General thread on functional disorders in Sweden

The ME Inquiry Report

The ME Inquiry Report

Senior Member (Voting Rights)
Unfortunately, it feels like we need a separate thread on functional disorders in Sweden now.

I take my starting point in a podcast that one of Sweden's medical associations (Svensk förening för allmänmedicin, SFAM) produces and which relatively recently released an episode on functional symptoms. There is a doctor called Carl Sjöström who is one of the driving forces in this issue in Sweden and who in this podcast promotes both Per Fink's TERM model and Recovery Norway. He talks in great detail about how doctors should approach patients using different techniques to gain their trust in order to get them to change the explanatory model for their illness.

The podcast is in Swedish [link here] but I have written two posts about the content and put auto translated links here:
On successfully manipulating patients (1)
On successfully manipulating patients (2)
 
So the first step is to find out what the patient's explanatory model looks like, and there you also need to broaden that to hear what the surrounding people's explanatory model looks like? What do relatives think? And it has been shown that we, especially doctors, rush through that very quickly. We can ask that question, but then we quickly move on and try to explain what we think is wrong. Most people should probably stay with that a little longer. Really explore how that explanatory model has arisen. What are the consequences of that explanatory model? How has it affected the patient's behavior and coping strategies?
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My explanatory model was approximately: there is some undiagnosed illness that makes it impossible to live a normal life, and to treat it, I must obtain an accurate diagnosis. Other people seem to have difficulty understanding me and tend to give poor advice and ineffective treatments.

This model arose precisely because it was considered common sense that unexplained symptoms were curable and explainable by a psychological framework, and were also not serious. That caused various problems, in particular a lack of urgency and an unwillingness to accept that I did not have control over the situation, and a deep sense of being misunderstood and being harmed by that misunderstanding.

Also, this sense of being misunderstood then leads to trying to help doctors better understand what I'm experiencing by going tinto detail and trying to think of everything that might be just a little bit abnormal. More information must be better, right? This behaviour is probably interpreted by doctors as somatizing or functional symptoms. But it's just a consequence of wanting to be understood and wanting a diagnosis that is true.

I suspect that the patients treated by Dr Sjöström who don't get better end up with similar views.
 
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Hoopoe said:
I suspect that the patients treated by Dr Sjöström who don't get better end up with similar views.
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Unfortunately, I recognize a lot in what you write. I also think that people who have been gaslighted and tormented by health care for a long time are very receptive to the kind and understanding care that Sjöström describes that doctors should use to "convert" their patients.
 
The hubris is off the charts.

They are essentially advocating for healthcare practitioners to become better gaslighters.

I’m dealing with something similar in Norway with three different medical workers that try to tell me, and more importantly my family, that I will get better if I dare to try to do a little more. My family is eating it up, because why wouldn’t they want there to be a solution?

When I ask for explanations I get some vague handwaving about allostasis, because they’ve already said that they don’t support the deconditioning model of ME/CFS. They don’t seem to understand that the allostatic model assumes that a prolonged lack of stimuli is the cause of ME/CFS.
 
The ME Inquiry Report said:
He talks in great detail about how doctors should approach patients using different techniques to gain their trust in order to get them to change the explanatory model for their illness.
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i.e. How to more effectively lie to patients, entirely to avoid the liar facing up to the stark appalling fact that they actually have no explanation and no treatment to offer.

This should be a formal crime, and a very serious one.
 
At this very moment, a PhD program is underway at the Faculty of Medicine at Linköping University called "Persistent Symptoms: Mind-Body perspectives". Several familiar BPS-lobby names are in the list of lecturers both Swedish and international.

List of speakers and link to program and curriculum can be found in my blog post.

Autotranslated link: Persistent Symptoms: Mind-Body perspectives
 
Article in Lakartidningen,

Time to modernise healthcare regarding functional disorders, Oskar Lindfors, Arwa Josefsson, Carl Sjöström

The Swedish guideline on post covid-19 and related syndromes classify six overlapping conditions. A functional perspective, as used in Denmark, distinguishes physiological reactions from diseases, aiding understanding and treatment. Functional symptoms arise from dysregulated adaptation systems reacting excessively. This dysregulation can persist, leading to various symptoms. Effective treatment focuses on stabilizing these systems through knowledge, behavioral changes and gradual exposure to discomfort. A biopsychosocial model addressing biological, psychological, and social factors is key. Denmark's structured approach has improved care, and similar competence-building efforts in Sweden could enhance treatment for post-infectious and long term functional conditions.

Above abstract on PubMed, https://pubmed.ncbi.nlm.nih.gov/40995868/

Original article in Swedish, https://lakartidningen.se/vetenskap/hog-tid-modernisera-varden-vid-funktionella-tillstand/
 
The ME Inquiry Report said:
There is indeed a campaign going on right now.

My comment on the article (autotranslated): Pseudoscientific trend spread by Läkartidningen
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Loving the final sentence:

Educate yourself about what this phalanx stands for, how it has acted historically, and what the consequences have been! Because what the authors of this article present as a modern approach is not particularly new. It can rather be compared to a backpack full of dirty laundry from the time of both witchcraft and hysteria.
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The idea that doctors should be trained in these techniques
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I agree.

I immediately start to construct techniques in my head to deal with physicians who use these techniques.

Maybe it would be a good idea to write our own guide for techniques for dealing with the health care system. Maybe there already is such a guide.
 
