The Swedish Affliction: Resignation Syndrome

Introduction:

Asylum-seeking refugees often suffer from psychological or physical trauma that compels them to flee from their homes, cross national boundaries, and relocate to a more secure state. However, there is arguably a lack of research on how forced immigration and previous trauma can specifically impact the health of refugee children. Accordingly, this paper will focus on a rather peculiar condition known as Resignation Syndrome in which refugee children slowly fall into an unconscious coma-like state as the conscious part of their brain shuts down. In the last fifteen years, hundreds of traumatized refugee children living in Sweden, but originating primarily from Slavic countries like Russia, have become afflicted. Unique to this syndrome is that there have been no reported cases outside of Sweden. While many hypotheses have been presented, there is no definitive answer to why Resignation Syndrome does not exist outside of Sweden. This essay argues that Sweden, a country known previously for its generous immigration laws, has recently become stricter, including a greater rate of denying asylum to asylum seekers. Accordingly, these restrictive laws foster a feeling of uncertainty amongst previously traumatized refugee children as their expectations of staying in Sweden are shattered. Subsequently, there is also a manifesting fear of being deported back to the child’s place of previously experienced trauma. 

Background:

 Before the theoretical analysis of why Resignation Syndrome exists solely in Sweden, it is critical to highlight the general information about the syndrome, including its symptoms, the profiles of the individuals it affects, and if any treatments are available. Resignation Syndrome was first reported late in the 1990s, but there has been an increase in the number of cases in the last two years (2017- 2019).^[1] In total, there have been approximately 800 cases of children suffering from the condition.^[2] Doctors researching the syndrome observe that those primarily affected are children of asylum seekers from vulnerable communities, including Yazidi refugees from Iraq and migrants from Slavic countries like Russia and Ukraine. The children affected by the syndrome are primarily young adolescents ranging from 7 to 19 years of age.^[3]

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 These adolescents have frequently experienced physical or psychological trauma from their home countries, a factor that compelled their families to flee and seek asylum in Sweden. Such traumas may include rape of a family member, physical abuse, threats to the family’s livelihood, or the witnessing of other forms of violence. The uncertainty and horror of these traumas leave a scarring impact on such young children. What’s more, beyond the trauma experienced back home, these refugee children also face “the trauma of the journey [and] the trauma of detention… at some point, the bucket is full. And they just collapse”.^[4] However, as stated previously, the children affected were only those whose families fled their home country and sought asylum in Sweden.

 Of the refugee children who have siblings, it was often the oldest child who is affected by the syndrome. The oldest children are better able to comprehend the trauma they experience either directly or indirectly through their family members, and also run a greater risk of being exposed to such trauma. Moreover, they usually have the greatest responsibility in comparison to the other siblings and so, are under greater pressure. Meanwhile, the younger siblings are not as aware of the family struggles and trauma nor are they exposed to it as much. Finally, refugee children who: exhibit psychological instability, have a history of mental health such as depression, and have overly sensitive personalities, run the greatest risk of falling ill.

Symptoms:

While the underlying theories of why the condition exists solely in Sweden will be discussed later in the paper, it is critical to highlight that before their affliction, many of these children have been living in Sweden for more than a couple of months. To be more specific, before their immediate showing of symptoms, many of these adolescents had begun their assimilation into the Swedish culture and had sufficient fluency in the language. It is only when they receive the notice that their request for asylum has been denied or they receive a warning of imminent deportation do they begin to display symptoms of Resignation Syndrome. The symptoms of Resignation Syndrome are similar to those suffering from Catatonia, a behavioral syndrome that involves a lack of proper movement and speech.^[5] At first, these affected children withdraw from social activities and slowly draw into themselves. They proceed to exhibit deterioration in their motor skills as they slowly lose the ability to speak, eat, and drink all together. Swedish doctor, Göran Bodegård describes the children as “passive, immobile, withdrawn, mute, incontinent, and not reacting to physical stimuli or pain”.^[6]

Secondary symptoms may also appear such as weight gain, viral infections, skin sores, and muscular deterioration. As Elizabeth Hultcrantz, a doctor who has treated those with Resignation Syndrome, told The New Yorker: “I think it is a form of protection, this coma they are in. They are like Snow White. They just fall away from the world”.^[7] In this state, the afflicted children’s parents are forced to feed them through feeding tubes and place their children in diapers as they are unable to walk. In the early stages of the Syndrome, there was a lot of public speculation regarding the children’s condition. At first, right-wing Swedish officials, certain sectors of the Swedish public, and even a handful of medical researchers believed the children were faking their symptoms or the parents were poisoning their children.^[8] Only after tests were run, was it shown that there was neither outside manipulation nor were the kids faking the illness, these children were seriously sick.

