An increasing number of women and children fleeing war and ISIS captivity are exhibiting lethargy and apathy with resemblance to depressive stupor or catatonia, in connection to traumatic events and reaction patterns involving  “apathic introversion” or Resignation Syndrome (RS), along with other symptoms interpreted to be psychosomatic have been reported.

Numerous phenomena resembling RS have been reported by physicians and anthropologists across contexts, cultures and time periods suggesting a common psychosomatic mechanism. Acute as well as prolonged death ensuing real or magical threat of death is known from cultures on most continents. “Epidemics” of dying in war and captivity where no hope remains has been described. (Kihlbom, 2013).

Nostalgia has been examined in relation to deterioration, apathy and dying. (Johannisson, 2001). The concentration camp term “muselmann” denoted those void of all hope exhibiting resignation behavior (Kertész, 1998) claimed to sustain for weeks without nutrition in a state of “archaic autohypnosis”. (Kihlbom, 2013).

Resignation, apathy and eventually death in response to severe unavoidable threat is a consistent finding throughout history and across cultures.

RS designates a long-standing disorder predominately affecting psychologically traumatized children and adolescents in the midst of a strenuous and lengthy migration process. Typically a depressive onset is followed by gradual withdrawal progressing via stupor into a state that prompts tube feeding and is characterized by failure to respond even to painful stimuli. The patient is seemingly unconscious. Recovery ensues within months to years and is claimed to be dependent on the restoration of hope to the family.

Descriptions of disorders resembling RS can be found in the literature and the condition is unlikely novel. Nevertheless, the magnitude and geographical distribution stand out. Several hundred cases have been reported exclusively in Sweden in the past decade prompting the Swedish National Board of Health and Welfare to recognize RS as a separate diagnostic entity.

From January 1st 2003 to April 31st 2005, 424 cases were reported (Hessle and Ahmadi, 2006) and out of the 6547 asylum applications submitted for children (0–17 years) in Sweden in 2004 (Von Folsach and Montgomery, 2006), 2.8% were thus diagnosed. No cases reported from other countries, the phenomenon appears unique to Sweden. [Source]

The Swedish word uppgivenhetssyndrom sounds like what it is: a syndrome in which kids have given up on life.

In Sweden: Several hundred children and adolescents have literally checked out of the world for months or years. They go to bed and don’t get up.

They’re unable to move, eat, drink, speak or respond. All of the victims of the disorder, sometimes called resignation syndrome, have been youngsters seeking asylum after a traumatic migration, mostly from former Soviet and Yugoslav states. And all of them live in Sweden.

Rachel Aviv, a staff writer at The New Yorker, described these children in the April 3, 2017, article “The Trauma of Facing Deportation.“ [Read the full article on pdf – p. 68]

Excerpts from an NPR interview with Aviv:

The children go into these coma like states when their families are notified that they will be deported. The only known cure is for their families to receive residency permits allowing them to stay in Sweden. It’s not a sudden, magical reawakening when family members read the approved residency permit in the non-responsive child’s presence. Somehow, the information gets through. While there are no long-term follow-up studies, Aviv says, over a period of days, weeks, sometimes a few months, the child begins to eat, move, react and come back to the world.

[Aviv] I first read about it in Frontiers in Behavioral Neuroscience. Because I was reading about it in an academic article, I didn’t think to doubt it. But when I met the two girls I wrote about, it felt very strange. There was a sense of unreality. There was a disconnect between how young and healthy, even beautiful, they looked. They looked like they were sleeping. It was a sickening feeling to know that they were in that position for years. People make comparisons to bears hibernating. But humans don’t hibernate. It felt surreal.

[NPR] The two sisters you wrote about were Roma, from Kosovo. The older sister lost her ability to walk within 24 hours of the family’s application for residency being turned down. Her younger sister is also “bedridden and unresponsive.“

[Aviv] They were lying in bed. Their doctors were manipulating their bodies, and the girls did not show any signs that they were aware that there were people around them. When I met them, one of the girls had been in that state for two years, the other one only for a few months. When the doctor shined a flashlight on the girls’ eyes, the one who had been sick the longest, she just sort of stared directly at the doctor as if she didn’t even notice that someone was opening her eyelid.

