Apathy

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.

There may be other factors contributing to a person's apathy. Activist David Meslin argues that people often care, and that apathy is often the result of social systems actively obstructing engagement and involvement. He describes various obstacles that prevent people from knowing how or why they might get involved in something. Meslin focuses on design choices that unintentionally or intentionally exclude people. These include: capitalistic media systems that have no provisions for ideas that are not immediately (monetarily) profitable, government and political media (e.g. notices) that make it difficult for potentially interested individuals to find relevant information, and media portrayals of heroes as "chosen" by outside forces rather than self-motivated. He moves that we redefine social apathy to think of it, not as a population that is stupid or lazy, but as a result of poorly designed systems that fail to invite others to participate.[9][10]

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 claimed that apathy is the "worst of them all" when it comes to the various evils of the world. 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."[11] 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.

Apathy in students, especially those in high school, is a growing problem . 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. This then leads to average grades and test grades but no real grasping of knowledge. 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.[12] 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.

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.[13] 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.[14] 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.

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.

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.[15]

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.[16] 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.[17]

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[18] and an informant/carer-rated version of the DAS.[19] Further a clinical brief DAS has also been developed.[20] 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[21]

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".[22] 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".[22] 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, or Huntington's disease, stroke. Marin argues that apathy is a syndrome associated with many different brain disorders.[22] This has now been shown to be the case across a range of neurological and psychiatric conditions.[2]

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.[23] However, although many patients with depression suffer from apathy, several studies have shown that apathy can occur independently of depression, and vice versa.[2]

Apathy can be associated with depression, a manifestation of negative disorders in schizophrenia, or a symptom of various somatic and neurological disorders.[24][2]

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).[3] 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.[25] 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.[26] 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.[3] 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.[27][28][29] 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.[30]

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.[31]

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 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, autism spectrum disorders, ADHD, and others. Some medications and the heavy use of drugs such as opiates or GABA-ergic drugs may bring apathy as a side effect.