Scared To Death... Literally

Earthquakes, terrorist attacks and muggings have all scared people to death. Sporting events, too, sometimes cause frenzied fans to drop dead. Neurologist Martin Samuels of Brigham and Women's Hospital explains how positive or negative excitement can lead to a heart-stopping surge of adrenaline.

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IRA FLATOW, HOST:

This is SCIENCE FRIDAY, I'm Ira Flatow.

(SOUNDBITE OF SCREAMING)

FLATOW: Can you be scared to death? Yes, in fact, you can. You can literally drop dead from fear, a phenomenon doctors call voodoo death. Kind of spooky, huh? Well, it can happen during an earthquake, a terrorist attack or a mugging, and you don't have to be frightened to death.

Sporting events, when you're rooting on your favorite team, can up your risk of heart failure, too. How does it happen, and what's the risk? Is there any chance a Halloween spook could send your heart aflutter? Here to talk about it is Dr. Martin Samuels. He's chairman of the Department of Neurology at Brigham and Women's Hospital, a professor of neurology at Harvard Med School in Boston. He joins us by phone. Welcome to SCIENCE FRIDAY.

DR. MARTIN SAMUELS: Oh, it's a pleasure to be with you.

FLATOW: You can actually be scared to death?

SAMUELS: You can indeed. There's no doubt that it's a real phenomenon.

FLATOW: How does that work?

SAMUELS: Well, it's a strong emotional reaction of any kind. It can be positive, as you said in the lead, or negative. And when this happens suddenly, there is a pulse of autonomic activity, we call it, which means automatic activity of the brain, which releases chemicals, natural chemicals related to adrenaline, which I'm sure everybody has heard about.

And that chemical is mainly good, but there's a small, small risk that it can do harm to the various organs, including your heart.

FLATOW: And as you say, it doesn't have to be a scary experience.

SAMUELS: No, just a sudden, usually unexpected powerful emotional experience. A scary experience would be one example of it, but a powerful positive emotion can do it, as well. I have an example of a guy who hit a hole in one, he played golf his whole life and hit a ball over a rise and didn't see where it went. He and his partner went over and looked down on the green, and the ball was in the hole.

And he said wow, I hit a hole in one, I can die now, and he did.

(LAUGHTER)

FLATOW: Oh jeez.

SAMUELS: So that's what I call a happy ending.

(LAUGHTER)

FLATOW: You also have an incident of a guy who bowled 300.

SAMUELS: Yeah, the guy bowled a perfect game, came back to his team and basically said the same thing as that golfer, you know, I've finally done it, I can die now.

FLATOW: And he did.

SAMUELS: And he did, yeah. So there's no doubt, there's no doubt this can happen. It can happen with positive or negative emotions. It's important to emphasize that it's a very rare phenomenon. It's the small, downside risk of having this powerful autonomic nervous system buried inside of all of our brains.

FLATOW: And there's some real research going into this. You talk about a group of investigators who studied this during the World Cup in Germany.

SAMUELS: Yes, because there were some anecdotal cases of people who had died during excitement around sporting events. Some investigators studied the risk of sudden death during the World Cup in Germany. All the games were being played in Germany. But what they did is cleverly compare the rate of sudden death on the days when the German team was playing versus days when the German team was not playing. These were all Germans, of course, watching the games there in Germany.

And the risk was almost three times greater on the days when the German team was playing. So when they had an emotional investment in the team, there was three times the risk of sudden death during those days.

FLATOW: Now why would your body be built this way?

SAMUELS: Well, what we think is this is left over from our days, our primitive ancestors in the wild. And when they were trying to escape, let's say from jaguars, it was important for them to have their heart beat faster, to pump blood to the muscles at the expense of other parts of the body like the gastrointestinal system, and this system was known as the sympathetic nervous system.

And the great physiologist, Harvard physiologist Walter Cannon was famous for calling this the fight and flight reaction that I'm sure almost all of your listeners have heard about. So the animal was faced with this sudden threat, and the choice is run or fight. In both cases, what that animal needs is a fast heartbeat, a lot of blood pumped to the muscles and so on.

So that's probably what happened. That system was a benefit. And so those genes were preserved over eons, and we have them in our brains.

FLATOW: So this Halloween, this is not something you should be fearful of. I mean...

SAMUELS: Not really, no, because I mean, in our era, for most people, Halloween is not really frightening. It's a fun thing. There was once a time, of course, it was a serious religious holiday, and many people probably were quite frightened. But the important thing to emphasize is that this can't be some kind of a game. That doesn't cause the sympathetic nervous system to have this kind of storm.

It has to be a real event. And that's one of the challenges in studying this, because you can't ethically put subjects at real risk. And so we have to look for experiments of nature, like earthquake and other events in which millions of people are simultaneously, suddenly put at risk. And it has to be a serious risk.

FLATOW: Are there any cases of somebody sneaking up behind you and yelling boo, you know, you jump?

SAMUELS: I don't have any such cases of my own personally. There have been anecdotes again reported about things like this, but it - I wouldn't say it's scientifically proved that that could happen. Theoretically it could.

FLATOW: Let me go to the phones, 1-800-989-8255. Mary, in Tampa Bay. Hi, Mary.

