In 1967, a woman was admitted to Baltimore City Hospital, complaining about shortness of breath, chest pains, nausea, and dizziness. She was 22 years old. She hadn't had health problems until just over a month earlier. Now she was extremely anxious, hyperventilating, sweating and nearly fainting.
After two weeks, she finally confided to the doctor what she believed was wrong with her. By then, she only had a few days to solve it. As it happened, the woman had been born on Friday the 13th in Florida's Okefenokee Swamp. The midwife who'd delivered her had also delivered two other children that day. She told the girls' parents that all three children had been hexed. The first girl would die before her sixteenth birthday. The second would die before her twenty-first. The third—the woman in this hospital—would die before she turned twenty-three.
As it happened, the first girl was killed in a car accident on the day before her sixteenth birthday. The second girl made it to her twenty-first birthday. She thought the spell was broken, so she went out to celebrate, but at the bar a fight broke out, a gun went off, and she was also killed.
This left the third woman convinced, beyond all doubt, that she would die as the woman had foretold.
Then, on the day before her 23rd birthday, she did.
These sorts of cases have long puzzled physicians. In 1942, Walter Cannon—who researched and named the "fight or flight" syndrome — published a paper titled "Voodoo Death," in which he gave examples from around the world of people dying from curses. Unlike his contemporaries, who suspected "voodoo deaths" were the product of overactive primitive minds, Cannon was convinced there was a biological side to it.
Yet until recently the idea that our beliefs, or our fears, could kill us was not taken seriously in Western medicinal circles, due to the lack of a mechanical explanation for how something as ephemeral as the mind could extinguish something as tangible as the body. Now, thanks to the work of a British psychologist and researcher named John Leach, that may change, as he has mapped out at least one road to this unfortunate end.
More than 20 years ago Leach, who is a survival psychologist, started to investigate why some people lived through their time prison camps, shipwrecks, plane crashes and other disasters, while others did not. He spent years trying to figure out what was special about the survivors.
"I got absolutely nowhere," Leach said, when reached in the U.K. "I couldn't find any special characteristics of these people. Then one day, I realized I was asking the wrong question. The real question is not, 'What makes a few people so extraordinary that they survive?' The real question is, 'Why do so many people die when there's no need for them to die?'"
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History is full of such stories, some of which Leach included in a 2018 paper. As far back as 1607 in the doomed American colony at Jamestown, some of its citizens were noted to have "die[d] of Melancholye." On slave ships, captives frequently died from "the sulks." In Auschwitz, North Korea and Vietnam, prisoners of war would lie down, smoke their last hidden cigarette, and be dead within 48 hours. One shipwreck survivor watched four others around him die, one by one. "I had no thought people could die so easily," he said. "Their heads just fell back, the light seemed to go from their eyes, and it was all over."
For years Leach pondered these cases, wondering what could cause a person to die of hopelessness. Then, around 2016 he homed in on the relationship between the prefrontal cortex and the basal ganglia, and the way dopamine in produced, or not produced, there. It was a revelation.
"With the advances in neurology and neurochemistry," he said, "the pieces started to fall into place. After all these years trying to get an answer for this thing, when I finally did, I thought, 'This is too easy. That can't be right.'"
When humans are faced with a threat, they deal with it in various mental ways. They either face the threat head on to defeat it, or they try to run away from it. This is known as "active coping."
Since Cannon first described the "fight or flight," response, a third option has been added to the list: freeze. This is known as "passive coping," and it happens when a threat is perceived as inescapable. It's a way for the organism to conserve energy until the threat passes.
But sometimes the threat — or the perception of it — doesn't pass. In that case, a person can lose hope of escape and, "the prefrontal cortex deliberately inhibits the production of dopamine in the basal ganglia to well below its functional level," says Leach. "That's associated with the feeling of hopelessness." If this continues for too long, it can become impossible to restart dopamine production. The person in this situation begins a "spiral of disengagement," which consists of five stages:
3) Aboulia (loss of emotional response, initiative and willpower)
4) Akinesia (lack of response to external stimuli, even to pain).
Most people who enter this neurological tailspin will emerge from it before they hit bottom. They take in new information. They adapt to the new situation. But the few who don't may find themselves at stage five: Psychogenic death. The light goes out of their eyes. They say their goodbyes. They may perk up briefly as if they finally have a goal they can imagine, a solution to their problem: That new goal is death. And within a day or so, they're gone.
In January, Leach will deliver a talk to the British Psychological Society Conference titled "Dysexistential syndrome: the pathology of psychogenic death," in which he will explain his thinking on these processes and their implications. But some in the field already see it as providing a missing piece to the mind-body puzzle.
"What John's paper has done," says Sarita Robinson, who teaches cognitive neuropsychology and psychobiology at the University of Central Lancashire, "is actually plug this gap and said, 'Look, the physical is important, yes. If you are in a concentration camp and you haven't got enough food, that is going to eventually kill you. But actually, the psychological pressures of being in that extreme environment could also be impacting on your likelihood of survival."
Robinson has seen this in her own life, when an elderly neighbor was sent to the hospital. "She was doing really well," Robinson recalled, "Then the consultants came in the morning and told her that she had cancer, and that's why she'd been so unwell. At that point she just went downhill and died that afternoon. It was literally giving upon life at that point."
There are countless anecdotal reports of deaths soon after a diagnosis like AIDS or cancer, in which the name of the disease seems to work like curse. Leach's model of dysexistential syndrome suggests a common mechanism.
David Kissane, who served as Chairman of the Department of Psychiatry and Behavioral Sciences at Memorial Sloan-Kettering Cancer Center in New York, studies the negative effects of "demoralization," which is different from depression, and may also be a key to understanding dysexistential syndrome.
"Depression is a loss of happiness, joy and pleasure in the here and now" Kissane says. "Demoralization is future-oriented, that I won't be able to experience pleasure in the days and weeks, months ahead."
According to Kissane, this ability to construct a meaningful (or even possible) path into the future is related to our dopamine circuits, whereas depression is more closely associated with the serotonin circuits. When a person becomes hopeless, or demoralized, this hope-related part of the brain doesn't function as it should.
"Demoralization can arise from a struggle to cope with a stress or event," says Kissane, "which can include a medical illness, or entrapment in a predicament that you can't control. Cancer is the illness par excellence that challenges patients existentially."
Leach has seen the same thing since he started writing on the subject.
"I've been contacted by people working in cancer units," he says, "with patients who've been diagnosed with different types of cancer. And sometimes when they realize they've got cancer, some, not all, suddenly just go downhill, following the pattern I've laid out, and die quite quickly, even though there is no need for them to have died so soon."
So while prison camps and shipwrecks might be rare in this world, the prevalence of deaths from despondency may be more far more common than anyone has known.
"The same phenomena that John's been looking at in camps," says Kissane, "match exactly the phenomena that we've been studying in oncology, palliative care, advanced progressive illness. And you can find them in everyday citizens, in every town throughout America."
On death and dying: