Voodoo death is brain's lethal response to fear.

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SAN DIEGO -- Voodoo death--or sudden death brought about by emotional shock--is a confirmed phenomenon, and the reason it occurs is no longer a mystery, Dr. Martin Samuels said at the annual meeting of the Association of Medicine and Psychiatry.A specific area of the brain has been mapped that is able to send signals affecting heart rate, and a distinct lesion has been identified, he said.In addition, several studies have looked at large natural disasters, such as earthquakes, to see whether excess unexplained death associated with the fear they cause had occurred. Those studies have found excess deaths and evidence of cardiac abnormalities. In one study, researchers collected Holter monitor data from patients in Greece after a 1984 earthquake. The data showed a fourfold increase in arrhythmias that lasted for 5 days after the earthquake.In general, although death can occur immediately, the investigations of natural disasters have suggested that the excess deaths peak at about 6 days after the disaster, said Dr. Samuels, a professor of neurology at Harvard Medical School, Boston. This may suggest two different types, he added.Those events are not to be mistaken for myocardial infarctions that may be related to stress; this is a distinct entity, Dr. Samuels cautioned.The first neurologist to conduct a systematic study of voodoo death was Dr. Walter B. Cannon of Harvard University, who published a seminal paper in 1942. For the study. Dr. Cannon, who was interested in the physiology of shock, collected descriptions of the use of the "pointing bone," a shamanistic practice of the Australian aborigines used to punish serious tribal transgressions. The bone was capital punishment. When a shaman pointed the bone at a tribe member, this person died, sometimes immediately, sometimes over the course of a few days.According to the descriptions, it was very efficient.Dr. Cannon is best known for originating the concept of the "fight or flight" response, and that is what this type of sudden death is related to, Dr. Samuels said.The heart is enervated, and it is this enervation that allows for the fight or flight response, involving adrenalin release and increased heart rate, that humans have when they perceive an immediate threat. In some cases, however, this response overwhelms the system. Catecholamines released as part of the response build up, opening the calcium channels and keeping them open. As a result, too much calcium flows into the cells of the myocardium, and the excess calcium creates free radicals, which cause cell death. Under the microscope, one sees bands of cells that have died in a contracted state and are highly mineralized, Dr. Samuels said.The reports of this type of sudden death reach back all the way to the Bible: An early follower of the Christian church, who has held back a tithe he owes, falls dead upon being confronted by Peter, who tells him he has fooled no one and has imperiled his immortal soul.More recently, a minister in Boston who was at home quietly reading the Bible died of fright when policemen on a drug raid mistook his apartment for the one they wanted and burst his door down. Lesions in that minister's heart confirmed that he had indeed died of this kind of sudden, sympathetic nervous system storm.One of the most interesting cases involved the famous "Siamese twins," Chang and Eng, who came to this country and lived in Mt. Airy, N.C., during the 19th century, Dr. Samuels said. Chang died first in the middle of the night, 1 year after having a serious stroke. When Eng discovered that his brother had died, he announced to a nephew that he, too, would die. One hour later, he did. An autopsy could not find a cause of death for Eng, noted Dr. Samuels.BY TIMOTHY F. KIRNSacramento Bureau