Aaron J. Louie
Psychopathology (PSY 469)
Dr. C. Keutzer
11/25/96

Voodoo death: Psychosomatic factors contributing to mortality

Is it possible that the stresses of our daily lives and how we deal with them affect our longevity? Do our personalities really predict the risk of coronary heart disease? Is it possible for psychological stresses to become so great as to lead to premature mortality? Voodoo death in Haitian American culture results when a person is "hexed," and no cure for the "hex" is known from any past experience by the subject, resulting in the patient's premature demise (Meador, 1992). However, the subject can recover from a near death state if convinced that a cure for this "hex" is possible (Meador, 1992). For example, Meador (1992) describes a case where a patient with a mild, non-life threatening carcinoma of the liver was assured by the family, the physician, and acquaintances that his full metastatized cancer was going to kill him. In this case, the combined family, friends, and medical community acted as the "witch doctor" in diagnosing a "hex" that eventually led to the patient's premature death (Meador, 1992).

It may seem preposterous to the practitioners of Western medicine that a patient could die simply due to psychological factors. Current research, however, has focused on the more subtle effects of the mind on physiological functioning, and the results are surprising. Affect and personality factors have been shown to have a significant effect on mortality, lending credence to accounts of voodoo death. First, I will examine the psychological factors affecting psychophysiological disorders. Second, some possible biological causes of psychophysiological disorders will be described. Third, two studies involving premature death will be analyzed.

Several factors contribute to the psychosomatic mechanism of hex death and psychophysiological disorders. Such factors include psychological symptoms, personality traits, and coping styles (Comer, 1996). Common psychophysiological disorders can include ulcers, asthma, chronic headaches, hypertension, and coronary heart disease (Comer, 1996).

First, psychological conditions, such as anxiety disorders, can often exacerbate any existing medical condition, as seen in the Meador (1992) subject. Other studies have analyzed "neurotic" and mental health facility patients, comparing their mortality rates with those of the population mean. Sims (1984) found that neurosis is highly correlated with premature death, including natural causes, suicide and accidental death. However, it may be that these results stem from the propensity of "neurotic" patients to engage in risky behaviors, such as cigarette smoking, reckless driving, unhealthy food intake, or alcoholism. Black, Warrack, and Winokur (1985) also found that patients with affective disorders, schizophrenia, drug abuse, and personality disorders were more likely to die from "unnatural" causes. They "found that former psychiatric inpatients with functional disorders were at great risk for premature death," (Black, Warrack, & Winokur, 1985, 86) which coincides with Sims's 1984 study. Negative psychological factors are undoubtedly correlated to the worsening of physical conditioning, leading to a shorter life span. Whether or not these psychological conditions are the direct cause of premature mortality remains to be confirmed.

Second, a more concrete relationship has been established between personality type and coronary heart disease. Shekelle, Vernon, and Ostfeld (1991), found that three MMPI (Minnesota Multiphasic Personality Inventory) variables hypochondriasis/hysteria, neuroticism, and somatic complaints could be "positively associated with incidence of uncomplicated angina pectoris as the first coronary event" ( Shekelle, Vernon, and Ostfeld, 1991, 183). Furthermore, male patients with elevated hypochondriasis/hysteria and somatic complaint scores who had survived an initial myocardial infarction were at greater risk for coronary death. Shekelle, Vernon, & Ostfeld (1991), also suggest that such personality factors may lead to an increased susceptibility to affective stress, resulting in a risk of heart attack. They also mention, however, that such results are not conclusive enough to produce overwhelming evidence that personality factors can shorten a person's life span (Shekelle, Vernon, & Ostfeld, 1991).

Finally, the coping strategy used by a person to deal with stress can often affect their long-term health--and often their longevity. Graves, Mead, Wang, Liang, & Klag (1994), describe a study conducted that identified the stress coping (temperament) strategies of 1337 medical students . Over the course of 41 years, they correlated the cause of death with the students' coping mechanisms. Graves, et al, classified three general strategies for dealing with stressors: stable, tension-in, and tension-out. In accordance with the above studies, they found that those subjects who expressed tension via psychophysiological reactivity (tension-in) rather than through anger or violence (tension-out) ran a higher risk of premature mortality (Graves, Mead, Wang, Liang, & Klag, 1994). "This temperament type was characterized by a tendency to respond to stress with anxiety, loss of appetite, and difficulty sleeping" (Graves, Mead, Wang, Liang, & Klag, 1994, 122). Such lifestyles may be the cause of the prevalence of coronary heart disease and early death in people with certain stress coping strategies.

