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The Giving Up-Given Up Complex Illustrated on Film

Arthur H. Schmale Jr., MD; George L. Engel, MD
Arch Gen Psychiatry. 1967;17(2):135-145. doi:10.1001/archpsyc.1967.01730260007002.
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FOR SOME YEARS we have been concerned with the settings in which illness occurs, the transitional phase between health and disease. In earlier studies our attention was first attracted mainly by the apparent significance of separations and object losses on the one hand, and affective responses of "despair," "discouragement," and "depression" on the other.1-3 More careful study of the affects involved led Schmale to define and characterize helplessness and hopelessness as the affective setting in which illness is likely to make its appearance.4 He subsequently studied the frequency with which these two affects were experienced and reported on both sick and well populations, as well as considering them from a developmental perspective.5-9 More recently we have put together a description of the psychological condition that we have observed so commonly to constitute a major setting of illness, and have


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