Discussion of Leon J. Saul's Article, Sudden Death at Impasse

It is encouraging to see, in Dr. Saul's paper, a recrudescence of interest in the long neglected topic of psychogenically induced death, but it it well to remember that sudden death for psychic reasons is much more complex than it appears and it apparently can be caused by more than one mechanism. Intense fright by producing vagal inhibition can produce what the idiom, “a heart-stopping fear” would lead us to expect, namely, instantaneous death. However, this mechanism cannot account for the slow death by convulsions of a Samoan

native who, with horror, realized that he had touched the tabooed chief's tinder box, nor can it account for the famous subject who was led to believe falsely that he was being exsanguinated but who died a hypotensive death, just as if his veins had been opened. And how are we to account for the surgical patient who is certain that he is to die, sustains a trivial operation, but does not recover; or the patient with mild pneumonia who loses his will to live and dies to the dismay and confoundment of his physicians? We do not understand the physiology or biochemistry of these states, much less the psychology.

I do not share Dr. Saul's view with Richter that sudden death occurs only when One is in a stage of inassuageable hopelessness. It also may occur when one expects death.

I hope that this brief, fascinating, clinical note will prompt more of us to be alert for the possibility of psychically induced or facilitated demise. It is an area rich with promise concerning essential life processes. The understanding of it can be of enormous help in elucidating that dim penumbra where psyche and soma meet, here with such devastating consequence.