
People can die from giving up the fight - dnetesn
https://medicalxpress.com/news/2018-09-people-die.html
======
drakonka
This has also been known to happen among African cichlids, a type of fish. I'm
sure it's likely other animals are affected as well but I have cichlids
myself, so I have more context with them specifically.

Cichlids tend to be highly territorial and socially competitive. They're
constantly vying for some rock or hole to "own". Usually it is recommended to
overstock a cichlid tank slightly in order to disperse aggression. With three
fish it's easy for the most aggressive alpha to pick on and injure the weakest
link. With twelve fish the most aggressive alpha will have that many more
others to compete with/take out his aggression on. Sometimes, however, the
weakest link still emerges. When this happens multiple fish might pick on the
weakling and chase him/her around, disallowing them from entering any kind of
territory among the rocks (they like rocks). They drive this weaker fish to
stay toward the top reaches of the tank. Eventually the fish just starts
hanging out there naturally because it knows it'll get bullied if it comes
down. Then, after some time of giving up on fighting for its own territory and
competing with the other fish, the weakling just...gives up. Even if the other
fish have left them alone by then, and the fish isn't physically injured or
lacking food or anything, the fish doesn't even try to reenter "society"
anymore and just...dies.

I got my cichlids a couple of years ago and have since decided that while I
will continue to care for these fish as best I can as I took on that
responsibility, I'm not going to be getting any more fish for ethical reasons.

~~~
dcow
What are the ethical reasons? Do you find it unethical to foster a species
that behaves in such a way? Strictly curious.

~~~
drakonka
After getting fish and seeing them in captivity first hand I've decided that I
don't think it's ethical to keep fish in captivity in general. As good a home
as I try to give them, they're still wild animals in a little box. I think no
matter the size of my aquarium or the effort I put into water maintenance,
providing suitable rocks, etc, all of my effort and good intentions will never
compare to the home they are meant to have in the wild. I just feel bad for
them and bad about myself for contributing to an industry that puts animals in
these kinds of conditions.

~~~
snikeris
Do you worry about his sense of purpose or something? Unlimited food, no
predators, might not be so bad for a fish.

~~~
drakonka
I worry about a lot of things, including but not limited to the expression of
all the instinctive behaviours that a fish would have in its natural habitat
that living in a glass box prevents (no matter how enriching we try to make
the captive environment). I could write a lot about this, but I've dwelled on
it enough as it is. Suffice to say I have just decided on a personal level
after keeping fish that I do not think they are a suitable species for
"ethical" captivity in the home.

~~~
malnourish
Legitimate question, how do you feel about dogs?

I find your ethics intriguing (in a positive way, to be clear).

~~~
drakonka
First I'd like to iterate that I am not trying to convince anyone to share or
understand my views on this, I'm only posting this because you asked the
question. I have some conflicting and sometimes contradictory feelings on
animals in captivity in general and tend to lean against captivity in the
majority of cases.

Personally I feel better about keeping dogs in captivity than fish. Dogs are
domesticated and _want_ to be around us. Not only that but they _can_ be
around us fully, as opposed to sitting in a box for their entire life. They
love and care for us in their own way, are very in tune with our emotions (and
we with theirs), and have evolved to live alongside us (if one chooses the
appropriate kind of dog for them). Where I live the laws on keeping dogs are
more strict than some countries, and dogs enjoy a lot of access with their
owners. They can't be left alone for more than a few hours at a time, so if a
person is to keep a dog they either take it (almost) everywhere with them or
sign up for dog daycare where the dog gets to spend the work day playing with
other dogs and humans. I think dogs are in tune with us enough to be
legitimately happy, and life alongside humans has become the "natural habitat"
for many types of dogs (again assuming one chooses the appropriate dog).

~~~
climb_stealth
> Where I live the laws on keeping dogs are more strict than some countries,
> and dogs enjoy a lot of access with their owners.

This sounds amazing! Where is this if I may ask? My experience in Australia is
that there are a lot of dogs and dog owners, but overall it is not very dog
friendly at all. For example you can't take pets on trains and it is uncommon
to take them to work.

