Social Theory & Health

, Volume 17, Issue 4, pp 407–426 | Cite as

From silence to diagnosis: the entry of the mentally problematic employee into medical practice

  • Ari VäänänenEmail author
  • Jussi Turtiainen
  • Anna Kuokkanen
  • Anders Petersen
Original Article


Since the 1970s, the various manifestations of mental health problems among Western employees have multiplied. This paper explores how occupational health physicians’ perceive the changes that have enabled the emergence of mental health concerns in the Finnish welfare regime. The interpretations of health professionals with long working careers (41 in-depth interviews of Finnish occupational health experts) are placed in a conflictual social arena, in which the tendencies of medicalization and informalization frame professionals’ work in the changing context of working life, culture and medical practice. The results emphasize three historical transformations: (1) the loosening of the stigma related to mental health problems (informalization of mental health problems), (2) the changing character of employees/patients (psychologically aware customers) and (3) the paradox of a new medical culture (decreasing medical dominance and increasing medicalization). This article demonstrates the ambiguity health professionals faced when patients with psycho-emotional health issues entered their occupational territory. It shows how the experiences of mental health professionals reflect the informalization of social contacts and conflicting tendencies related to medicalization. These are manifested in the social relationship between doctor and patient, the labelling of mental health problems and the medical culture related to mental health.


Employees Medicalization Mental health Informalization Physicians Stigma 



This work was supported by the Academy of Finland (Grant Number 267172). We would like to thank Ms Helka Hakala for her assistance in the collection and management of the data, as well as the health professionals who agreed to participate in the interviews carried out as a part of our study. We also thank Dr Erkko Anttila and Dr Pekka Varje their valuable comments.


