Sudden Death at Impasse

The possibility of sudden death from psychogenic causes has long been known. Walter Cannon, for example, has a paper on Voodoo Death. (1) Curt Richter has discussed sudden unexplained death in men and in animals. In speaking of cases in humans, and in asthmatics in particular, he concludes that some instances occur in situations of hopelessness—“literally a giving up when all avenues of escape appeared to be closed and the future holds no hope.” (3)

It was most interesting to read this sentence after already having written the following: Three cases in my experience, although a very small series, suggest by their similarity a certain mechanism in what might possibly be one form of psychosomatic death. This may be that certain persons with their particular physiological and psychological make-ups, when in unbearable situations of impasse, of “no exit” in which they cannot fight and from which they cannot escape, suddenly die. George Engel, with Arthur Schmale and others of his associates have been studying relationships of separation and depression to disease. (4)

The following vignettes demonstrate what is probably a special case of this over-all subject although in these depression and separation were not central features but a certain kind of hopelessness was present. The point is related to the physiological and psychological disturbances seen in separations when the last libidinal tie to another person is severed; when the last human bond is broken.

A professional man of about 45 reached such an impasse. He found himself in a totally unbearable situation, and felt forced to leave for another town. Just when he was ready to make this move, there developed in the town to which he was going difficulties which made this move impossible. Although in an anguished quandary, he boarded the train for the new locale. He had burned his bridges and now the bridge he planned to cross was demolished. He could see no third alternative. About halfway in the trip, at a ten-minute s