Asylum seekers with apathetic refugee children

Asylum seekers with apathetic refugee children was a medical and political debate in Sweden in 2006 concerning asylum seekers who came to Sweden with apathetic children. The period was a subject of media coverage starting in 2002, with 55 cases and in 2005 escalated to 424 cases. The refugee were mostly from Kazakhstan, Kirgizstan, Uzbekistan, Armenia and Azerbaijan but also former Yugoslavia. After a long, heated debate, psychiatrist Thomas Jackson, the state investigation expert, who was of the controversial idea that the children were being abused, was shut out of the debate. Jackson stated in an article that he was not a nationalsocialist. The debate ended with a more generous refugee policy formulating a new condition for the apathetic children titled "resignation syndrome" (uppgivningssyndrom in Swedish) Jackson vehemently opposes this diagnosis insisting on calling it coerced child abuse. Jackson has also criticized Swedish doctors and healthcare of indirectly contributing to child abuse. When suspicions of manipulation or abuse were uncovered, News24 published an article in 2005 of a "child-abuse scam being uncovered in Sweden".

Resignation syndrome

Resignation syndrome is characterized by depression, apathy, non-communication and loss of bodily functions. There is also signs of severe long-term stress and is worsened by asylum processes, waiting times and rejection to the home country. It is also followed by a gradual behavioral withdrawal into an unconscious and severely handicapping state that requires tube feeding. The children are unable to move, eat, drink or respond even to painful stimuli and are in this state for months sometimes years. The only known cure is for their families to receive residency permits to stay in Sweden. When the refugee familie's social situation improve, most children recovered. In other medical professions, the condition is seen as a hoax or child abuse with the goal of being granted permanent residence.

Debate

The debate involved several doctors, reporters and activists who all engaged with the goal of understand whether the children were simulating or if they were victims of severe abuse. According to an article published in Svenska Dagbladet by chief physician Hans Bendz, simulation is a known phenomena and that it is not impossible in the case of the apathetic children. A study conducted in 2016 stated that the children were either catatonic as a result of psychogenic stress due to waiting for asylum or that they were a victims of malingering by proxy rendering them unable to eat, drink or talk. The hypothesis was that the children had become severely catatonic once they had found out that they were being deported as families lacked asylum. The Swedish Social and Health Authority, in its Guidelines on Uppgivenhets Syndrome published in 2013, writes that a patient is not completely healthy until the family has received a permanent residence permit. However the debate sparked immensely as there was a difference of opinion on the origin of the phenomena. Swedish doctor Henry Ascher, together with Anders Hjern, claimed that it was due to trauma. This thesis was supported by Gellert Tamas. The phenomena was titled as an epidemic. In an open letter signed by 42 psychiatrists, they demanded that the government stop promoting child abuse by not granting permanent residence. In 2004, the government initiated a state investigation with the goal of analyzing and surveying the prevalence of the condition. Reporters from Sveriges Radio stated the experts in the state investigation had been lying.

Criticism against Tamas

Gellert Tamas, author and lecturer, published a book titled De Apatiska (lit. The Apathetic) criticizing Swedish doctors and politician who suspected that the children were simulating or were being manipulated. The book was criticized by Swedish doctor and associate professor Tomas J Eriksson stating that Tamas had failed to discuss why there was an increase from zero to 400 within a few years and why it decreased again. He also stated that Tamas had failed to explain why the condition only happened amongst children where the asylum process had not yet been granted and why the condition never occurred amongst unaccompanied children but only amongst children with families. Tamas also never discussed why the phenomena only occurred amongst children from former Yugoslav and Soviet republics. Eriksson also questions why Tamas does not explain how this never happens amongst Swedish children who are under severe pressure. Eriksson had stated in a debate on SVT that he had treated many refugee children and stated that the children were either poisoned or manipulated. Peter Engelsöy, deputy head and chief physician, stated in an article published by Aftonbladet that Gellert Tamas bok was full of incorrect statements and that Tamas had used character assassination on Engelsöy. The heads of the Swedish agency for child- and youth psychiatry (Barn- och ungdomspsykiatrin) criticized Tamas in an article published by Aftonbladet stating that Tamas was spreading rumors about the psychiatrists alleged incompetence in treating apathetic children. The criticism was that the psychiatrists could not solely base their clinical diagnosis on Tamas publications without the risk of encouraging child abuse. An article in Dagens Nyheter stated that Tamas credibility can be questioned. Tamas was reported by the governments state experts Marie Hessler and Nader Ahmadi to the Granskningsnämnden för radio och TV (The investigation committee for radio and TV) for having intentionally distorted the commentary of several participants in the Swedish television program Uppdrag Granskning's episode of "the toying of the apathetic". Thomas Jackson stated in lectures for health care staff and in his publications that Tamas book was dangerous for apathetic refugee children as he had spread rumors that the national agencies had in turn spread rumors that the children were simulating. According to an article published by DTMedia, reporters Gellert Tamas and Janne Josefsson did not listen to the criteria for forced simulation which Jackson presented in his participation on Uppdrag Granskning.

