Depression has been the object of different and separate research traditions in various disciplines. As Arthur Kleinman has noted, "If there ever was a situation accurately captured by the image of blind men and the elephant, this would seem to be it". In this study, an attempt is made to integrate the findings of relatively separate fields of psychosocial research of depression by narrative approach.

The founding idea of the study is that the narrative structure is not only present in told narratives but also in the way people understand and guide their life (inner narrative) and, ultimately, in the human life itself. Narrative structure knits together the temporal, intentional, material, social, causal, moral and emotional aspects of existence.

The phenomenological symptoms of depression, such as felt disconnectedness from social relations, hopelessness, feelings of worthlessness, lack of motivation, and loss of pleasure can be seen to reflect a breakdown of the functions of the inner narrative. Depression could thus be seen as a state in which an individual´s inner narrative has shattered or collapsed. The concept of narrative is will be used as a framework for understanding the process of depression as an interplay between the actual life situation, personal ways of interpreting it, cultural conceptions, and social interaction.

The study proceeds on three levels.
1. On the first, theoretical level, the integration of psychosocial research of depression from the narrative viewpoint is pursued.
2. On the second level, the forms, changes and tensions of Finnish cultural understanding of depression are explored using material from folklore, popular culture, and media.
3. On the third level, narratives of depressive persons will be analysed. These are gathered from e.g. biographical writings and interviews of members of self-help groups.

I am currently working for Marja-Liisa Honkasalo in her study Suffering, social memory and the Karelian heart. My task in this project consists of collecting and organizing data and conducting background research that serves as a contextualisation for how cardiovascular diseases and depression are experienced and understood by the North Karelian people. I work with various materials and themes such as letters and other contemporary texts written by North Karelians about health and illnesses and political documents that shed light on the vast structural changes that have taken place in North Karelia in the last few decades.

My previous research interests have included a study of identity construction through institutional interaction in a 12-step rehabilitation unit for substance abusers, and a study of the transition of the Alcoholics Anonymous movement in Finland in the late 1990’s.

The musculoskeletal diseases are a major public health problem in Finland. Chronic back pain affects 17 percent of all those over 30 years of age and about 25 percent of all work related disability pensions are due to this disease.

The aim of my current study is to achieve understanding on the subjective experiences of what the life and work are like to female and male back pain sufferers. How do men and women actively meaning-make their life and work in the social interaction between trust and trouble? My ongoing research focus on the process of early disability pension for women between 39 to 56 years old.

Back pain has an aberrant status in bio-medicine mainly because it is so baffling to medical professionals. My resent analysis shows how diagnosing back pain is an uncertain process that ranges from several months to several years, up to 20 years. This long process profoundly challenges the doctor-patient relationships. This problem involves especially lack of objective criteria for assessing in determining whether this is "real". This permitted a disrespectful attitude toward back pain sufferers. Only when the protagonists had actively defined their situation anew, did it indicate the turning points toward diagnosis and treatment.

In this data the addressed major disappointments focused on when subjective experience regarding one's pain or work (dis)ability was not given respectful considerations by the health care system: However, subjective experience proved to be capable of objective evaluations. How the multicausal subjective experiences and how these conflicting impacts should be interpreted are central questions for further research.

My mutiple data consists of 165 individually written autobiographies, obtained through the national writing competition "Elämän selkäranka" in 1999. During the spring 1999 I conducted in-depth interviews with 16 women and 7 men. This is a coherent data on questions regarding women's back pain and work related circumstances.

This research provides new knowledge and understanding of the complex microsocial circumstances of what work and everyday life are like for people suffering from back pain. The study offers new theoretical knowledge of how to conceptualise the subjective experience of back pain between back pain sufferers and the health care system. Moreover, it contributes new knowledge of how to improve the health care and the rehabilitation management, thus filling hithero neglected areas of relevant research.

This study in comparative religion aims at analysing some central cultural and religious subtexts and imaginary constructions behind both religious and secular everyday expressions of suffering in the contemporary Finnish culture.

The study aims at analysing meanings and cultural backgrounds of such metaphors as ‘nakedness’ and ‘becoming denuded/undressed/dressed’ which are frequently used in everyday language as well as in more poetic or rhetoric discourses to express basic existential situations, such as suffering. The basis of this observation was made in my doctoral theses (Utriainen 1999) where a lot of the caregivers of dying people described the situation of the dying using the metaphors of nakedness and nudity. My hypothesis is that these metaphors refer to the question of identity (as personal continuity and as the state of belonging to a community), and thus reflect Christian anthropological thinking.

