Give-up-itis: When People Just Give Up and Die

As suicide prevention month draws to a close, we focus on one phenomenon which, in many regards, can be viewed as suicide played-out in slo-mo

By John Leach

During World War Two, when a cargo ship was torpedoed and sank in the North Sea, some of the crew managed to escape the sinking vessel. One survivor reported a curious incident that happened on their life raft:

There were seven of us on the raft, but the third officer died about two hours before we were picked up. He was very despondent, and toward the end he lost heart and gave up and died.

In another case of so-called give-up-itis, an American prisoner of war held in Vietnam and described by his colleagues as a strong and sure “marine’s marine” began to shuffle around the camp, becoming increasingly disconnected from the world around him before finally lying down, curling up and dying. His last words were: “Wake me when it’s over.”

The term “give-up-itis” was coined by medical officers during the Korean War (1950-1953). They described it as a condition where a person develops extreme apathy, gives up hope, relinquishes the will to live and dies, despite the lack of an obvious physical cause.

The medical officers also noted that the lucidity and sanity of give-up-itis victims were never in question and no observation of psychosis or depression has ever been reported, even up to death. When spoken to, people with the condition respond rationally and appropriately, but then revert to their earlier state, suggesting that, in spite of the extremity of the situation, basic cognitive functions remain intact.

Despite the many recorded cases of this condition, there has been no attempt to study the pattern of this fatal condition. In my latest research, I have attempted to redress this and have identified five stages of give-up-itis.

The five stages of give-up-itis

First, people withdraw socially. Their mood and motivation drop, but they are still able to think.

The second stage is marked by profound apathy, which has been described as “colossal inertia”.

The next stage – the third stage – is aboulia. This is a psychiatric term that means a loss of willpower or an inability to act decisively. At this stage, a person with give-up-itis often stops talking, washing and generally looking after themselves.

The fourth stage is psychic akinesia. The person is now nearing the end. They no longer feel pain, thirst or hunger, and they often lose control of their bowels.

Then, bizarrely, just before death, the person often seems to make a miraculous recovery. But it’s a false recovery. The paradox is that while some goal-directed behaviour has returned, the goal itself appears to have become the relinquishing of life. This is stage five.

Brain circuit

The symptoms of progressive give-up-itis have parallels with impairment in the anterior cingulate circuit, a brain circuit that links specific areas of the frontal cortex (the part of the brain involved in higher order functioning) to regions deep within the brain. Impairment in this circuit, possibly through depletion of its major neurotransmitter, dopamine, produces the types of clinical symptoms seen in give-up-itis.

Give-up-itis commonly occurs in a traumatic situation from which there is, or is perceived to be, no escape and over which a person has little or no influence. While dopamine levels increase in a dangerous situation, they fall below base levels if the stressful situation is inescapable. People with reduced dopamine levels lack motivation, become apathetic and often have an impairment in routine actions. Aboulia and psychic akinesia are also associated with dopamine depletion.

The give-up-itis victim sees him or herself as being defeated, and death may be seen as a way to have some control over the stressful and inescapable situation. In other words, the continuing traumatic stress can be avoided through the strategic use of death. It’s death as a coping mechanism.

Give-up-itis is often seen as an unnecessary death and one which could and should be avoided. The modelling of the process of give-up-itis is a key step towards our understanding of this peculiar yet very real syndrome. Through this understanding, we should be able to prevent further deaths occurring in extreme situations.

Helpline for further assistance:

If you have concernes about someone who you believe to be at risk of self-harm, then UK charity ‘Papyrus’ is a good starting point to obtain immediate advice on how to help. To speak to them call, free, on 0800 068 4141 or visit here: www.papyrus-uk.org

About the author and source material:

The author of this article is John Leach is Visiting Senior Research Fellow at the University of Portsmouth. The article was first published in the online academic discussion journal, The Conversation, on September 27, 2018 and is reproduced here under CCL copyright provisions. The original article, which includes active links to all references, may be found here

This blog post is published here by the Health Information Library team at Peak Health Online. To visit our main website, which specialises in medication-free solutions for physical & psychological health and peak performance, our home page is here

Low Level Carbon Monoxide Poisoning: Brain Damage That’s Hard to Spot

By Julie Connolly

Carbon monoxide (CO), like many gases, cannot be detected by our human senses. We cannot see it, smell it or taste it. But unlike many gases, small amounts are extremely harmful to us.

