People can die when they’ve given up to life challenges; psychogenic death isn’t suicide, it isn’t linked to depression, but the act of giving up on life and dying usually within days, it’s real condition often linked to severe trauma. Five stages leading to progressive psychological decline and suggests give-up 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. Severe trauma might trigger people’s anterior cingulate circuit to malfunction. Motivation is essential for coping with life and if it fails, apathy sets in.

Death isn’t inevitable in for those suffering from give-up-itis and can be reversed by different things at each stage. The most common interventions are physical activity and 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. The five stages of give-up-itis are: social withdrawal, apathy, abolua, psychic akinesia and psychogenic death.

People that show social withdrawal lack emotion, listlessness and indifference and become self-absorbed. Apathy is 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.

Aboulia is 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 eating and withdraw further and deeper into themselves. At this stage, they have lost 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.

Psychic akinesia is a state of profound apathy and unaware of or insensitive to extreme pain, not even flinching if they are hit, and they are often incontinent and continue to lie in waste. Psychogenic death is the final stage-disintegration stage.
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