People may simply die because they've given up, life has defeated them and they feel defeat is inevitable, according to new research. The study is the first to describe the clinical markers for "give-up disease," a term used to describe what is medically known as psychogenic death. It usually follows trauma from which a person believes there is no escape, making death seem like the only rational outcome. If not stopped, death usually occurs three weeks after the first phase of withdrawal.
The researcher said:“Psychogenic death is real. It's not suicide, it's not linked to depression, but the act of giving up on life and dying usually within days is a very real condition that often comes with severe trauma.”
He describes in clinical detail the five stages that lead to progressive psychological decline and suggests that abandoning them may result from a change in a frontal-subcortal circuit of the brain that determines how a person maintains goal-directed behavior. The most likely candidate in the brain is the anterior cingulate circuit, responsible for motivation and initiating goal-directed behavior. Death is not inevitable in someone who suffers from 'give-up-itis' and can be reversed at any stage by several things. The most common interventions are physical activity and/or a person may perceive the situation as at least partially under control, both of which trigger the release of the feel-good chemical dopamine.
The five stages of give-up-itis are:
Social withdrawal – usually after psychological trauma. People at this stage may show marked withdrawal, lack of emotion, listlessness and indifference and become self-absorbed.
Apathy – an emotional or symbolic 'death', deep apathy has been seen in POWs and survivors of shipwrecks and plane crashes. It is a demoralizing melancholy different from anger, sadness or frustration. It has also been described as one who no longer strives for self-preservation. People in this phase are often confused, their instinct for cleanliness has disappeared.
Aboulie – a severe lack of motivation coupled with a muted emotional response, a lack of initiative and an inability to make decisions. People at this stage are unlikely to talk, often stop showering or eating and withdraw further and deeper into themselves.
At this stage, a person has lost intrinsic motivation—the ability or desire to begin 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.
Psychic akinesia – a further decline in motivation. The person is conscious but in a state of profound apathy and unaware or insensitive to even extreme pain, not even flinching when hit, and they are often incontinent and lying in their own filth. A lack of pain response is described in a case study in which a young woman, later diagnosed with psychological akinesia, suffered second-degree burns while visiting the beach for not removing herself from the heat of the sun.
Psychogenic death – This final stage is the disintegration of a person. It's when someone gives up. They can lie in their own excrement and nothing - no warning, no hitting, no pleading can make them live.
The progression from stage four, psychic akinesia, to stage five, psychogenic death, generally takes three to four days, and shortly before death there is often a false dawn — a flicker of life, such as when one suddenly enjoys a cigarette.
