Give-It-Up Itis ~ Yes, It is Real


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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