ACT ON APATHY

Giving up on life can lead to actual death in less than a month

Dark times.
Dark times.
Image: AP Photo/Eric Gay
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It’s a dark area of psychology, exploring death’s grip on a person who feels totally defeated by life. But as scientists learn more about the phenomenon, they’re finding it impacts people in five distinct stages.

The clinical name for this is psychogenic death. And if left untreated, a new study in the journal Medical Hypothesis shows, the five stages can run their course in as little as three weeks.

“Psychogenic death is real,” says University of Portsmouth researcher John Leach in a related statement. “It isn’t suicide, it isn’t linked to depression, but the act of giving up on life and dying usually within days, is a very real condition often linked to severe trauma.”

The condition may have everything to do with the inner workings of the brain, particularly changes that occur within a person’s anterior cingulate circuit, which is the area that controls motivation. When a person struggles to feel motivation, coping with life becomes more difficult and apathy can set in. If a person experiences severe trauma, it’s entirely possible that the event could trigger a malfunction in that circuit.

Once the malfunction occurs, Leach explains, five distinct stages typically precede death:

  1. Social withdrawal. When someone experiences severe trauma, one of the first signs is that they show a lack of emotion, and a listlessness that indicates an indifference toward life. This is actually a coping mechanism, an attempt to pull back from outward emotional engagement as a means to realign emotion stability. But if left unchecked, it can morph into full-on withdrawal. This has been seen in prisoners of war, who have described this state as feeling vegetative and passive.
  2. Apathy. In some ways, apathy is symbolic death. It’s a deep sense of melancholy that can indicate a person no longer strives for self-preservation. For people in this stage, Leach says, the smallest tasks can feel like the mightiest of efforts.
  3. Aboulia. This is the stage where physical activity starts to drop off. A person might stop cleaning themselves or even speaking to others. They withdraw even deeper into themselves. People who have recovered from this stage have described feeling as though their mind was made of mush. Essentially, the brain switches to standby mode and a person loses any motivation whatsoever.
  4. Psychic akinesia. Even extreme pain is difficult to feel in this stage, which is marked by further loss of motivation. In some cases, a person won’t flinch if they are threatened physically. As Leach describes it, one woman in this stage went to the beach and walked away with second degree burns. She was so apathetic toward the pain that she didn’t bother removing herself from the heat.
  5. Psychogenic death. This final stage is marked by the disintegration of a person. As described by Leach, “It’s when someone then gives up. They might be lying in their own excreta and nothing—no warning, no beating, no pleading can make them want to live.” In some cases the time between stage four and five can be as little as three or four days.

Of course, when someone is experiencing these stages, it is possible to revive them. Death isn’t inevitable. Common interventions include physical activity or introducing a person to a situation that they recognize as one they can truly control. That experience can release critically important dopamine into the brain, which brings them back to a state of life they previously experienced.

Reversing the slide toward death, Leach notes, “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.”