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History of demoralization
Various definitions of demoralization have been proposed since it was introduced. Frank (1961) first introduced the term demoralization as a definite cluster of symptoms, a state akin to the 'giving up-given up' complex, in which one primarily experiences persistent feelings of subjective incompetence or failure to meet one's own or others' expectations, an inability to cope and problem solve. An inability to cope is understood in Frank's works as feelings of being overwhelmed and defeated by one's circumstances and of being unable to effectively engage in problem-solving and perform tasks. According to the author, this state characterized psychotherapy clients seeking treatment who had exhausted personal resources, and were no longer able to cope with their personal problems. For this reason the demoralized individual responded readily to help and encouragement, as they were at a heightened state of suggestibility which interacted with expectations of improvement in the psychotherapeutic context (Frank & Frank, 1991).
Schmale & Engel (1967) subsequently identified a psychological state which may precede illness characterized by helplessness or hopelessness, feelings of being at a loss and 'at the end of one's rope' and unable to cope, naming it the 'giving up-given up' complex. An inability to cope, an essential element of the 'giving up-given up' complex, was described by Engel (1968) as the sense of psychological impotence in which previously used strategies, whether psychological or social, seem no longer effective in dealing with changes in the environment.
'Giving up' or demoralization indicated a complex state that included both helplessness and hopelessness. Sweeney et al. (1970) provided a differentiation of these giving up affects. The qualitative differences between the two affects were postulated to have distinct and underlying developmental bases. Helplessness was defined as a feeling of being left out or abandoned where loss of gratification is perceived as caused by external events or objects and cannot be regained by active self-intervention. Hopelessness was hypothesized to develop instead when the individual feels that he/she alone is responsible for the loss and that there is nothing that he or anyone else can do to overcome it. Helplessness is thus more active than hopelessness because of the orientation toward the environment. Further, the individual feels...