~~~
ObsoleteNerd
Thankfully that's slowly starting to change here.

[https://www.vic.gov.au/rentfair/pets-are-
welcome.html](https://www.vic.gov.au/rentfair/pets-are-welcome.html)

I've also noticed more workplaces allowing pets to be brought in occasionally,
and a significant number of cafes and shops allowing pets in and even
supplying water bowls and an area for them to tie up and rest while you
shop/eat.

~~~
climb_stealth
Ah yes, I like the sound of that! Of course it is in Victoria. You watch and
learn, New South Wales.

------
Footkerchief
Here's a link to the study:
[https://researchportal.port.ac.uk/portal/en/publications/giv...](https://researchportal.port.ac.uk/portal/en/publications/giveupitis-
revisited-neuropathology-of-
extremis\(1ba3ff20-86a2-4701-b6fd-776061f3191e\).html)

> The term ‘give-up-itis’ describes people who respond to traumatic stress by
> developing extreme apathy, give up hope, relinquish the will to live and
> die, despite no obvious organic cause. This paper discusses the nature of
> give-up-itis, with progressive demotivation and executive dysfunction that
> have clinical analogues suggesting frontal-subcortical circuit dysfunction
> particularly within the dorsolateral prefrontal and anterior cingulate
> circuits. It is hypothesised that progressive give-up-itis is consequent
> upon dopamine disequilibrium in these circuits, and a general theory for the
> cause and progression of give-up-itis is presented in which it is proposed
> that give-up-itis is the clinical expression of mental defeat; in
> particular, it is a pathology of a normal, passive coping response.

"It is hypothesized" is the closest it gets to evidence. This level of
research seems to be that journal's specialty:

[https://en.wikipedia.org/wiki/Medical_Hypotheses#Peer_review...](https://en.wikipedia.org/wiki/Medical_Hypotheses#Peer_review_debate)

This article is a press release that drastically overstates the already weak
claims of the paper itself.

~~~
dropit_sphere
I am actually personally acquainted with Dr. Charlton, former editor of MH. He
has some legit concerns about the epistemic effects of peer review (as well as
the "business" of science---obtaining grants, etc.).

I'm torn, because on the one hand I wish everything from MH came with a giant
"UNPROVEN AND DOES NOT FIT YOUR SCHEMA OF AN ACADEMIC PAPER" disclaimer, and
that that would pass through when adapted to other media (like, say, this
press release). On the other hand I basically share concerns about the peer
review process and the stranglehold it can have on research.

------
daphneokeefe
I know of two cases in my own family where one elderly spouse died, and the
other announced that they did not want to go on, and they died within about a
week.

~~~
macintux
My grandmother has not wanted to go on for 15+ years now after my grandfather
died, yet she's still here, and doing relatively well for a 95-year-old.

I definitely think there's a correlation between your mental and physical
health, but it's definitely not a simple one.

~~~
acct1771
You mean, not a 100% guaranteed one.

It's pretty simple, actually. The body cannot live (thrive) without the mind.

~~~
x220
Fake news. See: braindead people.

~~~
r_c_a_d
I think he was quoting The Matrix...

------
nostromo
How on earth do you separate causation from correlation in such cases?

To actually know this you'd need a group of random patients to "give up the
fight" and compare them to a control group. And you'd need the caregivers to
_not know_ which group is which.

A coach tells the team: "you lost because you gave up" \-- to which they
respond, "we gave up because we lost."

~~~
tonyedgecombe
Atul Gawande's book mentions a study that showed people who received hospice
care lived longer than those who got chemotherapy.

~~~
vkou
Was hospice vs chemotherapy randomly distributed to the control group, with no
patient or doctor choice on the matter?

Because otherwise, there's a million statistical biases that can creep into
that outcome.

~~~
tonyedgecombe
I can't remember the exact details now but that was how I interpreted it at
the time I read it.

~~~
vkou
How on earth did they get ethical approval to run this study?

