A Sophisticated Version
of Voodoo Death
Report of a Case
JAMES L. MATHIS, M.D.
A case is presented in which severe and eventually fatal asthma developed in a
previously healthy adult male following his mother's prophecy of "dire results" if
he went counter to her wishes. An indirect connection is suggested between the
mother's death wish and the outcome. It is postulated that fatal psychosomatic
conditions can be modifications of the more primitive and direct "voodoo death."
A brief discussion is given of the psychogenic factors involved.
T HE BELIEF that death could be pro- hopelessness and helplessness; in effect,
duced by magical means was an unques- a parasympathetic death.3 Zoological ex-
tionable part of man's early culture.1 perts have observed this in the deaths of
Many such cases have been reported in wild animals who find themselves sud-
primitive societies. Although modern denly caged in an apparently hopeless
man has coined the term "psychophysio- situation.4 The thin veneer of civilized
logical reactions" to cover these phe- intellect covering man's primitive emo-
nomena when they occur in his advanced tions serves as an armor to prevent vul-
society, actual deaths from such causes nerability to this type of influence. It is
are infrequently reported. The case to suggested that when this armor proves
be presented may represent a sophisti- too thin, modern man may also succumb,
cated version of "voodoo death." albeit less directly and more slowly, than
Cannon stated that voodoo death re- did his less sophisticated predecessors.
sulted when all body forces were mo-
bilized and maintained for an action
which never came.2 He felt that the Case Report
death was primarily due to prolonged
overstimulation of the adrenals by the Mr. X, age 53, was admitted on Jan. 7,
1960 with severe bronchial asthma. He was
sympathetic nervous system. Richter, transferred from his hometown hospital
however, felt that the demise was due to where he had been admitted 2 days previ-
a complete "giving up," a feeling of utter ously in a semicomatose condition. Routine
From the University of Oklahoma Medical
measures had failed to abort the attack. Af-
Center, Veterans Administration Hospital, ter 2 weeks' hospitalization he was dis-
Oklahoma City, Okla. charged symptom-free on bronchodilators
Received for publication July 1, 19fi3. and expectorants.
MATH IS 105
He was next admitted on July 13, 1960, topsy reported the cause of death as acute
in a similar condition. In the interim he had right ventricular dilatation and bronchial
been hospitalized in private institutions 6 asthma. The bronchial tubes were markedly
times. Three attacks had resulted in loss of constricted and filled with extremely tena-
consciousness and epileptic-like convulsions cious mucus.
for which he was given Dilantin. Non-spe- The history of X's illness is unusually
cific t-wave changes on an EKG had led to reminiscent of descriptions of psychological
digitalization, although no signs of cardiac (voodoo) death. He was the third child in
failure were noted by examination or his- a sibship of five. All except the youngest,
tory. These medications were continued, who is mentally retarded, are successful,
and some small nasal polyps were removed educated people. X did not complete the
under local anesthesia. He improved rapid- eighth grade, partially because he was giv-
ly and following a thorough work-up, he en the responsibility for keeping the incom-
was discharged with diagnoses of bronchial petent younger brother out of trouble, a
asthma and mild obstructive emphysema. role which he did not like, but which he
He went directly from the hospital to his filled well. He complained many times that
mother's home. In a few hours he was his mother never showed him the gratitude
wheezing again, and in less than 48 hr. he and appreciation he deserved for his care of
was readmitted by ambulance in a near- this brother. He described his mother as a
terminal condition. Medical management wonderful lady who made all the family de-
aborted the attack, but the patient became cisions correctly and who never met a situa-
extremely depressed and voiced feelings of tion she could not control.
utter futility and hopelessness. Psychiatric The father, a traveling salesman rarely
consultation advised transfer to its service home, died when X was in his early teens.
on Aug. 4, 1960. Since the older brother was in college, X
Medical management was continued with became the man of the household. He lived
the addition of Tofranil, 100 mg. daily. The with his mother and worked in local filling
asthma remained under control and the de- stations until 31 years of age. Two mar-
pression rapidly improved. On Aug. 11, he riages during this period rapidly ended in
was given a pass, but returned early from a divorce. Both failures were predicted by
visit to his mother's home where he noted his mother.
rapidly increasing wheezing. Shortly after At age 31, he bought a nightclub in a
entering the ward, his breathing began to moderate-sized city. His mother helped him
improve. finance the business and continued to keep
On Aug. 17, X was given another pass, the accounts of what proved to be a very
with strict instructions for his activities. He successful venture. During his one year of
was to visit his wife, but was to avoid all military service, she ran the club efficiently
contact with his mother. He returned in ex- and profitably by herself.
cellent spirits after 24 hr. with no signs of At age 38 X married a well-educated
asthma. He was now willing to discuss the school teacher 10 years his junior. He was
possible relationship of his asthma to mater- now a respected and successful business-
nal influence. In addition to this type of man, but he saw himself as an ignorant and
psychotherapy, plans for a future entry into inadequate man, extremely fortunate to
business were eagerly discussed. With one marry an esteemed woman of whom his
exception he remained in excellent spirits; mother approved. His wife resented the
the exception was that he retained grave dependency X felt toward his demanding
doubts of escaping his physical disability and disdainful mother, but the marriage oth-
permanently erwise was described as ideal. A son was
X was seen for a 30-min. interview at 5 born, the business prospered, and life was
P.M. on Aug. 23. Some dental work had uncomplicated until November 1959. At
been completed that day, and he was in ex- this time he received a profitable offer for
cellent physical and mental condition. At his business. His mother became distraught
6:35 P.M. he was found gasping for breath when informed of the proposed transaction.
