Humanistinen lääketiede, lääketieteellinen humanismi, medicinsk humaniora: Medical Humanities in Finland

Avril Tynan, Anna Ovaska, and Åsa Slotte discuss the fragmented but rich range of medical humanities research and teaching in Finland.

In 1927, Finnish physician Gösta Becker reported that patients often experienced treatment as if they were test subjects for medical practitioners. Although the illness was treated with skill and attention, the patients themselves were an afterthought or an inconvenience (cited in Pasternack, Puustinen, and Louhiala 2020). This dislocation is still central among concerns in philosophy of medicine and medical ethics: health, a medical issue, is in conflict with wellbeing, a social issue (Honkasalo and Andell 2017). Researchers at Tampere University have argued that humanities education in Finnish medical faculties is often sidelined in favour of naturalistic and empirical scientific education. Noting the need to unify medical education in Finland to better integrate humanistic aims, they suggest that an integrated approach is most viable. This means not simply “adding on” optional humanities courses, but centering medical teaching and education around professional values and activities, ethical responsibilities, and the tolerance of uncertainty amid complex work situations (Pasternack, Puustinen, and Louhiala 2020).

It is this fragmentation of naturalistic and humanistic approaches to medicine, and their somewhat clumsy reunion, that is reflected in the linguistic development of medical humanities in Finland. Multiple collaborative pedagogical and research projects have brought together humanities and social science scholars with healthcare professionals. These projects explore, among other things, the intersections between art, culture, and disease, or literature and medicine. Yet the English term “medical humanities” and its various translations have, until recently, been largely absent from this discourse.

Among university courses, research centres and topics, both humanistinen lääketiede (humanistic medicine) and lääketieteellinen humanismi (medical humanism) are used. Additionally, humanistinen ja yhteiskuntatieteellinen lääketieteen tutkimus (humanistic and social research on medicine) refers more broadly to research conducted in cognate fields, such as medical history, medical anthropology, transcultural psychiatry, philosophy of psychiatry, and medical sociology. These terms all accompany literal translations of tangential concepts, such as kerronnallinen lääketiede or narratiivinen lääketiede (both translating as narrative medicine), humanistinen terveystiede (health humanities), and the anglophone loan medical humanities itself.

The lack of a consensus surrounding the core terms does not detract from the quality of research and teaching currently taking place in these areas. Yet it does reflect and help to explain how the medical humanities in Finland are dispersed across and in between the disciplines of medical science, social science, and the humanities. Much of the work so far has taken place within diverse and distinct disciplines, including, but not limited to, history, linguistics, literary studies, anthropology, sociology, cultural studies, philosophy, science and technology studies, and gender studies. Scholars have been interested in exploring how different aspects of medicine, health, and illness influence, or are influenced by, specific facets of an individual field of research and pedagogy. While some of these scholars identify themselves under the umbrella of medical humanities, others recognise the term but identify it primarily either as a literary studies concept or as a pedagogical project located within medical faculties; still others do not recognise the term at all. Identifying and tracing the development of medical humanities in Finland is therefore messy, splintered across different faculties and departments, and under different terms and concepts.

The many directions of medical humanities

In Finland, unlike in most other Nordic countries, there are no dedicated centres for research and teaching in the medical humanities. However, at the University of Helsinki, medical humanities courses have been organised, intermittently, since 1994. Introduced by Matti Klockars, Swedish-speaking professor of general medicine, the courses were inspired by developments in medical humanities in the US, and particularly at Columbia University (New York). Today, the course is delivered in both Finnish and Swedish by physician Lena Sjöberg, who uses literature and film in her teaching of medical students. Furthermore, a collaboration between the Department of Public Health and the campus library, Lux Humana, brings together an extensive collection of over 4,000 fiction and non-fiction works aimed at students and teachers of medicine and health professionals. 

Since the late 1990s, Tampere University has led a number of collaborations between arts researchers and medical professionals, including the lecture series Taide ja taudit (Art and Diseases), and most recently literature and narrative medicine courses for students of medicine. Moreover, the university hosts a unit of Health Sciences, which brings together fields like medical ethics, public health, and social psychiatry. Elsewhere, at the University of Turku, the Asklepios programme provides critical perspectives on the study of illness, health, and wellbeing. Founded in 2002, Asklepios grew from a pedagogical collaboration between the faculties of medicine and humanities. Finally, at the University of Eastern Finland, the study programme Multicultural Dimensions of Health (Terveyden monikulttuuriset ulottuvuudet) has, since 2009, offered a range of courses in both Finnish and English. These courses respond to contemporary changes and challenges in cultural studies and health and wellbeing research as they intersect with, among other things, new technologies, gender, structural inequalities, and sustainable practices.

In addition to pedagogical projects, Finnish scholars have developed research which could be situated under the umbrella of “critical medical humanities.” Although the term is rarely used in Finland, similar concepts, such as  kulttuurinen terveystutkimus (cultural study of health)or kulttuurinen mielenterveystutkimus (cultural study of mental health), are in circulation (Mäkilä and Pietilä 2021).

