Table 1

Modes of explanation of resignation syndrome

ModelMechanismClinicalSocialPoliticalLocus of agency
MedicalDisorder affects biologically vulnerable individuals under certain circumstancesReinforces the role of the clinician and justifies interventionStrains social welfare systems that need to provide universal healthcareOften disregards sociopolitical dimensions of disease, at the same time doctors may be blamed for encouraging the phenomenonPaternalistic medical model that needs to protect the vulnerable individual, who is ill and dysfunctional; victims
FamilyInteractions in family system dynamicsJustifies interventions to address family dynamics, may disempower parentsRemoves blame from wider systemFocus on a certain kind of family rather than the wider sociopolitical forces at playAgency on family as a unit, ultimately parents or individuals
PsychologicalEffects of uncontrollability through models of learnt helplessness and hopelessnessClinical focus on individual and potential weakness, personality traitsRemoves blame from wider systemIndividuals considered problematic, potential consequences regarding immigrationAgency on individual
PoliticalImpact of political decisions governing the asylum processPoliticises role of clinician, warns of iatrogenesisPublic concerns over their vulnerability and welfarePragmatic response at a system level may worsen long-term outcomes or add to iatrogenic mechanismsAgency on sociopolitical system
CulturalSymptoms reflect patients' cultural or religious background and that of the country to which they migrateMay lead to disengagement, exoticisation, and call for experts to understand the phenomenonRisk 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 responsiveOn cultural group, cultural differences are highlighted, may lead to ‘othering’
IntentionalIntentional action (based on conscious decision) by family or the childClinical interventions likely to make things worseQuestions the authenticity and legitimacy of their claims, implies secondary gain and potentially malingeringCriticism of failed empathy and compassion, contrasts with country’s self-image as an international model for immigration/children’s rightsOn 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.