Abstract
Resignation syndrome (RS) designates a long-standing disorder predominately affecting psychologically traumatized children and adolescents in the midst of a strenuous and lengthy migration process. Typically a depressive onset is followed by gradual withdrawal progressing via stupor into a state that prompts tube feeding and is characterized by failure to respond even to painful stimuli. The patient is seemingly unconscious. Recovery ensues within months to years and is claimed to be dependent on the restoration of hope to the family. Descriptions of disorders resembling RS can be found in the literature and the condition is unlikely novel. Nevertheless, the magnitude and geographical distribution stand out. Several hundred cases have been reported exclusively in Sweden in the past decade prompting the Swedish National Board of Health and Welfare to recognize RS as a separate diagnostic entity. The currently prevailing stress hypothesis fails to account for the regional distribution and contributes little to treatment. Consequently, a re-evaluation of diagnostics and treatment is required. Psychogenic catatonia is proposed to supply the best fit with the clinical presentation. Treatment response, altered brain metabolism or preserved awareness would support this hypothesis. Epidemiological data suggests culture-bound beliefs and expectations to generate and direct symptom expression and we argue that culture-bound psychogenesis can accommodate the endemic distribution. Last, we review recent models of predictive coding indicating how expectation processes are crucially involved in the placebo and nocebo effect, delusions and conversion disorders. Building on this theoretical framework we propose a neurobiological model of RS in which the impact of overwhelming negative expectations are directly causative of the down-regulation of higher order and lower order behavioral systems in particularly vulnerable individuals.
Highlights
In Sweden, apathy has been the colloquial term for a condition characterized by global and severe loss of function affecting children and adolescents seeking asylum or undergoing migration process
With regards to the phenomenon referred to as Resignation syndrome (RS), our analysis has suggested catatonia to supply the best fit with clinical data, culture-bound psychogenesis to account for the regional distribution and predictive coding to supply a promising context in which to express a mechanistic model
The same motor loop may be abnormally affected either by psychological top-down regulation, or, by aberrant bottom-up regulation illustrated by akinetic catatonia and Parkinson’s disease functionally affecting the same ‘‘motor loop’’, by different mechanisms originating in the orbitofrontal cortex (OFC) and the substantia nigra respectively (Northoff, 2002)
Summary
In Sweden, apathy has been the colloquial term for a condition characterized by global and severe loss of function affecting children and adolescents seeking asylum or undergoing migration process. We argue: (1) that RS should be perceived as catatonia, a hypothesis readily testable by either neuroimaging or evaluation of treatment response; (2) that culturally transmitted and sanctioned beliefs may, through psychogenesis, account for the regional distribution; and (3) on a mechanistic level, that cultural and contextual influence may fundamentally change expectations and priors on the bodily functions inducing failure to activate both higher order and lower order behaviors in vulnerable individuals To support this claim we frame it in a predictive coding context that has been suggested to be causally involved in placebo and nocebo effects, delusions and conversion disorders
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
