Apathy

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For other uses, see Apathy (disambiguation).

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]

The apathetic may lack a sense of purpose, worth, or meaning in their life. People
that suffer from severe apathy tend to have a lower quality of life and are at a
higher risk for mortality and early institutionalization.[2] They may also exhibit
insensibility or sluggishness. 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 something that all people face in some
capacity and is a natural response to disappointment, dejection, and stress. As a
response, apathy is a way to forget about these negative feelings.[3] This type of
common 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. An extreme form of apathy may be someone being numb to different stressful
life events such as losing a job.

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,[4] including neurodegenerative conditions
often associated with dementia such as Alzheimer's disease,[5] and psychiatric
disorders such as schizophrenia.[6] Although many patients with pathological apathy
also suffer from depression, several studies have shown that the two syndromes are
dissociable: apathy can occur independently of depression and vice versa.[4]

Contents
1 Etymology
2 History and other views
2.1 Technology
2.2 Social origin
2.3 In the school system
2.4 Bystander
2.5 Communication
3 Measurement of Apathy
3.1 Apathy Evaluation Scale
3.2 Apathy Motivation Index
3.3 Dimensional Apathy Scale
4 Medical aspects | Pathological apathy
4.1 Depression
4.2 Alzheimer's disease
4.3 Anxiety
4.4 Other
5 See also
6 Notes
7 References
8 External links
Etymology
Although the word apathy was first used in 1594[7] and is derived from the Greek
ἀπάθεια (apatheia), from ἀπάθης (apathēs, "without feeling" from a- ("without,
not") and pathos ("emotion")),[8] it is important not to confuse the two terms.
Also meaning "absence of passion," "apathy" or "insensibility" in Greek, the term
apatheia was used by the Stoics to signify a (desirable) state of indifference
towards events and things which lie outside one's control (that is, according to
their philosophy, all things exterior, one being only responsible for one's own
representations and judgments).[9] In contrast to apathy, apatheia is considered a
virtue, especially in Orthodox monasticism.[citation needed] In the Philokalia the
word dispassion is used for apatheia, so as not to confuse it with apathy.[citation
needed]

History and other views

Christians have historically condemned apathy as a deficiency of love and devotion
to God and his works.[10] This interpretation of apathy is also referred to as
Sloth and is listed among the Seven Deadly Sins. Clemens Alexandrinus used the term
to draw to Christianity philosophers who aspired after virtue.

The modern concept of apathy became more well known after World War I, when it was
one of the various forms of "shell shock".[11] Soldiers who lived in the trenches
amidst the bombing and machine gun fire, and who saw the battlefields strewn with
dead and maimed comrades, developed a sense of disconnected numbness and
indifference to normal 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."

Technology
Apathy is a normal way for humans to cope with stress. Being able to "shrug off"
disappointments is considered an important step in moving people forward and
driving them to try other activities and achieve new goals. Coping seems to be one
of the most important aspects of getting over a tragedy and an apathetic reaction
may be expected. With the addition of the handheld device and the screen between
people, apathy has also become a common occurrence on the net as users observe
others being bullied, slandered, threatened or sent disturbing images. The
bystander effect grows to an apathetic level as people lose interest in caring for
others who are not in their "circle" and may even participate in their harassment.

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 Leo Buscaglia is quoted as saying "I have a very strong feeling
that the opposite of love is not hate-it's apathy. It's not giving a damn." Helen
Keller stated that apathy is the "worst of them all" when it comes to the various
evils in the world.[12] French social commentator and political thinker 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." 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

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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.[13]
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.[13] This then leads to
average grades and test grades but no real grasping of knowledge.[13] Many students
cited that "assignments/content was irrelevant or meaningless" and that this was
the cause of their apathetic attitudes toward their schooling. These apathetic
attitudes lead to teacher and parent frustration.[14] Other causes of apathy in
students include situations within their home life, media influences, peer
influences, and school struggles and failures. Some of the signs for apathetic
students include declining grades, skipping classes, routine illness, and
behavioral changes both in school and at home. In order to combat this lack of
apathy, teachers have to be aware that several students have different motivation
profiles.[15] Motivation profiles as in they are motivated by different factors or
stimuli.

