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Yes, Fear Can Kill You

Quiescence is the most paradoxical form of terror.

People who have suffered panic attacks — and I'm one — know that fear can be so intense that you feel like you're going to die. Your pulse races, your heart pounds, you find it hard to breathe. You might even pass out. But can your fear become so intense that it actually kills you?

This past Friday, Danielle Goldberg, a 26-year-old Staten Island woman, was riding in her building's elevator up to her sixth-floor apartment just before noon when her neighborhood suffered a blackout. For half an hour, she was trapped inside the small space, in the darkness, alone. In an effort to stifle a growing panic attack, she used her cell phone to call her mother, but it was no use. By the time rescue workers freed her half an hour later, she was unconscious. She died in the hospital a short time later. At first glance, the cause of her death seems clear: pure fright.

But the truth is a bit more complicated.

Yes, being trapped inside an elevator triggered a panic attack that sent Goldberg's fight-or-flight response — the sympathetic nervous system — into full overdrive. Her heart beat so wildly that it was unable to handle the exertion, and she went into cardiac arrest.

The extenuating circumstance, however, is that Goldberg suffered from a congenital heart condition. She was unusually vulnerable, and any extreme exertion of her cardiovascular system might well have had the same effect. We can't truly say that she died of fear any more than we can say of a jogger with a heart defect who drops dead while jogging "died of exercise" or that an elderly millionaire who dies in the saddle with a young admirer "died of sex."

This is not to entirely rule out the idea that you can die of fear, however. As I write in Extreme Fear, the full sympathetic nervous system response that we see in a panic attack isn't the body's only way of preparing itself for danger. Another is a state known as tonic immobility, or quiescence — in lay terms, "playing possum." When an animal is seized by an attacker, the caudal ventrolateral region of the PAG generates a response that from the outside looks like total collapse. In the teeth of a full-blown sympathetic response, the parasympathetic system now swings into overdrive.

The body, insensitive to pain, goes completely limp, often falling to the ground as awkwardly as rag doll, limbs splayed, neck thrown back. Eyes closed, it trembles, defecates, and lies still. It looks, in a word, dead.

This is the position of utter despair, a final last-ditch Hail Mary pass of a strategy. The one hope of quiescence is that the attacker, thinking its quarry has expired, will stop attacking. Indeed, many predators will not eat prey that looks dead. Hawks will starve to death if unable to attack moving prey.

The famed 19th-century missionary David Livingstone was a beneficiary of this effect when he was charged by a lion he'd shot at during a hunting trip in Africa. The animal grabbed him in its jaws and shook him like a rag doll. To his surprise, Livingstone found that he felt no pain, and that indeed it caused "a kind of dreaminess." Fortunately for him, the immobility response worked as intended, and the lion dropped him to go after some other hunters who were moving nearby.

Quiescence is the most paradoxical form of terror. With both branches of the autonomic nervous system at full throttle, the organism is both utterly relaxed and completely alert and ready for action. Pupils are dilated, breathing and heart rate rapid. Though paralyzed, incapable of voluntary action, it can suddenly spring to life and flee if the opportunity arises. If quiescence goes on too long, however, heart rate and blood pressure can plunge dramatically, indeed to the point of death.

Walter Cannon proposed that this phenomenon might explain the demise of indigenous tribesmen who believe themselves cursed by witchcraft. In a 1942 paper entitled "‘Voodoo' Death," he relates several such incidents, including an account by adventurer Arthur Glyn Leonard of a trip to the Lower Niger: "I have seen Kru-men and others die in spite of every effort that was made to save them, simply because they had made up their minds, not (as we thought at the time) to die, but that being in the clutch of malignant demons they were bound to die." Cannon surmised that intense fear can cause such a catastrophic drop in blood pressure that the belief in one's death can became self-fulfilling.

Follow me on Twitter: @extremefear.

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