Apathy

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For other uses, see Apathy (disambiguation).
Not to be confused with Antipathy.

AnxietyArousalFlow (psychology)WorryControl (psychology)ApathyBoredomRelaxation (psychology)
Mental state in terms of challenge level and skill level, according to Csikszentmihalyi's flow model.[1] (Click on a fragment of the image to go to the appropriate article)
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Apathy is a lack of feeling, emotion, interest, or concern about something. It is a state of indifference, or the suppression of emotions such as concern, excitement, motivation, or passion. An apathetic individual has an absence of interest in or concern about emotional, social, spiritual, philosophical, virtual, or physical life and the world. Apathy can also be defined as a person's lack of goal orientation.[2] Apathy falls in the less extreme spectrum of diminished motivation, with abulia in the middle and akinetic mutism being more extreme than both apathy and abulia.[3]

The apathetic may lack a sense of purpose, worth, or

sluggishness.[4] In positive psychology, apathy is described as a result of the individuals' feeling they do not possess the level of skill required to confront a challenge (i.e. "flow"). It may also be a result of perceiving no challenge at all (e.g., the challenge is irrelevant to them, or conversely, they have learned helplessness). Apathy is usually felt only in the short term, but sometimes it becomes a long-term or even lifelong state, often leading to deeper social and psychological issues.[5][4]

Apathy should be distinguished from reduced affect display, which refers to reduced emotional expression but not necessarily reduced emotion.

Pathological apathy, characterized by extreme forms of apathy, is now known to occur in many different brain disorders,[6] including neurodegenerative conditions often associated with dementia such as Alzheimer's disease,[7] Parkinson's disease,[8] and psychiatric disorders such as schizophrenia.[9] Although many patients with pathological apathy also have depression, several studies have shown that the two syndromes are dissociable: apathy can occur independent of depression and vice versa.[6]

Etymology

Although the word apathy was first used in 1594

Orthodox monasticism.[13] In the Philokalia the word dispassion is used for apatheia, so as not to confuse it with apathy.[14]

History and other views

philosophers who aspired after virtue.[16]

The modern concept of apathy became more well known after

social interaction
when they returned from combat.

In 1950, US novelist John Dos Passos wrote: "Apathy is one of the characteristic responses of any living organism when it is subjected to stimuli too intense or too complicated to cope with. The cure for apathy is comprehension."[18]

Social origin

There may be other factors contributing to a person's apathy.

Apathy has been socially viewed as worse than things such as hate or anger. Not caring whatsoever, in the eyes of some, is even worse than having distaste for something. Author

Charles de Montesquieu stated that "the tyranny of a prince in an oligarchy is not so dangerous to the public welfare as the apathy of a citizen in the democracy."[21]
As can be seen by these quotes and various others, the social implications of apathy are great. Many people believe that not caring at all can be worse for society than individuals who are overpowering or hateful.

In the school system

Apathy in students, especially those in high school, is a growing problem. It causes teachers to lower standards in order to try to engage their students.[22] Apathy in schools is most easily recognized by students being unmotivated or, quite commonly, being motivated by outside factors. For example, when asked about their motivation for doing well in school, fifty percent of students cited outside sources such as "college acceptance" or "good grades". On the contrary, only fourteen percent cited "gaining an understanding of content knowledge or learning subject material" as their motivation to do well in school. As a result of these outside sources, and not a genuine desire for knowledge, students often do the minimum amount of work necessary to get by in their classes.[22] This then leads to average grades and test grades but no real grasping of knowledge.[22] Many students cited that "assignments/content was irrelevant or meaningless" and that this was the cause of their apathetic attitudes toward their schooling, leading to teacher and parent frustration.[23] Other causes of apathy in students include situations within their home life, media influences, peer influences, school struggles and failures. Some of the signs of apathetic students include declining grades, skipping classes, routine illness, and behavioral changes both in school and at home. In order to combat this, teachers have to be aware that students have different motivation profiles;[24] i.e. they are motivated by different factors or stimuli.

Bystander

Also known as the

Kitty Genovese murder. The murder took place in New York and the victim, Genovese, was stabbed to death as bystanders reportedly stood by and did nothing to stop the situation or even call the police.[25] Latane and Darley
are the two psychologists who did research on this theory. They performed different experiments that placed people into situations where they had the opportunity to intervene or do nothing. The individuals in the experiment were either by themselves, with a stranger(s), with a friend, or with a confederate. The experiments ultimately led them to the conclusion that there are many social and situational factors that are behind whether a person will react in an emergency situation or simply remain apathetic to what is occurring.

Measurement

Several different questionnaires and clinical interview instruments have been used to measure pathological apathy or, more recently, apathy in healthy people.

