It’s that time of year again, folks. The nights are drawing in, there’s a nip in the air, and the streets are filling with tiny demons and goblins armed with goodie bags for treats – and, if you’re unlucky, certain tricks for those who displease them. That’s right friends, it’s spooky season. These days, Halloween is a mostly civil affair, but that wasn’t always the case. Back in the 19th and early 20th centuries, it was a night of dangerous pranks and vandalism. Rather than worrying about their houses getting TP’d, there were reports of people literally dying of fright on their front porches. Of course, that was over 100 years ago, when medical knowledge wasn’t as advanced as it is now. We’re sure the coroners recorded the cause of death as best they knew how, but you can’t really be scared to death – can you? Is it really possible to die of fright? “Yes, it absolutely is, sort of,” Dr Philip Lee, consultant physician in acute medicine and medicine for the elderly, told IFLScience. “Can one be scared to death? Yes,” Dr Martin Samuels, a neurologist and program director for Interdisciplinary Neuroscience at Brigham and Women’s Hospital, told ABC News back in 2006. He’s an expert on the phenomenon of sudden death, and he’s dedicated years to studying the hows, whys, and whos of death by fright. “There is unequivocal evidence that one can be scared to death under certain and very specific circumstances.” How can you die of fright? When it comes to being scared to death, there are basically two ways you can go, says Lee. “If you have an underlying heart condition, or hardened arteries due to high blood pressure, smoking, cholesterol, etc, then the chances of you dying of a sudden shock does increase,” he explained. “Either from a heart attack, or a stroke.” In this case, the cause of death is a huge surge of adrenaline from the brain, which pushes the body into immediate fight-or-flight mode. Your heart beats faster, your pupils dilate, and blood flows to your muscles, all in a prehistoric attempt to escape danger. However, a sudden influx of adrenaline into the heart can cause a dangerous condition called ventricular fibrillation – where the heart quivers (or “fibrillates”) rather than beating properly, and blood is not pumped through the body. That can be fatal on its own, but it’s especially dangerous when combined with another effect of the hormone surge: the release of calcium into the heart. “Calcium rushes into the heart cells, which causes the heart muscle to contract strongly," explained Dr Robert Glatter, an emergency physician at Lenox Hill Hospital in New York, to Live Science in 2015. "Basically, in a massive response, the calcium keeps on pouring in, and the heart muscles can't relax.” “It ultimately leads to a drop in blood pressure, because without blood for the brain, you lose consciousness,” he explained. “It doesn't have to be a person with pre-existing heart disease, although those people would certainly be at higher risk.” This isn't the only way it can happen. Under the right circumstances, a sudden fright – or, in fact, any strong emotion – can take you out by breaking your heart. “[It’s] a condition called takotsubo cardiomyopathy, where a sudden shock or grief causes heart failure and you die from that,” explained Lee. “Basically too much noradrenaline [or] adrenaline, and the bottom of your heart stops pumping properly.” Takotsubo cardiomyopathy is rare – although potentially not as rare as we think – and while it mostly affects women, it can strike anybody. Other than the fact that it can be triggered by sudden stress, researchers don’t know too much about how it happens, either. “I have cases of children with absolutely no heart disease who died on amusement-park rides,” Samuels told ABC News. “It would be like getting an enormous dose of speed or ecstasy.” Oh, and the name? It comes from the grisly effect the condition has on your heart. The left ventricle balloons out, so that it “looks like a fishing pot for octopus from Japan,” Lee told IFLScience. “Tako = octopus,” he explained. “Tsubo = pot.” But does it really happen? Getting scared to death may be rare, but it’s far from theoretical – there’s plenty of examples of people being frightened off their mortal coil throughout history. In 1855, Hannah Rallinson of Sheffield, England died after being told a particularly scary ghost story – her death, the coroner ruled, was “certainly … caused by the fright she had received on the previous day, up to which time she was in perfect health and spirits.” And two years after that, a teenager, Robert Mitchell, died after a farmhand dressed up in a white sheet to scare him on his way to