I met a boy that I didn’t write about. He lived in a hotel. He and his mother had received a residency permit already. He had been apathetic for about two years [while the family waited and worried that they would be deported]. Even though his family had received the residency permit about three months before, the only progress he had made was to open his eyes. He was sitting up, but he could not hold his head up on his own. We’d be talking — his family, his doctors — and suddenly I’d remember that he was in the room.

It was almost as if there was a mannequin in the room that I kept forgetting about. He didn’t seem to be there mentally. That was concerning. He should have been recovering by then. His doctors were hopeful that he’d get better, but there have been almost no follow-up studies about what happens to these children.

[NPR] You did write extensively about Georgi from the Russian province of North Ossetia, who went to bed and stayed there when his family’s permit was denied in 2015. In late May, 2016, Georgi’s family received another letter from the Migration Board. Their neighbor Ellina Zapolskaia translated it:

‘The Migration Board finds no reason to question what is stated about Georgi’s health,’ she read out loud. ‘He is therefore considered to be in need of a safe and stable environment and living conditions in order to recuperate.’

What was his recovery like?

[Aviv] I would never have known that he was sick. He looked and acted completely normal. But even with complete recovery, some of these children have missed two years of their lives, and that’s a big deal.

[NPR] Is it possible that the children who went into these coma like states knew of the syndrome? And if so, might they have been unintentionally showing symptoms as a way of saving their families from deportation?

[Aviv] I think everyone acknowledges that there’s a degree of psychological contagion. Georgi had a family friend with the condition; the two sisters had a cousin; and the boy in the hotel saw at least three other children in the hotel with the syndrome. It’s a little like the way anorexia emerged in the U.S. at a moment in time when people were preoccupied with body image and the media were emphasizing thinness.

The illness borrows from the culture, and suddenly you have all these people who are starving themselves and doctors began diagnosing anorexia. It’s hard to pinpoint what the mechanism would be for children to develop resignation syndrome. It seems to have become a culturally permissible way of expressing one’s despair.

In Mosul: Women and children freed from sexual slavery to ISIS are also falling into coma like state of deep sleep.

Since the operation to take back Mosul, Iraq began last year, approximately 180 women, girls and children from the Yezidi ethnic minority who were captured in 2014 by the Islamic State, or Isis, have been liberated, according to Iraq’s Bureau for the Rescue of Abductees.

Women rescued in the first two years after Isis overran their ancestral homeland came home with infections, broken limbs and suicidal thoughts.

But now, after three years of captivity, women are far more damaged, displaying extraordinary signs of psychological injury.

The girls are “very tired,” “unconscious” and “in severe shock and psychological upset,” said Dr. Nagham Nawzat Hasan, a Yazidi gynecologist who has treated over 1,000 of the rape victims.

“We thought the first cases were difficult,” Hasan said. “But those after the liberation of Mosul, they are very difficult.”

The shock expresses itself in women and girls who sleep for days on end, seemingly unable to wake up, said Hussein Qaidi, the director of the abductee rescue bureau.

“Ninety per cent of the women coming out are like this,” he said, for at least part of the time after their return.

Souhayla is just 16-years-old. She was captured at the tender age of 13.  She now lay on her side, on a mattress on the floor, unable to hold up her head. Her uncle props her up to drink water, but she can barely swallow. Her voice is so weak, he places his ear directly over her mouth to hear her.

Her uncle described her condition as “shock.” He invited reporters to Souhayla’s bedside so they could document what the terror group’s system of sexual abuse had done to his niece.

“This is what they have done to our people,” said Khalid Taalo, her uncle.

The girl walked out of the most destroyed section of Mosul this month, freed after three years of captivity and serial rape when her Isis captor was killed in an airstrike.

Both Souhayla and her family asked that she be identified as well as photographed, in an effort to shed light on their community’s suffering. Her uncle posted her image on Facebook immediately after her release describing what Isis had done to her.

For over a year, Taalo said, he had known his niece’s location, as well as the name of the fighter holding her. He enlisted the help of a smuggler who at great risk photographed Souhayla through the window of the house where she was being held and sent the images to her family.

But it was too perilous to try a rescue.

Souhayla escaped on July 9th [2017], two days after an airstrike collapsed a wall in the building where she was being held, Killing another Yazidi girl who had been held alongside her, including the captor who had been abusing them, her uncle said.