Apathy Evaluation Scale

Developed by Robert Marin in 1991, the Apathy Evaluation Scale (AES) was the first method developed to measure apathy in clinical populations. Centered around evaluation, the scale can either be self-informed or other-informed. The three versions of the test include self, informant such as a family member, and clinician. The scale is based around questionnaires that ask about topics including interest, motivation, socialization, and how the individual spends their time. The individual or informant answers on a scale of "not at all", "slightly", "somewhat" or "a lot". Each item on the evaluation is created with positive or negative syntax and deals with cognition, behavior, and emotion. Each item is then scored and, based on the score, the individual's level of apathy can be evaluated.[26]

Apathy Motivation Index

The Apathy Motivation Index (AMI) was developed to measure different dimensions of apathy in healthy people. Factor analysis identified three distinct axes of apathy: behavioural, social and emotional.[27] The AMI has since been used to examine apathy in patients with Parkinson's disease who, overall, showed evidence of behavioural and social apathy, but not emotional apathy.[28] Patients with Alzheimer's disease, Parkinson's disease, subjective cognitive impairment and limbic encephalitis have also been assessed using the AMI, and their self-reports of apathy were compared with those of caregivers using the AMI caregiver scale.[29]

Dimensional Apathy Scale

The Dimensional Apathy Scale (DAS) is a multidimensional apathy instrument for measuring subtypes of apathy in different clinical populations and healthy adults. It was developed using

Multiple Sclerosis, dementia, Parkinson's disease and schizophrenia, showing to differentiate profiles of apathy subtypes between these conditions.[33][34][35][36][37]

Medical aspects

Depression

Main article: Major depressive disorder

Mental health journalist and author John McManamy argues that although

depressed people, in which they get a sense that "nothing matters", the "lack of will to go on and the inability to care about the consequences".[38][self-published source?] He describes depressed people who "...cannot seem to make [themselves] do anything", who "can't complete anything", and who do not "feel any excitement about seeing loved ones".[38] He acknowledges that the Diagnostic and Statistical Manual of Mental Disorders
does not discuss apathy.

In a

Journal of Neuropsychiatry and Clinical Neurosciences article from 1991, Robert Marin, MD, claimed that pathological apathy occurs due to brain damage or neuropsychiatric illnesses such as Alzheimer's, Parkinson's, Huntington's disease, or stroke. Marin argues that apathy is a syndrome associated with many different brain disorders.[38] This has now been shown to be the case across a range of neurological and psychiatric conditions.[6]

A review article by Robert van Reekum, MD, et al. from the University of Toronto in the Journal of Neuropsychiatry (2005) claimed that an obvious relationship between depression and apathy exists in some populations.[39] However, although many patients with depression also have apathy, several studies have shown that apathy can occur independently of depression, and vice versa.[6]

Apathy can be associated with depression, a manifestation of negative disorders in schizophrenia, or a symptom of various somatic and neurological disorders.[40][6] Sometimes apathy and depression are viewed as the same thing, but actually take different forms depending on someone's mental condition.[41]

Alzheimer's disease

Depending upon how it has been measured, apathy affects 19–88% percent of individuals with

Cholinesterase inhibitors, used as the first line of treatment for the cognitive symptoms associated with dementia, have also shown some modest benefit for behavior disturbances such as apathy.[43] The effects of donepezil, galantamine and rivastigmine have all been assessed but, overall, the findings have been inconsistent, and it is estimated that apathy in ~60% of Alzheimer's patients does not respond to treatment with these drugs.[7] Methylphenidate, a dopamine and noradrenaline reuptake blocker, has received increasing interest for the treatment of apathy. Management of apathetic symptoms using methylphenidate has shown promise in randomized placebo controlled trials of Alzheimer's patients.[44][45][46] A phase III multi-centered randomized placebo-controlled trial of methylphenidate for the treatment of apathy has reported positive effects.[47]

Parkinson's disease

Overall, ~40% of Parkinson's disease patients suffer from apathy, with prevalence rates varying from 16 to 62%, depending on the study.[8] Apathy is increasingly recognized to be an important non-motor symptom in Parkinson's disease.[48] It has a significant negative impact on quality of life.[49] In some patients, apathy can be improved by dopaminergic medication.[50] There is also some evidence for a positive effect of cholinesterase inhibitors such as Rivastigmine on apathy.[51] Diminished sensitivity to reward may be a key component of the syndrome in Parkinson's disease.[52][53]

Frontotemporal dementia

Pathological apathy is considered to be one of the diagnostic features of behavioural variant frontotemporal dementia,[54] occurring in the majority of people with this condition.[55] Both hypersensitivity to effort as well as blunting of sensitivity to reward may be components of behavioural apathy in frontotemporal dementia.[56]

Anxiety

While apathy and anxiety may appear to be separate, and different, states of being, there are many ways that severe anxiety can cause apathy. First, the emotional fatigue that so often accompanies severe anxiety leads to one's emotions being worn out, thus leading to apathy. Second, the low serotonin levels associated with anxiety often lead to less passion and interest in the activities in one's life, which can be seen as apathy. Third, negative thinking and distractions associated with anxiety can ultimately lead to a decrease in one's overall happiness which can then lead to an apathetic outlook about one's life. Finally, the difficulty enjoying activities that individuals with anxiety often face can lead to them doing these activities much less often and can give them a sense of apathy about their lives. Even behavioral apathy may be found in individuals with anxiety in the form of them not wanting to make efforts to treat their anxiety.[57]

