"Per Fink, Hated..." Part I.- VI.

"Per Fink lagt for had..." / "Per Fink, Hated..." Part I.


Additional Information

Sphere of Influence

Grammar Tool


On 24 May 2014 Dagens Medicin (DM) published an opinion piece, "Per Fink manipulation" written by Dr. Stig Gerdes. Within this piece, Gerdes refers to a series of articles that DM has recently published on Fink and functional disorders.

With this post, I would like to assist the reader (especially those with ME/CFS) in understanding the original Danish-language series and ask that individuals fluent in Danish offer guidance in understanding this Danish-language series on functional disorders.


Additional information:

The article series is from Dagens Medicin (Today's Medicine), the online Danish-language edition.

No comments are allowed on the DM site for the article series. The following grammar tool, in English, is shared for educational purposes only. Accuracy has been attempted but is not guaranteed. All credit --for style, tone, content, etc.-- goes to the article's Danish-language author, Nana Frederikke Fischer, as well as to DM and Google Translate.

Numerous DM articles are free to the public, without registration. This particular Danish-language article series, however, requires registration. Registration is free and following registration, non-subscriber content can be freely accessed within a seven-day window. Please see dagensmedicin.dk.

Again, this post is a grammar tool to help non-Danish speakers (especially those with ME/CFS) to understand the original Dagens Medicine Danish-language series on Per Fink and functional disorders.

Sphere of influence:

Dagens Medicin is a leading magazine for medical professionals in Scandinavia, including Denmark, Sweden, Norway, and Finland. DM sister magazines are also published in Poland, Estonia, and Slovenia, according to wikipedia. (I believe editions are unique to each country, but I can't say if there are shared articles as well.)

Dagens Medicin also arranges educational seminars and courses for medical personnel, politicians, and other healthcare decision makers.

Dagens Medicin is owned by Bonnier Business Press International, "a privately held Swedish media group of 175 companies operating in 20 countries...Bonnier is controlled by around 75 family members, including some seventh-generation heirs."



Grammar tool:

Series title: "Per Fink lagt for had: Vi har lavet en arbejdsdeling, så det er mig, der tager tæskene"

"Per Fink, Hated: 'We've created a division of labor, so I'm the one who takes the beatings.'"

By Nana Frederikke Fischer / Dagens Medicin 2014

[Photo caption:] "I read practically none of the mail that comes in," says Per Fink. "Only if I have to, and I don't go online and read it, because it doesn't interest me. I'm not on Facebook because I think if I created an account that it would just get shut down."

For psychiatrist Per Fink, hate mail and public demonstrations are daily events where angry citizens accuse him of moving physical illness into the domain of psychiatry.

As research director for the Institute for Functional Disorders, Fink has grown accustomed to a life filled with daily hate mail and violent accusations.

A group of angry citizens accuses Fink of moving physical illness into the domain of psychiatry, and their accusations have contributed to the discussion of "functional disorders" being raised to a parliamentary level with a hearing in March and a consultation/deliberation/conference (samråd ) May 20th.

Fink is annoyed that such a small group has been able to set an agenda in the press, especially as he points out, when none in the group have been treated at his clinic.

A camera pans slowly across a group of about 15 people, then jerks suddenly and focuses on Per Fink who exits the main door of a red apartment block and quickly walks away. The camera follows at Fink's same pace, and in the background someone yells to the research director.

"How are you?" blasts a woman's voice from a megaphone.

Other voices can be heard in the blast as well. "Don't you feel bad?" shouts one. "You should feel bad about the way you treat others."

The voices become weaker as Fink continues walking away, but the camera persistently follows him, until he enters a staff-only parking lot.

"You're killing her, Per," a woman's voice complains in the background.

"Let her out!" shouts the camera(wo?)man in an aggressive tone.

"You're a fucking psychopath! You're murdering my sister!" shouts a woman's voice, now even higher, while Fink disappears into a building.

The video is from August 14th of last year and can be found on youtube. The user who posted the video has written that Fink and his clinic staff are behind the compulsory/forced admission of a young woman [Karina Hansen]. Fink and his colleagues are also accused of treating physical illness as a psychiatric disorder, and doing so because they need ' a success story '.

