RESIGNATION SYNDROME

Author: Biljana Meshkovska

Last update: 17/10/2019

 

As of January 1, 2014, the Swedish National Board of Health and Welfare has identified “resignation syndrome” as a new type of condition that can be given an official diagnosis (Sallin et al., 2016). Resignation syndrome has been defined as:

“a disorder predominantly affecting psychologically traumatised children and adolescents in the midst of a strenuous and lengthy migration process…depressive onset is followed by gradual withdrawal progressing via stupor into a state that prompts tube feeding and is characterised by failure to respond even to painful stimuli” (Sallin et al., 2016, p. 1)

What is particular of the syndrome is that all recorded cases have occurred and been registered only in Sweden, and it was brought to wider international attention through the article “The Trauma of Facing Deportation” published in the New Yorker in 2017. From 2003-2005, 424 cases were reported in Sweden out of 6547 asylum applications for children, with a diagnosis prevalence of 2.8% (Sallin et al., 2016). The numbers of newly-identified cases have decreased in more recent years, with 49, 85 and 84 new cases identified in 2014, 2015 and 2016 respectively, among children aged 6-17 (Socialstyrelsen, 2019). Resignation syndrome has only been identified among asylum-seeking children awaiting the outcome of their own and their family members’ asylum applications.

Some of the pioneering work on the topic in Sweden has been done by Göran Bodegård, a paediatrician, child and adolescent psychiatrist, and psychoanalyst who has directly treated cases of patients with resignation syndrome while leading the inpatient child psychiatric ward in Stockholm. Bodegård (2005a) studied 23 children between 2002-2005 whose families had arrived in Sweden from Central Asia and the former Soviet republics and whose residence status in Sweden at the time of onset of the resignation syndrome was not secure (either asylum applications were refused and deportation orders issued to the family prior to developing the syndrome, or asylum applications were still being evaluated). Bodegård described the children as overall passive, not reacting to outside stimuli, and unable to care for themselves or feed themselves (Bodegård, 2005a, p.1707). Although Bodegård finds that the granting of residence permits to the victim and his/her family was a ‘condition’ for recovery, the residence permit on its own was not sufficient for a child to fully recover (Bodegårda, 2005). Another study by Bodegård focused on 5 refugee children who had also been treated in Stockholm (2005b). In the context of the study, Bodegård found that recovery occurred, not only after the family received residence status in Sweden, but when the mother accepted that the child was not dying and began to assist in the recovery process (Bodegård, 2005b). The findings suggest that family support can play an important mediating role in the progress of and recovery from the syndrome.  Bodegård found that during the time the child was hospitalized, a mother acted as though the child was dying, despite guidance from healthcare providers to the contrary (Bodegård, 2005b). The mother’s behavior changes following the positive news of the asylum application and receiving of a residence permit, and her gradual acceptance that her child was not dying, corresponded to a child showing positive signs toward recovery within 1 week to 30 days of the announcement of the asylum decision (2005b). It took up to 6 months for the children in the study to fully regain their normal functions. Literature is lacking in regard to long term consequences of the syndrome.

Overall treatment strategies for those diagnosed with the syndrome include administering tube feeding in the hospital, and teaching the caregivers to do so, after which patients may be sent home, with the recommendation that they should be taken care of in a ‘secure and hopeful’ atmosphere (Sallin et al., 2016). There is no consensus as to whether or not patients should be hospitalised for as long as the syndrome is present, or sent home for care. Literature finds that tube feeding may last from months to years (Salling et al., 2016).

Sallin et al., (2016) propose the hypothesis that resignation syndrome is the same as another condition – catatonia, which is characterised (amongst other symptoms) by the inability to move. It is further proposed that resignation syndrome is ‘culture bound’, which means that the culture from which the patients come from, and what is socially acceptable, have an influence on whether or not the condition will occur and develop (Sallin et al., 2016, Santiago et al., 2019).

Nonetheless, scholars recognise that very little scientific information and academic work is available on this topic and call for additional research to be done. Thomas (2017) calls for further investigation of not only whether resignation syndrome is indeed catatonia but also into the factors that contribute to its onset, such as individual characteristics of the victims and experiences of prior traumatisation. Additional research is needed in regard to the best types of treatment, whether patients should be hospitalised or sent home, as well as on the long term consequences of the syndrome.

References

Aviv, R. (2017). Trauma of Facing Deportation. The New Yorker.

Bodegård, G. (2005a). Pervasive loss of function in asylum-seeking children in sweden. Acta Paediatrica, 94(12), 1706-1707.

Bodegård, G. (2005b). Life-threatening loss of function in refugee children: Another expression of pervasive refusal syndrome? Clinical Child Psychology and Psychiatry, 10(3), 337-350. doi:10.1177/1359104505053753

Sallin, K., Lagercrantz, H., Evers, K., Engström, I., Hjern, A., & Petrovic, P. (2016). Resignation syndrome: Catatonia? culture-bound? Frontiers in Behavioral Neuroscience, 10. doi:10.3389/fnbeh.2016.00007

Santiago, I., Freitas Neta, M., De Barros, J., Landim, J., Arrais, T., De Sousa, D., . . . Rolim Neto, M. (2019). Resignation syndrome in hidden tears and silences. International Journal of Social Psychiatry, 65(1), 80-82. doi:10.1177/0020764018792595

Thomas, S. (2017). Resignation syndrome: Is it a new phenomenon or is it catatonia? Issues in Mental Health Nursing, 38(7), 531-532. doi:10.1080/01612840.2017.1341229

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