Food, water and shelter. The three key physical things any person needs to find quickly in a survival situation to have the best chance of staying alive and well. There is, however, an important fourth aspect that all survival experts train for: finding and maintaining the right state of mind. While the phrase ‘’positive mental attitude’’ is often repeated and can seem a bit cliched, your frame of mind and your attitude in any given situation can literally mean life or death.
Many of the amazing survival stories we have all heard over the years started with several people, yet often only a few actually survive the entire ordeal. While in these instances some will perish due to unavoidable events and catastrophic injuries, others will die through foolish decisions made in a panic. However there have also been plenty of documented cases where people survive an initial traumatic event, such as a plane crash or a sinking ship, with no obvious injuries, yet they inexplicably die before rescue by appearing to simply give up.
There is even a name for this: Give-up-itis (GUI). Yes, that is actually the name, although it is also called psychogenic death, psychosomatic death or even voodoo death. It is a real, recognised, fatal condition with many documented references throughout historical and present times. GUI was named by American medics during the Korean war in the 1950’s, when they used it as a description in several cases of both American and South Korean prisoners-of-war who perished during captivity despite no obvious physical causes. It was also noted by the medics that these cases did not present depressive or psychotic symptoms and that the patients were considered to be of sound mind. It is important to note that suicide is not the same as GUI.
While this sudden death phenomenon has been often witnessed and documented, it is not very well understood and it may even be more prevalent than scientists and medics currently think. In 2018, a study into GUI was published by Dr John Leach, a research fellow within the Extreme Environmental Medicine & Science Group at the University of Portsmouth. The purpose of his research was to try and establish any patterns for the condition, it resulted in Leach identifying 5 different stages of psychogenic death:
Stage 1 – Social Withdrawal
The first stage usually occurs soon after psychological trauma, prisoners of war often display this behaviour after capture. It is a passive state where they stop interacting with others, becoming emotionless and indifferent. Leach suggests that this stage is a coping mechanism many people employ in order to adjust their emotional stability to the situation. However, if it remains unchecked, then the person may develop the more serious stages of GUI.
Stage 2 – Apathy
Leach alternatively describes this as ‘colossal inertia’. They are severely melancholy and lack any sense of self-preservation, stopping doing even basic tasks such as washing themselves and they will not put any effort into anything.
Stage 3 – Aboulia
Aboulia is a psychiatric term that means a lack of willpower and the inability to act decisively. At this stage, a person has completely lost the drive to carry out basic human needs such as eating or sleeping. They become completely withdrawn, devoid of emotion and they stop talking. After speaking to people who have recovered from this stage, Leach describes the state of their minds as their brains had essentially gone into stand-by mode, with no thoughts whatsoever.
Stage 4 – Psychic Akinesia
The researchers found that persons in this stage are still conscious but have retreated into such extreme apathy and detachment that they no longer feel or respond to pain, hunger or thirst. The lack of motivation is so apparent that people in this stage will lose control of their bowels and continue to lie in the waste.
Stage 5 – Psychogenic Death
The final stage is described by Leach as ‘’It’s when someone gives up. They might be lying in their own excreta, and nothing – no warning, no beating, no pleading can make them want to live.’’ By this stage, death will follow within a few short days. Sometimes, people can appear to recover briefly but it is a false recovery. To illustrate this, Leach recounted a story from the Nazi concentration camps, where cigarettes were extremely valuable as they could be traded for food. If an inmate who had been displaying the above behaviour suddenly lit up and smoked their last hidden cigarette, everyone else knew that they had reached the end and would die shortly.
Dr Leach goes on to explain that there appears to be a link between GUI and the physical impairment of a circuit within the brain called the anterior cingulate, which is responsible for motivation and goal-directed behaviour, possibly caused by a significant fall in levels of dopamine. This impairment produces clinical symptoms as described above. In his words; ‘’Severe trauma might trigger some people’s anterior cingulate to malfunction. Motivation is essential for coping with life and if that fails, apathy is almost inevitable.’’
So for someone who has experienced a traumatic event, who perceives that they have no control, think they are defeated and believe there is no escape, then they may see death as the only strategy to escape the stress and maybe find some control over their situation. But death in these cases is not inevitable and can be prevented. Physical activity can help increase dopamine levels and stop the decline to death. Dopamine levels also rise when a survivor is able to find or recover a sense of control or choice and therefore manage to regain some interest in life and the motivation to carry on.
So if you ever find yourself in a survival situation and you recognise yourself or a fellow survivor starting to slip down the stages towards give-up-itis, get them moving and give them tasks or choices, no matter how small, to help them retain self-control and motivation. Don’t let them die unnecessarily.