Fink, however, explains that none of this is true and that for the most part, he's just irritated that a little group, that uses Facebook and other webpages and who loudly shouts, can get so much attention. Fink describes the disgruntled protesters as a 'small group of frustrated people' and added that he won't be frightened by them.

At best, they can annoy him by pointing a camera at his face outside his workplace or by sending him an unstoppable flood of angry emails. Fink says quietly that it's always the same questions, but they aren't interested in listening to the answers. The task, therefore, of reviewing such emails has been delegated to another colleague.

"When I began in this subject, I stood in a surgical ward and thought about what it was that I should now give myself to in this life. And there was a patient in the department who everyone tried to avoid because she had several hundred admissions behind her, and still, no one could make a diagnosis.

This aroused my interest in this field - that there's a group who's being so badly treated. Everyone could see that it was wrong, so I tried to go in and help this group. If there are those who feel stepped on, that's a shame. But why the heck aren't they trying to concentrate their efforts on helping this group of patients?"

The Research Clinic for Functional Disorders wants to help patients who've been tossed around in the healthcare system without anyone being able to tell them what is wrong with them and what treatment they should have. This applies to people with fibromyalgia, chronic fatigue syndrome, whiplash, and to others.

And this is why Per Fink is frustrated, because a small group of angry critics are being unfair and trying to discredit him and the department, and to make patients with functional disorders seem difficult/burdensome/troublesome (besværlige) and convey that people should stay far away from them, when in fact the opposite is true. According to Fink, patients with functional disorders aren't difficult/burdensome/troublesome. They just need help.

End Part I.


Part II.

"Per Fink, Hated..." series continued:

Psychiatric or Physical

While an ever increasing number of patients are referred to his clinic, Per Fink now finds himself in a debate where he's criticized for converting diagnoses for physical illness into psychiatric disorders.

Fink has been the clinic's director of research since its opening in 1999, and his critics view him as championing the concept of functional disorders. Because the clinic's treatments are psychiatric in nature, Fink is accused of converting diagnoses for physical illness into psychiatric disorders.

His "TERM-model", a training program for general practitioners, has additionally been met with outrage by his circle of critics. They believe the model teaches doctors to ' act as if they are listening, "while in fact they have a biased assumption that the patient's suffering is a psychiatric disorder.

In academic circles, however, the model has been well-received and greatly supported, even winning the Academy of Psychosomatic Medicine's award for best training program in the psychosomatic field.

According to lawyer Keld Parsberg, the challenge with functional disorders is that medical science doesn't know the exact reason for them, and patients then are left being bounced around in the healthcare system. A system which mistakenly views their suffering as psychological, maintains Parsberg.

Parsberg took part in a March parliamentary hearing on functional disorders, in light of the concerns which various patient (support and advocacy) groups and critics have raised in the media.

Parsberg explained, "If these diseases are driven into the realm of psychiatry, then we [the state/insurers] can save money on social benefits because psychiatric disorders are always treatable. And if a patient can be treated, then the legal criteria regarding illness duration isn't fulfilled; so these citizens can't access social services, because such services require that their condition be chronic."

According to Parsberg, the possibility that certain groups of disabled patients will have access to social assistance, including financial assistance, is quite limited/restricted. Parsberg doesn't hold back from using extreme words when he speaks about Fink's treatment methods. In the parliamentary hearing, he called Fink's theory of/thesis on "Chronic Somatization" an attack on the Danish system. Parsberg also strongly criticized Fink's TERM-model:

"The first time I read Per Fink's TERM-model, I thought, I recognize this, and it turned out that I did recognize it because it's very similar to the questing/interigation technique that was used by courts in Nazi Germany, and later during the McCarthy-period in the US, where one takes a victim and asks some circular questions [uses circular reasoning?] which, with unfailing certainty, ends with the one being questioned saying, I am opposed to being controlled/opposed to those in power (styret). This was of course interesting. And the USSR also did this in their legal system," said Parsberg.

End Part II.


Part III.