At that point, she was strong enough to clamber through the rubble and make her way to the first Iraqi checkpoint.

When her family drove to pick her up, she ran to embrace them.

“I ran to her and she ran to me and we started crying and then we started laughing as well,” said Taalo, the brother of Souhayla’s father, who remains missing after the Isis took over their hometown. “We stayed like that holding each other, and we kept crying and laughing, until we fell to the ground.”

But within hours, she stopped speaking, he said.

By the time they reached the camp where her mother and extended family had found refuge after the Islamic State overran their village, Souhayla slipped into what appeared to be unconsciousness.

The doctors who examined her have prescribed antibiotics for a urinary tract infection. She also shows signs of malnutrition.

Neither explain her extreme symptoms, said her family and one of the doctors who examined her.

“I’m happy to be home,” she whispered with difficulty into her uncle’s ear, in response to a reporter’s question, “but I’m sick.”

Isis had been ruling Mosul for two months in 2014 when the group’s leaders set their sights on Sinjar, a 60-mile-long, yellow massif to the north. Its foothills and mountain villages have long been the bedrock of life for the Yazidi, a tiny minority who account for less than two percent of Iraq’s population of 38 million.

The centuries-old religion of the Yazidi revolves around worship of a single God, who in turn created seven sacred angels. These beliefs led the Isis to label the Yazidi as polytheists, a perilous category in the terrorist group’s nomenclature.

Relying on a little-known and mostly defunct corpus of Islamic law, the Isis argued that the minority’s religious standing rendered them eligible for enslavement.

On August 3, 2014, convoys of fighters sped up the escarpment, fanning out across the adjoining valleys. Among the first towns they passed on their way up the mountain was Til Qasab, with its low-slung concrete buildings surrounded by plains of blond grass.

That’s where Souhayla, then 13-years-old, lived.

A total of 6,470 Yazidis on the mountain were abducted, according to Iraqi officials, including Souhayla. Three years later, 3,410 remain in captivity or unaccounted for, Qaidi of the abductee rescue bureau said.

For the first two years of her captivity, Souhayla was forced through the Islamic State’s system of sexual slavery, raped by a total of seven men, she said.

When the push for Mosul began, she was moved progressively deeper into the area hardest hit by the conflict, as security forces squeezed the terrorist group into a sliver of land near the Tigris River. The area was pummeled by artillery, airstrikes and car bombs, and strafed by helicopter-gunship fire.

As Isis began losing its grip on the city, Souhayla’s captor cut her hair short, like a boy’s. She understood he was planning to try to slip past Iraqi security forces, disguised as a refugee, and take her with him, her uncle said.

Taalo now spends his days nursing his niece back to health. To sit up, she grasped one of the metal ribs holding up her family’s tent and pulled herself into a sitting position, as her uncle pushed from behind. But soon her strength was sapped, and she flopped back down.

He used a wash cloth to dab her forehead, as she lay in his lap. Her mouth fell open and her eyes rolled back.

After her escape, almost two weeks passed before she was able to stand for more than a few minutes, her legs unsteady.

Yazidi Girls: Iraqi officials say recent female escapees are also showing an unusual degree of indoctrination (I would refer to as brainwashing). 

Two Yazidi sisters, ages 20 and 26, arrived at the Hamam Ali refugee camp, where they drew the attention of camp officials because they wore face-covering niqabs and refused to take them off, despite the fact that Yazidi women do not cover their faces.

They described the Isis fighters who raped them as their “husbands” and as “martyrs,” said Muntajab Ibraheem, a camp official and director of the Iraqi Salvation Humanitarian Organization.

In their arms were the three toddlers they had given birth to in captivity, the children of their rapists. But they refused to nurse them, said the smuggler sent by their family to fetch them. He and camp officials filled out paperwork so that the children could be given to the state, he said.

A video recorded on the smuggler’s phone shows what happened when the sisters saw their family for the first time after their return. Their relatives rushed to embrace the gaunt women. They cried.

Their mother, distraught, stepped behind the tent, trying to steady herself.

A day after the video was taken, reporters went to see the women, and they could no longer stand. They lay on mattresses inside the plastic walls of their tent.

Family members said that except for a few brief moments, the women have not awakened since then, over a week ago. [Source]

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