"So, do you want to enter into a 50/50 lottery, where we will either try to
treat you, or let you die in peace? You don't get a choice of which, by the
way."

Even if I was a cancer patient with an extremely poor outlook, I would
probably have some pretty strong preference in the question of whether I
wanted chemo, or end-of-life care.

~~~
olliej
I agree, it seems unlikely that you could get an IRB sign off any study that
wasn't simply post-death statistic study.

You /could/ try to control that by try to separate the groups into "type of
cancer" and "stage", so that you're comparing like-to-like when looking at
mortality. But even then there are problems ("stages" are subjective, and
there's evidence that they're slowly shifting so that old stage three would
now be considered stage four), different Drs may be more aggressive at
directing people to chemo, etc.

I think there's also basic issues of what we're comparing, e.g. are you
undergoing chemo in an attempt to live a bit longer, or as an attempt to not
die. Because at the "you're going to die within 3-6 weeks" you're going to get
radically different survival rates for chemo than "you're going to die in 3-6
years". Which makes me wonder how you would deal with "EoL" chemo that does
cause the cancer to die back?

I'm having trouble wording it, but what I'm curious about is what happens when
you have a patient that

1\. Is dying, and given 3 months to live. Can choose between chemo and hospice
2\. Chemo successfully pushes the cancer back 3\. Cancer comes back 5 years
later 4\. Patient chooses hospice 5\. Patient "dies in hospice" 3 months
later.

Which group should the patient be placed in?

This is why I'm glad nothing I do impacts peoples health/safety/etc

------
petercooper
There's an entire, and fascinating, book on psychosomatic illnesses that goes
into this topic called _It 's All in Your Head_ by Suzanne O'Sullivan, an
Irish neurologist.

Most people seem to write off psychosomatic illnesses as they don't fit into
their models of how the world should work, but their existence and ways to
resolve them are well documented and doctors frequently find psychological or
neurological ways to resolve or alleviate them (e.g. prescribing
antidepressants to chronic pain sufferers).

The book also goes into how cancer can, in some circumstances, be hugely
affected by the mental outlook of the patient, but for some reason this
continues to be controversial in a way that 'dying of a broken heart' is not.

~~~
arountheworld
Psychosomatic is the bucket where lands everything lazy doctors don't want to
investigate.

~~~
olliej
Psychosomatic is actually an interesting one -- it's not just "lazy doctors"
\-- there's plenty of evidence to show that the brain is totally capable of
causing a range of side effects all on its own (Placebo and nocebo trials have
made this clear).

If you want annoying go for "Idiopathic". For example I have idiopathic optic
nerve hypoplasia. The last three words mean my optic nerve is narrow than it
should be - I have a gap in one quadrant of my peripheral vision - the
"idiopathic" bit means they don't know why.

~~~
taneq
> the "idiopathic" bit means they don't know why.

Oooh, sort of like "not otherwise specified" meaning "dunno what's going on".

------
typetehcodez
In it's most basic premise, life is perplexingly defined as "not death". And
what is life other than a struggle to fight entropy? Sisyphus is happy, and I
would argue - alive! [https://medium.com/@mustaphahitani/camus-suicide-and-
imagini...](https://medium.com/@mustaphahitani/camus-suicide-and-imagining-
sisyphus-happy-bec124dad750)

------
nprateem
As documented decades ago in "Man's Search for Meaning" by Frankl.

~~~
fsloth
Which is an excellent book. In dire cirmustances - how and why can you go on.
I really recommend it to everyone. In the book Victor Frankl - as a trained
doctor and therapist - documents and - this should be interesting to HN crowd
- _analyzes_ his own experience as a nazi concentration camp survivor. The
'lit a cigarette' example in the article is probably borrowed from the book.

~~~
amelius
Does this book make one feel better or more depressed?

The article has not a very good vibe to it, tbh.

~~~
gerbilly
The book as I remember it made you feel hopeful.

It is a very persuasive argument about how one can deal with even the most
'hopeless' situation.

It is also a brilliant description of the psychological effects of camp life.

The way he described the odd dislocated feeling they got when the allies set
them free was particularly memorable for me.

