Voodoo Death and Public Health

images-1After being condemned by a medicine man, a terrified man dies of fear. A woman commits a taboo action, and, convinced that punishment will be swift and lethal, she perishes. This type of voodoo death was a subject of great interest in the first half of the 20th century. U.S. physicians stationed in Australia, South America, the Democratic Republic of Congo, or other far-flung places occasionally got the opportunity to examine the victims of voodoo curses. Though these doctors usually found nothing wrong with the patients via standard workups, they reported it was clear that their charges felt very ill. Often the cursed would pass away, although the physicians couldn’t figure out the physiological cause of death. Other times, the victim would get a lucky break–he or she might receive a countercharm or assurance from a sorcerer that the curse had just been a joke–and in these cases, a rapid recovery could occur.

In the 1940s, Walter Cannon wrote a great account of this type of Voodoo Death for American Anthropologist. He relayed some anecdotes about the phenomenon and raised the possibility that maybe there was something to it. Perhaps strong emotions, like fear, can actually do us in. Cannon hypothesized that the cause of Voodoo Death was a hyperreactive sympathetic nervous system brought on by emotional stress. Excess nervous system activity could result in a fall in blood pressure, eventually leading to death. He compared reports of Voodoo Death to cases of shock that had been described during war: subjected to a terrible stress (like a grenade going off nearby), some soldiers would quickly die, even though no gross injury was apparent. And everyone has heard stories about someone dropping dead or having a heart attack following shocking news. Same concept.

Being cursed in a culture that believes in sorcery certainly sounds like a stressful event. One researcher working in northern Australia pointed out the strong social dimensions of a voodoo curse. Once someone is cursed, they are excluded from social life. The cursed individual is treated as though he or she is already dead. The only social interaction they can expect after being cursed is being present for the commencement of their funeral rites. Surrounded by people more or less pressuring them to die, victims cooperate, refusing food or drink and accepting their fate. In this view, voodoo works because people believe in it. It’s like the well known phenomonen in which being given a placebo is followed by improved health–except for the opposite happens. In fact, this expectation of sickness has been given its own name: the “nocebo” concept.

Not everyone agrees with the voodoo-death-caused-by-severe-stress-and-fearful-expectations hypothesis, of course. For example, some people think that the typical voodoo curse victim may be poisoned or simply denied food and water until they die. But in the 1970s, anthropologists like Barbara Lex voiced support for the theory that manipulating the autonomous nervous system via fear could be sufficient to result in death. Although we might consider Voodoo Death to be death by suggestion, the suggestion leads to a real physiological chain of events. A number of anthropologists who have championed this view have pointed out that their hypotheses can be tested. For example, if you examine a victim of a voodoo death curse, they should bare the telltale signs of parasympathetic activation: constricted pupils, pallid skin, etc. Unfortunately, or maybe fortunately, there haven’t been many cases of Voodoo Death easily accessible to researchers who want to gather this kind of data.

A doctor named Harry Eastwell, who provided psychiatric services to local communities in Northern Australia, described a scenario in which both psychological and physical deprivation were at work. The third most common “psychiatric” syndrome he treated in the region was a gross fear state, in which people (almost all males) were terrified that they were going to die from sorcery. Already in a sorry psychological state, these people may be prime candidates for “voodoo” deaths. Only two of his 39 patients suffering from this fear state died, though. And in both cases, mundane causes of death could be identified (although their state of fear may certainly have contributed to these proximal causes). Eastwell also reported that voodoo death could be averted by removing the victim from a situation in which everyone around them thought that death was a foregone conclusion and by treating any conditions that ailed them (like dehydration). After seeing a pattern in which water was either denied to a curse victim or they would not drink it themselves, he thought some of the mystique of the voodoo death had disappeared. While psychological forces were certainly at work, Eastwell believed that denial of fluids was an important cause of death in both victims of sorcery and those who suffered from other illnesses believed to be fatal. It should be noted that some researchers vehemently disagree that people in Northern Australia withhold food and fluids from the ill. So, like any interesting topic, the role of dehydration in hurrying along the cursed is controversial!

Although most voodoo deaths have been reported from the remote locations where cultural anthropologists used to do their fieldwork, similar anecdotes have emerged here in the U.S. For example, in 1960s Oklahoma, a healthy, successful man decided to sell a business that he operated with his demanding mother. Unhappy, she predicted that if he made the sale, something dire would happen to him. Two days later, despite having no previous history of breathing problems, he suffered his first asthma attack. Soon, he was in and out of the hospital for asthma that was out of control. One night, he called his mother and told her of his plans to reinvest the money from the sale of his business into a new venture. He also expressed optimism about his health prospects. She told him that no matter what he or his doctors thought about his chances of recovery, he should get ready for the worst. An hour later, he was dead. And this story isn’t entirely unique. I’m sure you can recall any number of stories about people who died of fright, or sadness, or because they had given up the will to live.

All of this makes you take a second look at your own culture. What proportion of illnesses and deaths are due to nocebo-type beliefs? Researchers have questioned whether certain surgical patients have a “predilection to death.” That is, these patients are convinced that they are going to die, and they may even view death as desirable. Not surprisingly, they are more likely to die. Although Voodoo Death sounds exotic, some researchers see Walter Cannon’s seminal paper on this subject as the beginning of a long and fruitful research agenda focusing on the link between emotions (like fear) and health outcomes. There is still a lot of confusion about whether and how Voodoo Death occurs in other places, but it seems we have been able to use this unusual topic to shine a light on an important cause of illness in our own society.