The idea that dying people hang on to life in order to celebrate one more birthday or holiday has no firm scientific basis, according to behavioral medicine researchers in the School of Medicine.
“I’ve worked in hospitals since I was about 16 years old, and I’ve seen that people in medicine have a lot of very strongly held beliefs, like the idea that certain people hang on,” says Judith A. Skala, Ph.D., research associate in the Behavioral Medicine Center. “But none of the studies has convincingly established that the time of death can be postponed through force of will or hastened by loss of the desire to live.”
Skala is the lead author of a review article that appeared in a recent issue of the journal Psychosomatic Medicine. With Kenneth E. Freedland, Ph.D., professor of psychiatry, Skala reviewed a number of studies that have looked at whether death rates increase or decrease before, during or after symbolically important occasions such as holidays or birthdays.
They looked at studies dating back to the early 1970s but found no convincing evidence that people can delay or hasten their own deaths.
Freedland and Skala study the effects of stress and depression on heart patients, and they have observed higher death rates in people who are depressed and have heart disease. But they say that those psychological effects on life and death unfold over months or years.
“You might find someone who is depressed following a heart attack and then look at the pattern of mortality over two or three years and see that people who were depressed right after their heart attack tended to die sooner,” Freedland says. “But that’s a long period of time. In contrast, in the studies of people delaying death by trying to hang on until an important holiday, we’re talking about a period as brief as a day or two.”
Freedland says that if it was possible to learn how people might tip the balance one way or the other, it could provide some insight into the psychological processes that can enhance or inhibit survival.
“The problem we ran into is that we didn’t find consistent evidence that people really have this ability,” Freedland says. “Not to say that they don’t. It’s just that we don’t see, in the overall pattern of evidence, that it’s been proven at all.”
The available research analyzed by Skala and Freedland is contradictory, shows only modest effects and some is of poor quality. In many cases, the studies also fail to explain the mechanisms that might delay or advance death.
For instance, one study claimed there was a 19 percent dip in deaths among prominent Americans in the month before their birthdays and a 14 percent rise in deaths in the month afterward. However, Skala and Freedland say, the original authors included the birth month itself in the “after” category. That meant some post-birthday deaths may have occurred before a person’s actual birthday.
Two other studies analyzed deaths among members of certain religious groups before and after major holidays. A study of Catholic priests found no variation in mortality around Christmas, Easter, birthdays or anniversaries of their ordinations. Another found a dip in deaths before and a rise after Christmas but no such pattern around Easter.
Skala and Freedland acknowledge that some terminally ill people who want to see a grandchild get married or to celebrate another important anniversary do survive until then, but they say the scientific literature contains no evidence that people can influence that timing by willpower alone. Part of the problem, they say, is the literature looking into the phenomenon consists mainly of population-based studies.
To truly learn whether people can “hang on” or “give up,” it will be necessary to pick a group of people with the same disorder at the same stage — say, terminal cancer. Then, studying those people during the time they have left, Freedland and Skala say it may be possible to identify psychological factors that seem to lengthen the time a person survives.
“If you were studying an individual — or a group of individuals — you could find out what was personally meaningful for those people,” Freedland says. “For one person, it might be a holiday. For another person, it might be a graduation. Each person will have his or her own reasons for wanting to continue living.”
Skala asks, “Are we to take that information and then think that if somebody didn’t make it to an important occasion, it wasn’t really as important to them as they said it was? Could it be that if they made it to somebody’s First Communion but didn’t make it to someone else’s Bar Mitzvah, that one particular relative meant more to Grandma than another?
“I can tell you from my experience as a nurse that many times patients really want to make it to an event or a holiday, but they simply can’t.”
And, Skala says, there also are many people who mope about the fact that they’re still living into their 90s. Yet their stated desire to die doesn’t seem to hasten their deaths.
In their article, Skala and Freedland cited the 1970 film Little Big Man, in which Chief Dan George delivers the famous line “It is a good day to die.” Then he goes up to the top of a hill expecting to do so.
Instead, he is doused by a passing rainstorm and decides, with a shrug, that perhaps it is not such a good day to die after all.