Uppgivenhetssyndrom?

[YumIsPeople]

The Trauma of Facing Deportation

Thoughts?

How much conscious intent is there to stay in Sweden, if any? The culturally-bound nature of the condition seems weird, especially given that it is not seen in the home countries of these asylum seekers, nor in Sweden, except among select groups of refugees. I was thinking that the family could be exaggerating the symptoms, but apparently not, since a lot of the kids are inpatient. If it is some kind of malingering, those are some very dedicated malingerers, especially for children, enough that if it is so imperative to them they stay in Sweden, I think they should be accommodated if at all possible.

The rejection of ECT as "unethical" strikes me as a bit odd. Surely, it would be better than lying comatose in bed for potentially years on end? It really sounds like a tactic to keep the child ill in order to allow the family to stay in Sweden. Now, honestly, depending on the conditions they face going back to, maybe this is a good move for the families (and maybe even the children), but still, I wonder if ECT would work. Also, apparently, as of Jan. 2016, no patients have been tried on benzos or ECT to the knowledge of the authors of that paper, which I think substantiates the view that the children are being used as bargaining chips with the Swedish government. (I was also thinking ketamine would help.) Perhaps this is in the best interest of the children in some cases, but we can't pretend that this isn't happening.

"In a seventy-six-page guide for treating uppgivenhetssyndrom, published in 2013, the Swedish Board of Health and Welfare advises that a patient will not recover until his family has permission to live in Sweden. 'A permanent residency permit is considered by far the most effective "treatment,"’ the manual says. 'The turning point will usually be a few months to half a year after the family receives permanent residence.' The guidelines draw on the Israeli sociologist Aaron Antonovsky’s notion of a 'sense of coherence.' Mental well-being, Antonovsky theorizes, depends on one’s belief that life is orderly, comprehensible, structured, and predictable. Antonovsky suggests, as Freud did, that psychological illness is born of narrative incoherence, a life story veering off course."

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[birchswing]

It's like the opposite of the phenomenon where Japanese people get very depressed on arriving in Paris:

Paris syndrome - Wikipedia

EDIT: Anecdotally, I dream about Sweden in about 50% of my dreams. And I only lived there one year of my life a very long time ago. It formed, when I was 9 years old, my entire political and moral world view, which has largely remained unchanged. My inability to fly intersecting with my feelings about Sweden are this deep underlying current in my life that are so big that they're like a bedrock you don't even see or consciously feel. So, yes, I think there could be something to all this.

EDIT 2: I used to call our summer house on a lake in Sweden my "home at the end of the world." I used to always think that if something disastrous happened, that's where I would go. No plumbing, but still such a wonderful place. My mind always still goes there. My mother sold it, and I do feel displaced even though it wasn't a practical place to go (it was near where my grandparents lived far out in the country who passed away), and I had ceased to travel anyway. I still think of it very often. It's the most placid place I know. Björkbacken (birch meadow), we called it.

EDIT 3: Also, it probably doesn't help people wanting to leave when the government itself makes this commercial for the country that makes me just . . . I don't know the emotion:

 

[singasongofjoy]

It's like the opposite of the phenomenon where Japanese people get very depressed on arriving in Paris:

Paris syndrome - Wikipedia

EDIT: Anecdotally, I dream about Sweden in about 50% of my dreams. And I only lived there one year of my life a very long time ago. It formed, when I was 9 years old, my entire political and moral world view, which has largely remained unchanged. My inability to fly intersecting with my feelings about Sweden are this deep underlying current in my life that are so big that they're like a bedrock you don't even see or consciously feel. So, yes, I think there could be something to all this.

EDIT 2: I used to call our summer house on a lake in Sweden my "home at the end of the world." I used to always think that if something disastrous happened, that's where I would go. No plumbing, but still such a wonderful place. My mind always still goes there. My mother sold it, and I do feel displaced even though it wasn't a practical place to go (it was near where my grandparents lived far out in the country who passed away), and I had ceased to travel anyway. I still think of it very often. It's the most placid place I know. Björkbacken (birch meadow), we called it.

EDIT 3: Also, it probably doesn't help people wanting to leave when the government itself makes this commercial for the country that makes me just . . . I don't know the emotion:

wow. That commercial... I mean, now I want to go live in Sweden... immediately. Well done.

