My book deals with several different categories of death via the autonomous influence of unconscious processes within the body. Here I offer a few examples.
Psychogenic death and personality
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"There does undoubtedly appear to be an association between neurosis and an increased mortality from natural causes." (Sims, 1984, p. 361)
The following story was told to me by a reliable friend of mine (Ritwa Lampinen) who at that time (about 20 years ago) had been working as a psychiatric nurse in the geriatric ward of the large, state mental hospital of Clinic Rheinau in Rheinau, Switzerland.
"The patient was already about 70 years old and had been diagnosed with schizophrenia. She had never taken medication. She was very headstrong and lived resolutely in her own, private world into which she let only a chosen few ever take a peek. She was from a "better home" in Zuerich, even came out in society as a debutant while a teenager, but had already been in and out of several different psychiatric hospitals before finally ending up in Clinic Rheinau.
"Her room by us was stuffed full of books, pictures, beautiful and expensive clothes, and several antique treasures from past times. Above all, there were hundreds of black, paper-back school books which were written full with ideas of the spiritual teacher Rudolf Steiner, with quotes from the poet Morgenstern as well as with notes of her own, private thoughts.
"Ms. X tolerated no great interference into her daily routine. Insofar as she was a truly original personality on the ward, her individual way to be was rather well accepted by the staff. For example, no one was allowed to ever touch her without warning her in advance and she spoke only with those few persons of her own choosing.
"She later acquired some health problems - I don't remember anymore which ones - so that we wanted to send her to the hospital for a general medical checkup. Ms. X vigorously resisted our offer of help. She adamantly maintained that, if she was forced to go away, she would most certainly die, since she could simply not accept any change whatsoever in her life. Finally, we had to force her admittance to the nearest somatic hospital located in a neighboring city more than 25 km away from Rheinau.
"The day before she had to leave us, she put all her personal things into order, either giving particular belongings to persons of her choice - I, for example, received one of her most guarded, black notebooks - or else simply directing us as to what we were to do with this or with that. She, herself, took nothing with her into the hospital which was actually very unusual for her normal behavior. She also said «Goodbye» to all her fellow patients and caretakers before she finally left. As I recall, she had only been about three or four days in the hospital before she died, suddenly and unexpectedly, and without any known, acute cause of death."
Here are some more stories:
"At the Denver State Hospital, in 1910, a man was admitted in a panic, of three days' duration. He paid little attention to the hospital but kept staring out of the window at people, who, he said, were coming to lynch him. Finally, with the words, "They are coming now," he fell over dead. Autopsy showed that the organs were in amazingly good condition; no lesions were observed anywhere." (Walters, 1944, p. 84, contribution from Dr. Earl D. Bond to discussion)
"A Negro aged 41, a laborer, was brought to the hospital because recently "voices" had told him to go forth into the world to preach and found a new religion and because he had made extravagant claims to the effect that he was related to King Solomon, after whom he intended to shape his life.
"There was no significant family history, no account of serious illnesses and no record of misdemeanors. There was a history of fairly heavy indulgence in alcohol, but this had not produced any acute mental disturbances. The first deviation from his usual good health and normal behavior was noticed about two months before his hospitalisation, when he began to attend church a great deal and to pray more than usual. To his companions he stated the belief that he was consecrated to the Holy Ghost and could "speak in tongues." While this was not interpreted by his Negro associates as being anything abnormal, they conceded that it was a definite change in behavior. When admitted to the hospital he was disoriented as to time and place and was childish in his reactions; he said that he was in constant auditory touch with the Lord. He had no insight into his mental disorder but thought he had been sent to the hospital to be treated for a severe cold.
"Physical examination revealed hard and tortuous radial vessels; vigorous arterial pulsations on the left side of the neck; a diffuse apex beat of the heart, perceptible over a considerable area of the chest; diminished muscle tone; a loud systolic murmur over the apex, and accentuation of the second aortic sound. The blood pressure was 220 systolic and 165 diastolic, and the pulse rate was 120 per minute. Serologic tests gave negative results and there were no neurologic findings.