Treatment:

Furthermore, there is no medical cure for Resignation Syndrome. Feeding tubes help sustain the life of the child, but it does not serve as a medical treatment. More precisely, no medicine can help the child regain both his or her motor functions and livelihood. The best way, according to Swedish medical practitioners to treat Resignation Syndrome is “to promote and maintain a secure and hopeful environment, encouraging a sense of coherence.”^[9] This security may come from granting asylum or permanent residency to these refugee families, thereby, eliminating the fear and uncertainty of being deported back to the place of previously experienced trauma. It is up to the parents to transmit this sense of hope as the afflicted children are dependent upon rebuilding security in their lives.

Through their parents’ tone, touch, and the general shift in the atmosphere resulting from good news, the children have a chance of coming out of their coma-like state. Doctor Hultcrantz “knows that the children can be healthy again, they are not damaged for life if you take care of them”.^[10] She goes on to describes the afflicted child’s recovery as “more sound, more life in the house… the siblings are more joyful… the parents sit around the child and they touch the child and they hug the child”.^[11] However, this renewed sense of security does not guarantee recovery, and if the child does recover, it takes a long time to feel secure as nightmares and stress continue to linger. Typically, the previously afflicted child will have no recollection of falling into this coma-like state and it takes a couple of months for the child’s livelihood to be restored.

Causes of Resignation Syndrome:

This section will examine three causes that may factor into why children suffer from resignation syndrome. These contributing factors include, but are not limited to 1) the immense amount of stress placed on refugee children, 2) an ensuing lack of proper mental health treatment for the stress the child is under as well as the past trauma he or she has experienced, and 3) a psychodynamic hypothesis in which the migrant mother (or even father), often the subject of physical abuse or sexual assault, projects his or her trauma onto the child, who subsequently adopts this trauma as its own.

The Stress Factor:

 Previous trauma before one’s migration as well as the trauma of leaving your home and immigrating to a new country can place an immense amount of stress onto a child. For instance, before migration, children may experience the stress of living through a state war, the loss of a parent’s career (frequently leading to a lack of funds), critical illness, the sexual or physical abuse of a family member, or the witnessing of violent acts such as murder. A refugee child might suppress these experiences but such trauma stays with them and so, they seek out security in countries like Sweden. These experiences are usually the driving force of what compels families to flee and seek refuge in nearby states. It is also important to reiterate that there is incredible stress imbued within the immigration process as well.

The Netflix documentary, Life Overtakes Me, follows the narrative of three refugee children suffering from Resignation Syndrome. One of these children was Karen, a twelve-year-old refugee from Eastern Europe and the oldest of three siblings. In his home country of Ukraine, Karen witnessed the shooting and subsequent murder of a family friend, a situation in which he and his father barely escaped.^[12] This witnessing of violence alongside various other threats made against the family compelled them to flee and seek refuge in Sweden. Amid their immigration, Karen began exhibiting signs of Post Traumatic Stress Disorder after the trauma he suffered. He became paranoid, frequently thinking there was someone outside trying to shoot them. Notwithstanding, the family was granted a temporary thirteen-month residency in Sweden and Karen began improving, assimilating in the Swedish school system and learning the language.

Unfortunately, soon thereafter, the family was forced to re-apply. Amid that uncertainty, Karen fell ill again. He stopped talking, eating, and walking; soon after that he became diagnosed with Resignation Syndrome. Karen had found security in Sweden, making friends and moving on from the trauma he experienced back in Ukraine. Nonetheless, as a consequence of this uncertainty in applying for residency again, the perceived danger of going back to his place of trauma was psychologically something Karen could not handle. In line with this narrative, a report published in the Asylum Seeker Resource Center (ASRC) stated that “these children cannot recover from [their home country] because [their home country] is the cause of their trauma”.^[13] The family is stilling awaiting news of whether their residency was granted and Karen has remained unresponsive for 14 months.