Government investigation

According to Nader Ahmadi, research leader of the state investigation SOU:2006, in some cultures, children could be used "holistically" for the survival of the family. Nader Ahmadi has also stated in an article by Gefle Blad that "manipulation, simulation and poisoning of the children is not impossible". Most children were from former Soviet republics and former Yugoslavia. Marie Hessler, head of the Stockholm County Council's child psychiatry unit, stated that she had never witnessed any similar cases in the neighboring Nordic countries. Hessler was heavily criticized in the fevered debate for her neutrality by the Liberals, the Center party and the Christian Democrats. In 2005, there was a case of a severely depressed boy who faced deportation and the Swedish humanitarian organizations demanded he be granted permanent residence. However the proposal was voted against by from the Moderate Party. At the time, Migration minister Barbro Holmberg said that giving special treatment could increase the risk for even more asylum children to become apathetic. The Green Party's leader Gustav Fridolin accused her of being racist stating that asylum families would never manipulate their children. Holmberg was also criticized in chronicles published in Barometern and Gefle Blad for having stated that "refugee parents drugged and abused their own children". Annica Ring, executive official in the Migration Board office in Solna, Stockholm, was interviewed by Svenska Dagbladet. In this interview she stated that the board had been investigating some "irregularities" amongst the refugee families indicating that the parents were in some way responsible for the condition of the children either through psychological manipulation or medication. The board reported this to the social authorities and when nothing happened, they turned the report to the police who suspected that the children had been poisoned. The board was heavily criticized by Swedish media. Björn Sundin, reporter, stated first that he did not believe the state investigation expert Thomas Jackson's theory after he, as a symbolic protest, joined Svenskarnas Parti, but Sundin noted that Jackson's argumentation had validity and credibility and that the critique of Jackson was not met objectively. Famous Swedish author Lars Ulwencreutz praised Jackson in his book for "having the bravery of calling the phenomena child abuse".

Child abuse

However Thomas Jackson, psychiatrist, doctor and the elected expert of the state investigation during the Labour party at the time, concluded that the children were under severe abuse being tube fed by parents or guardians with the goal of weakening the child in order to gain wealth from the Swedish welfare system. This led to a large controversy and Jackson was labeled as an incompetent nazi by author Gellert Tamas and by reporters Malena Rydell and Jenny Wennberg of Arbetarbladet. According to Jackson, the abuse still continues to this day and he has proposed the term "commando syndrome". Jackson has reported that after his investigation, he was contacted by trafficking gangs from Eastern European countries who threatened him. After having contacted the police they stated that the threats were due to the unveiling of criminal networks. Jackson published an article in Dagens Medicin but it was removed as Jackson's standpoint was too controversial. Jackson's thesis is supported by Marc Feldman, MD PhD, expert on Munchausen by proxy. Tomas Eriksson, elected expert of the state investigation, has stated that the children might be manipulated or poisoned. Lise Tamm, state prosecutor, began an investigation based on reports that refugee parents were criminally abusing their children, but socialtjänsten, the Swedish social service, had "conflicting interests" with the authorities which made an investigation impossible. Tamm stated in 2006 that the Migration board had reported nine parents in Stockholm who were suspected of abusing their children. Tamm concluded that Gellert Tamas had intentionally distorted her commentary of the situation. In 2011, child right experts Laila Lindberg and Sara Damber stated in an article published by Svenska Dagbladet that apathetic children were denied help as health care personal often lacked courage and knowledge in their diagnosis of the potential abuse of the children. In an other article by Svenska dagbladet, the National Board of Health and Welfare had failed in reporting the suspected abuse of children by refusing to cooperate with the authorities. Some healthcare personnel had witnessed how parents in secret emptied out the nurishing drop from the children's tubes. In some cases, there were reports of families hating their children who were not always sick. According to an article published by Aftonbladet in 2005, Janna Valik, general director of the Migration agency, failed to investigate reports of abuse amongst apathetic children and was displaced by the government. The Chancellor of Justice started an investigation of the Migration agency to determine of the correct procedure had been followed.

