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New research shows that people can die simply because they have given up, believing that life has beaten them and that they are convinced that defeat is inevitable.
The study describes the clinical markers of abandonment, a term used to describe what is psychologically called psychogenic death.
It usually results from a trauma that a person thinks is impossible to escape, making death the only rational outcome, says Dr. John Leach, a research fellow at the University of Toronto. Portsmouth.
"Psychogenic death is real," he said. "It's not a suicide, it's not related to depression, but giving up life and dying, usually within a few days, is a very real condition often related to trauma." serious."
In the study, he describes the five stages leading to progressive psychological decline.
He also suggests that abandonment could result from a change in the frontal-subcortical circuit of the brain that governs a person's behavior. The likely candidate is the previous cingulate circuit, which is responsible for motivating and initiating targeted behaviors, he said.
"Serious trauma can lead to dysfunction of some people's previous ping-pong circuit," he said. "Motivation is essential to cope with life and if that fails, apathy is almost inevitable."
However, he noted that death is not inevitable in a person who surrenders and can be reversed by different things at each stage.
The most common interventions are physical activity and / or a person able to see a situation is at least partially under his control, two factors that trigger the release of the neurotransmitter dopamine.
"Inverting the tendency to abandon toward death tends to occur when a survivor finds or recovers a sense of choice, control, and tends to be accompanied by a person licking his wounds and taking a new interest in life, "he said.
The five stages of abandonment are:
1. Social withdrawal, usually after psychological trauma. People at this stage can manifest marked withdrawal, lack of emotion, apathy and indifference, and become egocentric.
Prisoners of war have often been described in this initial state, having been withdrawn from life, vegetating or becoming passive.
According to Leach, withdrawal can be a way to deal with any external emotional commitment to allow for an internal realignment of emotional stability. If nothing is done, it can lead to apathy and extreme withdrawal.
2. Apathy, an emotional or symbolic "death". Deep apathy has been observed among prisoners of war and survivors of shipwrecks and aircraft accidents. It's a demoralizing melancholy different from anger, sadness or frustration, said Leach. He has also been described as someone who no longer seeks to preserve himself. People at this stage are often disheveled, their instinct of cleanliness has disappeared, he adds.
A prisoner of war who was also a doctor said that at this point he was waking up every morning, but unable to use energy to do anything, reports Leach. Others describe it as a severe melancholy, where even the smallest task seems to be the most powerful effort.
3. Aboulia, a serious lack of motivation associated with a moderate emotional response, a lack of initiative and an inability to make decisions.
People at this stage are unlikely to speak, frequently stop washing or eating, and withdraw more and more deeply.
At this point, a person has lost his intrinsic motivation – the ability or the desire to act to help – but it can still be motivated by others, through a persuasive education, of reasoning, antagonism and even physical aggression. Once external motivations are removed, the person goes back to inertia.
"An interesting thing about the aboulia is that there seems to be an empty mind or a content-free conscience," Leach said. "At this point, the people who have recovered describe it as having a mind like a whiff or having no thought. In aboulie, the mind is waiting and a person has lost motivation for goal-oriented behavior. "
4. psychic akinesia, a further decline in motivation. The person is conscious, but in a state of deep apathy and unconscious or insensitive to even extreme pain, without flinching if touched, and is often incontinent and continues to get lost.
The lack of response to pain is described in a case study in which a young woman, later diagnosed with psychic akinesia, suffered second-degree burns when she visited the beach because she had not not removed from the heat of the sun.
5. The psychogenic death, which Leach describes as the disintegration of a person.
"It's when someone quits then," he said. "They can lie in their own droppings and nothing – no warning, no beating, no plea – can make them want to live."
In concentration camps, people who reached this stage were often known to be close to the death of other prisoners when they took out a hidden cigarette and started to smoke it. Cigarettes were very valuable in the camps and could be exchanged for important things like food.
"When a prisoner took a cigarette and lit it, his campmates knew that the person had really given up, that she had lost confidence in their ability to continue and would soon be dead," Leach said. .
The progression of the fourth stage, psychic akinesia, to the fifth stage, psychogenic death, usually takes three to four days. Shortly before death, there is often a flicker of life, for example, when someone suddenly enjoys a cigarette.
"It appears briefly that the empty mind stage has passed and has been replaced by what might be described as goal-oriented behavior," said Leach. "But the paradox is that even though goal-oriented behavior often happens, the goal itself seems to have come true."
Source: University of Portsmouth
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