Is it real? Yes, this
is a real condition when people just give up and die.
I first encountered this phenomenon reading
the 1946 classic, Man’s Search for
Meaning by Viktor Frankl. During
WWII, Frankel, who was a medical doctor and psychiatrist, was incarcerated in
four concentration camps where he and other inmates observed people giving up
and dying. They were not insane and displayed no
physical illnesses. However, the pattern
of shuffling gait, disconnecting with the world around them, lying down and
curling up, incontinence, and lying in their own excrement meant only one
thing: That man would be dead in three days.
The concentration camp prisoners saw this so often that they could
predict almost to the hour when their colleague would die. They just gave up.
Recently, a friend gave me an article about Give-Up-Itis [GUI]
published online in The Conversation
magazine published on September 27, 2018.
A new study by researcher John Leach, published in the Journal of Medical Hypotheses on 14 June
described GUI as a real medical condition known as extremis but commonly known as
fatal withdrawal. GUI most often
occurs from a traumatic situation from which there is no perceived escape and
the person has no control. From a historical perspective, Leach described how
GUI has been documented in 16th century Jamestown records, Africans
who had been captured by European slave traders, concentration camps, atomic
bombings, and POW camps of WWII, Korea, and Vietnam.
GUI has also been documented in cases of chronic or acute severe trauma
such as the case of survivors of a shipwreck who witnessed their friend giving up
and dying just hours before rescue.
Stages:
1.
Social
withdrawal; no motivation
2.
Apathy;
disheveled and dirty; shuffling walk
3.
Loss
of motivation; ceases personal hygiene; lack of speech output (empty mind)
4.
Catatonic
state; stupor; ceases eating; no external responses even to pain
5.
Basic
cognitive functioning intact; death
GUI is caused by frontal-subcortical
circuit dysfunction which results in lack of dopamine. In a medical setting, dopamine can be
administered and the condition reversed. However, in the field, medical intervention is not
available. “Motivation and goal-directed behavior are essential for coping and
in the field, they could pushed into action by a leader if compelled to move
around every day” to avoid accepting mental defeat (Leach, 2018, p. 18). In his research, Leach also identified
numerous examples how good people are essential to recovery. At first paternalism and sometimes strong leadership
and kind words helped victims snap out of their despair.
The shuffling walk at Stage 2 was a key indicator to
scientists that dopamine deprivation could reverse GUI. Physical activity has been known to increase
dopamine and whether forced or voluntary, activity and adopting goals was
proven to be essential to survival. Dopamine
production is increased during activity and engaging in goal-oriented
behaviors. For example, daily shaving
and undressing for sleep were examples of personal control and goal-oriented
activity in Frankl's concentration camps. The bottom line is that having
good people around to help them get through trauma was essential to
survival.
References:
Leach, J. (2018). “Give-up
itis” revisited: Neuropathology of extremis.
Journal of Medical Hypotheses,
(120), 14-21. https://doi.org/10.1016/j.mehy.2018.08.009
The Conversation. Give-up-itis: when people just give up and
die. Published September 27, 2018. Retrieved
from https://theconversation.com/give-up-itis-when-people-just-give-up-and-die-103727
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