Other

Often, apathy is felt after witnessing horrific acts, such as the killing or maiming of people during a

ADHD, and others. Some medications and the heavy use of drugs such as opiates may bring apathy as a side effect.[60]

See also

Notes

  1. ISBN 978-0-465-02411-7
    .
  2. ^
    PMID 33888648
    .
  3. ^ Marin, R. S., & Wilkosz, P. A. (2005). Disorders of diminished motivation Archived 2012-11-22 at the Wayback Machine. Journal of Head Trauma Rehabilitation, 20(4), 377-388.
  4. ^ a b "Apathy". Cleveland Clinic. Retrieved 30 December 2023.
  5. PMC 9465416
    .
  6. ^
    S2CID 49428707
    .
  7. ^
    PMID 30123816
    .
  8. ^
    S2CID 35664376
    .
  9. S2CID 13411386
    .
  10. ^ "Apathy - Definition and More from the Free Merriam-Webster Dictionary". Merriam-webster.com. Retrieved 25 February 2014.
  11. ^ "Henry George Liddell, Robert Scott, A Greek-English Lexicon, ἀπάθ-εια". Perseus.tufts.edu. Retrieved 25 February 2014.
  12. ISBN 978-0-548-12371-3
    ).
  13. JSTOR 10.1163/j.ctv1sr6hq6.7
    .
  14. S2CID 59323805
    .
  15. ^ "Greek Lexicon :: G543 (KJV)". V3.blueletterbible.org. Archived from the original on 2 October 2017. Retrieved 25 February 2014.
  16. ^ Maier, H.O. (1994). "Clement of Alexandria and the Care of the Self". Journal of the American Academy of Religion. 62 (3): 720–721.
  17. PMID 16816263
    .
  18. ISBN 978-1199716941
    .
  19. ISBN 9780449234525
    .
  20. ISBN 978-0-87785-146-2
    . But if we listen to the best men and women everywhere ... they will say that science may have found a cure for most evils; but it has found no remedy for the worst of them all—the apathy of human beings.
  21. ^ ""The tyranny of a prince in an oligarchy is not so dangerous to the public welfare as the apathy of a citizen in a democracy."--Montesquieu, Spirit of the laws, 1748. From the series Great Ideas. | Smithsonian American Art Museum". americanart.si.edu. Retrieved 15 March 2024.
  22. ^
    S2CID 145803015
    .
  23. ^ Sanders J, Ticktin R. "Finding the Root Cause of Student Apathy". Pan.intrasun.tcnj.edu. Archived from the original on 24 March 2013. Retrieved 25 February 2014. Apathy in High School Students: An Examination Into Causes and A Suggested Plan for Change
  24. S2CID 145228051
    .
  25. ^
    PMID 5797312. Archived from the original
    on 4 November 2013.
  26. ^ "Apathy Evaluation Scale (Self rated)" (PDF). Dementia-assessment.com.au. Archived from the original (PDF) on 26 January 2014. Retrieved 25 February 2014.
  27. PMID 28076387
    .
  28. PMID 30349863
    .
  29. PMID 34532963
    .
  30. S2CID 16313833
    .
  31. S2CID 15540782
    .
  32. S2CID 173994534
    .
  33. S2CID 53173573
    .
  34. PMID 33816664
    .
  35. S2CID 209343166
    .
  36. PMID 34298224
    .
  37. S2CID 245423518
    .
  38. ^ a b c McManamy J. "Apathy Matters - Apathy and Depression: Psychiatry may not care about apathy, but that doesn't mean you shouldn't". Archived from the original on 20 August 2014.".
  39. PMID 15746478
    .
  40. S2CID 34996374
    .
  41. PMID 9706539
    .
  42. PMID 28689673
    .
  43. ^ Malloy PF (2 November 2005). "Apathy and Its Treatment in Alzheimer's Disease and Other Dementias". Psychiatric Times.
  44. S2CID 30971352
    .
  45. PMID 24021498
    .
  46. PMID 24169147
    .
  47. PMID 34570180
    .
  48. S2CID 43614772
    .
  49. S2CID 35925068
    .
  50. PMID 23543483
    .
  51. S2CID 7052710
    .
  52. PMID 27452600
    .
  53. PMID 29672668
    .
  54. PMID 21810890
    .
  55. doi:10.1016/j.cobeha.2018.01.022
    .
  56. PMID 36567496
    .
  57. ^ Abraham M (10 October 2020). "Apathy: Anxiety's Unusual Symptom". Calm Clinic. Retrieved 25 February 2014.
  58. ^ Sederer L (26 July 2012). "The Enemy Is Apathy". Psychiatric Times.
  59. PMID 19560715
    .
  60. PMID 23106029
    .

References

External links

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