Model | Mechanism | Clinical | Social | Political | Locus of agency |
Medical | Disorder affects biologically vulnerable individuals under certain circumstances | Reinforces the role of the clinician and justifies intervention | Strains social welfare systems that need to provide universal healthcare | Often disregards sociopolitical dimensions of disease, at the same time doctors may be blamed for encouraging the phenomenon | Paternalistic medical model that needs to protect the vulnerable individual, who is ill and dysfunctional; victims |
Family | Interactions in family system dynamics | Justifies interventions to address family dynamics, may disempower parents | Removes blame from wider system | Focus on a certain kind of family rather than the wider sociopolitical forces at play | Agency on family as a unit, ultimately parents or individuals |
Psychological | Effects of uncontrollability through models of learnt helplessness and hopelessness | Clinical focus on individual and potential weakness, personality traits | Removes blame from wider system | Individuals considered problematic, potential consequences regarding immigration | Agency on individual |
Political | Impact of political decisions governing the asylum process | Politicises role of clinician, warns of iatrogenesis | Public concerns over their vulnerability and welfare | Pragmatic response at a system level may worsen long-term outcomes or add to iatrogenic mechanisms | Agency on sociopolitical system |
Cultural | Symptoms reflect patients' cultural or religious background and that of the country to which they migrate | May lead to disengagement, exoticisation, and call for experts to understand the phenomenon | Risk of stigmatising, othering and reduced empathy. May potentiate discriminatory responses in combination with assumption of secondary gain | More structural or intersectional concerns are hidden behind 'cultural”'issues, removes immediacy to act, be responsive | On cultural group, cultural differences are highlighted, may lead to ‘othering’ |
Intentional | Intentional action (based on conscious decision) by family or the child | Clinical interventions likely to make things worse | Questions the authenticity and legitimacy of their claims, implies secondary gain and potentially malingering | Criticism of failed empathy and compassion, contrasts with country’s self-image as an international model for immigration/children’s rights | On individual or family as malingering for secondary gain purposes, children and families as untrustworthy ‘others’ |
Sources: Sallin et al. 2016, Hacking, 2010, Von Folsach & Montgomery, 2006, Bodegård, 2005b.