The Research Centre for Culture and Health (Kulttuurin ja terveyden tutkimusyksikkö) at the University of Turku has, since 2013, brought together researchers in culture, art, health, wellbeing, and illness. Founded by medical anthropologist Marja-Liisa Honkasalo, the Centre grew from collaboration between the faculties of medicine, social science, education, and the humanities. From its inception, the Centre has had a clear agenda to explore questions of health and illness, broadly and critically, from the perspectives of cultural research and social science. A recent project in the Centre, “Words for Care: Literature, Healthcare and Democracy,” applies a narrative medicine framework that seeks to strengthen narrative competence in social and wellbeing work and activities. The project integrates narrative medicine with cultural language learning and will develop multilingual narrative medicine practices for social and healthcare professionals who speak Finnish as a second language. In 2024, the Centre’s research seminars are being organised primarily in English, in order to draw a larger international audience. Further medical humanities research is also hosted by the SELMA Centre for the Study of Storytelling, Experientiality and Memory, which ran three seasons of the SELMA Medical Humanities Seminar Series in 2021 and 2022.

In other Finnish universities, certain departments and research groups have become “hubs” for researching and teaching topics related to health, illness, and medicine. At the University of Jyväskylä, cultural approaches to mental health are taught and studied in the Department of Music, Art and Culture. At Tampere University, research in the field of Gender Studies brings together multiple projects that combine the study of gender, embodiment, biomedicine, biotechnology, and healthcare. At the University of Arts Helsinki, the “Health, Narrative, and the Arts” project offers training in narrative skills for professionals in healthcare and social work. The University of Eastern Finland hosts the research group Historical Developments in Medical Education,” and, finally, the University of Oulu is home to various projects and researchers concerned with the history of medicine and science, particularly within the research unit of History, Culture and Communication Studies.

Swedish-speaking medical humanities in Finland

Yet the story of medical humanities in Finland, from a multilingual perspective, becomes more interesting still when we consider the linguistic makeup of the country. Finland is officially a bilingual country, with two national languages: Finnish and Swedish, the latter spoken as the mother tongue of approximately 300,000 of the population of 5.5 million. In reality, Finland often feels like a tri-lingual country, with English polemically competing for dominance in the larger cities (and particularly in the capital, Helsinki). 

Finland is a Nordic and not a Scandinavian country, and the Finnish language shares little with the Scandinavian languages of Sweden, Norway, Denmark, and Iceland. English, unsurprisingly, is thus the de facto lingua franca. However, the isolation of Finland from its Scandinavian neighbours is also apparent in some medical humanities circles. Nordic networks of medical humanities, while nominally including Finland, are linguistically either Scandinavian or anglophone. The Nordic Network for Narratives in Medicine, for example, while integrating a number of Finnish projects and researchers, encourages participation in English or a Scandinavian language (not Finnish), while the Nordic-Baltic Network of Philosophy of Medicine and the Nordic Network for Gender, Body and Heath coordinate their activities in English.

Image credit: Maksim
Norway, Sweden, and Denmark make up the Scandinavian countries. These plus Finland and Iceland compose the Nordics. South of Finland, Estonia, Latvia, and Lithuania make up the Baltic states

If Finnish and English are well represented in medical humanities research in Finland, the case of the minority language, Swedish, is intriguing, since it is developing slowly, caught between Finnish academic life and the established networks of medical humanities in Scandinavia. Nevertheless, there are a growing number of Swedish-speaking researchers working in fields closely associated with medical humanities at Åbo Akademi University, Finland’s only exclusively Swedish-speaking university. Yet, as the above descriptions of the fragmentation of medical humanities in Finland suggest, these researchers have generally worked within their own fields, without sufficient structures to support their research. Some have sought out networks in Sweden, although efforts are being made to improve the coherence of Swedish-speaking medical humanities within Finland, too. 

In Autumn 2023, a conference on medicinsk humaniora, the widely used Swedish translation of “medical humanities,” was held at Åbo Akademi University. Efforts to build and strengthen Swedish-speaking networks of research and pedagogy within Finland are also reflected in the implementation of a course in medicinsk humaniora, offered since 2020 by the Department of Nordic Folkloristics, and the visibility of the multidisciplinary project “VaccAtt,” both at Åbo Akademi University. 

Contributions by Swedish-speaking Finns have informed the current field of medical humanities in Finland. Since the 1990s, literary scholar Merete Mazzarella has helped to shape the instruction of humanistic approaches to medicine in both Finland and Sweden, teaching at the Universities of Helsinki, Uppsala, Gothenburg, and Umeå. In 2005, she published the influential Den goda beröringen (The Good Touch), a collection of essays on humanism and medicine, care, doctors, and literature. In 2006, the sociologist and historian Jutta Ahlbeck defended her doctoral thesis, Diagnostisering och disciplinering: medicinsk diskurs och kvinnligt vansinne på Själö hospital 1889–1944 (Diagnose and Discipline: Medical Discourse and Female Madness at the Hospital of Själö 1889–1944). Her research has influenced the creation of Johanna Holmström’s novel Själarnas ö (2017, The Island of Souls) and other artistic work and documentaries. More recently, philosopher Åsa Slotte published her nonfictional essay book Ur mammas mörker: Essäer om sjukdom, diagnoser, omsorg och hur jag blev filosof (Out of Mother’s Darkness: Essays on Illness, Diagnoses, Care, and How I Became a Philosopher) in 2022, establishing a dialogue between healthcare, the reading public, and the field of medical humanities. 