In 2015 (the most recent year for which statistics are available), 53 people in the UK died from accidental carbon monoxide poisoning. This compares with 170 people in the US. While this may not seem like a huge amount, deaths from carbon monoxide are largely preventable. There is, however, a general lack of knowledge about the dangers of carbon monoxide among both the general public and the scientific community.

The symptoms

We know the most about acute poisoning; we have some understanding of the wide range of symptoms and after effects that people who are poisoned in a single episode to a large amount of carbon monoxide suffer. But what we don’t know as much about are the effects of poisoning at lower levels, where people are exposed to smaller amounts of carbon monoxide, sometimes over a lengthy period, that do not trigger their carbon monoxide alarm.

Such people suffer nonspecific but significant symptoms. They may well have engaged with healthcare professionals, and had their symptoms investigated, but the nature of such symptoms do not lend themselves to a straightforward diagnosis once obvious physiological causes have been discounted.

The symptoms of acute poisoning may include headache, stomach upsets, dizziness, drowsiness, confusion, and seizure, leading to coma and death. These are the cases that are more likely to be reported by the media.

Those of chronic poisoning, meanwhile are variable, somewhat vague, and nonspecific. People report fatigue, flu-like symptoms, memory issues, musculoskeletal pain, motor disorders and emotional (affective) disorders, where they may be irritable, moody or depressed. These symptoms vary widely from person to person, for reasons as yet not fully understood, but are not necessarily connected to the amount of carbon monoxide to which they have been exposed.

Fine – or dead

Another aspect of the lack of knowledge about carbon monoxide concerns the aftermath of poisoning. Carbon monoxide is understood to leave the blood quickly once the person is away from the source of poisoning.

This is in line with the popular view of how we are poisoned, which is that the damage carbon monoxide causes results from oxygen starvation (hypoxia), as carbon monoxide binds with haemoglobin to form carboxyhaemoglobin. Oxygen cannot, therefore, be transported in to or out of the body’s organs and tissues. A person is essentially slowly suffocated.

This line of thinking means that the assumption that once the person is away from the carbon monoxide, recovery will commence, is easily made. But mechanisms of poisoning are more complicated. Hypoxia undoubtedly plays a significant role, as does what is known as reperfusion injury, which is further damage caused when oxygen returns to tissues that have been previously starved. Carbon monoxide, however, also binds to proteins other than haemoglobin, and it is a toxin which is known to affect cellular respiration and causes an inflammatory response. The brain and the heart seem most susceptible to damage.

People who have been poisoned may therefore suffer from neurological or cognitive deficits, psychological effects and cardiovascular issues. Cruelly, such symptoms may occur weeks after initial poisoning symptoms have abated, and for some people they will be permanent.

Prolonged impact

What also often remains unsaid but is crucial to consider is the emotional toll of poisoning. This is something that is evident from my ongoing research, which centres on collecting the accounts of those who have been affected by carbon monoxide poisoning.

One sufferer I’ve spoken to has had to change her career entirely, as she could no longer cope with the demands of running her own, previously very successful, business. A young teacher I met with struggles with hyperacuity, meaning that she has become extremely and painfully sensitive to all loud noises. Relationships can also be adversely affected, as people don’t have the same emotional behaviours, and memories are altered. A husband I spoke to completely forgot that his wife of 30 years had never liked drinking tea. It has a significant impact: people have to learn to live with what is in effect a brain injury.

Such sufferers may not be able to communicate, work or perform their usual daily activities in the same way that they did before they were poisoned. Some of my participants had many months or even years of visiting GPs and having investigations, only to be told that there is nothing wrong to be found. It is natural, of course, for GPs to focus on the person in front of them, rather than that person’s environment. There is currently very little tailored support for people in this situation.

Steps to take

Carbon monoxide is common; our bodies generate very small, measurable amounts. Habitual tobacco users have higher quantities, but seemingly without the burdensome, nonspecific symptoms described here. In domestic settings, excess carbon monoxide is formed by the incomplete combustion of any carbon-based fuel; so any faulty heating or cooking appliance using gas, wood, coal or smokeless fuel, and so on, could be a risk.

Many homes in middle and low income countries rely on some sort of solid fuel for cooking, lighting and heating, with the result that significant quantities of carbon monoxide are released into the indoor environment, although statistics are not always readily available for the burden of suffering that this causes.

In contrast, we know that one in six UK homes are estimated to have a dangerous gas appliance. Gas appliances should ideally be serviced annually. This includes all of the mandatory safety checks and some manufacturer-specific checks to ensure that the gas is burning safely.

