Giving up on life can kill you, literally. Losing the desire to live is not the same as suicide, but – unless other people intervene –  a person’s decline and death are inevitable once they enter this state of “give-up-itis”.
The first study to describe the five stages of “give-up-itis”, medically reported as a psychogenic death, was released on Thursday.
People usually die within three weeks of the first stage of withdrawal, preceded by trauma, said US researcher Dr John Leach, from Portsmouth University.
He 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.”
Death seems the “only rational outcome” to people who feel there is no escape from the trauma.
“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. This tends to be accompanied by that person licking their wounds and taking a renewed interest in life,” Leach said.
Physical activity and regaining some control – both of which activate the feel-good hormone dopamine – are the most common ways to reverse the decline.
Leach identifies the five stages of “progressive psychological decline” as social withdrawal, apathy, aboulia, psychic akinesia and, ultimately, psychogenic death.
People are listless, indifferent and self-absorbed, which can be a way of coping, in the first stage of withdrawal. “Prisoners of war have often been described in this initial state … of vegetating or becoming passive,” Leach said.
By the next stage of “profound apathy”, a deep melancholy and lack of energy can set in. At this stage, people are often dishevelled. This can affect the survivors of aircraft crashes and shipwrecks.
People are likely to stop speaking, give up washing and withdraw further by the third stage, known as aboulia. An inability to make decisions and inertia also mark this stage.
Leach said people had lost their “intrinsic motivation” at this stage, but others could still motivate them. If people intervened with persuasion, nurturing, reasoning, antagonism or physical assault, they could make a difference.
People with aboulia appear to have an empty mind. “People at this stage who have recovered describe it as having a mind like mush, or of having no thought whatsoever,” said Leach.
Sensitivity to pain and incontinence are signs of the fourth stage of psychic akinesia. In this state, people do not feel extreme pain and lie apathetic in their own waste.
By the final stage, which occurs some three to four days later, the person has reached a point of no return.
“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,” Leach said.
At this point, prisoners in concentration camps would smoke precious, hidden cigarettes that were worth food – a signal to fellow prisoners that they had given up and would soon die.
Shortly before death, a “false dawn, flicker of life” could be glimpsed, for instance when the person enjoys the cigarette.
“It appears briefly as if the ‘empty mind’ stage has passed and has been replaced by what could be described as goal-directed behaviour,” Leach said.
The goal, however, seems “to have become relinquishing life”.
The US research said a change in the circuit in the brain, which controls motivation and goal-directed behaviour, could trigger this condition. Severe trauma may cause the anterior cingulate circuit to malfunction, setting the potentially deadly cycle in motion.