You can die from ‘give-up-itis’: Doctor warns many pass away when they simply stop trying in life

Social withdrawal

After a life trauma many people avoid the contact of others.

As seen in prisoners-of-war, they may also struggle to show emotion and become indifferent to other people’s suffering.

This can be a way of coping because it allows them to disengage from their feelings in order to be more emotionally stable, according to Dr Leach.

But, if it persists, they may struggle to gather enthusiasm or interest for anything.

Apathy

This occurs when a person is no longer interested in looking after themselves and may even lack the motivation to shower, Dr Leach said. 

The Italian chemist Primo Levi, who survived the Holocaust, said: ‘After only one week of prison, the instinct for cleanliness completely disappeared in me.’ 

For some, ‘the smallest task begins to feel like the mightiest effort,’ according to an Englishman who was held in a Russian prison between 2003 and 2005.

Aboulia 

If apathy goes unchecked, it can lead to aboulia – the inability to take initiative or make decisions. 

‘Many inmates ceased to wash. This was the first step to the grave,’ a concentration camp victim said.

‘It was an almost iron law: Those who failed to wash every day soon died.’

People with aboulia may withdraw deeper with themselves and struggle to even speak.

Often, people at this stage continue to look after others, such as their children, but become less and less motivated to care for themselves. 

‘An interesting thing about aboulia is there appears to be an empty mind or a consciousness devoid of content,’ Dr Leach said.

‘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.’ 

Psychic akinesia

Psychic akinesia can occur when a person’s motivation drops so much they may even become incontinent and lie in their own waste.

Also at this stage, many prisoners-of-war have become unaware of pain and may not even flinch during beatings.

In Dr Leach’s research, he describes a 19-year-old woman diagnosed with psychic akinesia who suffered second-degree burns while on a beach.

Although likely in extreme pain, she was not motivated enough to cover up.

Psychogenic death

The final stage of ‘give-up-itis’, Dr Leach describes psychogenic death as someone totally losing the will to live.

‘They might be lying in their own excreta and nothing – no warning, no beating, no pleading can make them want to live,’ according to Viktor Frankl, an Austrian psychiatrist and survivor of the Holocaust.

In concentration camps, people who reached this stage were often known to be near death when they started smoking cigarettes.

Cigarettes were highly valuable in camps and could be traded for food.

‘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,’ Dr Leach said.

Before passing away, someone may even show a flicker of life, such as enjoying a 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,’ Dr Leach said.  

‘But the paradox is that while a flicker of goal-directed behaviour often takes place, the goal itself appears to have become relinquishing life.’

But death does not have to be inevitable in a person suffering from give-up-itis.

Exercising and realising you do have at least some control over your life both trigger the release of the feel-good hormone dopamine, according to Dr Leach.

‘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. 

‘We all knew that if we didn’t get our minds off dying that any one of us would be next,’ a prisoner of war added.