Carbon monoxide audible alarms and monitors also need to be in place, even in households that only use electricity as fuel, as carbon monoxide can travel between properties. Currently, less than half of UK households have a carbon monoxide alarm, compared with around three quarters of Australian homes.

About the author and source material:

Julie Connolly is Senior Lecturer in Health and Social Care, Liverpool John Moores University. This article first appeared in the academic discussion journal, The Conversation, on 20th September 2018, and is reproduced here under CCL copyright provisions. The original article, with links to all references, may be viewed here.

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Need help?

If you suspect a problem, call the gas emergency number on 0800 111 999, or the Health and Safety Executive (HSE) Gas Safety Advice Line on 0800 300 363.

Mindfulness Meditation: Just Ten Minutes a Day Improves Concentration

 

By Peter Malinowski

Practising mindfulness meditation for ten minutes a day improves concentration and the ability to keep information active in one’s mind, a function known as “working memory”. The brain achieves this by becoming more efficient, literally requiring fewer brain resources to do these tasks.

Many big claims have been made about the effects of meditation, but too often the scientific evidence behind these claims is weak or even lacking altogether. In our latest study, published in Scientific Reports, we addressed several shortcomings of earlier research to gain more certainty about what changes when people meditate.

Collaborating with colleagues from Osnabrück University in Germany, we carried out a randomised controlled study to investigate the effects of mindfulness meditation on cognitive functions that are important in daily life.

For our study, we randomly allocated 34 participants to one of two groups. For eight weeks, one group practised mindfulness meditation while the other group – the control group – performed muscle relaxation exercises.

Using so-called “active controls” – where controls are given a similar task rather than doing nothing – rules out many alternative reasons for changes in task performance. For example, simply being selected for the experimental group or engaging in any new activity might boost performance, without being the effect of meditation practice.

We also addressed other limitations of earlier research. For example, in some studies, the cognitive tasks were so simple that all participants, experimental and controls, reached an optimum level, which overshadowed the potential effects of meditation. Sometimes, participants only needed to distinguish and respond to four different stimuli that repeatedly appeared on a screen, one by one. Soon, all participants had optimised their performance. To avoid this, we used the challenging multiple object tracking task.

The task involves tracking two to five discs (“targets”) that are moving on a computer screen, among 16 identical discs that are also moving on the screen. Participants need to concentrate on the target discs without getting distracted by the other non-target discs.

Multiple Object Tracking demo

We tested participants on this task a few days before and after practising either meditation or the relaxation exercises for eight weeks. (Participants in the meditation group meditated about four times a week over the eight-week period.)

In the meditation group, the accuracy of tracking the targets rose by about 9% – a statistically significant change – showing that their concentration and working memory had improved. The participants in the control group did not improve at all.

A more efficient brain

To find out what changed in the brain, we recorded the participants’ brain activity with an electroencephalogram (EEG) while they performed the task. We combined this with a method we pioneered 15 years ago: rapidly switched the moving discs on and off at a fixed rate of 11Hz. Their continuous flickering drives a brain signal called the steady-state visually evoked potential (SSVEP). Put simply, the brain generates electrical activity with the same frequency as the flickering discs, a signal that is then picked up by the EEG.

We found that after the eight weeks of training the SSVEP signal was reduced by about 88% – again, only in the meditation group. Based on previous work, we know what this reduction means. The brain networks involved in tracking the discs became more refined so that fewer brain resources were needed to carry out the task.

One simple technique

Most research investigating mindfulness meditation uses complex programmes, such as mindfulness-based stress reduction. However, because these programmes include yoga, stretching and different types of meditation, it is impossible to say whether reported improvements are truly the result of a particular meditation practice.

For clarity, we instructed the meditation group to do one simple meditation exercise for ten minutes a day. The exercise is called mindful breath awareness meditation. It involves focusing on the sensation of your breath – for example, the air flowing in and out of your nostrils. If any thoughts, feelings or other sense impressions arise, you should just recognise them and return to the breath, without judging the distraction or further thinking about it.

It is curious that simply focusing on the breath in a balanced way can have such an effect on concentration and working memory. We think this is happening because meditation is a form of brain network training, where the same brain networks are repeatedly activated and so become more efficient. It seems that this form of meditation targets core brain networks, interconnected areas of the brain that work together and play a key role in many cognitive tasks.

