GEORGE L. ENGEL, M.D.
Study of the life settings in which patients fall ill reveals that illness is commonly preceded by a period of psychological disturbance, during which the individual feels unable to cope. This has been designated the giving-up—given-up complex and has the following five psychologic characteristics: a feeling of giving up, experienced as helplessness or hopelessness; a depreciated image of the self; a sense of loss of gratification from relationships or roles in life; a feeling of disruption of the sense of continuity between past, present, and future; and a reactivation of memories of earlier periods of giving-up. It is proposed that this state reflects the temporary failure of mental coping mechanisms with a consequent activation of neurally regulated biological emergency patterns. Changes in body economy so evoked may alter the organism's capability to deal with concurrent pathogenic processes, permitting disease to develop. As such, the giving-up—given-up complex is neither a necessary nor a sufficient condition for disease development, merely a contributing factor.
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ENGEL GL. A Life Setting Conducive to Illness: The Giving-Up—Given-Up Complex. Ann Intern Med. 1968;69:293–300. doi: 10.7326/0003-4819-69-2-293
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Published: Ann Intern Med. 1968;69(2):293-300.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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