"The patient suffered from dyspnea and tired easily on exertion. He was given the treatment routine for such a condition and with the general toning up of the cardiac condition the hallucinations ceased, as did the extravagant delusions. At the end of three the patient was sent home free from the psychosis and with improvement of the cardiac condition. After being at home for a few months he suffered acute cardiac decompensation with rapidly developing general anasarca, and died of pulmonary edema." (Nolan & Lewis, 1937, S.789-790)
"A young individual, in the second or third decade of life, suddenly becomes restless and excited. This psychomotor activity increases and is accompanied by hilarity or fearful anxiety in response to extrospective or introspective pressure of ideas. Work and duties are neglected. Sleep becomes difficult and often impossible. Impulsive or responsive aggressiveness increases. The individual breaks equipment or furniture or assaults his neighbor, apparently without reason. He is then admitted to the hospital. The excitement and restlessness continue day and night with only momentary respite. Excitement increases until it becomes a continual maniacal furor, in which the individual will tear off his clothes, tear the clothes to strips, take the bed apart, rip the mattress to pieces, bang, and pound almost rhythmically on the walls and windows, dash wildy from the room, assault anyone in reach, and run aimlessly, and without apparant objective, from one end of the room to the other.
"The pulse becomes rapid even in periods of momentary rest. Food and fluids are refused and weight loss becomes apparent. Perspiration is profuse and continual. The blood pressure falls and the pulse becomes thready. Fever is then noted. Early in the furor it ranges around 1000 F. rectally. When confined to a room, the patient will thrash against the wall or butt his head against it. If placed in restraints, either in a continuous tepid tub or bed, (in pack or sheet) the patient will strain ceaselessly against the restraints in an atttempt to tear out and maintain his externally objectiveless activity. "Fever increases, the pulse becomes more thready and rapid, blood pressure falls further, perspiration drips continually, the tongue becomes dry and furred. The skin becomes flushed and feels hot to the touch. After varying periods of excitement of from hours to days, the temperature may rise to 1050 F. rectally or 1070 F. rectally or even 1100 F. rectally. The skin may become pale or cyanotic and suddenly all activity ceases, respiration and cardiac activity stop and the patient is dead. This end may come so suddenly that the attending psychiatrist is left with a chagrined surprise and the puzzlement is intensified after the postmortem examination because the autopsy generally fails to disclose any findings which could explain the death. Therefore, the usual final diagnosis is (1) an unclassified psychosis (2) exhaustion from overexertion in a state of acute manis." (Wendkos, 1979, p. 165-166)
Sudden Unexpected Death Syndrome (SUDS)
"About half the cases of death referred to the medical examiner come to him because the cause of death is unknown, rather than because there is positive evidence of foul play. They include not only deaths in which the fatal seizure is sudden and unexpected, but also those in which the cause of death is obscure because no physician was in attendance during the terminal illness." (Moritz, 1940, p. 798)
"Without warning Neng Yang lost consciousness on December 21, 1987É . He died on Christmas Eve, the third victim in his clan, and 115th in the U.S., of Sudden Unexplained Death Syndrome (SUDS), a mysterious malady that strikes young, apparently healthy Southeast Asian men - especially Hmong. Neng Yang's family believes an autopsy performed on a clan member, another SUDS casualty, caused the 23-year-old student's death. Hmong religion holds that the spirit cannot leave a mutilated body to join its ancestors before rebirth and may claim the life of a relative in a cry for release. É Reported in Japanese and Philippine medical literature in the 1950s and '60s, SUDS began to appear in the U.S. after the influx of Southeast Asian refugees in the mid-1970's. Forty-nine cases occurred in the peak years of 1981 and 1982, but only a handful show up annually now. The phenomenon still baffles U.S. doctors. Typically, victims lead ordinary lives and have no apparent illnesses. They die in their sleep, with perhaps a telltale gurgling or laboured breathing, and no traces of drugs or abnormal organs are found. Chaotic cardiac impulses make the heart beat erratically, interrupting the blood supply and depriving the brain of oxygen, but the underlying cause remains a mystery. Researchers speculate that the stress of culture shock may be a contributing factor. Statistics indicate that the longer an immigrant lives in this country, the less risk he runs of dying from the disorder." (Hmong, 1988, p. 607)