From fragmentation towards fusion

In writing this article on multilingual medical humanities in Finland, we have been struck by the extraordinary fragmentation of the field caused, among other things, by the lack of centres dedicated to teaching and researching medical humanities. Moreover, it is apparent that language, more than geography, has become a structuring – perhaps even a binding – element of medical humanities research and pedagogy in Finland. The University of Turku (the Finnish-speaking university) and Åbo Akademi University (the Swedish-speaking university) are minutes from one another, in the same city, and yet there is significant isolation in our research and in our networks. However, collaboration between the two universities exists, for example, in vaccine research and in historical and artistic research concerning the Själö mental hospital. 

Even where English may be the lingua franca among medical humanities scholars in the Nordics, or even in Europe, language has seemingly dictated the directions our work and our networks have taken. Finnish speakers have sought to develop a strong identity in Finnish, while contributing to global developments in English; Swedish speakers in Finland have looked to expand their networks through collaboration with Swedish speakers in Sweden, while maintaining global connections in English. However, efforts are being made to bridge these gaps and, as Finland becomes more multilingual, more attention is being paid to the meanings and uses of languages other than Finnish, Swedish, and English.


Acknowledgements

We thank Marja-Liisa Honkasalo for her correspondence, which provided the information on the early days of the Research Centre for Culture and Health. We are also thankful to Lena Sjöberg, who illuminated the history of Lux Humana.


About the authors

Avril Tynan (PhD) is a Research Council of Finland (formerly Academy of Finland) Research Fellow (2023–2027) at the University of Turku, Finland, and editor of Storyworlds: A Journal of Narrative Studies. In 2024, Tynan is organising and chairing the seminars of the Research Centre for Culture and Health. She has published widely on the role and representation of illness and recovery, ageing, and death in anglophone, francophone, and other literatures. Her current project, “Reading Recovery: Narratives of Recovery in Culture, Medicine and Society,” explores the relationship between recovery and narrative from a critical perspective that interrogates narrative’s claim to cure. She is also a member of the Erasmus+ project, “#ENDOs” (2023–2026), co-ordinated by Le LABA in Bordeaux. A native speaker of English, Tynan also works in French and Finnish.

Anna Ovaska (PhD, M. Soc. Sc.) is a researcher at Narrare: Centre for Interdisciplinary Narrative Studies at Tampere University, and co-editor of Finnish philosophical magazine niin & näin. Her current project “Reading Pain” (Kone Foundation 2020–2024) explores critical and embodied modes of reading experiences of pain and develops interdisciplinary literary pedagogy. Anna is also a member of the project “Words for Care: Literature, Healthcare and Democracy” (Kone Foundation 2024–2026). She teaches narrative medicine at Tampere University, with Dr Laura Karttunen, and in the Asklepios programme, at the University of Turku. Her recent book Shattering Minds: Experiences of Mental Illness in Modernist Finnish Literature (2023) explores modernist narratives of mental illness. Anna’s first language is Finnish, and she also speaks English and Swedish.

Åsa Slotte (PhD in Philosophy) is a researcher at the Department of Philosophy at Åbo Akademi University. She is also an author and essayist at Förlaget M, a Swedish-language publishing house in Finland. She has worked in fields including medical philosophy, ethics, feminist philosophy, and illness narratives. In her doctoral thesis, Varför vård? Om anorexi, diagnoser och moralisk förståelse (Why Care? On Anorexia, Diagnoses and Moral Understanding, 2019), she conducted field interviews with young women suffering from eating disorders and combined their narratives with moral philosophy. She is Swedish-speaking, and she also speaks English and Finnish. 


References 

Ahlbeck, Jutta. 2006. Diagnostisering och disciplinering: medicinsk diskurs och kvinnligt vansinne på Själö hospital 1889–1944. Doctoral Dissertation, Åbo Akademi.

Holmström, Johanna. 2017. Själarnas ö. Helsinki: Förlaget M.

Honkasalo, Marja-Liisa, and Kia Andell. 2017. “Pääkirjoitus.” Kipinä 1: 1-4.

Mazzarella, Merete. 2005. Den goda beröringen: om kropp, hälsa, vård och litteratur. Helsinki: Söderström.

Mäkilä, Annastiina, and Pekka Pietilä. 2021. “Katsaus kulttuuriseen mielenterveystutkimukseen Suomessa.” J@rgonia 19(37): 114-142.

Pasternack, Amos, Raimo Puustinen, and Pekka Louhiala. 2020. “Humanistiset aiheet ja taiteet lääkäriksi oppimisen tukena.” Lääkärilehti 50: 2772-2776a.

Slotte, Åsa. 2022. Ur mammas mörker: Essäer om sjukdom, diagnoser, omsorg och hur jag blev filosof. Helsinki: Förlaget M.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.