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gambler. The same way as for alcoholism (Egerer and Sulkunen 2010) they emphasize thesuffering of their patient.“The whole time he readjusts his glasses takes them off and on, looks tohis right and left. This disperses also a sense of suffering.” (GP5F I6)In this study we argued (ibid.) that the institutional structure of primary health care might bea reason for the French, often long time family practitioners, to feel more compassion fortheir patients. In Finland general practitioners in health centres often change and thereforecannot build up more than a punctual professional relation to their patients. Moreover, theFrench doctors are concerned about the loss of control of their gambling patients. Thisperspective on gambling addiction becomes even more obvious later, when looking at thetherapy approaches. Finnish GPs see more the social problems and the harm to others as anoutcome of problematic gambling. The family’s food, or rent money seems a common topichere.“Yes, but she, she did not get any food for the family, as she gambled herpurse empty.” (GP2FIN I3)It is not surprising that Finnish GPs often refer here to the third clip of the mother, whogambles while doing the groceries – a slot machine in a supermarket is not an uncommonsight in Finland – and French participants relate here quite often to Rose, the French mother,who gambles away her son’s heritage. On the other side, when talking about the gambler’spersonal social costs Finns particularly point out the problem of pension gambled away,which is not a topic at all for their French colleagues, although the French clip is about apensioner. It seems that in a culture of everyday gambling (Matilainen 2006 and Valkama2006) an especially vulnerable group (here: old people) has to be constructed to point outone’s own competence of gambling reasonably. In France in comparison gambling is a riskytime-out for everyone: Hence, one of the consequences discussed more often than in Finlandis a possible social exclusion of the problematic gambler. The problematic gambler just staystoo long “out of time” and does not re-enter normal everyday life.Although all interviewed GPs acknowledge that pathological gambling does not fall into theirrealm of expertise there are significant differences between the two countries. French GPsconsider it nevertheless as their obligation to help.“Well, we have to identify them, talk to them.” (GP7F I3)Only “talking” as therapy points already out that they consider their possibilities ofintervention as rather small and therefore delegate the gamblers to a psychologist. TheFinnish colleagues share this approach, but question a special duty to help by themselves.“And, I have never seen that we would have the resources for something like that. Well,perhaps one gets RAY 14 money for that, but at least never from the city budget.” (GP1FIN I3)As above alluded loss of control plays a bigger role for the French GPs. When talking abouttherapies, treatment and chances of recovery for pathological gamblers, they therefore prefercompulsive measures. There should be a custodian for the gambler or a withdrawal of thegambler’s credit cards.14 The gambling monopoly association in Finland is called RAY (Except lottery and sport-bets). They give partof their winnings to social projects, treatment and research.6
“I would place him under custodianship.” (GP2F I5)It is not that Finnish GPs would not discuss those measures as well, but they much more oftenrely on the problematic gambler’s reason to limit him-/herself. The gambler themselvesdecides to give away credit cards or ask for a ban from gambling places.“Perhaps she could place herself under a custodianship…” (GP1FIN I1)Obviously here the traditional Anglo-Saxon and Nordic addiction concept of loss of control(Levine 1978) is stronger with the French GPs.Even more interesting in the light of a general theory of addiction are thecomparisons, participants of both countries made between the chances of recovery betweenalcoholism and pathological gambling. As pathological gambling is for them a mentaldependence it is easier to recover on oneself than from the physical dependence alcoholism.“But he, he has got nevertheless his whole head! He is sober, heis not drunk.” (GP1F I2)“Then it could be that way that as alcoholism is physical, it is then easier to quit from thepsychological one.” (GP7FIN I1)Conclusion and DiscussionI showed in this paper that GPs images of pathological gambling differ between Finland andFrance. For French GPs the non-substance based gambling addiction is on the one sideunderstood as a mental disease and dependence. People personally suffer but it is less severethan physical dependence. Here the participants clearly follow the French traditionaladdiction concept of a psychological disorder (Bergeron 1999). It seems that the institutionalbackground in France is a source to understand this side of pathological gambling. Althoughonly marginally discussed as a health problem it is nevertheless integrated into the medicalprofession’s realm of responsibility. On the other side, French GPs prefer compulsivemeasures to handle gambling problems and therefore obviously believe their patients havelost the possibility to control the behaviour by themselves. But loss of control is one of themain points of the Anglo-Saxon, and also Nordic, understanding of addiction (Levine 1978).Here the Finnish GPs tend to divert from their country’s traditional concept of addiction, asthey rely on the gambler’s own insight to take measure to limit themselves. Then again, whendiscussing consequences of problematic gambling they do stick to the traditional Finnishview on addiction and mainly are concerned (like for alcoholism) about the social problemsevoked by excessive gambling.We already briefly argued in the results section of this paper that thesedifferences might be rooted in the norms of accepted gambling in the countries. In France’sculture of time-out gambling the will to come back to normal life is more crucial than in theFinnish everyday’s gambling culture. A Finnish excessive gambler still stays in normal sociallife – the French one exits it too long. This might also explain why in the Nordic and Anglo-Saxon time-out drinking cultures the question of control became so important, whereas ineveryday wine-drinking societies as France this is less of an issue. These findings lead us tothe conclusion that considering addictions as a form of internalized social control make sensewhen looking at general practitioners’ images of gambling addiction in Finland and France.The embedding of the GPs in their institutional background on the other sidecan be seen in the interviews, too. Here the professionals do not differ much from theirperception on alcoholism (Egerer and Sulkunen 2010): the structure of health care limits orenables involvement with the patient.7
Page 1 and 2: - Draft paper. Please do not quote,
Page 3 and 4: etween GPs’ images in Finland and
Page 5: The majority of the participants in
Page 9 and 10: AppendixCodingConsequences:Biologic
Page 11 and 12: ReferencesAlexander, Bruce (2004):

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