The Science of Being Scared to Death

In 1977 in a small DC suburb, a family of six was watching What's Happening when the wing of a plane crashed into their house. Dennis Clarke, his then-wife and their four children managed to escape unhurt, but their house was demolished. All the passengers onboard the plane died, and they weren't the only casualties: the woman who lived across the street from the Clarkes was found dead on her porch. She had witnessed the crash, and saw the burning jet fuel coming towards her in a river of fire. It never reached her, but she died all the same. "If anybody was scared to death, it was her," Clarke told me.

Death by fright is a phenomenon that was first documented by anthropologists in societies that had strong taboos and a belief in hexes. Individuals who had been cursed or broken a taboo would become so distraught that they would drop dead. When physiologist Walter Cannon brought it to the attention of the medical community, he termed it "voodoo death"—a name that has stuck. "It is a fatal power of the imagination working through unmitigated terror," Cannon wrote.

Of course, the real cause of voodoo death (or psychogenic death, the name I'll stick with) is a bit more scientific than that. To get an expert to explain things, I called Gregory Davis, a forensic pathologist of 22 years and a chief medical examiner in Alabama.

As it turns out, the culprit behind psychogenic death is a hormone we're all familiar with: adrenaline. "Adrenaline is part of the fight-or-flight response of the body to a circumstance that someone perceives as danger," Davis told me. "It's meant to be helpful, of course, but sometimes—it's rare, but sometimes it actually causes damage to individual heart muscle cells." This, Davis went on, can lead to heart dysrhythmia and death.

In short: when you're in a crisis situation, your sympathetic nervous system is dumping massive amounts of adrenaline into your body, and occasionally this evolutionary response backfires. Most of the time, though, it has the intended effect, as when the Clarkes realized their house was falling down around them. In that instance, the family survived because their fight-or-flight response did its job.

In a phone call, Clarke told me that fuel vapor from the plane had caused tiny flames to dance in the air in his living room. "My first thought was, 'Man, that is really pretty.' My second thought was, 'This ain't good.' So I jumped up." The Clarkes went through the laundry room into their garage, but the crash had cut off power to the house, and the garage door wouldn't open. "I just gave it a terrific yank, and up it went," says Clarke. The adrenaline pumping through his body prompted action without much conscious thought, and contributed to the family's survival.

Usually, it seems that psychogenic death is triggered when both fight and flight are no longer viable options—it corresponds with the feeling of being trapped, either by physical circumstances or mental convictions. Historically, prisoners of war are vulnerable to it, and sleep paralysis has also been linked (but only when that paralysis was combined with psychological stress and strong religious superstition). Davis told me a story about a burglar who was found by the police hiding in a closet, and dropped dead before the officers could even touch him. "He was obviously terrified of being caught, and when he was in fact caught, it was too much." The burglar was cornered and overpowered, and his heart short-circuited.

Oddly, fear is not the only emotion that can trigger psychogenic death, though it is probably the most common. "It could be any strong emotion," Davis told me. This rang a bell, as I had come across this news story several months before: an elderly champion bridge player was dealt a statistically incredible hand, a true once-in-a-lifetime event, and she died from the excitement before she could even play it. Even her son, in the midst of his mourning, said he was glad she had gone out the way she did, and her friends called it "the perfect bridge player's death." Psychogenic death, it turns out, has less to do with terror and more to do with being profoundly overwhelmed.

Dr. Martin Samuels, the preeminent living scholar of psychogenic death, collects these kinds of unusual death stories. As he told Scientific American in 2009: "There are people who have died in intercourse or in religious passion. There was a case of a golfer who hit a hole in one, turned to his partner and said, 'I can die now'—and then he dropped dead. A study in Germany found an increase of sudden cardiac deaths on the days that the German soccer team was playing in the World Cup."

But before you add this to your list of things to worry about, remember that cases of psychogenic death are extremely rare. In decades of serving as a medical examiner, Davis said he had only come across one case where he thought fright could be the cause of death, and that he could easily go the rest of his career without seeing another. (Unfortunately, Davis could not comment on the case in question, because it involves criminal charges and an impending trial.)

And don't swear off horror movies, either. In an interview with NPR, Samuels points out that "people's conscious conception of how frightened they are isn't correlated at all with the nervous system's real reaction…It turns out that there's not much correlation between what people say frightens them and what indeed really does frighten them and causes this autonomic storm." It's more about the things you'd never expect. Like seeing a plane crash into your neighbor's house.

All in Your Head is a series that takes a scientific look at all things spooky and scary. Follow along here.