  1. Abraham, J. 2007. Building on sociological understanding of the pharmaceutical industry or reinventing the wheel? Response to Joan Busfield’s ‘pills, power, people. Sociology 41 (4): 727–736.CrossRefGoogle Scholar
  2. Anttila, E. and A. Väänänen. 2015. From authority figure to emotion worker: Schoolteachers and the pressures of democratization in the Finnish School Teachers’ Journal from the 1950s to the 1980s. Pedagogy, Culture and Society 23(4): 555–574.CrossRefGoogle Scholar
  3. Barling, J., and A. Griffiths. 2003. A history of occupational health psychology. In Handbook of occupational health psychology, ed. J.C. Quick and L.E. Tetrick, 19–33. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  4. Beard, M.R. 2017. Re-thinking oral history—a study of narrative performance. The Journal of Theory and Practice 21 (4): 529–548.Google Scholar
  5. Brenninkmeijer, V., and N.W. Van Yperen. 2002. How to conduct research on burnout: Advantages and disadvantages of a unidimensional approach in burnout research. Occupational and Environmental Medicine 60 (1): 16–120.Google Scholar
  6. Brinkmann, S. 2016. Diagnostic cultures. London: Routledge.CrossRefGoogle Scholar
  7. Brinkmann, S. and A. Petersen. 2016. Diagnoser. Perspektiver, Kritik og Diskussion. [In English: Diagnosis. Perspectives, Critique and Discussion]. Aarhus: Klim.Google Scholar
  8. Broer, C., and B. Besseling. 2017. Sadness or depression: Making sense of low mood and the medicalization of everyday life. Social Science and Medicine 183: 28–36.CrossRefGoogle Scholar
  9. Broom, D.H., and R.V. Woodward. 1996. Medicalization reconsidered: toward a collaborative approach to care. Sociology of Health & Illness 18 (3): 357–378.CrossRefGoogle Scholar
  10. Brown, A. 2005. Medical specialists’ accounts of the impact of the internet on the doctor/patient relationship. Health 9 (3): 319–338.CrossRefGoogle Scholar
  11. Brown, P., M.E. Elston, and J. Gabe. 2015. From patient deference towards negotiated and precarious informality: An Eliasian analysis of English general practitioners’ understanding of changing patient relations. Social Science and Medicine 146: 164–172.CrossRefGoogle Scholar
  12. Busfield, J. 2011. Mental illness. Cambridge: Polity.Google Scholar
  13. Busfield, J. 2000. Introduction: Rethinking the sociology of mental health. Sociology of Health & Illness 22 (5): 543558.CrossRefGoogle Scholar
  14. Cederström, C., and A. Spicer. 2015. The wellness syndrome. London: John Wiley and Sons Ltd.Google Scholar
  15. Charles, C., A. Gafni, and T. Whelan. 1999. Decision-making in the physician–patient encounter: revisiting the shared treatment decision-making model. Social Science and Medicine 49 (5): 651–661.CrossRefGoogle Scholar
  16. Conrad, P., and J.W. Schneider. 1980(1992). Deviance and medicalization: From badness to sickness. Philadelphia: Temple University Press.Google Scholar
  17. Conrad, P. 2007. The medicalization of society. On the transformation of human conditions into treatable disorder. Baltimore: The Johns Hopkins University Press.Google Scholar
  18. Crowley-Matoka, M. and G. True. 2012. No one wants to be the candy man: Ambivalent medication and clinician subjectivity in pain management. Cultural Anthopology 27(4): 689–712.CrossRefGoogle Scholar
  19. Durkheim, E. 1964. Rules of sociological method. New York: Free Press.Google Scholar
  20. Ehrenberg, A. 1991. Le culte de la performance. Paris: Hachette-Pluriel.Google Scholar
  21. Ehrenberg, A. 2010. The weariness of self. Diagnosing the history of depression in the contemporary age. Montreal: McGill-Queen’s University Press.Google Scholar
  22. Elston, M.A. 2009. Remaking a thustworthy profession in twenty-first century Britain. In The new sociolology of health service, ed. J. Gabe, and M. Calnan, 17–36. London: Routledge.Google Scholar
  23. Eurofound. 2010. Changes over time—first findings from the fifth European working conditions survey. Luxembourg: Office for Official Publications of the European Communities.Google Scholar
  24. Gabe, J., and M. Bury. 1988. Tranquillizers as a social problem. Sociological Review 36 (2): 320–352.CrossRefGoogle Scholar
  25. Goffman, E. 1961. Asylums: Essays on the social situation of mental patients and other inmates. Garden City: Anchor Books.Google Scholar
  26. Greenhalgh, T., J. Howick, N. Maskrey, and for the Evidence Based Medicine Renaissance Group. 2014. Evidence based medicine: A movement in crisis? British Medical Journal 348: g3725.CrossRefGoogle Scholar
  27. Halfmann, D. 2012. Recognizing medicalization and demedicalization: Discourses, practices, and identities. Health 16 (2): 186–207.CrossRefGoogle Scholar
  28. Hannikainen, M., and S. Heikkinen. 2006. The labour market, 1850–2000. In The road to prosperity: An economic history of Finland, ed. J. Ojala, J. Eloranta, and J. Jalava, 165–186. Helsinki: SKS.Google Scholar
  29. Honneth, A. 2004. Organised self-realization: Some paradoxes of individualization. European Journal of Social Theory 7 (4): 463–478.CrossRefGoogle Scholar
  30. Horwitz, A.V. 2002. Creating mental illness. Chicago: University of Chicago Press.Google Scholar
  31. Jutel, A. 2011. Sociology of diagnosis: A preliminary review. In Sociology of diagnosis, vol. 12, ed. P.J. McGann, D.J. Hutson, and B.K. Rothman, 3–32. London: Advances in Medical Sociology.CrossRefGoogle Scholar
  32. Julkunen, R. 2008. Uuden työn paradoksit: Keskusteluja 2000-luvun työprosess(e)ista. Tampere: Vastapaino.Google Scholar
  33. Keohane, K. and A. Petersen. 2013. The social pathologies of contemporary civilization. New York: Ashgate Publishing.Google Scholar
  34. Kuokkanen, A., P. Varje, and A. Väänänen. 2013. Transformation of the Finnish employee ideal in job advertisements from 1944 to 2009. Acta Sociologica 56 (3): 213–226.CrossRefGoogle Scholar
  35. Liu, K., M. King, and P.S. Bearman. 2010. Social influence and autism epidemic. AJS: American Journal of Sociology 115 (5): 1387.Google Scholar
  36. Löyttyniemi, V. 2001. Doctors drifting: Autonomy and career uncertainty in young physicians’ stories. Social Science and Medicine 52 (2): 227–237.CrossRefGoogle Scholar
