Dying abandoning the fight of life, imagining that failure is inevitable and that it is the only possible end, is a real syndrome, frequent after severe trauma: the person thinks that there is no escape, making death the only rational end. This study by a researcher from the University of Portsmouth is probably the first to decipher this long process and to describe its clinical markers. Work presented in the journal Medical Hypotheses that may allow relatives and doctors to detect the first signs of this long disintegration and reverse this deadly descent.
Dr John Leach, a researcher at the University of Portsmouth describes the successive clinical markers of this form of abandonment which he calls "give-up-itis" and which, if left unchecked, can cause death in only 3 weeks. This renunciation syndrome affects people who are victims of traumatic stress and who will respond to it by developing extreme apathy, by giving up hope, by giving up life, without any obvious “organic” cause. This "abandonnite" characterized by progressive demotivation and executive dysfunction has its corresponding clinical signs, a dysfunction of the frontal-subcortical circuit, linked, the author suggests, to an imbalance of dopamine in this circuit.
A mental defeat that results in a very real condition: Psychogenic death is real, writes Dr. Leach. " It's not suicide, it's not a form of depression, it's abandonment of life and death within days, a very real condition often associated with severe trauma ." This clinical reality, the author documents it in 5 stages, 5 stages which will lead to this progressive psychological decline then to abandonment. This abandonment is concomitant with a change in the frontal-subcortical circuitry of the brain, involved in maintaining goal-directed behavior. The likely candidate in the brain is therefore the anterior cingulate circuit, responsible for motivation and directed behavior.
5 steps to total surrender
- Social withdrawal: it is frequent after a psychological trauma. People at this stage may exhibit marked withdrawal, lack of emotion, apathy and indifference, and become more self-centered. The author brings here the example of prisoners of war often described in this state of "vegetation". Withdrawal allows freedom from external emotional involvement and an internal realignment of emotional stability, but without recovery or intervention, can lead to apathy and extreme withdrawal.
- Apathy is described as “emotional or symbolic death”. The example given here is that of survivors of shipwrecks and plane crashes. It is a demoralizing melancholy different from anger, sadness or frustration. At this stage, the subject no longer seeks to preserve himself, he sometimes appears "disheveled" and his instinct for cleanliness has disappeared. Much like in depression, even the smallest task represents an inordinate effort.
- Abulia , this lack of motivation associated with an emotional reaction, the absence of any initiative and the inability to make decisions is characteristic of the next stage in this process of abandonment. At this stage, the subject hardly speaks any more, can stop washing or performing certain primary tasks such as eating, and withdraws more and more deeply. He has lost all intrinsic motivation, ability or desire to act for himself. However, he can still be motivated by those close to him, through persuasion, reasoning, and even “physical pressure”. But as soon as these external motivations cease, the subject returns to inertia. In this state, comments Dr. Leach, the mind seems empty and the consciousness devoid of content.
- Psychic akinesia marks a further decline in motivation. The person is conscious but in such a deep and unconscious state of apathy that they may even be insensitive to pain to the point of not reacting to physical violence. The abandonment is also physical, with symptoms of incontinence and letting go of “one's own waste”.
- Psychogenic death , the last stage is presented as the disintegration of the person. “That's when she gives up and no amount of advocacy, treatment or even physical pressure can make her want to live again. This final step “happens quickly” explains the author, who estimates that only 3 to 4 days is the time that separates psychic akinesia from psychogenic death.
“ It's as if the 'empty-mind' stage has been replaced by what could almost be described as goal-directed behavior. But the paradox is that the goal itself has become reality ”.
