People
can die from giving up the fight
University of Portsmouth
People can die simply
because they’ve given up, life has beaten them and they feel defeat is
inescapable, according to new research.
The study, by Dr John
Leach, a senior research fellow in the University of Portsmouth’s Department of Sport and Exercise Science, is the first
to describe the clinical markers for ‘give-up-it is’, a term used to describe
what is known medically as psychogenic death.
It usually follows a
trauma from which a person thinks there is no escape, making death seem like
the only rational outcome.
If not arrested, death
usually occurs three weeks after the first stage of withdrawal.
Dr Leach said: “Psychogenic death is real. It isn’t suicide, it isn’t linked to depression, but the act of giving up on life and dying usually within days, is a very real condition often linked to severe trauma.”
He describes in clinical
detail the five stages leading to progressive psychological decline and
suggests give-up-itis could stem from a change in a frontal-subcortical circuit
of the brain governing how a person maintains goal-directed behaviour.
The likely candidate in
the brain is the anterior cingulate circuit, responsible for motivation and
initiating goal-directed behaviours.
He said: “Severe trauma
might trigger some people’s anterior cingulate circuit to malfunction.
Motivation is essential for coping with life and if that fails, apathy is
almost inevitable.”
Death isn’t inevitable
in someone suffering from give-up-itis and can be reversed by different things
at each stage. The most common interventions are physical activity and/or a
person being able to see a situation is at least partially within their
control, both of which trigger the release of the feel-good chemical dopamine.
“Reversing the
give-up-itis slide towards death tends to come when a survivor finds or
recovers a sense of choice, of having some control, and tends to be accompanied
by that person licking their wounds and taking a renewed interest in life,” he
said.
The five stages of
give-up-itis are:
1. Social withdrawal – usually after a psychological trauma. People in this stage can show a marked withdrawal, lack of emotion, listlessness and indifference and become self-absorbed.
Prisoners of war have
often been described in this initial state, having withdrawn from life, of
vegetating or becoming passive.
Dr Leach said withdrawal
can be a way of coping, to pull back from any outward emotional engagement to
allow an internal re-alignment of emotional stability, for example, but if left
unchecked it can progress to apathy and extreme withdrawal.
2. Apathy – an emotional or symbolic ‘death’,
profound apathy has been seen in prisoners of war and in survivors of shipwreck
and aircraft crashes. It’s a demoralising melancholy different to anger,
sadness or frustration. It has also been described as someone no longer
striving for self-preservation. People in this stage are often dishevelled,
their instinct for cleanliness gone.
Dr Leach said one
prisoner of war who was also a medical officer described being in this stage as
waking each morning but being unable to summon the energy to do anything.
Others describe it as a severe melancholy, where even the smallest task feels
like the mightiest effort.
3. Aboulia – a severe lack of motivation coupled with
a dampened emotional response, a lack of initiative and an inability to make
decisions.
People at this stage are
unlikely to speak, frequently give up washing or eating and withdraw further
and deeper into themselves.
At this stage, a person
has lost intrinsic motivation – the ability or desire to start acting to help
themselves – but they can still be motivated by others, through persuasive
nurturing, reasoning, antagonism and even physical assault. Once external
motivators are removed, the person reverts to inertia.
Dr Leach said: “An
interesting thing about aboulia is there appears to be an empty mind or a
consciousness devoid of content. People at this stage who have recovered describe
it as having a mind like mush, or of having no thought whatsoever. In aboulia,
the mind is on stand-by and a person has lost the drive for goal directed
behaviour.”
4. Psychic akinesia – a further drop in motivation. The person
is conscious but in a state of profound apathy and unaware of or insensitive to
even extreme pain, not even flinching if they are hit, and they are often
incontinent and continue to lie in their own waste.
A lack of pain response
is described in a case study in which a young woman, later diagnosed with
psychic akinesia, suffered second-degree burns while visiting the beach,
because she hadn’t removed herself from the sun’s heat.
5. Psychogenic death – Dr Leach describes this final stage as
the disintegration of a person.
He said: “It’s when
someone then gives up. They might be lying in their own excreta and nothing –
no warning, no beating, no pleading can make them want to live.”
In concentration camps,
people who reached this stage were often known to be near death by fellow
prisoners when they took out a hidden cigarette and began smoking it.
Cigarettes were highly valuable in the camps and could be traded for important
things such as food.
Dr Leach said: “When a
prisoner took out a cigarette and lit it, their campmates knew the person had
truly given up, had lost faith in their ability to carry on and would soon be
dead.”
The progress from stage
four, psychic akinesia, to stage five, psychogenic death, generally takes three
to four days and shortly before death, there’s often a false dawn – a flicker
of life, for example, when someone suddenly enjoys a cigarette.
Dr Leach said: “It
appears briefly as if the ‘empty mind’ stage has passed and has been replaced
by what could be described as goal-directed behaviour. But the paradox is that
while a flicker of goal-directed behaviour often takes place, the goal itself
appears to have become the relinquishing life.”
The research is
published in Medical Hypotheses.