Professional Documents
Culture Documents
Walter B.
Cannon and
Voodoo
Death:
A Perspective
From 60
Years On
1564 | Editorials
References
1. World Health Organization
(WHO). WHO launches the first global
strategy on traditional and alternative
medicine. Available at: http://www.who.
int/inf/en/pr-2002-38.html. Accessed
May 20, 2002.
2. McNeil D. With folk medicine on
rise, health group is monitoring. New
York Times. May 17, 2002:A8.
3. National Center for Complementary and Alternative Medicine. Major
domains of complementary and alternative medicine. Available at: http://
nccam.nih.gov/nccam/fcp/classify. Accessed June 7, 2001.
4. Green LA, Fryer GE Jr, Yawn BP,
Lanier D, Dovey SM. The ecology of
medicine revisited. N Engl J Med. 2001;
344:20212025.
5. Weiss R, Fintelmann V. Herbal
Medicine. New York, NY: Thieme;
2000.
EDITORIALS
from the liverall effects that together prepare the animal to attack or runto fight or flee.
Cannon thus elegantly lays out
both the physiology and the evolutionary rationale for the fight
or flight response, a term still in
use today that he coined to describe this neurophysiological
behavioral response pattern.
We could not have provided a
better rationale for this aspect of
the phenomenon today. This
piece has stood the test of time.
In the 60 years since Cannon
first published his work, we have
simply gained a clearer understanding of the brain regions that
become activated when a fearful
stimulus is experienced and a
better road map of the pathways
linking those brain centers involved in receiving sensory signals (in Cannons example, seeing
a bone pointed at one) to the
part of the brain that processes
the emotional component of
fearthe amygdala. In todays
terms, we would call this the
vision-to-fear pathway or auditory-to-fear pathway, depending
on the sense through which the
threat is initially received.
We have a deeper understanding of the neurotransmitters and
neuropeptides involved in initiating these responses and perpetuating them through learning and
memory. We know how such
chemical signals are translated
into electrical impulses and how
quickly or slowly they are conveyed along nerve fibers. And
we now know that such nerve
chemicals and proteins are made
by genes within the nucleus of
nerve cells, that are switched on
and off by all sorts of chemical
and physical signals. We know
that when we learn to fear something there are permanent
changes in the shape and wiring
of nerve cells that make it more
likely that the next time we experience the fearful stimulus, those
same pathways will be switched
on all the more rapidly.
Strikingly absent, however,
from Cannons explanation is the
hormonal stress responsethe
cascade of hormones released
from the brain, pituitary gland,
and adrenal gland within minutes of exposure to any sort of
stressor. This is because in 1942,
when the article was written,
many of these hormones were
yet to be discovered. Furthermore, the term stress, popularized by Cannons admirer Hans
Selye and others in the postwar
period, was not yet in general
use. The structure of cortisol, the
hormone released from the cortex of the adrenal glands during
stress, was identified in 1936 by
Edward Kendall and Tadeus
Reichstein,2,3 who received the
Nobel Prize for their discoveries
in 1950 together with Philip
Hench. However, the full cascade
of hormones involved in the hormonal stress response was not
fully elucidated until the identity
of the brains hypothalamic stress
hormone, corticotropin releasing
hormone or CRH, was discovered by Wylie Vale in 1981.4
Thus, Cannon could not have
included in his scenario of the
possible causes of voodoo death
the role of hypothalamic CRH released after signals from the
amygdala, the brains fear center,
reached the hypothalamus. Nor
could he include how the crosstalk between the brain stem
adrenaline centers involved in
initiation of the sympathetic response could coordinate with
hormones released from the
brains hypothalamic stress center5 to cause a massive release of
both adrenaline-like nerve chemicals and stress hormones. Together these might well cause ill-
Editorials | 1565
EDITORIALS
References
1. Cannon WB. Voodoo death. Am
J Public Health. 2002;92:15931596.
2. Mason HL, Myers CS, Kendall EC.
The chemistry of crystalline substances
isolated from the suprarenal gland.
J Biol Chem. 1936;114:613631.
3. Hench PS, Kendall EC, Slocumb
CH, et al. Effects of cortisone acetate
and primary ACTH on rheumatoid
Alternative
Therapies and
Public Health:
Crisis or
Opportunity?
1566 | Editorials
systems: the brain and the immune system. Pharmacol Rev. 2000;52:
595638.
8. Goldstein, DS. The Autonomic Nervous System in Health and Disease. New
York, NY: Marcel Dekker Inc; 2001.
ALTERNATIVE IN THEIR
ORIGIN
Therapies and other health
practices seem to have been labeled alternative in the Western
biomedical setting because they