~~~
Buttons840
Things like Nazi gas chambers are interesting in a horrific sort of way, but
this book did not concentrate on those types of things.

The book focused on things which I found to be subtly more disturbing, like
the ability of an overweight Nazi guard to curse a death camp prisoner for
being "swine, who doesn't know how to work!" while the prisoner is literally
working themselves to death in front of the guard to just stands around being
fat and worthless. Does the guard not see the irony? How is it possible that
he does not? Do I myself hold any absurd views like that Nazi guard?

Ultimately the book showed me that there are decent and indecent people in any
group, and made me want to be a decent person. I wouldn't say the book is
depressing.

------
pontifier
This hits close to home. I've had many diverse failures in the past 2 years.
Every attempt I've made to create, or build has been thwarted by corruption,
power struggles, and lying theives who seem to be getting on just fine.

It is totally demoralizing to feel that there is no possibility of success.

Vivid thoughts of violent revenge are the only sparks of life I feel anymore.

~~~
throwaway010718
It is a pity the human mind can become a dark abyss.

Be careful indulging thoughts of revenge. They will subside with time, but
then decades later you find yourself in a dark place again and all those re-
enforced feelings will bubble up again.

Thoughts of revenge are detrimental to success. You aren't guaranteed to be
successful no matter how hard you try, but you certainly can't be successful
if you ruminate on revenge.

Please if you own a gun, then find a friend with a safe and give it to them.
Liquidate all your cryptocurrency so you don't hire a hitman. Don't let this
brief period destroy your entire future.

There are people whose children were murdered in front of them by a Nazi
soldier and never got "violent revenge" and went on to live fulfilling
honorable lives. Is your injustice anywhere near as bad ? Please find the
strength to find a way to get through this without resorting to violence.

~~~
pontifier
The world would be better off without some people. That being said, there's a
big difference between the call of the void and true intent to act.

I can't imagine that any parent who saw their child murdered wouldn't at least
entertain the thought of revenge. But I also see a profound power imbalance in
your story. The powerful can act with impunity. Give the parent the power of
reprisal and things start to look different. The child might have lived.

Perhaps there would be a bit less corruption and dishonesty in this world if
there was a bit more fear of real consequences for ones actions.

------
fokinsean
Reminds me of how concentration camp life is described Man's Search for
Meaning[0]. The prisoner's could tell when someone was about to die if they
noticed them refuse to get up for work for the day or smoke their cigarettes
(which were used for currency rather than smoking). This reflected them giving
up hope and they would usually pass within a few days.

[https://en.wikipedia.org/wiki/Man%27s_Search_for_Meaning](https://en.wikipedia.org/wiki/Man%27s_Search_for_Meaning)

------
arountheworld
When people say medicinal cannabis doesn't "cure", they should read this. It
helps people eat, sleep and be in a good mood and that provides foundation for
willingness to fight. My view is that people who deny this medicine are
criminals and should be brought to justice.

------
woop-throwaway
I smell bullshit. After my own trauma I went to sleep with a prayer “please
god don’t wake me up the next day”, for a year. Thankfully one can’t get a gun
easily in Europe, otherwise I won’t probably be writing this... and I haven’t
experienced even an appetite loss, not saying about social etc. After SSRIs
I’m not that anymore, but I’m still ready to give up at first chance, just I
know at worst I lose a job and a house. But death.. for good or bad, it
doesn’t work that way.

~~~
andrewmcwatters
I don't mean to dismiss your experience, but this is such a super-tunnel
vision point of view there's nothing here to gain. Your sample-size is one
person, and for some reason you bring up gun control laws, which changes the
course of discussion.

Of course many people with depression don't just die of being depressed.
That's not what this article is describing.

Depression isn't severe trauma. Severe trauma can _cause_ depression, and
what's explained here, is that it can cause death by psychosomatic cause.

------
innocentoldguy
I experienced going down this path. I was recently in an accident and
shattered my spine. If it hadn’t been for the support of my family, I don’t
think I’d still be here. Life seemed to be a pointless and miserable dead end
and I was ready to go. Fortunately, my family helped me work through it and I
survived.