"Per Fink, Hated..." series continued:

Interaction/interplay is the answer

But the debate, in addition to the tough rhetoric, has a premise that Per Fink doesn't agree with. His goal, as the research director explained, is to "challenge the notion that an illness is either physical or mental."

The clinic, using scans, discovered that patients' brains respond differently than others, when the body experiences pain. In this way, it is a biological approach, said Fink, who also points out that a significant number of the clinic's patients do not have psychological complaints, only physical.

"So in that sense it's a very physical condition that we're facing. That which then suggests we're over in the psychiatric realm, however, is that it's therapies from psychiatry which have proven effective," said Fink, referring to the clinic's combination of cognitive therapy, graded rehabilitation/exercise, and in some cases antidepressants.

"I know this is going to sound arrogant, but I really do think this is a rather uninteresting discussion. Whether it's mental or physical doesn't matter in this context. What it's really about is how best to deal with this group," he said.

Nevertheless, Fink considers it 'a serious problem' that municipal authorities treat patients with functional disorders quite differently [than other patients], when determining what social services they qualify for.

"In most cases, it's about ignorance. We can call and talk to the social worker though, and after that it's not a problem in most cases," said Fink.

According to its website, the clinic is quite successful in terms of patient satisfaction. The most-recent satisfaction survey, from 2011, shows that 86 percent of patients found the treatment 'outstanding' or 'good'. And no one seemed to believe that the process was 'poor' or 'unacceptable'.

End Part III.


Part IV.

"Per Fink, Hated..." series continued:

Emotionally-charged parliamentary hearing

The Institute for Functional Disorders, however, has become the center of a delicate/tricky/embarrassing debate, that’s managed to find its way to politicians, as witnessed by the March parliamentary hearing.

The President of the Parliamentary Health Committee, Karen Klint (S), opened the public hearing by stressing that the primary goal was not to 'designate/select a scape goat'. Klint further appealed that the hearing not be used to discuss individual cases, but she still had to interrupt one presentation because a doctor began discussing one such case.

“I've never before experienced someone not following the code of ethics," commented Klint, who further described the debate/hearing as 'very emotional'.

Klint had to ask the doctor to leave the podium, and she threatened as well to end the hearing, which caused the noise level within the room's audience to rise.

The hearing’s audience included Bente Stenfalk, the woman behind a protest group on Facebook and the protest website funktionellidelse.dk [functional disorder/illness - singular/generic], which is confusingly similar, both in name and layout, to the research clinic's official website, funcionellelidelser.dk [functional disorders - plural].

Stenfalk describes Fink as the 'ringleader' behind the diagnosis functional disorder, and she explained that this is why his character/why he personally has been the target of much of the criticism.

"When you write about it," said Stenfalk, you get into a habit -- 'PF', so we know what people mean. It's clear that PF stands for Per Fink and that he's under attack because he is of course the leader. The others are similar, but Per Fink is the one who's pushing this through/forward."

"I'm not against him helping people with stress or other psychiatric conditions," said Stenfalk. He can do that to his heart's content, as far as I'm concerned [Note: I (the poster) am unsure about this sentence: Han må hjertens gerne vaere der for min skyld.]. We just don't want him to take physical diagnoses and convert them instead to psychiatric disorders. I can't see why he should be supported by the municipalities, regions, etc. when there's no evidence."

The research clinic, however, rejects criticism that there’s no evidence of positive effects from [their] treatment, and refers to publications that are linked to the clinic's website—including among other things, a research article from 2012 with results that show a positive effect from cognitive behavioral therapy for patients with functional disorders.

Laura Krogsgaard, who's writing a PhD on IBS, which can be defined as a functional bowel disorder, was also at the hearing, and she wasn't surprised that the clinic's work has documented a positive effect on patients.

Although her knowledge lies within a specific functional disorder, she believes Fink's definition is very relevant for the patients she sees. It therefore irritates her that the hearing became 'muddy', with a number of presenters interpreting the concept of 'functional disorder'.

"I think the term 'functional disorders' is very real,” said Krogsgaard. It's something we use for illnesses where you can’t detect any structural or biochemical changes that might explain the patient's symptoms."

