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Dr. Saul presents an interesting thesis in his paper. I have had experience with patients who have reached an impasse and who have made suicidal attempts or have successfully committed suicide. This constellation as a setting in which a solution by suicide occurs fits in with my own clinical experience.
The patients presented by Dr. Saul, however, do not appear to be in the category of Cannon's Voodoo Death. Two of his patients died from demonstrated cardiac infarction and one during status asthmaticus. In the cardiac death, it might be quite possible that the coronary arteries were already implicated and that the contribution of the impasse represented an increased stress situation in a pre-prepared “somatic” situation.
Unfortunately, we do not know as to whether the patient with status asthmaticus had a previous history of asthma and if so, what had been the manifestations. There is no question that any individual episode of asthma may be triggered off by the stimulus of a conflict situation, which in this instance perhaps led to the status.
These patients may perhaps represent the utilization of somatic systems in the service of an unconscious suicidal wish. However, they do not fall into the “unexplained” deaths.