Life-threatening Loss of Function in Refugee Children: Another Expression of Pervasive Refusal Syndrome?

Five children from asylum-seeking families required hospital care due to serious loss of function arising in the ‘limbo’ conditions in which they were living as refugees. Hopelessness, helplessness and an uncertain time perspective dominated family life; they had not worked through the traumas of the intolerable life from which they had fled. The massive loss of functions in the children resembles that of pervasive refusal syndrome (PRS), but the purposive aspect of the refusal seemed less pronounced. Treatment applying the principles for managing PRS was rapidly successful. The fixed behaviour of the mothers - staging a delusion/fantasy that the child was dying - was interpreted as a desperate coping strategy. It made the situation ‘understandable’ and bestowed on them a role and a meaningful function. Improvements in the children were not noticed until the mothers gave up this ‘lethal’ mothering. The interplay between parents and their children seemed of greater importance to the child than the information provided by the actual circumstances of their lives. The hypothesis about ‘lethal mothering’ presented here adds a psychodynamic perspective to the theory of ‘learned hopelessness and helplessness’; both are seen as relevant in understanding the devitalization reported here, and for understanding and treating PRS more generally.