UCL in the News: Death? It's just a state of mind

What is it about certain people, he asks, that enables them to survive starvation, extreme cold, extreme heat or lack of oxygen? He suggests that genes, environment and luck all play a part. …

But what Montgomery was not able to tackle in the lectures is the question of the will to live in medical situations. …

Is Montgomery suggesting that some people who succumb to fatal illnesses may just lack the will to survive? "No. It's important not to generalise - otherwise you end up insulting the dead and upsetting the bereaved." Nor is his suggestion faith-based: "When I talk about the will to live, which very few people do, I'm not talking about intervention with prayer. I'm talking about behavioural psychology. What I am saying is that one's mental attitude or emotional state can cause fatal illnesses or help one survive. There's a lot of data to suggest this is the case."

He cites the so-called Whitehall study by Sir Michael Marmot, professor of epidemiology and public health at University College London, which concluded that life expectancy and susceptibility to fatal disease can be influenced by social status. Marmot surveyed civil servants and found that, of those who suffer coronary heart disease, what was important wasn't just diet or whether a person smoked, but sense of status. "Middle management were in the worst position in terms of stress, because they had low status," says Montgomery. "The higher-ranking people were OK because they would say: 'Make it so,' and walk away. They didn't have the stress of putting something into practice. The middle managers did and they were stressed as a result.

"The point is one's emotional condition - stress - can cause coronary disease. The St John Ambulance see this a lot - people who have heart attacks at football matches." …

In his lectures, Montgomery focuses on cases of survivors in more dramatic life-or-death situations - fitting, perhaps, for a doctor who is himself familiar with extreme activities. Montgomery once jumped out of a plane at 14,000 feet with no clothes on, he has twice run a 100km ultra-marathon, and reportedly holds the world record for underwater piano playing (110 hours). He also once stayed awake for eight days in a row at work.

Extreme situations clearly intrigue Montgomery. He is fascinated by the fact that survivors often mentally rehearse how they would behave in life-or-death situations, and connects such behaviour to his notion of the will to live. …

Montgomery concedes that more work is needed on the notion of the will to live. "But when you come - as I often do - across two patients who seem to be in a similar condition and have the same strengths and weaknesses, but one dies and one lives, I'm convinced there is a will to live and that it's important in deciding who survives." …

The Christmas Lectures will be broadcast on Channel Five at 7.15pm from December 24-28.

Stuart Jeffries, 'The Guardian'