~~~
barking
Well done yourself as well as your family.

------
lordnacho
Related might be some articles about people dying when they retire. Not
working and not having a purpose was, according to some of these articles I
read, causal of death. Not sure how well supported.

------
nathanvanfleet
Using the term "give-up-itis" discredits this article. It's like describing it
as a "case of the mondays" when you die.

~~~
TangoTrotFox
A small nitpick of your nitpick. Our obsession with 'proper sounding' language
is likely counter productive. When you translate many of the formal phrases we
use into their original language, it's not far up from give-up-itis.
hypothermia = underheated, brontosaurus = thunder lizard, cardiac arrhythmia =
heart lacking rhythm, hematoma = blood mass, etc.

Choosing to continue the tradition of naming things in a way such that only a
relatively small chunk of society would immediately understand their meaning
is something that I've never understood.

~~~
drunken-serval
> Choosing to continue the tradition of naming things in a way such that only
> a relatively small chunk of society would immediately understand their
> meaning is something that I've never understood.

Jargon has its place. In regards to medical jargon, it serves as both a signal
knowledge of medicine and pointing to a specific idea. Using plain language
may or may not refer to the specific idea at hand and it definitely signals a
lack of knowledge.

It's the same reason people who use computers say "cursor" instead of "pointy
thing".

~~~
TangoTrotFox
I don't think one signals knowledge by choice of vocabulary, but rather by
what is said. If you've ever been pitched something in a field you're an
expert in by an imposter, they're more than capable of talking the talk. It's
the content of what is actually said where their fraud is exposed. It's not
for a lack of knowledge of vernacular or even its misuse, but for lack of
understanding the topic which they are discussing. By contrast if you
translate e.g. Socrates to pidgin, I'm certain the wisdom would no doubt still
resonate simply because of what is said and the logic behind it, regardless of
how it is said.

The precision is certainly a reasonable argument, yet that may be begging the
question. The reason these words are more precise than alternatives is because
these words are the ones chosen to associate with whatever 'thing' we might be
referencing. Blue berry is hardly precise in terms of the words used, yet you
know exactly what I am referencing with those words. Had we adopted such a
tradition there we might find ourselves calling them _vaccinium cyanococcus_
in a parallel dimension, and certainly there they would likely find the notion
of blueberry to be an insufficiently precise alternative.

------
hi41
Few months back I read that an article about children of refugees in Europe
going into a coma like state. Could this be related?

~~~
photik
Impossible to tell without directly interfacing with them, but more likely
what they're talking about is a dissociative mechanism to deal with
situational trauma.

------
manmal
This is what happened to my grandmother. She had had a hard life full of
catastrophes (20+ of her relatives died in Auschwitz and Dachau), being
stifled (grandfather forbid her to take a job), and resulting depression and
alcoholism. She had had an essential tremor for 20 years, but apart from that,
she was fine according to doctors. She told anybody she‘d just did not want to
continue anymore. She developed a sore area of skin on her foot which
eventually landed her in hospital, lost almost all her weight, and never
returned home.

She never talked about the cruelties she and her family had to endure from the
Nazis. And in the end, she didn’t seem to even remember. It was simply too
much for her to ever cope.

Just an n=1, but personally I am convinced that you can die from giving up (or
a broken heart, on another matter).

~~~
thrav
I’m honestly most surprised that this isn’t just common sense. Anyone who pays
attention for a minute can see it play out all around them.

------
SZJX
So it seems from the summary that eventually the direct cause of death is the
person not eating anything. However there are more than one way why a person
might have reached that state. Anorexia is another such example. The title is
a bit sensationalist IMO. It's just a case of severe depression/psychological
disorder where the person doesn't even eat, which has been known since
eternity and documented in countless legends/fables. It isn't some sort of
magical/previously unknown process where a person suddenly dies if they give
up, etc.

------
eezurr
This reminds me of a short novel I had to read back in elementary school. I
think it was called "Thunder Rolling in the Mountains" (yes). The Native
Americans were fleeing the colonials all the way up to the Canadian boarder.
Later on, during the treaty process, they are given a relatively small parcel
of land to rebuild their home. The book ends with Chief Joseph of the Nez
Perce dieing from a "broken heart". I thought that was bullshit and that the
author was using a euphemism for a heart attack. ~20 years later I guess I am
proven wrong.