Andy said:
The Swedish guideline on post covid-19 and related syndromes classify six overlapping conditions. A functional perspective, as used in Denmark, distinguishes physiological reactions from diseases, aiding understanding and treatment. Functional symptoms arise from dysregulated adaptation systems reacting excessively. This dysregulation can persist, leading to various symptoms. Effective treatment focuses on stabilizing these systems through knowledge, behavioral changes and gradual exposure to discomfort. A biopsychosocial model addressing biological, psychological, and social factors is key. Denmark's structured approach has improved care, and similar competence-building efforts in Sweden could enhance treatment for post-infectious and long term functional conditions.
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Amazing, almost every word of this is a lie.
The ME Inquiry Report said:
There is indeed a campaign going on right now.

My comment on the article (autotranslated): Pseudoscientific trend spread by Läkartidningen
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Even by the usual standards, this amounts to an extreme level of dishonesty. But as usual the blame is elsewhere, with those who allow all this fraudulent nonsense to be said without any pushback, total systemic failure across the board. As usual. They already have all that they are demanding, and it's demonstrably a total and miserable failure. But as usual, they are presenting it both as some new idea that no one ever tried before, but also as something tried-and-tested. It just needs to be more biopsychosocial for more time, in perpetuity.

Here they work around it by pointing to another country where things are just as disastrous as anywhere else, so the lie is still extreme, but obviously such a level of blatant dishonesty is completely incompatible with being a professional. The mass of record they are putting out of their dishonesty and incompetence shows that none of them has given a single second's thought about even the possibility of being wrong. This is an extremist position, taken even further the prior extremist position of those who put this disaster in place. All totally incompatible with any claim of expertise, this is basically the exact opposite of how professionals behave.

And they wonder why so many people no longer trust health care professionals.
 
I planned post the following episode from the same podcast from SFAM mostly as rage bait to y'all:

Medicalization of difuse symptoms on psychological bad health

sfampen.transistor.fm

SFAMpen | Märit Löfgren om medikalisering av diffusa symtom på psykisk ohälsa.

Vad är medikalisering? Vad är livet och vad är sjukdom? Är det lättare för både patienten och doktorn att medikalisera än att normalisera och tillsammans arbeta för undvika överdiagnostik och överb...
sfampen.transistor.fm sfampen.transistor.fm

(Sorry, only in Swedish.)

It starts in this way:

"... the biopsychosocial perspective can help us understand ..."

"... long time depression can lead to pain ..."

"... long time pain can lead to depression ..."

Wait... What! The last quote doesn't fit in the normal pattern for BPS people!

Later in the episode:

"... diagnoses where no clear etiology has been found such as fibromyalgia and ME ... is hard to balance things ... over time conditions such as neurosyphilis and alzheimer's has got their medical etiological explanations ... there might appear new explanations and treatments for fatigue and ME ..."

So this appears to be a person, who speaks about "biopsychosocial perspective", but also is at least half honest.

Interesting.
 
Okay, this person on the other hand seems to be a full BPS loony:

Arwa Josefsson about long term pain
sfampen.transistor.fm

SFAMpen | Arwa Josefsson om långvarig smärta

Hur mår våra patienter med långvarig smärta? Hur kan vi stötta ett hälsofrämjande perspektiv och hjälpa våra patienter att återta chaufförskapet i sina liv? Det och mycket mer om långvarig smärta d...
sfampen.transistor.fm sfampen.transistor.fm

(Still only Swedish.)

She's on the same level as that horrible Carl Sjöström about whom @The ME Inquiry Report wrote.

"I'm enthusiastic for a heath centered perspective that helps patient to stop being patients get agency and get to be in the driver's seat of their own life!!!!"

Dude! You are saying that patients' problems are psychosomatic! That's all you're saying! This kind of manipulative newspeak provokes me more than what they are actually doing. Just say what you mean without all the empty nonsense words!

I get too upset to be able to listen through this episode. I commend you, @The ME Inquiry Report, for your fortitude and endurance in listening to these kind of things.

I web searched for her name and ME/CFS, and what do I find? She's co-author of the article Andy links to above:

Andy said:
Article in Lakartidningen: Time to modernise healthcare regarding functional disorders, Oskar Lindfors, Arwa Josefsson, Carl Sjöström
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Even more on functional symptoms to come, in Sweden:

• November 11-12, 2025 Nordic Network Meeting - Consultation Liaison Psychiatry and Functional Neurological Symptoms. Michael Sharpe, Helene Hegeland and Carl Sjöström among others [program]

• November 19-21, 2025 District Medical Meeting. Lecture Arwa Josefsson: ”Funktional symtoms - hands on” [program]

• January 13, 2026 Theme day on "functional disorders" Swedish Association for General Medicine (SFAM) [invitation]

Summary of information available on the blog (Autotranslated): Functional symptoms seem to be a hot topic right now
 
Andy said:
Article in Lakartidningen,

Time to modernise healthcare regarding functional disorders, Oskar Lindfors, Arwa Josefsson, Carl Sjöström
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Nina E. Steinkopf has written an important response to the problematic article on functional symptoms in Läkartidningen. However, they did not include it because she is not a physician, so now the article is available on her blog instead.

Direct link to Steinkopf's article (Autotranslated): An increase in competence must be based on recognized research

To my blog (Autotranslated): Läkartidningen rejects reply on functional symptoms
 
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