It’s a staple of ghost stories, horror films, spooky TV shows, and creepy books. And I suppose for someone with a heart condition, it may well be true. But can a young, healthy person be literally scared to death, without any physical cause?

'Rebecca S., Seattle

For once fiction writers and doctors agree: It’s possible to die of fright, or for that matter grief, anger, joy or just about any other intense emotion. Most victims are older, and likely in precarious health to start with, but a few are young'in some cases really young. One British kid, in what is surely a mother’s worst nightmare, was reportedly so freaked out by a visit to the dentist in 1970 that she died of a heart attack at age four.

Sudden death due to stress has been reported throughout history. Physician George Engel, in a 1971 review in Annals of Internal Medicine, notes that in the New Testament the apostle Peter tells Ananias, “You have lied not to man but to God,” whereupon Ananias and later his wife Sapphira fall down dead. For more recent instances, Engel over a six-year period compiled press accounts of 170 deaths due to “disrupting life events.” Three-fifths involved men, commonly 45 to 55 years old; the peak age for women was 70 to 75. In 27 percent of cases, the largest category, the precipitating event involved fear. Examples: “A 63-year-old security guard died after being bound by robbers. … A woman seeing some teenagers outside her apartment beating and robbing a bus driver died while phoning the police. … A 35-year-old man accused of robbery told his lawyer, ‘I’m scared to death!’; then collapsed and died.

As the above may suggest, most of Engel’s cases aren’t that startling. In fact, the most dramatic story I could come up with after hours of rooting around in the journals involved a hated assistant at a college whom the students pretended to execute: “The assistant was held with his head on the chopping block, eyes bandaged, while one student made the noise of a swinging axe [and] another dropped a warm, wet cloth on his neck. The assistant died instantly.

Yow. But the lack of detail smells to me of urban legend, and others have reached the same conclusion. The typical victim per Engel is a middle-age male who undergoes a mildly traumatic event and dies within an hour. Not to be callous, but so what? Sudden cardiac death (fatal heart attack, essentially) is common'roughly 450,000 cases per year in the United States excluding deaths in hospitals. Eighty-five to ninety percent of the time the victim has heart disease. Sure, in cases linked to an emotional jolt, maybe stress was a factor; still, the guy usually had problems to start with and at most was pushed over the edge.

The same can often be said of younger victims of noncardiac sudden death. Engel tells of a 17-year-old boy who collapsed and died at 6 a.m., June 4, 1970; exactly one year previously, at 5:12 AM, June 4, 1969, his older brother had died of car-crash injuries. Coincidence or something more? Who knows? Fact is, the 17-year-old was done in by hemorrhage following a ruptured aneurysm, a condition arising from birth defect, injury, etc., not fraternal grief. The demise of the 4-year-old dental patient is harder to explain, but she’d been sedated to calm her, and anesthesia in the young is inherently risky.

The most interesting scared-to-death cases are what we might call willed deaths. The classic scenario was described by physiologist Walter Cannon in a famous 1942 paper entitled “‘Voodoo’ Death”: The victim learns he’s eaten taboo food or gets hexed by a sorcerer, panics, and dies of no obvious organic cause. Many such accounts are hearsay, but Clifton Meador reported two well-documented cases in 1992. In the first, a 60-year-old man was brought to the hospital near death after being cursed by a voodoo priest. The attending physician staged a “cure” in which, through sleight of hand, the victim was persuaded he’d vomited up a live lizard, the embodiment of the curse. He soon recovered and lived 10 more years.

OK, this mope’s real problem was that, pre-“cure,” he was sure he was a goner, stopped eating, and was wasting away from starvation. Case No. 2 resists such easy analysis. Here the patient was a man in his 70s who’d been diagnosed with incurable cancer and told he had only a few months left. Wanting to live till Christmas, he ate and exercised as directed and walked out of the hospital for the holidays much improved. He was readmitted shortly after New Year’s close to death and expired within 24 hours. An autopsy found the cancer diagnosis had been exaggerated; his physical complaints weren’t enough to kill him. Instead, he and everyone else were convinced he was going to die, so he did.

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