Looking back at resignation syndrome: the rise and fall of a culture-bound endemic.

Abstract

Resignation syndrome was endemic to Sweden for more than two decades. This paper explores how it emerged, sustained, and disappeared. Conceived to be caused by trauma and the stress of migration, permanent residency was considered necessary for recovery and became part of treatment. However, respecting national borders, affecting only some migrant groups, and with child abuse and feigned illness to gain asylum exposed, the understanding of the endemic shifted and aspects other than trauma and stress were acknowledged. Migration policy was altered with permanent residency permits replaced by temporary, and in legal procedures for residency, little weight was awarded to resignation syndrome. Management came to centre around child protection and sometimes involved separation of patient and family. The asylum procedure was kept separate from treatment. The strategy was found effective. Invoking residency as a part of treatment was suggested to have generated simulation but also expectations in turn producing and maintaining symptoms. In effect, as the illness-driving narrative and the incentivising medicolegal practice were reversed, the endemic faded. The thesis here put forward is that resignation syndrome was a condition created, maintained, and reversed by society. However, it is not the first, nor is it the last. Trending illness manifestations in general may benefit from a constructivist analysis, the resignation syndrome example showcases how, and that mitigation is possible.