Methodologically the study is a study of metaphors. It deals with metaphors of nakedness and dress as metaphors of identity as process. Material for the case studies for analysing the use of the metaphorical pair of nakedness and dress are: 1) selected biblical narratives; 2) Greek orthodox liturgical songs; 3) Finnish Lutheran hymn texts; 3) texts by the caregivers of the dying (reanalysis of some of the material of my doctoral theses) and 4) ethnographical and interview texts derived from the project directed by Marja-Liisa Honkasalo: Expressions of suffering - ethnographies of illness experience in contemporary Finnish contexts - with which my study works in close co-operation. The present work participates also in two other projects: Body and Society in the Biblical World directed by Martti Nissinen and Risto Uro; and Gender, Body and Ethics in Late Christian Culture and Theology, proposed to the Academy of Finland by Elina Vuola.

The philosophical and theoretical frame of the study is provided by phenomenology of the body and its feminist and ethical applications.

I currently work on my doctoral thesis on experiences of abortion and abortion ethics. I am approaching the theme by comparing Finnish expressions of experiences of abortion to Anglo-American feminist discussions on abortion ethics.

In Finland abortion was legalized in 1950, and the law was reformed in 1970. The current abortion law allows abortion to be performed at woman´s request for various medical and social reasons. However, woman´s desire to have an
abortion is not in itself a sufficient reason to interrupt pregnancy. In practice the interpretatation of law is broad and the general view is that it is easy to get an abortion in Finland. Still, what that the current law
signals is found highly problematic by those concerned with women´s rights.

In my MA thesis I examined how and what Finnish women tell about their experience of abortion. In addition to women´s interviews I analysed newspaper editorials. In my Ph.D. study I will expand the analysis by collecting stories written by people who have experienced abortion or
accompanied their spouses in abortion process. I want to include stories of men´s experiences in my study, because I am interested in getting a more detailed picture of those agents of abortion that public discussion does not mention.

Yet another source of data for my study is the variety of feminist theological and philosophical texts on abortion. I will compare ideas of
feminist theologians exploring Christian tradition of abortion ethics to secular feminists’ texts examining concepts of (woman’s) body, self and citizenship. Finally, I will compare Finnish expressions of experiences of
abortion to Anglo-American feminist discussions on abortion ethics.

My current project examines the meanings of ischaemic heart disease in medical, institutional and everyday contexts. How are is meaning bestowed in different contexts and how do the cultural ideologies and the social practices of health care system and everyday life become embodied as ways of being sick and carrying illness? Ischaemic heart disease is a major health problem in Finland, causing 1/3 of all deaths alone. It has been the target of large scale national programs since 1960's. As a specific, publicly notified disease entity, ischaemic heart disease exists not only in particular individuals, but serves as a structuring factor in social situations, as a social actor and mediator. The scale of the problem and the intensive agency of diverse institutions dealing with it provides the background for my focus on how the category of ischaemic heart disease is filled by the sufferers themselves. I have analysed the treatment of an infarction, and the transformations related to it, as a ritual. At the moment I am working on how the ritual messages of the treatment coincide with local concepts of health and illness, autonomy and morals in everyday settings and individual suffering.

Methodologically my study is based on participant observation, interviews, and the analysis of medical and health educational material. I have done 8 moths of participant observation in the emergency room, cardiac care unit, and the medical ward of a local hospital to grasp the realities of the health care settings. I have interviewed hospital staff and patients in the hospital and in their homes. The results will be published as a monograph in 2004. My study is part of Marja-Liisa Honkasalo's project Expressions of Suffering -Ethnographies of Illness experiences in Finnish Contexts", which is funded by the Academy of Finland.

Finland is a country which is known for its exceptionally high rates of both cardiovascular diseases (CVD), depression and suicide. Geographically, they co -vary, having the highest incidences in the eastern and the lowest in the western areas of Finland. The "eastern excess" is about 50% among middle aged men regarding mortality in CVD. According to careful epidemiological studies, the geographical incidence difference of CVD and suicide has persisted throughout decades. The general mortality difference between eastern and western parts of Finland may constitute a persistent long-lasting pattern too, at least during the time period reliable data has been accessible.

In the field of public health, there is abundance of epidemiological research on this topic, looking, in cardiovascular epidemiology, separately at heart diseases, and in psychiatric epidemiology at depression and suicide, which are considered etiologically intertwined. Currently, the main medical explanatory theories are based on risk factors: for CVD factors as dietary fat and smoking, and for depression and suicide the rapid structural change in the country and the ensuing solitude, mediated by abundant use of alcohol, especially among men. The repeated results of careful causal epidemiological studies of CVD point out that there are not one single measurable explanation for the disease, and the well-known bundle of explanations: food fat, smoking, heavy use of alcohol, genes and so on, explain only a part of its variance. There is scanty ethnographic research done in this field. However, quite a lot Finnish folklore studies illuminate people's own beliefs and understandings of heart diseases and melancholy and their etiologies and interconnections.