While stress is a contributing factor for why refugee children suffer from Resignation Syndrome, it does explain the regional distribution of the condition. More precisely, many refugee children who have not migrated to Sweden, but other countries, are also under an immense amount of pressure, live in stress-induced conditions, and face the uncertainty of deportation as well. Yet, there have been no reported cases outside of Sweden despite other refugee children also facing enormous amounts of stress. Accordingly, there must be another  hypothesis that explains why Resignation Syndrome does not transcend past Swedish boundaries.

A Psychodynamic Hypothesis

 Another potential driving force of Resignation Syndrome is the practice of “projective identification”. In many cases, refugee mothers (and occasionally fathers) have been subject to traumatizing experiences such as rape or physical abuse, motivating them to sever their ties to their home state and flee to another country. This period is marked “by a painful period of hopelessness, helplessness and indeterminate time perspective as an asylum-seeker in a foreign country”.^[14] The mother and/or father, unable to cope, are believed to project their trauma onto their child, who has often either directly witnessed or heard about the abuse suffered by either parent. In other words, the child identifies with his or her parent’s loss of hope, and internalizes their trauma, slowly withdrawing from the world. Thus, these refugee children may not have directly experienced this trauma, but when their parents project their trauma onto them, they subsequently identify with this sense of hopelessness, slowly recognizing the trauma as their own. Accordingly, the refugee child gradually “takes up the position of devitalized infant…as a form of protection against this emotional toxicity… surviving together [as a family] in their current life circumstances”^[15]

 This hypothesis is supported by one of the narratives in Life Overtakes Me. A young Russian girl named Dasha gradually became afflicted with Resignation Syndrome after her family fled to Sweden. Her mother had been raped in the woods of Siberia but hadn’t told her children. Inpportunly, Dasha heard the story of her mother’s rape when the asylum-seeking family had an interview with the Swedish Immigration Center. Upon this news, Dasha immediately began crying, slowly rejecting her food and stopped talking altogether after a few months (Life Overtakes Me, 2019). It was only until her family was granted Swedish residency did Dasha finally recover after 8 months of being unresponsive. It is important to highlight that this change in atmosphere, greater security, and positive news was transmitted to Dasha by her mother.  To Dasha, “this profound change in the reality of their situation was accepted as a truth” only when her mother, sensing greater security in her life, was able to move past her trauma and overcome her hopelessness.^[16] In doing so, the mother’s sense of hopelessness is no longer projected upon Dasha, thereby, “reawakening [her] lust for life”.^[17]

 Accordingly, this hypothesis may, in circumstances when the child has not personally experienced the trauma, explain why Resignation Systems occurs. To reiterate, it has been demonstrated that in the projection of the mother or father’s trauma onto their child, the son or daughter gradually recognizes the trauma as his or her own. Thus, while this may be one of several causes of Resignation Syndrome, it does not explain the regional distribution of the illness. Many refugee children’s parents, who have fled to countries other than Sweden, have also faced similar trauma and have subsequently projected this sense of hopelessness onto their sons or daughters. Accordingly, there should be evidence of other refugee children, who are living outside of Sweden, that suffer from Resignation Syndrome. Yet, as previously mentioned, no reported cases have been reported past Swedish national boundaries; therefore, the psychodynamic hypothesis falls short of explaining this bizarre phenomenon.

Mental Health Hypothesis:

 A final contributing factor frequently cited by medical researchers for why Resignation Syndrome exists is a theory of mental health. This theory is more preventative as it stipulates that had these refugee children received proper mental health treatment upon experiencing this trauma, they may have never fallen ill. In more precise words, the hypothesis suggests that Resignation Syndrome could have been avoided if parents or other family members had provided sufficient mental health treatment for their children who had suffered from past trauma. To be more specific, with proper treatment of past traumatic experiences, these refugee children are not forced to suppress their trauma or have it resurface when there is a threat of deportation. Accordingly, the theory argues that in the treatment of trauma, the children never run the risk of falling into this comatose state; and so, Resignation Syndrome can be prevented. Nevertheless, this theory fails to account for the fact that usually, these families lack the economic capital to gain access to these treatments for their children. Even if they did have the economic capital, these refugee families are frequently in life-threatening circumstances; therefore, they do not have time to provide their child with this treatment. Moreover, in certain circumstances, parents may not take notice of the trauma experienced by the child if they are still in shock or if they deny having experienced the trauma in the first place. In this scenario, the parents would not find mental health treatment necessary.