Bystander
Also known as the bystander effect, bystander apathy occurs when, during an
emergency, those standing by do nothing to help but instead stand by and watch.
Sometimes this can be caused by one bystander observing other bystanders and
imitating their behavior. If other people are not acting in a way that makes the
situation seem like an emergency that needs attention, often other bystanders will
act in the same way.[16] The diffusion to responsibility can also be to blame for
bystander apathy. The more people that are around in emergency situations, the more
likely individuals are to think that someone else will help so they do not need to.
This theory was popularized by social psychologists in response to the 1964 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.[16] 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.

Communication
Apathy is one psychological barrier to communication. An apathetic listener creates
a communication barrier by not caring or paying attention to what they are being
told. An apathetic speaker, on the other hand, tends to not relate information well
and, in their lack of interest, may leave out key pieces of information that need
to be communicated. Within groups, an apathetic communicator can be detrimental.
Their lack of interest or passion can inhibit the other group members in what they
are trying to accomplish. Within interpersonal communication, an apathetic listener
can make the other feel that they are not cared for or about. Overall, apathy is a
dangerous barrier to successful communication. Apathetic speakers and listeners are
individuals that have no care for what they are trying to communicate, or what is
being communicated to them.

Measurement of Apathy
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.[17]

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.[18] 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.[19]

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 factor analysis, quantifying Executive apathy (lack of
motivation for planning, organising and attention), Emotional apathy (emotional
indifference, neutrality, flatness or blunting) and Initiation apathy (lack of
motivation for self-generation of thought/action). There is a self-rated version of
the DAS[20] and an informant/carer-rated version of the DAS.[21] Further a clinical
brief DAS has also been developed.[22] It has been validated for use in motor
neurone disease, dementia and Parkinson's disease, showing to differentiate
profiles of apathy subtypes between these conditions[23]

Medical aspects | Pathological apathy

Depression
Main article: Major depressive disorder
Mental health journalist and author John McManamy argues that although
psychiatrists do not explicitly deal with the condition of apathy, it is a
psychological problem for some 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".[24] 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".[24] 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.[24] This has now been shown to be the case across a range of
neurological and psychiatric conditions.[4]

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.[25] However, although many
patients with depression suffer from apathy, several studies have shown that apathy
can occur independently of depression, and vice versa.[4]

Apathy can be associated with depression, a manifestation of negative disorders in

schizophrenia, or a symptom of various somatic and neurological disorders.[26][4]

Alzheimer's disease
Depending upon how it has been measured, apathy affects 19–88% percent of
individuals with Alzheimer's disease (mean prevalence of 49% across different
studies).[5] It is a neuropsychiatric symptom associated with functional
impairment. Brain imaging studies have demonstrated changes in the anterior
cingulate cortex, orbitofrontal cortex, dorsolateral prefrontal cortex and ventral
striatum in Alzheimer's patients with apathy.[27] 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.[28]
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.[5]
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.[29][30][31] A phase III multi-centered randomized placebo-
controlled trial of methylphenidate for the treatment of apathy is currently
underway and planned for completion in August 2020.[32]

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.[33]

Other
Often, apathy is felt after witnessing horrific acts, such as the killing or
maiming of people during a war, e.g. posttraumatic stress disorder. It is also
known to be a distinct psychiatric syndrome[citation needed] that is associated
with many conditions, some of which are: CADASIL syndrome, depression, Alzheimer's
disease, Chagas disease, Creutzfeldt–Jakob disease, dementia (and dementias such as
Alzheimer's disease, vascular dementia, and frontotemporal dementia), Korsakoff's
syndrome, excessive vitamin D, hypothyroidism, hyperthyroidism, general fatigue,
Huntington's disease, Pick's disease, progressive supranuclear palsy (PSP), brain
damage, schizophrenia, schizoid personality disorder, bipolar disorder,[citation
needed] autism spectrum disorders, ADHD, and others. Some medications and the heavy
use of drugs such as opiates may bring apathy as a side effect.[34]