"I think the problem,” continued Krogsgaard, “is that some people give an interpretation of it [functional disorders] that’s not part of the definition. I think many people interpret it as meaning that there’s a psychological cause for the symptoms, because you can’t explain them. But that's not what it means," she says.

This is in line with her PhD supervisor, Peter Bytzer—specialist chief physician in gastroenterology in the medical division of Køge Hospital—who gave a presentation on patients with irritable bowel syndrome during the hearing.

"One of the codewords/key issues (kodeordene) perhaps is that some doctors don't perceive/recognize this as an actual illness, but see it instead as a little complaining," said Bytzer, who called for patients' symptoms to be seen as real, even if you can't find what's wrong.

End Part IV.


Part V.

"Per Fink, Hated..." series continued:

We will make you pay [--original phrase in English, not Danish]

It's hard to say how many people actually identify with these hardcore critics who are active on social media and who participated in the demonstration outside the research clinic.

Facebook groups--who not only oppose Per Fink but also the system in a broader sense--have around 1,300 to 7,600 members. The group that has the most members uses English, and they have 7,600 members worldwide.

Demonstrations in August of last year didn't have a large turnout, but what the critics lacked in size, a few of them made up for with their mouths. This can be seen, for example, on the youtube clip from the August demonstration, when the group of angry protesters stood on the sidewalk outside the research center. They faced the research clinic and passed a megaphone within the group in order to shout various accusations and threats to the research director.

“Per Fink, there is something rotten in the state of Denmark, and it's you," [--original statement in English] declares a woman who's the first to stand with the megaphone in her hands.

From here, there follows accusations that Fink has kidnapped a patient and destroyed her family, and the woman with the megaphone says before passing it on, "We will make sure that you're going to pay for your crimes." [--original statement in English]


End Part V.


Part VI.

"Per Fink, Hated..." series continued:

Taking the beatings

Roughly speaking, the harshest critics can be divided into two groups. One group opposes the very concept of 'functional disorder', which they believe labels physical problems instead as psychiatric problems. The other group focuses on a single patient, whom they claim, Fink helped to remove from her family and admitted [into hospital] against the patient's will. It's the second group that's behind the demonstration outside the clinic. Due to confidentiality, however, the clinic can't comment on this particular case, and it's therefore tangled in a web of unanswered questions.

While the role of a muzzled target would understandably frustrate many, Fink has accepted the role and in some ways even prefers it.

"We've created a division of labor, so it's me who takes the beatings," he said. "I try as much as possible to keep the department free/uninvolved (fri), because we would otherwise spend too much time on this. So I try to take/absorb it, when there's action (der er udadtil)."

"Basically, I'm a very patient person. I know when I should take something personally and when I shouldn't. If it were because I'd made a mistake, I'd probably take it more personally. That's harder. But in this case, well..." said Fink. His eyebrows were, for the first time, drawn together, and he looked down at the table for a long time before continuing.

"We know we're helping a lot of people, and what we're doing is great. I believe - I think - that it's a little group of sick people that I'm up against, so why should I be mad at them. I'd react more if it were doctors or professionals. I would be worried about that, since they should know better," said Fink with a vow, quickly throwing his two fists into the air (siger han og løfter i en kort, hurtig bevægelse sine to knyttede hænder op). Then he slaps his hands down on his lap, looking more calm than a few minutes before.

End Part VI.

(Series unfinished)


On the author comment: According to Dan Peterson there are at least nineteen million dark horses. My own estimate is closer to 30 million.

We need the whole political and medical world to be asking about these kinds of psychogenic claims. Where is the evidence? Not rhetoric, not oodles of quite poor published papers, but hard evidence!
Thanks, Alex. If I keep the dark-horse tag, I'll play with the wording to make it more accurate.

And just as a general fyi, there are a few more sections to this series, which I'll update as able.

My personal opinion is that the author has earned herself a "useful idiot" moniker, and the quality of her work is embarrassing for DM, as well as the University of Southern Denmark (Syddansk Universitet) and its journalism program.
Thanks for translating this.

It seems Per Fink explictly acknowledged that he doesn't listen to patients and doesn't believe their views on treatments, on the (poor quality) scientific methodology that he uses as the basis of his claims.

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