~~~
nostromo
He died of heart failure. The "broken heart" line was poetic license from his
caregiver.

~~~
MisterTea
I mean it still perfectly describes what happened. His heart done broke.

------
johnchristopher
I don't really get why the article leaves out how malnutrition is certainly an
essential factor in that process, especially since it offers examples from
people dying in concentration camps.

------
fierro
this is the saddest article I've ever read

------
xhrpost
> Dr. Leach said one prisoner of war who was also a medical officer described
> being in this stage as waking each morning but being unable to summon the
> energy to do anything. Others describe it as a severe melancholy, where even
> the smallest task feels like the mightiest effort.

I would have just assumed this to be depression or a part of it. However, the
article is claiming this symptom is something different?

------
amelius
Is this related to "depersonalization" as experienced e.g. by people with
extreme anxiety?

~~~
WalterSear
This is driven by depressive, anhedonic mechanisms, rather than anxious or
dissociative ones.

------
kazinator
> _' give-up-itis', a term used to describe what is known medically as
> psychogenic death._

I have found my new metal band name, and feel freshly inspired to write some
new tunes.

Ladies and gentlemen, give it up for Give-up-Itis!

~~~
TuringTest
Just to be clear: Psychogenic Death is the name of the band and Give-up-Itis
is the tune, or is it the other way around?

------
706f6f70
Head's up on the publication's goal:

> Medical Hypotheses is a forum for ideas in medicine and related biomedical
> sciences. It will publish interesting and important theoretical papers that
> foster the diversity and debate upon which the scientific process thrives.
> [. . .] Medical Hypotheses was therefore launched, and still exists today,
> to give novel, radical new ideas and speculations in medicine open-minded
> consideration, opening the field to radical hypotheses which would be
> rejected by most conventional journals. Papers in Medical Hypotheses take a
> standard scientific form in terms of style, structure and referencing. The
> journal therefore constitutes a bridge between cutting-edge theory and the
> mainstream of medical and scientific communication, which ideas must
> eventually enter if they are to be critiqued and tested against
> observations.

Not saying it's completely without merit, but this should not be interpreted
as a scientific study of any type.

~~~
resu_nimda
Pretty unnecessary FUD. Did you have any objection to the actual content? How
did you determine that the work was "not a scientific study of any type"?
Seems un-scientific to dismiss the whole thing based on that paragraph.

~~~
scott_s
Looking at the abstract (there are several links in the comments), I think
it's accurate to say it's not a scientific study because it's not a _study_.
That is, to me, a "study" implies some systematic examination of some
observable thing. But this paper is more a formal hypothesis: the author is
proposing that a particular phenomenon exists, with some anecdotal support.

That means that the story title is not accurate, as it declares the thing
exists, when the entire point of the paper is that it _may_ exist.

~~~
resu_nimda
_That means that the story title is not accurate, as it declares the thing
exists, when the entire point of the paper is that it may exist._

To be fair that is on par with a lot of science journalism (though I do
realize this article was published by the journal itself). But I take the
point and on a closer read I understand the original comment a bit better, the
journal isn't actually purporting to put forth scientific studies, just
hypotheses.

------
srinivgp
People can also suffer greatly from not giving up the fight.

------
known
aka
[https://en.wikipedia.org/wiki/Takotsubo_cardiomyopathy](https://en.wikipedia.org/wiki/Takotsubo_cardiomyopathy)

------
jrlocke
Wet streets cause rain.

~~~
coldtea
Superficial readings cause facile dismissals.

