Professor Dr. Henry Ascher

In Sweden, hundreds of traumatized refugee children fall into a coma-like state, falling ill with what is known as resignation syndrome. The Swedish documentary film „Life Overtaken“ by two-time Oscar-nominated filmmakers John Haptas and Kristine Samuelson tells the story of this phenomenon, which was first observed in the early 2000s. Pediatrician and Professor Dr. Henry Ascher from the University of Gothenburg says that around a thousand cases of the illness are known in Sweden to this day. He is researching this enigmatic syndrome, also focusing on the social differences among those affected.

By Tamara Gajić

Professor Ascher, in 2014 the Swedish National Board of Health and Welfare included resignation syndrome as a distinct diagnosis. How can this illness be described?

There is currently no laboratory test or objective medical examination to accurately verify a diagnosis. Experience shows that a series of clinical examinations are performed that can ultimately define the syndrome. However, the illness can vary over time: in some patients, especially in the early stages, an active form of refusal is evident, for example, refusing to eat. The course of the disease ultimately fluctuates between these active protests and a more passive attitude, though this increasingly develops into an apathic state. In principle, the children detach themselves from the outside world and withdraw.

What is ultimately the trigger of the disease and how does the progression manifest?

As a rule, these are children who have suffered extremely severe trauma, for example, having witnessed a rape or even the gang rape of their mother, which unfortunately is not uncommon. Sometimes they have been abused themselves. Then many of these children arrived in Sweden, feeling safe that these horrific experiences would never happen again. Many of them were very, very good at school, learned Swedish quickly, and within a few years were top students in their classes. And then came the decision that they should be sent back to hell. And then this kind of symptom appeared. We have descriptions of children in other very difficult circumstances who have more or less detached themselves from the world around them in order to cope with a situation, for example, children who were very poorly treated in orphanages. They showed symptoms as if they had a severe cognitive impairment. And then, when they are placed in a loving family, they develop into completely normal children.

Are only traumatized children and adolescents with a migration background affected by this, or have such cases also been documented in adults?

Various forms of trauma that adults also experience can trigger this condition. Refugee aid workers have reported about women from Bangladesh who were subjected to severe abuse and thus fell into this state of resignation after their asylum applications were rejected. For them personally, this meant nothing less than being sent back to the place where they had been abused. But what was truly surprising, and for which we still do not have a good or more than a hypothetical explanation, is why it occurred in Sweden among such a large number of children in a very specific period of time.

Given that there have been countless wars and war refugees throughout history, it seems surprising that this syndrome was discovered so late. Why is that?

When we go back, for example in literature or feature films, we can find various stories that address similar cases in both children and adults who came from war zones. And in chaotic war situations, the fate of children is often overlooked because adults write history. I have heard people from various war zones report about children who were unconscious without even having been injured, and who even died for unexplained reasons, which could be related to resignation syndrome. Interestingly, the Swedish Nobel laureate Selma Lagerlöf wrote a novel as early as 1899 in which she describes such symptoms from the perspective of a child. It is about a little girl who has lost her parents and relatives and is therefore taken in by a priest's family. The protagonist has an incredible imagination, but she is not allowed to develop her imagination further, which is why she becomes increasingly depressed. And at some point, she no longer wants to. She doesn't care whether she lives or dies.

Now, her research is largely limited to Sweden. Is resignation syndrome diagnosed as such in other countries as well?

We do not have exact figures, but further cases have been reported in Europe, such as from the refugee camps on the Greek islands since 2015. There is also a scientific study from the Pacific island nation of Nauru, where Australia operated refugee camps under very severe living conditions. However, the high numbers that we had in Sweden for a time are not comparable to other places.

The affected children have lost all hope for a good future. To what extent are the parents and doctors confident that they can change this situation at all?

When the healthcare sector was taken by surprise by the numbers, no one knew for sure how we should handle these cases. But gradually, people realized that a multidisciplinary treatment was necessary and that we urgently needed to care for the parents, because they were often panicked and very afraid that their child would die. So we had to restore hope to the parents, support them in not sharing their traumas and worries with the children, but rather finding other ways to channel or cope with their own fears. Then, of course, it was necessary to care for the child both medically and psychologically, to ensure they took in enough food so as not to lose weight, and to monitor that the body remained in balance. The children needed physiotherapy because they were not moving, to prevent them from getting stiff joints. And we also learned that it is important to stimulate the children's various senses so that they could sit up in their wheelchairs, go out into the fresh air, or listen to music. So it was truly a multidisciplinary approach and a regular program to avoid the child lying in bed day and night. If we can revive the hope that the children realize through their parents that the threat they fear has been eliminated, then they can actually recover and return to a probably normal life. But that takes time, a very long time.

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Photo: Johan Wingborg