A simple objective cultural explanation for resignation syndrome is that it is another manifestation of honor violence. However, studies that suggested the family was staging the illness were labeled xenophobic while research that theorized the migratory process precipitated the condition became the basis for government policy. Hence, a 2013 guide for treating apathy published by the Swedish Board of Health and Welfare advised “A permanent residency permit is considered by far the most effective ‘treatment,’ and that a patient will not recover until his family has permission to live in Sweden.” In brief, political correctness tainted the studies because it was more politically expedient to grant residency to all families with children suffering from the syndrome than to acknowledge that this could be another manifestation of honor violence where cultural traditions allow parents to abuse their own children. If honor violence is proven to be the reason for the syndrome than Sweden’s immigration policy is the cause of the illness not the cure.
Honor violence is a form of domestic violence that is committed by family members against other family members to either prevent the family from being dishonored or restore the families damaged honor. Victims of honor violence typically internalize the values of their family or community and feel guilty and responsible for the perceived offense against honor. Honor violence is typically attributed to assaults and murders of women who have refused arranged marriages or defiled the family's honor by not following traditions. Honor violence is not always punitive for alleged violations of cultural traditions. Anything that preserves the family honor is permitted including forcing children into slavery or child marriage to settle a debt. Being deported back to a country where the family status and honor would be diminished could be motivation for shaming a child into staging resignation syndrome. The New Yorker article did not mention that the majority of mothers of the apathetic refugee children had been subjected to physical and/or sexual abuse and were described as severely traumatized. One study suggested a Munchausen by proxy scenario proposing the idea that the mother staged the illness as a method to cope with her own trauma. The theory characterized the syndrome as ‘lethal mothering’, a behavior that is consistent with honor violence. In honor based tribal cultures men can justifiably subject their wives to physical and sexual abuse and mothers can willingly harm their own children to preserve the family honor. A 2016 study claimed that almost all children with resignation syndrome suffered traumatization from physical abuse, harassment or by witnessing violence and abuse in the close family. Intrafamily violence is also consistent with honor crimes.
There is another unusual phenomenon among refugee children in Sweden that is not included in the New Yorker article. It is referred to as 'Balcony Girls' and unlike resignation syndrome this malady did not prompt lengthy medical studies. ‘Balcony Girls’ is the term for young women and girls who are either forced to jump or are thrown off the balconies of their homes. Forensically it is death due to fall from height. Culturally it is death by Islamic Sharia law. It is a more common form of honor violence also referred to as honor killing. Similar to how the apathetic children may be forced to sacrifice themselves for their family, the young girls are forced to defend the honor of their families by committing suicide. The families inform the girls that if they do not commit suicide they will kill them. Sometimes they give them the choice of overdosing on pills, jumping in front of a train, hanging or jumping off the apartment balcony.
Forensically, pushing someone off a balcony is an easy way to get away with murder. When the body is found it is difficult to determine whether the cause of death is accident, suicide, or homicide. But on the up side nothing cuts down on those Swedish rape statistics like women not reporting for fear of being tossed off a balcony. When analyzing a fatal fall from height, pathologic features alone are not sufficient to assess the cause of death. Postmortem findings are typically considered in the context of the victim’s social, medical, and psychiatric history in conjunction with findings at the death scene and toxicology results. When the whole family participates in honor killing their interviews are going to suggest suicide.
In addition to dozens of balcony ‘accidents’ there have been several other incidents of honor killing in Sweden that involved multiple stab wounds, burning, beating with an iron bar and baseball bat, dousing in hot oil, and facial mutilations. If the women are fortunate enough to survive they are forever stigmatized.
Honor crimes have been recognized by the Swedish authorities as a subset of domestic violence but do not appear to have been as extensively studied as resignation syndrome. A report titled Resignation Syndrome: Catatonia? Culture-Bound? was published in the journal of Frontiers of Behavioral Neuroscience in 2016. The report detailed medical, psychological and cultural case studies that considered various neurological disorders, epidemic hysteria, and stress induced disorders resulting from a lengthy migration process. The study provided the age of the patients as 7–19 with the average being 14.3, the gender ratio was 2 males to 3 females and noted that all the cases were refugees belonging to a political or ethnic minority. They observed that there was a disproportionally large number originating from former Soviet Republics or former Yugoslavia with cases from Bangladesh and Africa and that the Uighur ethnic group was over-represented among those affected. Aviv wrote about two sisters who are Roma from Kosovo but does not disclose their religion. Roma, also known as Romani, are commonly referred to as Gypsies and the vast majority of the Roma population in Kosovo are Muslim. The Islamic religion did not appear to be mentioned in The New Yorker article.
Although Islam is not mentioned, Aviv details how the children became the focus of intense public and political debate on immigration. She describes how 42 psychiatrists accused the government of “systematic public child abuse” and how they claimed that the time it took the Migration Board to process their applications was causing the disease. Swedish news started broadcasting dramatic images of children on stretchers being expelled from the country. Thousands of Swedes signed a petition to stop the deportations and five of Sweden’s political parties demanded amnesty for the children. Consequently, Sweden's Migration Board decided that all families of apathetic children would be granted residency permits. Remarkably, there have never been any fatalities associated with this disease. According to Aviv’s article no one knows why the illness is specific to Sweden and “there is now universal consensus that the children are not faking”. Perhaps it is specific to Sweden because they are the only country that would grant residency to an entire family that may be abusing their own child to prevent deportation.
The children may not be faking. An investigation that considered honor violence as a motive could test the children for substances that would simulate the symptoms and go undetected in a typical toxicology screening. By drugging them the family could make the children, the physicians and the researchers think they are suffering from resignation syndrome. It took a very long time for law enforcement to distinguish honor killings from more typical types of domestic violence and to adapt their investigations to include the potential of a family conspiracy. Swedish police developed an interview guide and checklist for assessing honor related crime. It is unfortunate that this assessment tool has not been applied to resignation syndrome.
It is not surprising that liberal pro-immigration bias is evident throughout The New Yorker article. In addition to romanticizing this bizarre phenomenon, Aviv exploits the children’s illnesses to characterize refugees as ‘the moral crisis of our era’ and portray Sweden as having the most diligent and conscientiousness response to refugees. Denial of refugee violence is necessary to maintain the liberal ideal of Sweden as a successful progressive socialist utopia – even at the expense of children falling into comas and girls falling off balconies.