The general aim of the study is to examine the problem at issue from ethnographic points of view, contextualizing the research problem with the local history and present everyday life in a North Karelian village. Theoretically, the illness pattern is conceptualized
1) in a social context of rural life, which, since the 1960'ies, has faced heavy changes, especially continuous displace of the population, and
2) as an "imaginary landscape of suffering", which means
multi - layered memories of social traumas, and
historically and culturally constructed expressions of suffering, and
identity issues constituting links between the present and past.

The study makes use of multiple data. A 10 month long ethnographic field work is conducted in a North Karelian village, with about 50 interviews with villagers and their relatives. In addition, archive material from Finnish Literature Society focusing on local North-Karelian ethnomedical illness categories and illness theories, and from local county archives are used.

The topic of the on-going Ph.D. research is Diaspora and everyday Islam - Somali women's experiences of health, illness and healing. It is an inter-disciplinary study in the fields of comparative religion and medical anthropology. The research focuses on Somali women's suffering and symptoms in the context of diaspora. Furthermore, women's agency and attempts to alleviate distress and illness will be studied. The theoretical framework benefits from the discussion about memory. The research suggests that women's symptoms soak up significance from the life world of suffering, diaspora and cultural change. Bodily symptoms may also be seen as a form of communication through which Somali women can express their distress and furthermore, to try to bring about action in order to relieve it. Islam gains importance as a source of guidance and strength. Islamic healing practices are being availed of in order to heal illnesses, but in addition, Islam may be seen as a way to heal social suffering at a communal level. The research is based on ethnographic fieldwork among Somali refugee women living around metropolitan Helsinki, Finland. The doctoral thesis will be completed in 2002.

Research carried out among Swedish-speakers inhabiting the coastal areas of Finland found that they lead healthier, longer and more active lives than their Finnish-speaking neighbours. Common health indicators used to explain mortality do not differ significantly between the two groups, nor does the gene pool. It is believed that strong social ties and a high degree of social capital gives them this advantage over Finnish-speakers. In a country having one of the highest incidences of depression and suicide in Europe it is especially interesting to understand what it is that makes a certain group of people fare better than the rest of the population. What makes people inhabiting Swedish-speaking areas of the country healthier and keeps them alive longer than the majority population? What perceptions do Swedish-speakers themselves have of these theories and what explanations do they present regarding this phenomenon?

The aim of my research was to understand the sources of well-being and by contrast, the sources of uncertainty and distress that are a threat to well-being among people living in farming communities in the coastal areas of Southwestern Finland. I sought to investigate how people interpret illness and how their everyday theories of illness causation can be understood as a window on culture. Within the framework of this study I understand illness as a profoundly cultural and social phenomenon and as way for distressed individuals to have a dialogue with society.

The study is based on 12 months of fieldwork conducted 2002-2003 in a coastal village. It discusses how social and cultural change affects the life of farmers, how they experience change and how they act in order to deal with changing life circumstances. Using social suffering as a methodological approach the study looked at how change is related to lived experiences, idioms of distress, and narratives. Its aim was to draw a locally specific picture of what matters are at stake in the local moral world that these farmers inhabit, and to investigate how they emerge as creative actors within this local world.

A central assumption made about change is that it is two-fold; both a constructive force which gives birth to something new, and also a process that brings about uncertainty regarding the future. Uncertainty is understood as an existential condition of human life that demands a response, both causing suffering and transforming it. The possibility for positive outcomes in the future enables one to understand this ”small suffering” of everyday life both as a consequence of social change, which fragments and destroys, and as an answer to it - as something that is positively meaningful. Suffering is seen to engage individuals to ensure continuity, in spite of the odds, and to sustain hope regarding the future.

When the fieldwork was initiated Finland had been a member of the European Union for seven years and farmers felt it had substantially impacted on their working conditions. They complained about the restrictions placed on their autonomy and that their knowledge was neither recognised, nor respected by the bureaucrats of the EU system. New regulations require them to work in a manner that is morally unacceptable to them and financial insecurity has become more prominent. All these changes indicate the potential loss of the home and of the ability to ensure continuity of the family farm.

Although the study initially focused on getting a general picture of working conditions and the nature of farming life, during the course of the fieldwork there was repeated mention of a perceived high prevalence of cancer in the area. Cancer statistics for the area do not, though, significantly differ from any other part of the country. The study asked how villagers express and interpret what cancer is and what they consider contributes to the existence or lack of cancer. I was mainly concerned with how perceptions of cancer, through talk about cancer, reflect core values tied to place, work and social relations. This ”cancer talk” is replete with metaphors that reveal cultural meanings tied to the farming life and the core values of autonomy, endurance and permanence. It also forms the basis of a shared identity and a means of delivering a moral message about the fragmentation of the good life; the loss of control; and the invasion of the foreign into the intimate sphere of the home.

The study opens up a vital perspective on the multiplicity and variety of the experience of suffering and that it is particularly through the use of the ethnographic method that these experiences can be brought to light.

Link to ethesis:
https://oa.doria.fi/bitstream/handle/10024/3882/goodlive.pdf?sequence=1