 

[rolltide09]

Frankly, I think Elisabeth Hultcrantz - the quack at the center of this - is advising and helping these families to keep the children sedated or administering some sort of paralytic. It's nothing but propaganda and manipulation of the public. As if the entire thing weren't creepy enough, and further evidence (as if I needed any) of the degree to which radical leftism/secularism is truly a mental disorder when taken to the extremes that are seen in places like Sweden, the part about the breast exam took the whole thing to another level of bizarre/surreal. A breast exam on 12 year old in a vegetative state because you're concerned she might develop breast cancer during the months she's in bed? Seriously? Even the American author's description of the event adds yet ANOTHER layer of bizarre/surreal. I'm at a loss.

 

[birchswing]

Frankly, I think Elisabeth Hultcrantz - the quack at the center of this - is advising and helping these families to keep the children sedated or administering some sort of paralytic. It's nothing but propaganda and manipulation of the public. As if the entire thing weren't creepy enough, and further evidence (as if I needed any) of the degree to which radical leftism/secularism is truly a mental disorder when taken to the extremes that are seen in places like Sweden, the part about the breast exam took the whole thing to another level of bizarre/surreal. A breast exam on 12 year old in a vegetative state because you're concerned she might develop breast cancer during the months she's in bed? Seriously? Even the American author's description of the event adds yet ANOTHER layer of bizarre/surreal. I'm at a loss.

Sweden is one of the safest places in the world to live, one of the best places to do business, per its population has one of the world's strongest economies, and through its freedoms influences the entire world's thinking.

You picked out a breast exam to demonstrate an entire society having mental illness. Well let's compare a breast exam to things that happen in the US: black sites, Guantamo Bay, poisoning citizens in gas chambers and with Versed, no healthcare for many, the Judge Rotenberg center where autistic children are "treated" with aversive electrical shocks, legal child abuse in all 50 states, non-medically-indicated, Medicaid funded routine genital mutilation. Not one of those things exists in Sweden because they're barbaric and have been outlawed for decades.

So what mental disorder does the US have?

I will pick empathy every time, even if it means self-doubt, hand-wringing, and wondering what more we can do to serve the most vulnerable.

 

[northernpsy]

Long article, but I did a quick search through the text for the terms "conversion disorder" and "malingering" and didn't find anything. Huh, funny that they don't even address that possibility at all when any competent psychiatrist would have to include those in the differential. If we're just going to totally ignore the possibility of manufactured symptoms in the face of obvious secondary gain, I think I'm going to be writing up some of the other mysterious syndromes I have seen in my patients, such as Opioid Deficiency Syndrome and Xanax-Is-The-Only-Psych-Drug-That-Ever-Helped-Me Syndrome.

This part:
"Hultcrantz, who has treated more than forty children with apathy, empathizes with her patients so viscerally that answers to routine questions can make her cry."

doesn't make me think, "Wow, what an incredibly caring doctor". It makes me think, "Wow, this person has extremely poor boundaries and probably is not able to evaluate her patients in an objective manner because she is so blinded by her own personal feelings and agenda".

I am tired of people turning psychiatry into a total joke by using psychiatric diagnoses to try to legitimize their personal political agendas.

 

[Shikima]

Long article, but I did a quick search through the text for the terms "conversion disorder" and "malingering" and didn't find anything. Huh, funny that they don't even address that possibility at all when any competent psychiatrist would have to include those in the differential. If we're just going to totally ignore the possibility of manufactured symptoms in the face of obvious secondary gain, I think I'm going to be writing up some of the other mysterious syndromes I have seen in my patients, such as Opioid Deficiency Syndrome and Xanax-Is-The-Only-Psych-Drug-That-Ever-Helped-Me Syndrome.

This part:
"Hultcrantz, who has treated more than forty children with apathy, empathizes with her patients so viscerally that answers to routine questions can make her cry."

doesn't make me think, "Wow, what an incredibly caring doctor". It makes me think, "Wow, this person has extremely poor boundaries and probably is not able to evaluate her patients in an objective manner because she is so blinded by her own personal feelings and agenda".

I am tired of people turning psychiatry into a total joke by using psychiatric diagnoses to try to legitimize their personal political agendas.

This is why I gave up on the APA and have little regard for the older psychiatrists in the area where I practice.