 Furthermore, while mental health treatment may help the child move past their personally experienced trauma, the trauma of their parents may still be projected onto them. The trauma of the migrant journey is another unavoidable stress factor for refugee children. Accordingly, further treatment would be necessary as a consequence of this added stress. In light of these weaknesses, the mental hypothesis arguably is not a compelling explanation for why Resignation Syndrome exists. In that it is not a compelling contributing factor, this theory does not go far enough to explain why the condition exists only in Sweden.

Recent Swedish Immigration Policy:

 Until recently, Sweden was known for its generous immigration laws and in particular, its lenient asylum granting policies. Accordingly, many asylum-seeking families and individuals fled to Sweden under the impression that they had a high chance of being granted asylum and correspondingly, a secure future living condition. Yet, in 2015,  “a record-breaking 162,877 asylum seekers entered Sweden, which along with Germany was the preferred destination for a wave of Syrians, Afghans, Russians, and others who reached European soil in search of protection and better lives”.^[18] In light of this influx of immigrants, anti-immigrant sentiments began to grow in Sweden, causing the Swedish government to institute border controls. Subsequently, in late 2016, a restrictive family reunification and asylum law came into force. The law introduced  “new restrictions on asylum seekers, including rules that would limit the number of people granted permanent residency and make it more difficult for parents to reunite with their children.”^[19] This law may be correlated to the increase in the number of Resignation Syndrome cases starting in 2017. Of course, it is important to note that this could also be a coincidence as there is no proven correlation between the two.

Culture-Based Hypothesis:

 As a result of these recent restrictive immigration laws passed in Sweden, it is plausible to argue that the recent cultural change in Swedish society serves as both a contributing factor of Resignation Syndrome as well as a sufficient explanation for why the illness exists only in Sweden. To reiterate, asylum-seeking families and their traumatized children were operating under the assumption that they had a high chance of being granted asylum in Sweden. However, as a consequence of this restrictive asylum law, their chances of receiving asylum were greatly diminished. Accordingly, these refugee children who are assimilating into Swedish society and know the language well, have both their expectations and hopes of securely staying in the country, shattered. Either their families’ request for asylum is denied, they are not granted permanent residency, or they receive a notice of imminent deportation. In comparison, countries like Greece, Hungary, and Romania have always been known to have stricter immigration laws; therefore, refugees fleeing to those countries are aware that the chances of their asylum being granted is less.^[20] While there is not enough research to argue that this cultural policy shift in Sweden definitively explains why Resignation Syndrome exists solely in Sweden, it is more probable than the other hypotheses put forth. In other words, this culturally-based hypothesis has enough credible support to suggest it plays both a contributing factor for the condition and explain why the illness exists only in the Swedish state.

 To further this hypothesis, the surprising denial of asylum due to stricter immigration laws is coupled with the refugee child’s manifesting fear of returning to his or her place of trauma. This fear, according to Bodegård, is a “perpetuating retraumatization [that] possibly explains the endemic distribution” of Resignation Syndrome.^[21] As previously mentioned, refugee families flee their home country as it tends to be the place in which they experience their trauma. Therefore, if a child is faced with the uncertainty of being deported back to the place of their suppressed trauma, then that trauma has the possibility of resurfacing. This refugee child’s traumatic resurface risks transforming into Resignation Syndrome.

Conclusion:

 As exemplified in this paper, there are many potential contributing factors for why  Resignation Syndrome exists primarily amongst refugee children. Nonetheless, unique to this illness is the fact that all reported case has been within the national boundaries of Sweden. While many contributing factors explain why the Syndrome exists, only the cultural hypothesis can fully explain its regional distribution. To reiterate, this hypothesis argues that the recently more restrictive changes to Sweden’s immigration laws, including a stricter asylum policy, explains Resignation Syndrome’s regional distribution. This fear of being deported back to the child’s place of trauma frequently manifests itself into the symptoms of the syndrome.

It is important to highlight that these are simply theoretical hypotheses, as there is not enough research on Resignation Syndrome to garner a definitive answer. As a society, we need to further study this bizarre illness and more generally, we need to research the trauma both directly and indirectly faced by refugee children. These children’s toolbox for coping with such trauma is much less than their parents; thus, they run the greatest of falling victims to conditions like Resignation Syndrome.