collect some milk. Then there’s the case of Kenneth Lay, the founder and CEO of energy company Enron. In 2001, the company collapsed into the largest bankruptcy in US history at that point. Shareholders filed a $400 billion lawsuit, and Lay, along with several other executives, were indicted for a variety of charges – only Lay, unlike the 21 others who faced trial, never saw a day in prison. Why? You guessed it – the fear of getting his comeuppance killed him, says Samuels. “He was in his 60s, probably going to prison, probably for life, nothing he could do about it,” he told ABC. “All you could say is that it is the perfect set up for the sudden death.” Another doctor, cardiologist Dr Holly Anderson, told ABC about a 60-year-old woman’s reaction to bad news about her husband’s health. As the couple left the doctor’s office, Anderson recounted, the woman felt a sudden tightness in her chest and she was unable to breathe. “After I had whisked her off to the emergency room and hooked her up to an EKG, I was surprised to see her whole heart had stopped moving, yet she had perfect blood supply to the heart,” Anderson said. ”She was so emotionally overwhelmed about her husband's condition it literally stopped her heart.” In fact, it’s probably more common than you think. According to Samuels, there’s about one sudden death every day in any major city – a number which increases after major catastrophes. For example, after the Fukushima disaster in 2011, the rates of sudden cardiac and unexpected death in nearby Iwate prefecture more than doubled compared to the previous year, and in 1994, when Los Angeles suffered one of the strongest earthquakes ever recorded in the US, rates of sudden cardiac death immediately increased by a factor of five. “My own view is that any human is potentially at risk. We all carry this little bomb inside us,” Samuels told ABC. “We're all at risk. If the situation is just right, if the stress is bad enough, if it's acute enough, if there's no way out, any of us can die.” Scary! So should I be worried? Well, when it comes to dying of acute stress, you should probably not, uh, stress about it too much. Just think about “Mrs AB”, an apparently healthy 43-year-old Canadian woman who dropped dead after minor and uneventful surgery. Puzzled, her doctors spoke to her sister, who revealed that a fortune teller nearly four decades earlier had told the woman she would die at 43. “We wonder if the severe emotional tensions of the patient superimposed on the physiological stress of surgery had any bearing upon her death,” the doctors concluded. In any case, it takes a big event to scare a person to death – and it may not be the kind of thing you expect. “People's conscious conception of how frightened they are isn't correlated at all with the nervous system's real reaction,” Samuels explained in a 2012 interview for NPR. “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.” In other words, while a life-changing event like a tsunami or the death of a loved one could feasibly scare you to death, you’re unlikely to meet the Grim Reaper this weekend while handing out candy. “You can have a sudden cardiac-related event related to an adrenaline surge, but I think it would be a stretch to say you could get that from someone coming in a werewolf costume to your front door,” said Dr Vincent Bufalino, a cardiologist and president of Advocate Medical Group in Downers Grove, Illinois. “This is the kind of thing that you can't prepare for. If it happens, it happens, and you hope your body doesn't overreact to that event.” Samuels agrees. “I don't believe there are any studies showing that Halloween falls into this category [of events that can cause sudden death],” he told ABC. But if something does take you by surprise, there’s some good advice out there on how to cope. The best part is, it’s easy – you’re doing it right now. “Things like taking a few deep breaths might seem kind of silly, but when you're breathing, it makes the heart slow down a little bit,” advised Humaira Siddiqi, the chief of psychiatry at Kaiser Permanente in northern Virginia, in The Atlantic. “You're consciously slowing down the body’s sympathetic response, and when you do that, the grip the sympathetic system has on the body is loosened, and you're allowed now to relax and get [in] control.” “It's a good thing that we have the fear response. It's a good thing that we have anxiety, and it's even a good thing we have depression, because they are signals or alarms that something's wrong,” she added. “We've evolved with fear as an adaptive mechanism. If something like that could kill us off, we would not have evolved with it.” Source