cyanotic, and semicomatose. He was pro- When, with much indecision and misgiving,
nounced dead at 6:55 P.M. A complete au- and with the support of his wife, he decided
VOL XXVI, NO. 2, 1964
106 VOODOO DEATH
to accept the offer, his mother said, "Do this the story. X had told his mother that he
and something dire will happen to you." had concrete plans to reinvest his money in
Two days later he had his first mild spell of another business which would not require
wheezing. her intervention. He expressed optimism
X had no previous history of respiratory for his future health. His mother made no
difficulty of any kind. He and his wife attempt to dissuade him, but ended the con-
agreed that he had not had a common cold versation with a statement to the effect that
in about 10 years. He consulted his physi- regardless of how he or the doctors felt, he
cian and was given some capsules which de- should remember her warning and be pre-
creased this wheezing and cough to an ac- pared for her prediction of "dire results."
ceptable level for the next several weeks. Give or take a few minutes, X was dead
Relations with his mother remained strained. within the hour.
On Jan. 2, 1960, the sale of his business
was completed. The next day his asthma
was much worse. Two days later he was Discussion
rushed to the hospital via ambulance, and
on January 7 he was transferred to the V.A. Psychophysiological conditions are
hospital. Upon completion of the sale his
mother had become very angry and had known to be present in a large percent-
repeatedly reminded him of her prediction age of medical patients, but the possi-
of dire results. She had used the words, bility that emotional factors may con-
"Something will strike you." tribute in a major way to an illness is not
Numerous hospitalizations, asthmatic at- often considered. Psychological death,
tacks 3 4 times per week, three convulsions,
— whether by the weird incantations of a
and the apparent inability of the medical primitive shaman or by the malevolent
profession to help him, dovetailed into X's wish of a thwarted mother, is a difficult
growing idea that mother was right again. thing for a scientifically trained physi-
The depression for which psychiatric con- cian to accept. Whatever name is given,
sultation was sought was marked by his fre- it seems evident that such things may oc-
quent protestations of the hopelessness of
his condition. A hopeful sign appeared cur in a more complex although less
when he was able consciously to see some dramatic form in our modern civilization.
connection between the asthmatic attacks The influence of the mother's death
and contact with his mother. However, he wish in this case can be regarded at least
did not forget that mother had previously as a triggering mechanism for the asth-
proven infallible; in fact, he reminded me matic attacks. X may have interpreted
of this on the afternoon of his death. the prophecy as a sign that mother was
This last interview was primarily con- lost and reconciliation impossible. This
cerned with his plans to reinvest the capi- might explain the further aggravation
tal from the sale of his business. The de- and intensity of the attacks, and the fatal
sirability of excluding his mother from the
new venture and whether or not she would attack could be regarded as the final
resent this were discussed. He expressed event in a chain of circumstances in
the belief that he was "allergic" to his which mother's prophecy played a major
mother, but could not understand how this precipitating and sustaining role.
had developed so late in life. No attempt In a summary of the psychogenic fac-
was made, and this was also true of past in- tors in bronchial asthma, French and
terviews, to approach the problem on other Alexander state: "Firstly, the asthmatic
than a very superficial level. The interview attack is a reaction to the danger of sep-
ended with X reaffirming his fear of his
mother's prediction. aration from the mother, and secondly,
In reconstructing the events of his death, the attack is a sort of equivalent of an
it was found that X had called his mother inhibited and repressed cry of anxiety
shortly after 5:30 P.M. His wife, present in and rage, and thirdly, the sources of
the mother's home at the time, confirmed danger of losing the mother are due to
some temptation to which the patient is velopment of a previously nonexistent
exposed."5 and eventually fatal disease due to "voo-
In a study of a hospitalized medical doo-like" suggestion, then it may be that
population Schmale was impressed by much of the voodoo death of folklore was
the depression which followed a real or also psychologically provoked through
symbolic loss of or separation from an physiological mechanisms different from
important person in individuals with life- those described by Cannon and Richter;
long unsupported dependency needs and that is, through development of psycho-
rejection.6 The question arose as to why somatic disease.
such patients developed physiological V. A. Hospital
symptoms rather than pure psychological 921 N.E. 13th St.
depression. X poses a similar problem. Oklahoma City, Okla.
Also unanswered is whether the asthma
developed as a "voodoo-like" response to
the mother's threat and continued to be References
aggravated to the point of death, or
whether it developed from other causes 1. FBAZEH, J., and GASTON, T. H. The
and was aided and nurtured by the per- New Golden Bough. Criterion Books,
ceived hopelessness of the situation. New York, 1959.
2. CANNON, W. B. Voodoo death. Psycho-
Passive-dependent individuals such as som. Med. 19:182, 1957.
Mr. X are not rare. They are highly sug- 3. RICHTER, C. On the phenomenon of
gestible people. When a situation arises sudden death in animals and men.
which threatens a loss of dependency Psychosom. Med. 19.191, 1959.
gratifications, real or symbolic, these 4. Personal communication from Warren
people may develop physical illness and Thomas, D.V.M., Director, Lincoln Park
serious depression. In the case presented Zoo, Oklahoma City, Okla.
the mother's suggestion of "dire results" 5. FRENCH and ALEXANDER. Psychogenic
was direct and verbal. More often than factors in bronchial asthma. Psychoso-
matic Medicine Monographs II and IV,
one realizes it may be implied or even 1941.
fantasied by the victim and it may be 6. SCHMALE, A. H., JR. Relation of separa-
well to investigate the frequency with tion and depression to disease. I. a re-
which this actually occurs. port on a hospitalized medical popula-
If this case represents the sudden de- tion. Psychosom. Med. 20:259, 1958.
VOL. XXVI, NO. 2, 1964