"Following Neng Yang's wishes and their own convictions, his parents, You Vang Yang and Ia Kue Yang, did not want an autopsy. The attending physician assured them they would be notified if the hospital wanted one. When they arrived at the funeral home to prepare the body for burial, horrified relatives learned that the state medical examiner's office had done an autopsy without family consent." (Hmong, 1988, p. 607)
Sudden Infant Death Syndrome (SIDS)
"SIDS is a mysterious and unresolved problem affecting children between the ages of 1 week and 4 months old and is responsible for more than one-third of all postnatal deaths occuring in the first year of life in the United Kingdom. There is evidence in a minority of these patients of some vital infection, but the microscopic changes in the lungs vary between normality and well-established zones of interstitial pneumonitis. This may be associated with alreslar wall thickening; however, the changes rarely appear sufficiently severe to have caused death, and it has been postulated that viral infection may trigger aphoe or an anaphylactic reaction. It seems likely that this disease is multifactorial and that viral infection is just one of a group of disorders that may cause it." (Schofield & Krausz, 1992, p. 966)
"Sudden, unexplained infant deaths (SUIDs) are those for which no cause of death was obvious when the infant died. Sudden infant death syndrome (SIDS) (also know as crib death) is the most frequently determined cause of SUIDs. SIDS is "the sudden death of an infant under 1 year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and a review of the clinical history" (Willinger, James, & Catz, 1991) SIDS should not be diagnosed if these criteria are not met." (Services, 1996, p. 1)
Following are several examples of psychogenic death via the intentional influence of conscious physiological processes within the context of a world picture.
Death omens and premonitions
"The patient was a 71-year-old immigrant Greek farmer who had had a duodenal ulcer for 15 years. Operation had been recommended on two previous occassions, because he had been unable to follow a medical regimen. Each time he had refused, saying that he preferred suicide to surgery. Intractable pain brought him again to the hospital and made surgical treatment mandatory. A psychiatric consultation was requested because the patient was said to be "depressed." Only in the course of being interviewed did the conviction of death emerge as a significant clinical finding.
"The patient was a pleasant and cordial man who was concerned about his pain, but displayed none of the signs or symptoms of depression. In a matter-of-fact way, he simply stated that he would die following subtotal gastrectomy. He could not accout for this conviction, which he seemed to accept with complete equanimity.
"His recent exacerbation of ulcer pain had been precipitated by a crop failure, which he interpreted as an act of God against him. Twenty years before, he had had his jaw broken in a fist fight at the market place where he sold vegetables. He lost a great deal of money in the law suit which followed, and received no satisfaction from his assailant. In describing the events, his manner abruptly changed and he acted as if he were at the moment reliving the experience. "The joy went out of living," he asserted, and everyone turned against him. He no longer went to the market place. Instead, he lived his life in bitter solitude, noting with grim satisfaction the successive deaths of those who had acted against him at the trail. It was shortly after his last enemy had been buried that his crops were destroyed by drought and his ulcer pain returned. This was God's vengeance for his having willed the death of his enemies.