 

[clausewitz2]

Long article, but I did a quick search through the text for the terms "conversion disorder" and "malingering" and didn't find anything. Huh, funny that they don't even address that possibility at all when any competent psychiatrist would have to include those in the differential. If we're just going to totally ignore the possibility of manufactured symptoms in the face of obvious secondary gain, I think I'm going to be writing up some of the other mysterious syndromes I have seen in my patients, such as Opioid Deficiency Syndrome and Xanax-Is-The-Only-Psych-Drug-That-Ever-Helped-Me Syndrome.

This part:
"Hultcrantz, who has treated more than forty children with apathy, empathizes with her patients so viscerally that answers to routine questions can make her cry."

doesn't make me think, "Wow, what an incredibly caring doctor". It makes me think, "Wow, this person has extremely poor boundaries and probably is not able to evaluate her patients in an objective manner because she is so blinded by her own personal feelings and agenda".

I am tired of people turning psychiatry into a total joke by using psychiatric diagnoses to try to legitimize their personal political agendas.

I get what you're saying, but a syndrome stemming from inadequate endogenous opioids is not a totally crazy thing. We have all met the former heroin users who really need to be on maintenance forever and have things go very badly when they try to come off it, and there are certainly people out there who are crushingly depressed for years and only experience a miraculous remission of these symptoms with opioids. Practical and legal challenges to ever diagnosing this aside, why should we be surprised that some people have deficits in this neurotransmitter system?

 

[birchswing]

Long article, but I did a quick search through the text for the terms "conversion disorder" and "malingering" and didn't find anything. Huh, funny that they don't even address that possibility at all when any competent psychiatrist would have to include those in the differential. If we're just going to totally ignore the possibility of manufactured symptoms in the face of obvious secondary gain, I think I'm going to be writing up some of the other mysterious syndromes I have seen in my patients, such as Opioid Deficiency Syndrome and Xanax-Is-The-Only-Psych-Drug-That-Ever-Helped-Me Syndrome.

This part:
"Hultcrantz, who has treated more than forty children with apathy, empathizes with her patients so viscerally that answers to routine questions can make her cry."

doesn't make me think, "Wow, what an incredibly caring doctor". It makes me think, "Wow, this person has extremely poor boundaries and probably is not able to evaluate her patients in an objective manner because she is so blinded by her own personal feelings and agenda".

I am tired of people turning psychiatry into a total joke by using psychiatric diagnoses to try to legitimize their personal political agendas.

Your post is incredibly rude to those suffering and is self-admittedly ignorant (you said you didn't read the article).

So you're upset both that the article did not use psychiatric diagnoses and also that psychiatric diagnoses are used to legitimize political agendas? Which is it?

They absolutely *do* say that it's a conversion disorder and a form of unconscious "malingering." They don't use those words, but the report says that this diseased state is both a result of psychological trauma resulting in willed death (conversion disorder would apply) and as a personal sacrifice to save the family ("malingering" if you must use that word). Just because you didn't read the article doesn't mean it's not stated. This has been widely studied in Sweden by many psychiatrists and to assume you have better knowledge of the situation because you control-F'ed "conversion disorder" and didn't find it is ludicrous.

The reason I put malingering in quotes is that if you read the article you will see that at least one of the children remained in this catatonic-like state after returning to their home country when there would be no possible secondary gain.

The doctor crying to routine answers is not crying to the patients but when asked about the patients, something you might do as well if you worked with this population. She is not a psychiatrist. She is volunteering and encouraging the parents of the non-responsive children to seek medical treatment.

You sound like a card-carrying member of the Sweden Democrats. Some of us know Sweden's history and are very sensitive to not repeating the humanitarian disasters of the 20th century. When there is an unexplained phenomenon like this, why would you not err on the side of "I don't know, this must be looked into more" rather than the "they're making it up so don't give a **** about them" side?

 

[birchswing]

malingering can't be "unconscious"....

I'll use Trump's excuse that I put it in quotation marks. And here's the congressional inquiry to prove that I was right after the fact.

