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Abstract
In health research, the concept of risk is used in several domains. It features in epidemiology and health promotion as well as in the sociology and anthropology of health and illness. Important problems are embedded in risk as an analytic category, and some of these are widely discussed within the discipline. First, risk cuts out the experience of illness and replaces it with problematic objectifications. Second, there are a multitude of different meanings assigned to risk which make it problematic as an analytic category. Third, the question of uncertainty has, along with the discourse of risk, attained a solely normative meaning of threat, or has become a residual category in anthropology and social science. Fourth, the individualizing character of the concept of risk eclipses the collective, historical, social and political processes that contribute to the uncertainties of life. Departing from the methodological approach to ‘social suffering,’ this paper will argue through two ethnographic studies that normative and individualizing assumptions lead social studies to overlook the way that local actors, rather than narrowly controlling contingency, may engage in it and live with it as a normal experience of human life. Along with risk, there are variations in local attitudes to uncertainty and there are socially shared ways of accounting for and acting with it. A major challenge for social studies is to embrace the need for the development and implementation of a neutral, non-normative language of contingency. The paradigm of social suffering enables a broader perspective to be brought to bear upon the lived experience of affliction and illness so as to expose a greater variation in human responses to the distress of everyday life.
Notes
1 The interdisciplinary research project Expressions of suffering—ethnographies of illness experience in contemporary Finnish contexts (The Academy of Finland 1999 – 2004). This studies illness experiences and their representations as cultural questions (see http://medanthro.kaapeli.fi for more details, and also Honkasalo et al. 2004).
2 The verb saada in Finnish means literally to receive or to get, and it is regularly used with illnesses as an alternative for the verb to have (e.g. I had got a cold, I had got a heart attack). This was something we often laughed about with the informants, why do we say that people received a heart attack?
3 About non-being, see Barth 1919/1968, notably Heidegger Citation1927/1962.
4 de Martino (1908 – 1965) was a historian of religion by training. Currently, de Martino is regarded as a founding father of Italian anthropology and his work has stimulated a whole generation of studies, or even more, in cultural anthropology, folklore studies and the history of religion, focusing on marginalized people in Mezzogiorno but also more generally among the marginalized in Italy. Only one of his ethnographic works is translated for the English speaking audience, but there are some good reviews available in English (Saunders Citation1993, see also Pandolfi Citation1991).
5 de Martino Citation1958, 3, il rischio di non esserci. The other side of non-esserci is the state of nothingness, or non-being. For him, the threat of non-being is an essential content of human suffering.
6 Argument from contingency, see e.g. Russel (Citation1957).
7 Diaspora is an emic term for the description of the North Karelian social change, launched by Siiri Mekri, a teacher, in the local newspaper Pogostan Sanomat in 1964.
8 A large part of Finnish Karelia was ceded to the Soviet Union after the Second World War. The ceded area in Karelia comprised 10% of the country and 12% of its population. All Finns were evacuated from the area into other parts of Finland but for decades a national meta-narrative of loss and sorrow prevailed. It would be difficult to understand the culture of illness in North Karelia without taking this history into account.
9 A pseudonym. I have changed all data that could reveal identity.
10 There was a striking difference between the everyday theories of cancer, connoting stigma and shame, and those of heart disease.
11 A great part of the population consists of Russian Orthodox. In several of their rituals, food and eating together have a significant role.
12 Women's organizations, most of all the Martha Association, were active in the implementation of the project's aims. Without their contribution, the project would not have succeeded. The Martha Organization for Finnish women is over 100 years old and its social aims were tightly bound with the emerging Finnish nation state. The first pioneers were middle class women and they focused their interests on family life. To have a competent mother in a clean home was a building block for a proper society (see Marakowitz Citation1993). The Martha Organization was an important part of the construction of civil society, especially among middle class married women. In rural areas such as North Karelia, farmer's wives were also active Marthas.
13 A note from the chronicles of The North Karelian Marthas.
14 I define ritual practice according to de Martino (Citation1959: 89 – 97), as symbolic practice with the aim of protecting people and maintaining their presence and agency in the world.
15 In Finland, the suicide rate among men has been one of the highest in Europe, as is that of heart disease mortality. Since the 1960s, the suicide rate has shown an increasing trend. A typical feature of Finnish suicide is the high mortality rate among young men (below 35 years of age) and thus the absence of a linear correlation between mortality and age, as is the case in most other countries. Finnish women's suicide rates have been at the mean level of European countries. The WHO and the Finnish Ministry of Health and Social Affairs defined suicide as a major public health concern in their local programmes. In the late 1980s, a special research and prevention programme was launched along with the WHO programme Health for All by 2000. By detecting various risk or exposing factors, the aim of the Finnish Suicide Prevention Study programme was to reduce the suicide rate by 20% by 1995, again with the rhetoric of ‘preventing unnecessary deaths’ (see Lönnqvist et al. Citation1993, Upanne et al. Citation1995). Even though the research project started with a theoretical approach that included a process model of several socio-cultural background factors of suicide, depression gradually came to be considered a major risk factor for suicide (see Suicide Prevention in Finland Citation1999). The project produced concrete psychiatric recommendations, often focusing on safe and effective psychofarmaca use.
16 A total of 1,500 Finnish people committed suicide that year, and 25% of them left a note. The prevalence of suicide notes in other studies is about the same. Other themes in the notes, according to my theme analysis, were ‘testaments,’ ‘practicalities,’ ‘illness,’ ‘confused’ and ‘miscellaneous.’
17 In order to protect identification, slightly revised.
18 The verb in Finnish is pärjätä. It literally means more than to cope or to survive; it also contains a connotation of comparing oneself with others, being visible in others' eyes.
19 This is not to deny the taboo character of suicide in Finland. In Russian Orthodox religious practices, the priests refuse to bless the suicide victim in a church funeral.
20 In the seminar The Future of Medicines, Helsinki, 19 August 2005.