MARY: Hi.

FLATOW: Hi there.

MARY: I was curious because I have a really good reaction when I get scared, so at work, all the time - probably once a week I scream bloody murder because people like to jump out at me, or someone just walks around a corner, and I scream. So I get scared often. What kind of consequences, or - if you get scared often, does it not matter as much?

SAMUELS: That's a very important point. I'm really glad, Mary, that you brought that up, because it turns out that people's conscious conception of how frightened they are isn't correlated at all with the nervous system's real reaction.

So in the past, people have tried to give people what are called stress tolerance tests. They show them spiders and see how high their blood pressure would go, how fast their heart rate would go. It turns out that there's not much correlation between what people say frightens them and what indeed really does frighten them and cause this autonomic storm.

So people frightening you at work, and your jumping or screaming when you see something, that's probably just part of your natural way of handling things. It's very unlikely that that's really an example of one of these serious sympathetic storms.

FLATOW: OK, Mary?

MARY: Good to know. Thank you.

FLATOW: Mary, how do you handle the cable bill when it arrives?

(LAUGHTER)

MARY: I just, I don't know, it's just funny. I laugh. It gets me really good, but I just get really - I startle easily.

FLATOW: All right, have a happy Halloween.

MARY: Thank you.

FLATOW: 1-800-989-8255. A lot of people asking questions. Let's go to Peter in Oxford, Iowa. Hi, Peter.

PETER: Hi. Actually there's a case in Iowa City, which I live near, of someone getting excited during a basketball game, watching it on TV, and he got angry, and he fell over and died. I'm curious, though, if there's any evidence of preconditions in the people that die. And I'll take your answer off the air.

FLATOW: OK, thanks.

SAMUELS: Peter, that's a very, very important question, and I'm often asked that question, are there any predispositions, can we predict in advance certain underlying conditions predisposed to this. And even though it seems intuitive that if you had an underlying heart disease of a more typical type, let's say hardening of the arteries, of the coronary arteries, which is a more common, typical type of heart disease, that you might be at greater risk for this phenomenon.

But in actual fact, this is a very rare phenomenon, and there actually isn't any evidence that that's the case, even though it's intuitive that that ought to be the case. In actual fact, this - everybody is about at equal, very low risk for this phenomenon that we're talking about today. So I have plenty of examples of children, of people with proved no coronary disease, autopsy proved no coronary disease, who have had this happen.

Now of course that's the obverse. That doesn't prove that point that Peter raises, but by - even though it's intuitive, that may not be true that there's a particular underlying group of people who are at risk.

FLATOW: Have you got another anecdote for us of...

SAMUELS: Oh, one of my favorite ones is the Siamese twins Cheng and Eng, who you know were connected at the chest. They lived 63 years connected to each other, had 21 children, if you can believe that, ended up living in North Carolina during the Civil War period.

And they had an ambivalent relationship with each other. They were very different types of people. And in any case, one of them died during the night, and the other one woke to find his brother connected to him by this band, dead. I can't imagine a more stressful situation than that.

And there was a nephew present in the room, and apparently he said your Uncle Cheng just died, I shall now die. And in fact - Eng was his name, in fact did die, dropped dead. And those bodies were actually taken to Philadelphia. An autopsy was performed there, and anybody who visits the Academy of Medicine in Philadelphia can actually see the plaster cast that was made there and the autopsy report that was done.

So that's a really famous case of two important characters, one of whom died of this phenomenon that Walter Cannon called voodoo death.

FLATOW: Yeah, we have - we actually have them up on our website in a video called - on our website at sciencefriday.com. You can see a video Flora did. Any last anecdote?

SAMUELS: Oh, there's the earthquake, of course. Earthquake is a good example because it's an experiment of nature in which millions of people are suddenly put at risk, and it's not a game in a neuropsychologist's laboratory. And so it's the real thing. Anybody who's been in an earthquake knows that you can't really prepare for it.

It's a frightening event, and obviously there's a very small risk that something would happen to you, but there is a real risk. So on several occasions, several major earthquakes in Japan and here in North America, (technical difficulties) for the relative risk of sudden death around the time of earthquake, and it goes up predictably about three to five full (technical difficulties) stays up for about five days after major earthquakes.

FLATOW: All right, Dr. Samuels, thank you very much for taking time to be with us today, and a safe Halloween to you.

SAMUELS: Thank you very much, and thanks a lot for inviting me on. Bye-bye.

FLATOW: You're welcome. Dr. Martin Samuels, chairman of the Department of Neurology at Brigham and Women's Hospital and professor of neurology at Harvard Med School in Boston, and he was on the phone with us. So don't be afraid for Halloween. Just, you know, as I say, the scariest thing you may see is that cable bill coming in.

We're going to take a break, and we're going to continue to talk about the science behind some things that we talk about on Halloween, like Dracula, werewolves, zombies. There is some truth behind the legends. How much truth is there? We're going to talk to some folks who will tell us about that, our number 1-800-989-8255. You can also tweet us @scifri, @-S-C-I-F-R-I. Stay with us, we'll be right back after this break.

(SOUNDBITE OF MUSIC)

FLATOW: I'm Ira Flatow. This is SCIENCE FRIDAY from NPR.

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