What do you think of the Stockholm Solution?

Sweden uses a different approach for eating disorders not based on pschotherapy or the traditional clinical model. They claim a 75% success rate. There's a documentary on it, you can watch the first ten minutes here free:

http://www.youtube.com/watch?v=xEKpFRPjKcQ

http://www.journeyman.tv/18138/documentaries/ the-stockholm-solution.html

What do you guys think? Is this guy really on track or out to lunch?

I think it makes a lot of sense.  I've long thought that a poor diet is at the root of a lot of disordered eating problems ... overeating as well as undereating.  The solution they're describing is what gets referred to here as 'mechanical eating'... eating to a fairly rigid schedule.   Overeaters benefit as much as undereaters from that.  Normalising the diet, developing a regular eating pattern and boosting the nutrition content is certainly a powerful tool.  

I'm sure psychology plays a part, however, although possibly not to the extent we'd all like to believe.  After all, if someone tells me I'm fat because I have emotional problems and not because I eat too much that rather lets me off the hook, doesn't it?   Despite the fact that someone else with precisely the same emotional issues may be a healthy weight.    Eating disorders (discussed in another thread) seem characterised by those unpleasant features of obsession, compulsion, phobia... and maybe that's just something people have to learn to live with as part of their personality and lean how to manage?  Ultimately, even if you are never cured, it's not a problem if at the same time you're eating properly.

I havent had the chance to watch the clip because I have to run to class, but I wanted to commen that eating disorders like anoxeria and bulmia are classified as a mental health issue (they are in the DSM IV) and so any treatment that leads out psychotherapy is missing a crucial past of treatment.

holy crap!  i watched the clip and ordered the DVD.  i've long suspected that the common wisdom around eating disorders is missing the boat.  well, several boats, actually.

keb, the DSM is just a book, and the disorders in it just represent the current opinions of a bunch of american white guys.  it changes all the time, and it's just based on the best knowledge of the moment; it's not delivered by the hand of god.  new research, new knowledge --> new edition of the DSM.

anyway, the "stockholm solution" doesn't say that there's no mental health implications; it says that the psychological problems are a symptom rather than a cause.

i'm really blown away and encouraged by this ;)  thanks for posting, 42dwhateveryournameis!

I'd have to agree with pgeorgian that the DSM is ever-changing and is really not the end-all be-all...after all, homosexuality was once in the DSM! So to just take the DSM as fact is kind of irresponsible in a way...because it focuses on the Western cultural viewpoint on things, and does not really take into consideration other cultural viewpoints that can be critical for someone.

I think there is too much emphasis on viewing anything as a mental illness that needs to be treated. This view can be extremely damaging in its own right. BUT I think this could be effective for some people, in that every one is different and what works for some may not work for others. I can't wait to go home to watch the youtube cilp...I'm at school right now. =(  But I read the blurb in the second link and it really seems interesting and promising in ways. It's a bit disappointing that the psychiatric field isn't delving into it, although not surprising to say the least!

I particularly like this statement, “we say that the psychiatric symptoms – such as anxiety, depression and obsessional behaviour – are the consequences of the distorted eating rather than the cause”. 

I'm skeptical that it works for everybody.  Surely there are more reasons for eating poorly than ignorance and body chemistry? 

I was insulted at first - I've been told many times that I'm fat because I eat too much (and I'm sure the reverse is true for anorexics), and it trivializes the fact that it is HARD to follow a "proper diet" - there are tons of emotions and social reasons there.  However, the more I thought about it, there could be some truth.  The more I don't overeat, the less I want to; the more I follow a proper diet the easier it gets. 

So I guess what to do is jump right in with a proper diet - and eventually your emotions will catch up. 

Original Post by pgeorgian:

... opinions of a bunch of american white guys.  ...

 Did you really have to go that far?

tom, i wouldn't have, if it weren't about 90% true.

one of the biggest problems with viewing EDs purely through the lens of the DSM is that those people who don't meet the criteria (yet) have very limited access to treatment of any description.  the implicit message, often, is "come back when you're sicker."  and often "sicker" translates into "dying."

and with the death rates of, particularly, anorexia, it's pretty obvious that new approaches and perspectives are desperately needed. 

Ok, so I have had the opportunity to watch the clip!

I agree that the DSM is always being updated and has its faults, but I dont think you can dismiss the mental health aspects of an eating disorder because of the amount of disordered thoughts many patients have in regard to their body, shape and weight.

In my opinion the best approach is a combination of treatments. Sure, these patients need to be taught better eating behaviours, and working with dieticians is a very big part of treatment. But I also think counseling and psychotherapy should also be a part of treatment.

I took a class in college taught by one of the top ED researchers. She did cross-historical, cross-cultural research on anorexia nervosa and bulimia nervosa. She found AN in every culture she studied, throughout history. The unique feature to Western AN was the fat phobia- in other cultures and at other times, people had the exact same symptoms of AN without being afraid of gaining weight. However, BN was only found in Western cultures- when there were cases of it in non-Western cultures, the person had experienced significant Western influence.  

If it helps you, that's great.

By the way, 42dnevncmus stnads for the latin motto Fortudine Vincimus (By Endurance, We Conquer).

I think their approach holds a lot of merit. If you read about the Ancel Keys starvation experiments during WW II many of the previously healthy men experienced many of the behaviors typically associated with anorexics. There is an American clinic using this approach not far from me that I looked into earlier this year. Would have loved to have tried it but, unfortunately, the fee is astronomical.

hey - my dvd arrived the other day and i finally got to watch it.  more and more, i think this approach and way of thinking make sense...i just wonder why it hasn't caught on (no i don't.  i know that the psychiatric community doesn't want it to catch on).

just wanted to throw my recommendation out there in case anyone's thinking about buying/watching this doc.