I used that term because of the following:

In a hundred-and-thirty-page report on the condition, commissioned by the government and published in 2006, a team of psychologists, political scientists, and sociologists hypothesized that it was a culture-bound syndrome, a psychological illness endemic to a specific society. Every culture possesses what Edward Shorter, a medical historian at the University of Toronto, calls a “ ‘symptom repertoire’—a range of physical symptoms available to the unconscious mind for the physical expression of psychological conflict.”
​

Combined with:

The Swedish government’s report proposed that the apathetic children were from “holistic cultures,” where it is “difficult to draw boundaries between the individual’s private sphere and the collective domain.” They were sacrificing themselves for their family by losing consciousness. “Even if no direct encouragement or directive is given,” the report said, “many children raised with holistic thinking may nonetheless act according to the group’s ‘unspoken’ rules.”​

To square these two beliefs (involuntary conversion disorder and secondary gain), they are suggesting there are cultural forces people feel, rather than know, that lead them into these available physical states when certain psychological stressors are present.

My point was not to not to argue how you can square away these seemingly conflicting factors, but that they had been presented, whereas @northernpsy was saying conversion disorder and malingering had not been presented as theories. It seems to me that both were presented as theories, theories that are furthermore theorized to intersect with each other, even if those precise diagnostic terms weren't used.

 

[splik]

"secondary gain" is almost always a factor in conversion disorder btw, and in fact it is present is most any chronic illness

 

[WingedOx]

This part:
"Hultcrantz, who has treated more than forty children with apathy, empathizes with her patients so viscerally that answers to routine questions can make her cry."

Yeeesh....

 

[OldPsychDoc]

malingering can't be "unconscious"....

I agree, but it can be done with such an extreme lack of insight as to seem unconscious.
I've had many admits where the only way they could imagine to get their needs met was to show up at the hospital.

 

[rolltide09]

She is not a psychiatrist. She is volunteering and encouraging the parents of the non-responsive children to seek medical treatment.

She's inserting a feeding tube, doing a physical exam (complete with a breast exam on young girls, for some reason), taking photographs of them, and contacting the migration board with their story to try and extort a residency permit for the family. This paragraph says it all:

"Karl Sallin, a pediatrician at Karolinska University Hospital, who is writing a Ph.D. dissertation on apathy, said that he finds it disturbing that doctors seem content to let children dwell in a coma-like state for months or years, until Sweden grants them residency. “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,” he said. “I think it’s an open question if there’s a medical solution to the problem, because no one has really tried.” There is little empirical research on the illness, a necessary step toward devising treatments. “I’ve tried to persuade people to collaborate with me on studies, but there’s been this resistance to look into the brain and acknowledge that there is a biological system at work,” he said. “People have built this sort of belief system around these children, and this is where the residency permit comes in—it’s the symbol in this battle."

Notice that when the author of the article tries to ask the parents and kids questions, Hultcrantz immediately interrupts and guides them to the "correct" answers. Notice also that the psychiatrists and other activists involved with this racket have decided that the syndrome is only seen in refugees from certain places because it is culture-specific, yet they are refusing to consider in any of their studies whether Sweden's culture is the issue, here---none of the physicians in their native countries have ever heard of such a thing. So, apparently there is nothing else in a child's life that can trigger such an illness - ONLY being denied permanent residency in Sweden. That is the one and only cause. How convenient.

 

[WingedOx]

I agree, but it can be done with such an extreme lack of insight as to seem unconscious.
I've had many admits where the only way they could imagine to get their needs met was to show up at the hospital.

Operant conditioning is a helluva drug.

 

[Ceke2002]

@birchswing Not once I have detected any note of anyone on here saying 'Well we don't know what's wrong with them, so they must be making it up, eh, who cares let 'em suffer'. And from what I've read about Elisabeth Hultcrantz I think the following quote is rather apt: "The sufferer who frustrates a keen therapist by failing to improve is always in danger of meeting primitive human behaviour disguised as treatment"

That's the thing with pathological rescuer types, it's never really about helping, it's about seeing a person not as an individual but as a narcissistic extension of oneself, where they only exist insofar as it is their role to make the individual feel better about themselves, so they can engage in some sort of self indulgent, masturbatory fantasy about what an oh so wonderful and compassionate person they are.

If this is some sort of newly emerging, legitimate disorder, or even a much older disorder presenting itself in a different form, then fine, start working on a proper treatment for these people. What Hultcrantz is doing isn't treatment, and it sure as hell doesn't look like empathy to me either.