People Really Do Die From Losing Their Will To Live: New Study Defines "Give-Up-Itis"

Survivors lie in multi-tiered bunks in a barracks in the newly liberated Buchenwald concentration camp. Many later reported that their otherwise healthy friends and family members appeared to perish from hopelessness. This condition has now been given the name 'give-up-itis' or psychogenic death. United States Holocaust Memorial Museum, courtesy of National Archives and Records Administration, College Park

Aliyah Kovner 27 Sep 2018, 21:37

As unscientific as it sounds, "give-up-itis" is a real term used to describe a medically documented yet poorly understood phenomenon wherein a person who has lost the will to live actually dies, despite no apparent physiological cause. The condition was first described in Americans and South Korean soldiers who perished in captivity at prisoner-of-war (PoW) camps during the Korean War, and was later applied to Vietnam War PoWs, shipwreck survivors, and retrospectively identified as a common occurrence in Nazi concentration camps based on the recollections of internment survivors.

The common thread of give-up-itis cases is that it onsets during a psychologically traumatic situation that feels inescapable. The sufferer responds to these seemingly hopeless conditions with increasingly extreme apathy; withdrawing from life around them to the point that they eventually exit the mortal coil entirely.

However, past observations show that death from give-up-itis is not inevitable. People have recovered from states identical to those that preceded death in others after someone or something convinced them to engage with reality once again.

After examining many historical and modern records, University of Portsmouth research fellow Dr John Leach concluded that give-up-itis may be more prevalent than previously thought: apparent cases have been noted as far back as the 1600s and recent case reports on the deaths of elderly people and hospital patients bear the condition’s hallmark features. Hoping to advance our comprehension of this bewildering condition, and therefore our ability to circumvent it, Leach set out to provide the first-ever description of its clinical markers. His paper, now published in Medical Hypotheses, defines a pattern of five phases give-up-itis follows and – as the forum’s name suggests – hypothesizes on the brain activity that underlies it.

"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," Leach said in a statement, further explaining that people with give-up-itis appear to regard death as the best possible coping mechanism to the unbearable stresses of their situation.

The first phase, social withdrawal, is frequent in individuals suffering significant trauma, yet in give-up-itis, unchecked withdrawal may progress to the next phase: apathy. Leach drew upon survivor’s stories to describe this type of apathy as a demoralizing melancholy different from anger, sadness, or frustration that feels like one is “shut in profound inertia”. At this point, the individual will often stop cleaning themselves. In stage three – aboulia – the apathy intensifies until a person has no initiative to perform any day-to-day tasks; they often stop speaking and eating.

"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."

Stage four, psychic akinesia, is characterized by the loss of response to physical stimuli, even intense pain. Finally, if no intervention occurs, give-up-itis sufferers progress to the fifth phase: death.  

At this point, Leach said, “[t]hey might be lying in their own excreta and nothing – no warning, no beating, no pleading can make them want to live."

Leach believes that changes to several linked brain regions, collectively called the anterior cingulate circuit (ACC), may be responsible for the pathology of give-up-itis. The ACC is involved in motivation and initiation of goal-directed behavior, and disruption of dopamine signaling in these regions causes similar apathetic behavior.

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