"The surgeons made every effort to reassure the patient, and the psychiatrist tried to review and reinterpret his reality situation. The patient remained friendly, courteous, and unshakable in his premonition of death. The subtotal gastrectomy was performed without complication. Three days later, however, in the course of an uneventful recovery, he suddenly became dyspneic, developed atrial flutter, and died within a few hours. Autopsy disclosed a large mural thrombus which occluded the pulmonary valve." (Hackett & Weisman, 1960, p. 279)
"Belgrad, Oct. 5, 1928 - In the village Koprivnica, a farmer named Ujsek said several months ago that he would die October 4th, 1928. On the appointed day he called his family, ordered his coffin, bade farewell to his friends and at noon, as he was seating himself at the the table, died of apoplexy. The populace believing that it was a miracle was much excited. (Neues Wiener Tagblatt, October 6, 1928.)" (Menninger, 1948, p. 35)
Important pathogenic factors
"From the sketch of pathological-anatomical features, I would like to emphasize that they are in no way satisfactory from the standpoint of a dynamic-biological holistic approach to the death process, and that they are indeed only the last, visibly remaining link of a chain available as they are to us only from the static approach of the autopsy table." (Arnold, 1949, p. 389-390)
"É that 'voodoo' death may be real, and that it may be explained as due to shocking emotional stress to obvious or repressed terror". (Cannon, 1957, p. 189)
"The pulse towards the end would be rapid and 'thready'. The skin would be cool and moist. A count of the red blood corpuscles, or even simpler, a determination by means of a hematocrit of the ratio of corpuscles to plasma in a small sample of blood from skin vessels would help to tell whether shock is present; for the 'red count' would be high and the hematocrit also would reveal 'hemoconcentration'. The blood pressure would be low. The blood sugar would be increased, but the measure of it might be too difficult in the field." (Cannon, 1957, p. 189-190)
"may have died a so-called vagus death, which is the result of overstimulation of the parasympathetic rather than of the sympathicoadrenal system." (Richter, 1957, p. 196)
"death may result from the effects of a combination of reactions, all of which may operate in the same direction, and increase the vagal tone." (Richter, 1957, p. 197)
Arnold, O. H. (1949). Untersuchungen zur Frage der akuten tödlichen Katatonien. Wiener Zeitschrift für Nervenheilkunde und deren Grenzgebiete, 11(4), 386-401.
Cannon, W., B. (1957). 'Voodoo' Death. Psychosomatic Medicine, 19(3), 182-190.
Hackett, T. P., & Weisman, A. D. (1960). Psychiatric Management of Operative Syndromes: I. The Therapeutic Consultation and the Effect of Noninterpretive Intervention. Psychosom. Med., XXII(4), 267-282.
Hmong (1988, October 1988). Mysterious Death Strikes Young Hmong. National Geographic, pp. 607f.
Menninger, E. (1948). Death from Psychic Causes. Bull. Menninger Clinic, 12(1), 31-36.
Moritz, A. R. (1940). Sudden Death. N. Engl. J. Med., 223(June-December), 798-801.
Nolan, D. C., & Lewis, M. D. (1937). Psychic Phenomena in Association with Cardiac Failure. Arch. Neurol. Psychiat. Chicago, 37, 782-795.
Richter, C. P. (1957). On the Phenomenon of Sudden Death in Animals and Man. Psychosomatic Medicine, 19(3), 191-198.
Schofield, J. B., & Krausz, T. (1992). The Respiratory System. In J. O. D. e. a. McGee (Ed.), Oxford Textbook of Pathology (Vol. 2a Pathology of Systems, pp. 943f.). Oxford: Oxford University Press.
Services, U. S. D. o. H. a. H. (1996). Guidelines for Death Scene Investigation of Sudden, Unexplained Infant Deaths: Recommendations of the Interagency Panel on Sudden Infant Death Syndrome (Morbidity and Mortality Weekly Report (MMWR) No. Vol. 45 / No. RR-10). Public Health Service / Centers for Disease Control and Prevention (CDC).
Sims, A. (1984). Neurosis and Mortality: Investigating an Association. J. Psychosom. Res., 28, 353-362.
Walters, M. (1944). Psychic Death - Report of a Possible Case. Arch. Neurol. Psychiat. Chicago, 52, 84f.
Wendkos, M. H. (1979). Sudden Death and Psychiatric Illness. New York-London: SP Medical & Scientific Books.
Willinger, M., James, L. S., & Catz, C. (1991). Defining the sudden infant death syndrome (SIDS): deliberations of an expert panel convened by the National Institute of Child Health and Human Development. Pediatr. Pathol., 11, 677-84.
(Last revision: 06. January 2001)