Many biological causes also contribute to psychophysiological death and disorders. E. H. Friedman (1995) synthesizes work from several sources to come up with a theory for the neurobiology of psychosomatic death involving the panic and anxiety responses, leading to a malfunctioning of the brain stem, altering heart rhythm, eventually leading to a fatal heart attack. Furthermore, in the studies mentioned above, many psychological conditions were tightly linked to poor eating habits and unhealthy addictions, which have their own negative effects on the health of a person.

One sociological study focused on sociocultural factors affecting timing of death. Byers and Zeller (1987) found that mortality rates rose significantly immediately following Christmas day in Ohio. "Thanatologists and other social and behavioral scientists have long given credit to the notion of personal mastery and control over both psychological and physiological condition" (Byers & Zeller, 1987, 394). The results of this study, which suggest that a person can "hold on" through a significant cultural or emotional event--such as Christmas--then "choose" to die in the days following that event, may prove the notion of psychosomatic death to be valid.

One of the most sobering examples of how psychological, physical, and emotional trauma can combine to result in physical illness or death is the effect of the WWII Nazi persecution on the victims and survivors of the Holocaust. The effect of years of torture, starvation, and imprisonment, combined with the constant loss of loved ones, resulted in several psychophysiological disorders. The Psychological Perspectives of the Holocaust and of its Aftermath (Braham, 1988) delineates several psychological characteristics typical of Holocaust survivors: a. A pervasive, depressive mood with morose behavior and the tendency to withdraw, general apathy alternating with occasional shortness, angry outbursts, feelings of helplessness, and insecurity, lack of initiative and interest, prevalence of considerable psychosomatic stress, persecutory attitude, and expression. b. A severe and persevering guilt complex related to the fact of having survived when so many others had perished. c. A partial or complete somatization that can range from rheumatic or neurologic pains and aches in various body areas to such psychosomatic diseases as peptic ulcers, colitis, respiratory and cardiovascular syndrome, and hypertension. These may be accompanied by mental confusion or nightmares. (Braham, 1988, 46)

Civilians imprisoned by the Nazis because of their involvement in the resistance movements or because of their racial or ethnic origins have higher morbidity rates on follow-up when compared to other control groups. Long-term malnutrition, endless forced labor, exposure to combat, and severe beatings to the head have all been identified as potential causal agents of these high rates, depending on the group examined (Sigal & Weinfeld, 1985). Such atrocities can serve to illuminate the causes and mechanisms of psychosomatic death and provide possible clues to treatment of psychophysiological illnesses.

As evidenced by the accounts above, Holocaust victims suffered from psychophysiological complications as a result of their psychologically and physically traumatic ordeal in Nazi concentration camps. Evidence also points to the assumption that terminally ill patients "wait" until Christmas passes to die, providing another example of the mind's effect on the biological system of the body. Neurobiological findings link one possible pathway between the panic response and the onset of a heart attack. Stress coping strategies can affect mortality rates in medical students. Personality types may determine the risk of a heart attack. Psychological conditions can also affect long-term health and longevity. Although these findings may not prove or disprove the existence of voodoo death, they do explain some of the more subtle effects of the mind on health and longevity.

Black, D. W., Warrack, G., & Winokur, G. (1985). The Iowa record-linkage study: III. Excess mortalitiy among patients with "functional" disorders. Archives of General Psychiatry, 42, 82-88.

Braham R. L. (1988). The psychological perspectives of the Holocaust and of its aftermath. New York: Columbia University Press.

Byers, B. D. & Zeller, R. A. (1987). Christmas and mortality: Death dip, no; death rise, yes. Professional Psychology: Research and Practice, 18, 394-396.

Comer, R. J. (1996). Fundamentals of abnormal psychology. New York: W. H. Freeman & Co.

Friedman, E. H. (1995). Neurobiology of sudden death. Psychother Psychosom, 63, 212.

Graves, P. L., Mead, L. A., Wang, N. Y., Liang, K. Y., & Klag, M. J. (1994). Temperament as a potential predictor of mortality: Evidence from a 41-year prospective study. Journal of Behavioral Medicine, 17, 111-126.

Meador, C. K. (1992). Hex death: Voodoo magic or persuasion? Southern Med. J., 85, 244-247

Shekelle, R. B., Vernon, S. W., & Ostfeld, A. B. (1991). Personality and coronary heart disease. Psychosomatic Medicine, 53, 176-184.

Sigal, J. J., & Weinfeld, M. (1985). Control of aggresssion in adult children of survivors of the Nazi persecution. Journal of Abnormal Psychology, 94, 556-564.

Sims, A. (1984). Neurosis and mortality: Investigating an association. Journal of Psychosomatic Research, 28, 353-362.