3 October 2006). Increasingly tougher punishments were being called for in the newspapers, invoking rather novel terms such as “rapid-jurisdiction”6 and “immediate-judicial-reply”7. The populist political rhetoric that was thus incorporated in the media can be seen as a response to, while also validating, the newspapers’ conceptualisations of the aggressors and their motives.

In the latter years of the decade under study, a particular phrase—initially uttered by a borough-council chairman in relation to event I—would become repeated with growing intensity: “Keep your paws off our healthcare workers”8 (Het Parool, 13 December 2003). This phrase carries a specific connotation—one of bestial limbs—thus portraying “the other” as uncivilised or even sub-human. Additionally, “our healthcare workers” re-affirmed the in-group through a collectively shared identity (Douglas, 1992). In connection to event VI, articles quoting the Amsterdam mayor mentioned a similar expression, though with slight differences; “keep your paws off personnel of the public authorities” (de Volkskrant, NRC, 5 September 2009), “keep your paws off people from the public authorities” (AD, 5 September 2009), “keep your paws off our people” (De Telegraaf, 5 September 2009). Although most articles did not specify who was being addressed, one of the newspapers left little doubt by reconfiguring the utterance as: “Moroccan boys must keep their hands off public service employees” (NRC, 9 September 2008).

Effective punishment was advocated to tackle this problem, alongside interventions on parenting. Journalists argued, for example, that the “Moroccan” community had to be addressed “to teach their youngsters manners” (AD, 5 September 2008), and needed “first aid in upbringing” (de Volkskrant, 5 September 2008). Other articles stated: “Punishment helps. Upbringing helps too” (de Volkskrant, 13 September 2008), and white-Dutch parents were called upon to help their Dutch–Moroccan neighbours because “otherwise they will never learn to raise their children the way the mayor wants it” (NRC, 17 October 2008). Anxieties regarding a general deterioration of societal “norms and values” were gradually being reconfigured therefore, with blame reoriented towards those of “Moroccan” heritage.

Marginalised accounts of those designated as the perpetrators

The voices of the apparent perpetrators of the violent episodes were largely disregarded in the media reporting (as is also reflected in the length of this sub-section). In the coverage of incident I that occurred in 2003—involving the infant choking on a peanut—a lot of attention was devoted to the question of whether the ambulance had arrived in time. Although two of the articles also offered a glimpse of the families’ despair and the corresponding experience of time as seemingly decelerating while waiting for help, most reports prioritised statements of the Public Prosecution Service stipulating that the ambulance had arrived in good time at the place of the accident, for example by employing headlines such as “Ambulance for Yasemin not too late” (AD, 7 April 2004); “Public Prosecution Service satisfied” (Het Parool, 7 April 2004); “Ambulance did not arrive too late for baby” (Trouw, 7 April 2004). Thus, the officially agreed upon chronology was legitimised over the relatives’ experiences that it had been too late to save their daughter’s life. Symbolic violence connected to the representation of the family and community as irrational and impatient (see earlier section) thus predominated, rooted in systemic inequality and a related lack of legitimacy of the claims of these citizens from a marginalised social group. Also within newspaper coverage on subsequent incidents, the apparent perpetrators’ perspectives and voices were only marginally present. The brief quotations of the designated aggressors in referring to discrimination (event III), or subordination (event IV) were not legitimised within the general emphases of the newspaper articles.

The line of reporting on incident VI reflects a similar symbolic violence rooted in systemic violence: The day after the incident took place, the “aggressor” offered a distinctly apologetic account during an interview on local television. Indicating that he could not remember having uttered threats as he had been very emotional out of fear that his younger brother might die, he nevertheless affirmed: “But if I said all of that, then I am sorry and I offer my apologies,” as all newspapers quoted. Although the young man thus presented himself in keeping with the values of mainstream society, no subsequent attention was given to his apologies and media discourse continued as before; portraying him (and other “Moroccan boys”) as deviant. The symbolic violence experienced by the young man due to the skewed media representations of the event was captured in one article, which quoted him as saying that “now the story has turned around. Now suddenly I am the perpetrator […]. In the newspapers only a few lines have been written on the stabbing. The rest of the articles are devoted to the ambulance nurses. The things that really matter are not covered by the newspapers” (Het Parool, 6 September 2008).


The three layers of Žižek’s (2008) conceptualisation of violence that were neatly captured in this last quote can be detected in many media representations of aggression towards ambulance personnel included in our study. Subjective violence—enacted by a clearly identifiable actor—was the narrow focus around which the six main Dutch newspapers sought to create a “fascinating lure” (Žižek, 2008, p. 1) by: (1) focusing on the injustice done to the ambulance nurses, thereby implicitly categorising other elements such as the stabbing of a young man, the choking of a little girl, a man suffering a heart attack, and so on, as less newsworthy and consequentially less important; (2) repeatedly claiming that the situation was worsening, as substantiated through the incorporation of quotes or letters to the editor making this assertion, numerous references to previous incidents or articles, and merging aggression against ambulance personnel with that against other public sector employees; (3) employing narrative schemas, which in some instances appeared to be so powerful that they were adhered to regardless of cases—as occurred in relation to incident V, where references to initial media accounts continued to be made despite official conclusions that the claims regarding aggression had been incorrectly made, and event VI, where the newspapers predominantly adhered to a “bad parenting” frame and neglected the public apologies offered. Although more palpable aggression (subjective violence) was foregrounded within all newspaper articles in our subsample, Žižek’s other two formats were made apparent within our discourse analysis.