Sweden

In a study conducted in September 2011 by Henry Ascher from the University of Gothenburg, the refugee children were caught in an ambiguous debate between on the one side Swedens humane migration policy, following the UN Convention on the Rights of the Child, and on the other hand the suspicion of guardians abusing their children once receiving the decision of deportation. According to an article by the BBC, the phenomena occurs only in Sweden and is labeled as "resignation syndrome". Jackson has commentated on this stating that the correct term for this phenomenon should be "commando syndrome". In an article by Melissa Sartore of the Ranker, the children became ill first after the parents had been denied asylum. She has described it as a "mysterious disease". Göran Bodegård writes in his commentary of the paper "Pervasive Refusal Syndrome (PRS) 21 years on—a reconceptualization and renaming" that after the families were denied residency, 400 children fell ill. In 2016, Dagens Medicin published an article about the increasing numbers of apathetic refugee children. BMJ published an article about Karolinska Institutes controversy wether or not the children were simulating or being abused. According to an article by Professor Karl Lofgren from the Victoria University of Wellington, he discusses how the children could be traumatized by war despite not having lived in a war zone since the majority came from former Yugoslavia and the Soviet Union. Lofgren also stated that there was no psychiatrist involved in the state investigation. This is incorrect as Thomas Jackson is mentioned as the licensed psychiatrist. Lofgren also writes that when all refugee children were granted general amnesty in 2005, there was a decrease in cases in 2007. Thomas Jackson has stated that there are over 2000 children possibly being abused since many of the guardians now are paid by the state to provide care the children.

Bill Schiller from the BBC aired a radio episode stating that this phenomenon did not exist in other countries which led to a savage debate wether or not the children were faking. According to an article by Svenska Dagbladet, the amount of apathetic refugee children has decreased ever since financed care were provided for the guardians at home. Migrationsverket, Swedens Migration Agency, suspected 13 cases of malingering by proxy where parents were found abusing their children. Several doctors and nurses stated in an interview that the parents used physical violence on the doctors if they did not immediately recommend asylum. Many doctors also provided the guardians with tubes in order to nurture them and thereby furthering the abuse. Some children were also isolated with windows and curtains closed. Karl Sallin, a paediatrician at Karolinska University Hospital, told the New Yorker that "another way to give the children hope would be to treat them properly and not leave them lying on a bed with a nasal tube for nine months". In the spring of 2005, the debate about the apathetic refugee children had grown stronger mobilizing asylum rights movements with organizations, individuals, political parties and religious communities who all campaigned for a general amnesty. Apathetic refugee children and their parents were subjects of skepticism as an increasing suspicioun of forced manipulated coercing was a possible risk. Gellert Tamas claimed these statements were not true.

Björn Lundin, head physician at the child- and youth psychiatric clinic and Stefan Croner, head physician at the child- and youth medicine clinic, presented Munchhausen by Proxy as a theory in an article explaining that in some cases the children are victims of severe abuse. The doctors stated that in these cases one of the parents, usually the mother, is the perpatrator.

Nocebo effect

According to an article by Hannah Bradby in 2017, there was a risk of the "nocebo effect", the "evil twin" of placebo effect, where a doctor, through a supposedly neutral medical intervention, brings about unwanted side-effects. Well-meaning doctors reinforce the necessity for refugee children's extreme suffering in order to persuade the Migration Board to grant residency permits which leads to a self-fulfilling prophecy where the parents decide that only granted residency will make the child healthy again. The idea was criticized as it prevented a proper medical investigation of the childs condition. Bradby also states that within days after the child is separated from the parents, regardless of the previous condition of the child, the child becomes healthy eating and drinking like normal. Jackson has stated that this type of phenomena does not exist in Norway as the children who fall victim of this are separated from the parents in order to see if they recover.

Culture

In 2011, Stockholm State Theater, having drawn inspiration from Gellert Tamas book "De Apatiska" (lit. The Apathetic), hosted a play mocking politicians and medical personnel who suspected malingering by proxy and who disagreed with the idea that the children were traumatized from war. There is also an Australian group who performs named "Apathy for beginners"

See also

• Psychosomatic illness