Interview with Per Fink
Per Fink has been a professor of Functional Disorders since 2009 and has for a number of years focused his research on the diagnosis and treatment of functional somatic disorders as well as on classification, especially the research criteria for Bodily Distress Syndrome as well as Health Anxiety.
Both the topic of his Ph.D. and later his Doctor of Medical Science focus on somatization and Per Fink is active in a network for experts in the field of functional disorders as well as involved in several cross-disciplinary projects with both national and international stakeholders. Among the prizes he has received you find a Prize for Civil Courage from 2019.
Marianne Kastrup: Does working in the field of functional disorders require a particular courage?
Per Fink: Well, it is complicated but certain functional disorders – in particular Chronic Fatigue Syndrome – have very strong patient organizations that may be quite aggressive. I experienced when I some time ago lectured at Columbia University in New York to be met by a large very noisy demonstration. In the US and the UK, the organizations are quite powerful but also in Denmark members of the organization can be very offensive. One way to be heard is to contact the political system. Local politicians are in closer contact with the local health systems so instead the patient organization takes contact to members of the Danish Parliament trying to convince the politicians that patients with the disorder are not receiving appropriate treatment as they are certain to suffer from a definite physical disorder.
One strategy used by the organization is to spread rumors that the doctors and researchers involved are controversial and not to be trusted. And if you try to respond they may have an attitude of knowing better which does not encourage a constructive dialogue. However, it is an integrated part of my job description as a professor to communicate our research results to the public and raise awareness about functional disorders and to improve treatment for these patients, who in general have been neglected and badly treated in our health care system. Consequently, I have over time experienced some unpleasant interactions with the group. But I do not feel personally hit by the criticism as I have nothing to hide – on the contrary, we base our treatment on evidence-based research. A negative consequence of the contact to the political system is further that I have to spend quite a lot of my time answering questions from our politicians – time that is taken from research.
Is the militant group representing a small or a large fraction of the patient population?
Luckily it is only a small proportion of the patients with chronic fatigue syndrome that react like that and more that 90% are interested in receiving the treatment offered. In fact, we have a very high patient satisfaction, and the majority of patients express contentedness that their complaints are taken seriously, and a treatment is offered that may reduce their symptoms - and some even become healthy. This is not just the case with respect to chronic fatigue syndrome but patients with other functional disorders, e.g. fibromyalgia or whiplash syndrome express the same satisfaction.
But it is only the chronic fatigue syndrome organization that reacts with such aggressivity towards our approach to the disorder. The other patient organizations are different and more interested in a constructive dialogue despite they do not always agree with us in everything.
Do such groups support you in public?
Unfortunately, there are several examples that patients who openly express support or satisfaction with our work may be subject to various kinds of retaliation. In the worst case I have seen an example that a patient who openly supported us experienced that false accusations about him reached his work place. Thus, we are cautious encouraging patients to step up and tell their story in public, despite it would be very important to get some of the many uplifting stories published.
How is your collaboration with somatic colleagues?
In general, we have a splendid collaboration, but you may experience now and then colleagues who get exhausted when encountering patients who insist on that their problem is exclusively physical and find it unacceptable that it is more complex. But unfortunately, a few colleagues do support the more aggressive organizations and their attitude towards treatment which I have difficulty in accepting as they should have a certain insight in the scientific evidence.
I find studying functional disorders very exciting as you move across fields and touch different disciplines. But when there is a shortage of resources, and everyone is pressed it becomes more difficult.
So how do you see your research field?
I see a functional disorder as a way to express that you are distressed, like others may react with depression or anxiety. I know that our research has contributed to a significant improvement in the treatment of functional disorders, and this has helped a lot of patients. However, it is frustrating that there is a small group of patients having so strong illness believes, that they reject the treatments that we suggest. For some of these people, illness in a manner of speaking becomes their way of life. Furthermore, from a research point of view, it is difficult to recruit these patients to participate in research projects which of course is problematic, if we should learn how to help and treat these group. We have tried to include anthropologic expertise to overcome these obstacles. □