Symbolic violence—perpetuated through the use of language alongside selective and pejorative representations of particular actors or actions (Žižek, 2008)—was apparent in descriptions of the six most reported incidents. In some instances newspaper articles placed emphasis upon language denoting anger, instead of other emotions such as despair or frustration. In these cases aggressive behaviour was implied to stem from irrational impatience linked to inappropriate attitudes and limited knowledge, or from a lack of respect connected to deficits in upbringing and cultural background. In contrast, newspaper reports on incidents involving white-Dutch youths downplayed agency and parenting by emphasising the influence of alcohol and by employing loose definitions of senseless aggression. Rhetorical devices and (subtle) variations in connotation were accordingly used to reinforce such ethnic differences. Whereas some actions were described as “riots” or anomic “rebellion” amidst a problematic society, others were depicted as “terror,” and while some actors were labelled as mindless “vandals,” others were called “tormentors” or “problem-youth.”

These selective and divergent depictions can in turn be seen as interwoven with and rooted in systemic violence (Žižek, 2008, p. 1)—whereby the claims of the more powerful professional or political groups were regularly reported and legitimated while the accounts of the more marginalised were neglected and usually discounted. This format was particularly visible through the varying attention and legitimacy given to different accounts of blame attribution, in that occurrences in which white-Dutch aggressors were involved were predominantly discussed to underline suggestions that the general societal situation was worsening, and tougher (zero-tolerance) policy-interventions were urgently needed. Incidents in which Dutch–Turkish or Dutch–Moroccan aggressors were involved were not only implied as more severe, but also attributed to their cultural background, thus simultaneously building upon and reinforcing group stigmas around these marginalised groups, while “the things that really mattered” for these groups remained largely overlooked. The voices of more powerful groups in society were therefore privileged in the media, for example in the attention given to the perspective of the Public Prosecution Services, whose statement that the ambulance had arrived in good time during incident I, was legitimised over the family’s anguish that it had been too late to save their daughter’s life. Spokespersons of the ambulance services and the political system were given a defining voice within newspaper accounts, thus further disenfranchising the already disadvantaged.

A critical analysis of discourse, as applied in our study, is advocated by Fairclough through its contribution to “a political strategy and movement to ensure that the social transformations […] address the fundamental problems and dangers facing us which neo-liberal capitalism has either failed adequately to address or contributed to exacerbating” (2010, p. 21). Building on this approach, our Žižekian (2008) framework has assisted in disentangling three formats of violence—enabling a more critical consideration of dominant claims that severer punishments were urgently needed. The increase in media accounts on violence against paramedics appeared to affirm the validity of such demands, while also reproducing a publicly shared impression of decadent “norms and values.” As the decade progressed, the increasing targeting of blame towards already marginalised groups, especially the Dutch–Moroccan and Dutch–Turkish communities, involved the more or less conscious manipulation of existing concerns to gain the support of the Dutch population and to obscure professionals’ own roles within problematic interactions.

In legitimating the selective and stigmatising (symbolically violent) media accounts of violence, for example in terms of dysfunctional minority-ethnic young men and parenting, policies focused on zero tolerance and tougher sanctions may merely serve to perpetuate symbolic and systemic violence, in turn potentially contributing towards greater levels of subjective violence in the future. An alternative approach, informed by our three-layered analysis of violence, would instead be framed by consideration of the deeper layers of violence which underpin more tangible manifestations of aggression. This would ward against “knee-jerk” approaches (Lodge & Hood, 2002) and lead to a more multi-dimensional approach to reducing experiences of aggression—in terms of interactional awareness, tackling symbolic violence and stigma, alongside policies addressing deeper forms of inequality and exclusion in society.

An approach following Žižek’s more Lacan-oriented work would go further still—although very different research methods than those employed here would be needed to explore these further layers of ideological structure. Such a critique of ideological processes would not only require a deconstruction of the discursive but, moreover, an interrogation of “the kernel of enjoyment” and desire implicit within any ideological regime (Žižek, 1989, p. 125). From this perspective, representations in which “others” are blamed for the disruptive occurrences, inadvertently serves to keep the fantasy alive that something approaching a perfectly united and harmonious Dutch society might be possible, if only Dutch–Moroccan and Dutch–Turkish groups would fully integrate into Dutch society and raise their children correctly. These representations would also be understood as concealing that “society doesn’t exist” (Žižek, 1989, p. 125); that this is also mere fantasy. The appeal of such fantasies may become heightened during periods of growing inequality and reduced social cohesion, rendering their warping effects upon media reporting and policy-making all the more insidious and therefore in need of interrogation.


The authors are grateful to Rineke van Daalen for her insightful input during the research phase, as well as to Christian Bröer and the anonymous reviewers for their constructive comments on earlier drafts.


1. The terms aggression and violence are used interchangeably because in most literature no clear distinction is made between the two, although violence has been given a more abstract connotation by some.

2. Undesirable behaviour was defined as verbal aggression, physical aggression, discrimination, and bullying.

3. A total of 61 specific incidents were covered.

4. Paragraphs and single words quoted from Dutch newspapers are given here as translations carried out by the authors.

5. In the indication of the actors that were involved, we have not been able to circumvent denominations commonly used in the Netherlands, such as “Turkish,” “Moroccan.” We consider these phrasings incorrect representations that consequentially taint interpretations by suggesting that the indicated persons were “outsiders,” whereas most of them were born and raised in the Netherlands. To acknowledge the emic nature of these terms within the Findings section, we use quotation marks when applying them, except when quoting phrasings verbatim from newspaper articles.

6. In Dutch: “snelrecht.”

7. In Dutch: “lik-op-stuk.”

8. In Dutch: “blijf met je poten van onze hulpverleners af.”


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About The Authors

Nicole Cuijpers
University of Amsterdam

Patrick R. Brown
University of Amsterdam

Assistant Professor, University of Amsterdam

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