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14. Verdouw, Emily, and Lane Sainty. “The Strange Illness Among Sweden’s Refugee 13. Children Is Now Being Seen In Australia’s Offshore Detention Camps.” BuzzFeed. Last modified September 27, 2018. https://www.buzzfeed.com/lanesainty/refugee-children-resignation-syndrome-sweden-australia.

^[1]“Sweden’s Mystery Illness: Resignation Syndrome,” Doctors of the World, last modified February 20, 2018, https://doctorsoftheworld.org/blog/swedens-mystery-illness-resignation-syndrome.

^[2] Ibid.

^[3] Karl Sallin et al., “Resignation Syndrome: Catatonia? Culture-Bound?,” Frontiers in Behavioral Neuroscience 10 (2016):doi:10.3389/fnbeh.2016.00007.

^[4] “Sweden’s Mystery Illness: Resignation Syndrome,” Doctors of the World, last modified February 20, 2018, https://doctorsoftheworld.org/blog/swedens-mystery-illness-resignation-syndrome/.

^[5] “Catatonia: Symptoms, Causes, and Treatment,” WebMD, last modified January 30, 2019, https://www.webmd.com/schizophrenia/what-is-catatonia#1.

^[6] Bodegård in  Karl Sallin et al., “Resignation Syndrome: Catatonia? Culture-Bound?,” Frontiers in Behavioral Neuroscience 10 (2016): doi:10.3389/fnbeh.2016.00007.

^[7]  Hultcrantz inJoselito Dias and Iago Santiago, “Resignation Syndrome in Hidden Tears and Silences,” SAGE Journals, last modified August 3, 2018,

^[8] Life Overtakes Me, directed by Kristine Samuelson. (2019; Sweden: Netflix, 2019), Film.

^[9] Karl Sallin et al., “Resignation Syndrome: Catatonia? Culture-Bound?,” Frontiers in Behavioral Neuroscience 10 (2016): doi:10.3389/fnbeh.2016.00007.

^[10] “Sweden’s Mystery Illness: Resignation Syndrome,” Doctors of the World, last modified February 20, 2018, https://doctorsoftheworld.org/blog/swedens-mystery-illness-resignation-syndrome/.

^[11]Ibid.

^[12]Life Overtakes Me, directed by Kristine Samuelson. (2019; Sweden: Netflix, 2019), Film.

^[13] “Child Trauma on Nauru – The Facts,” Asylum Seeker Resource Centre, last modified November 16, 2018, https://www.asrc.org.au/2018/08/28/child-trauma-on-nauru-the-facts/.

^[14] Göran Bodegård, “Pervasive loss of function in asylum-seeking children in Sweden,” Acta Paediatrica 94, no. 12 (2005): 344, doi:10.1080/08035250510036778.

^[15]  Göran Bodegård, “Pervasive loss of function in asylum-seeking children in Sweden,” Acta Paediatrica 94, no. 12 (2005): 345, doi:10.1080/08035250510036778.

^[16] Göran Bodegård, “Pervasive loss of function in asylum-seeking children in Sweden,” Acta Paediatrica 94, no. 12 (2005): 347, doi:10.1080/08035250510036778.

^[17]Ibid.

^[18] Admir Skodo, “Sweden: By Turns Welcoming and Restrictive in Its Immigration Policy,” Migrationpolicy.org, last modified May 26, 2019, https://www.migrationpolicy.org/article/sweden-turns-welcoming-and-restrictive-its-immigration-policy.

^[19] Dan Bilefsky, “Sweden Toughens Rules for Refugees Seeking Asylum,” The New York Times – Breaking News, World News & Multimedia, last modified June 21, 2016, https://www.nytimes.com/2016/06/22/world/europe/sweden-immigrant-restrictions.html.

^[20] Senay Boztas, “These Are the Toughest Places for Asylum Seekers to Enter Europe,” Telegraph.co.uk, last modified February 5, 2016, https://www.telegraph.co.uk/news/worldnews/europe/12140900/These-are-the-toughest-places-for-asylum-seekers-to-enter-Europe.html.

^[21]Bodegård in  Kenneth P. Nunn et al.”Pervasive refusal syndrome (PRS) 21 years on: a re-conceptualisation and a renaming,” European Child & Adolescent Psychiatry 23, no. 3 (2013): xx, doi:10.1007/s00787-013-0433-7.