Recent legal action resulted in urgent medical evacuation of a child in an unconscious state following a progressive social withdrawal and failure to speak, eat or drink. The child was unresponsive, dehydrated and at risk of death from the physical complications of this extreme state.
Medical experts noted there are no adequate medical or mental health facilities on Nauru to treat this condition. This outbreak raises serious questions about the impact of our offshore facilities for vulnerable populations and the capacity of the current system to respond adequately.
What is resignation syndrome?
Resignation syndrome is a rare psychiatric condition that presents as a progressive social withdrawal and reluctance to engage in usual activities such as school and play. Children may become isolated and appear depressed and irritable. They frequently resist others’ attempts to support or encourage them to engage.
As the condition progresses, the child may stop talking and isolate themselves in bed, and may stop eating and drinking. The most serious stage of the disorder is when the child enters a state of profound withdrawal and is unconscious or in a comatose state.
This appears to be a state of “hibernation” in response to an intolerable reality. They are unresponsive, even to pain. They appear floppy, without normal reflexes, and require total care, including feeding and intravenous fluids as they risk kidney failure and death from complications of immobility, malnutrition and dehydration.
Missy Higgins makes an impassioned plea for compassion towards refugees on Q&A. Post continues below…
This is a life-threatening condition needing high level medical care.
Various names have been used to describe this condition since it was originally described in children showing a retreat from external reality. Terms previously used for this condition include depressive devitalisation and pervasive arousal-withdrawal syndrome. Both point out the withdrawal and lack of response.
Many children with the condition were experiencing trauma, including environmental stress and psychiatric disorders in parents and carers. Common features are the ongoing nature of the trauma and the child’s feelings of hopelessness and helplessness in the face of inescapable stress.
In these situations, children appear to give up or resign themselves to an overwhelming situation and cope with this by a profound disengagement or withdrawal.
Trauma in immigration detention
There are many factors contributing to trauma for child asylum seekers and refugees. Some are traumatised by experiences in their countries of origin and the process of fleeing. Experiences in detention and processing centres also directly contribute to feelings of lack of safety, anxiety and confusion.
Children are exposed to distress and despair in others around them and in their own parents. Some experience separation from important attachment figures. These traumas contribute to high rates of distress and mental health problems. As periods of time spent in these environments increase, mental health deteriorates.
In Nauru currently, some children may have been there for five years with little or no hope of finding a place of safe resettlement. Their mental health problems are compounded by a lack of support and mental health services and limited access to family support. Depression in parents further isolates vulnerable children.