  37. Marcus, S.C., and M. Olfson. 2010. National trends in the treatment for depression from 1998 to 2007. Archives of General Psychiatry 67 (12): 1265–1273.CrossRefGoogle Scholar
  38. Martimo, K.-P., and J. Mäkitalo. 2014. The status of occupational health services in Finland and the role of the Finnish Institute of Occupational Health in the development of occupational health services. Helsinki: Finnish Institute of Occupational Health.Google Scholar
  39. Mathieson, C.M. 1999. Interviewing the Ill and healthy. Paradigm or process? In Qualitative health psychology, ed. M. Murray and K. Chamberlain, 117–132. London: Sage Publications.Google Scholar
  40. MacKinlay, J., and L. Marceau. 2002. The end of the golden age of doctoring. International Journal of Health Services 32 (2): 379–416.CrossRefGoogle Scholar
  41. McDaid, D., M. Knapp, H. Medieros, and The MHEEN Group. 2008. Employment and mental health: assessing the economic impact. London: The MHEEN Network.Google Scholar
  42. McLaughlin, K. 2011. Surviving identity. Vulnerability and the psychology of recognition. London: Routledge.Google Scholar
  43. Moloney, M.E. 2017. ‘Sometimes, it’s easier to write the prescription’: Physician and patient accounts of the reluctant medicalization of sleeplessness. Sociology of Health & Illness 39 (5): 333–348.CrossRefGoogle Scholar
  44. Nyman, H., and M. Kiviniemi. 2015. Katsaus eläketurvaan vuonna 2014 [In English: Report on social security related to pensions in 2014]. Eläketurvakeskuksen raportteja 4. Tampere: Juvenes Print.Google Scholar
  45. OECD. 2012. Sickness, disability and work: Breaking the barriers. Synthesis of findings across OECD countries. Paris: OECD Publishing.Google Scholar
  46. Patton, M. Q. 1980(2002). Qualitative research & evaluation methods. Thousand Oaks: Sage Publications.Google Scholar
  47. Petersen, A. 2016. Præstationssamfundet [In English: The Performance Society]. In Fremtidsparat?: Hinsides PISA - nordiske perspektiver på uddannelse, ed. D Sommer and Klitmoller, 51–72. Copenhagen: Hans Reitzels Forlag.Google Scholar
  48. Rose, N. 2007. The politics of life itself: Biomedicine, power and subjectivity in the twenty-first century. Princeton, NJ: Princeton University Press.CrossRefGoogle Scholar
  49. Renedo, A., A. Komporozos-Athanasiou, and C. Marston. 2017. Experience as evidence: The dialogic Construction of Health Professional Knowledge through Patient Involvement. Sociology, 1–18 (First Published January 16, 2017).Google Scholar
  50. Rüsch, N., M.C. Angemeyer, and P.W. Corrigan. 2005. Mental Illness stigma: Concepts, consequences and initiatives to reduce stigma. European Psychiatry 20 (8): 529–539.CrossRefGoogle Scholar
  51. Scheff, T. 1967. Mental illness and social process. New York: Harper and Row.Google Scholar
  52. Shorter, E. 1997. A history of psychiatry. From the era of the asylum to the age of prozac. New York: Wiley.Google Scholar
  53. Social Insurance Institution. 2012. Drug Imbursement statistics. The use of depression medication in 2000 − 2011. Helsinki: Social Insurance Institution. Accessed 10 Sept 2017.
  54. Statistics Finland. 2009. The educational structure of the Finnish population. Helsinki: Statistics Finland.
  55. Statistics Finland. 2016. Recipients of disability pension in 1996–2015. Prime minister’s office Finland. Accessed 15 Feb 2017.
  56. Skeggs, B. 2013. Values beyond value? Is anything beyond the logic of capital? The British Journal of Sociology 65 (1): 1–20.CrossRefGoogle Scholar
  57. Skeggs, B., and V. Loveday. 2012. Struggles for value: Value practices, injustice, judgment, affect and the idea of class. The British Journal of Sociology 63 (3): 472–490.CrossRefGoogle Scholar
  58. Szasz, T. 1961. The myth of mental illness: Foundations of a theory of personal conduct. New York: HarperCollins.Google Scholar
  59. Thoits, P.A. 2016. “I’m not mentally ill”: Identity defection as a form of stigma resistance. Journal of Health and Social Behavior 57 (2): 135–151.CrossRefGoogle Scholar
  60. Totton, N. (ed.). 2006. The politics of psychotherapy: New perspectives. Buckingham, UK: Open University Press.Google Scholar
  61. Väänänen, A., J. Turtiainen, E. Anttila, and P. Varje. 2012. Formulation of work stress in 1960–2000: analysis of scientific works from the perspective of historical sociology. Social Science Medicine 75(5): 784–794.CrossRefGoogle Scholar
  62. Väänänen, A., M. Murray, and A. Kuokkanen. 2014. The growth and stagnation of work stress: The publication trends and scientific representations in 1960–2012. History of the Human Sciences 27(4): 116–138.CrossRefGoogle Scholar
  63. Wainwright, D., and M. Calnan. 2011. The fall of work stress and the rise of wellbeing. In Work, health and wellbeing: The challenges of managing health at work, ed. S.C. Vickerstaff, C. Phillipson, and R. Wilkie, 161–186. Bristol: Policy Press.Google Scholar
  64. Williams, S.J., and M. Calnan. 1996. The ‘limits’ of medicalization: Modern medicine and the lay populace in ‘late’ modernity. Social Science and Medicine 42 (12): 1609–1620.CrossRefGoogle Scholar
  65. Williams, S., and J. Gabe. 2015. Peter Conrad: The medicalization of society. In The Palgrave handbook of social theory in health, illness and medicine, ed. F. Collyer, 615–626. Basingstoke: Palgrave MacMillan.CrossRefGoogle Scholar
  66. Williams, S., J. Gabe, and P. Davis. 2008. The sociology of pharmaceuticals: progress and prospects. Sociology of Health & Illness 33 (5): 710–725.CrossRefGoogle Scholar
  67. Wouters, C. 1992. On status competition and emotion management: The study of emotions as a new field. Theory, Culture & Society 9 (1): 229–252.CrossRefGoogle Scholar
  68. Wouters, C. 2007. Informalization: Manners and emotions since 1890. Los Angeles: SAGE.Google Scholar

Copyright information

© Springer Nature Limited 2019

Authors and Affiliations

  • Ari Väänänen
    • 1
    • 2
    Email author
  • Jussi Turtiainen
    • 3
  • Anna Kuokkanen
    • 1
  • Anders Petersen
    • 4
  1. 1.Finnish Institute of Occupational HealthTyöterveyslaitosFinland
  2. 2.University of KentCanterburyUK
  3. 3.HelsinkiFinland
  4. 4.Department of SociologyAalborg UniversityAalborg EastDenmark

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