It is easy to see how this is relevant for daily life. Staying concentrated, singling out important from distracting information and keeping it in mind, are useful skills in situations of information overload. For instance, radar operators perform better on this task and, on a more mundane level, so do people playing fast-paced video games. So, let’s get started:

We feel the formless stream of air at the tip of our nose and let thoughts, sounds and feelings pass without evaluation…

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About the author and source material:

The author of this article is Peter Malinowski, Reader in Cognitive Neuroscience, Liverpool John Moores University. The article was first published in the online academic discussion journal, The Conversation, on September 19, 2018 and is reproduced here under CCL copyright provisions. The original article, which includes active links to all references, may be found here.

Stretching: Still Important for Weight Loss and Exercise

By David Prologo

There seems to be a lot of confusion regarding the value – or lack thereof – of muscle stretching to accelerate recovery after exercise. “Stretching clears out your lactic acid,” and other similar claims abound. Is any of this true?

Sort of.

First, it is important to understand the difference between stretching for recovery and stretching for remodelling.

Recovery

During exercise, muscles are called upon to work. During this work, fuel is used up, waste products are created and muscle fiber structure is disrupted by multiple micro tears. Imagine a banquet, for comparison, during which the food is eaten, garbage is accumulated (napkins, chicken bones, etc.), and the table settings disrupted. Before the next banquet, the food needs to be restocked, the garbage cleared, and the tables reset.

For muscles, this process of resetting for the next event is called recovery. The muscle is returned to full function without soreness.

This is not the process that leads to body change per se, but it is important for athletes who wish to compete at their highest level multiple times during a short period.

Athletes have tried many things to speed up recovery: cryotherapy, massage, compression, ice water immersion, stretching, hyperbaric oxygen, anti-inflammatories and electromyostimulation, just to name a few. These interventions are aimed at decreasing lactic acid, inflammatory markers and other molecules that build up following intense exercise.

Of these, only massage is consistently effective. Multiple studies have shown that stretching does not aid significantly in waste removal or serve in any capacity to accelerate muscle recovery.

Remodelling

Most of us aren’t training for professional competitions, though, but are exercising to be healthy, lose weight and improve our moods.

For that, we need to focus on our body’s remodelling response to exercise, which is not the same as recovery from exercise.

Plainly said, when we exercise consistently, our bodies adapt to that stressor by changing our muscle structure, metabolism and physiology. It is that change, that remodeling, that leads to all the positive benefits of exercise. To stick with our banquet example, if we realized that 500 people are going to show up at every event, but we only have 10 tables set at present, we would change our capacity to be ready for the next event. We would increase the efficiency in the kitchen and set more tables. Likewise, our body remodels itself to adapt to increasing exercise.

Many studies also have been conducted to determine how to optimise the body’s remodeling response to exercise. After 35-plus years of study, six variables emerge as consistently aiding the body in its effort to reorganise in response to exercise: timing of nutritional intake (specifically protein), type of exercise, massage, sleep, low-dose creatine and – you guessed it – stretching.

Perhaps the most well-known and accepted benefits of muscle stretching exercises are improved or maintained range of motion, or both; alignment of bones and joints; and strengthening of connective tissues – all elements that optimize performance. Many studies have shown that flexibility training (dedicated attention over time to muscle stretching as part of an exercise program) directly improves muscle function, and ultrasound images have documented favourable alterations in muscle architecture following weeks of regular stretching, such as longer fibres. What’s more, a recent study has clearly shown that stretching over time improves blood flow to the muscles during subsequent exercise in animals.

Prior negative commentary around muscle stretching may be misleading to the casual observer. It is true that studies have shown static stretching routines (reach, hold for 30 seconds, release, next stretch) prior to a workout or competition lead to decreases in strength during that event, and that stretching before activity does not prevent injuries, as was long thought. But these are very specific circumstances that don’t apply to most people.

So do I stretch or not?

If you are an elite athlete trying to decrease injury, increase strength or accelerate muscle recovery right before your next event – then no.

If you are most people, exercising to lose weight, be well and improve mood – then yes. It will help with muscle remodelling, connective tissue strengthening, range-of-motion improvement, joint alignment and potentially blood flow during subsequent exercise – all beneficial effects in the long run.

Explore Further:

If you’d like to explore our range of fitness and physical therapy products, please see here, or for products designed to support peak performance, including mental preparation, see here. To see our complete range of medication-free health and well-being products, please return to our home page, which is here

Source Material and Acknowledgements:

The author of this article is David Prologo, Associate Professor, Department of Radiology and Imaging Sciences, Emory University. The article was first published in the online academic discussion journal, The Conversation, on August 6, 2018 and is reproduced here under CCL copyright provisions. The original article, which includes active links to all references, may be found here.