Getting to the Heart of Illness –
and
of Heart Disease
Listed on the following paragraph[next page] is an extended
set of everyday expressions, many of which are mentioned in other
sections of this book and all of which refer to the ‘heart’.
Together they ‘get to the heart’ of what I call the ‘felt body’
or ‘lived body ’. For the ‘heart’ they refer to is not a mere
biological organ which mechanically pumps blood, and neither do the
expressions refer merely to ‘states of mind’ separate from and
independent of the body. Instead the ‘heart’ they all refer to is
an organ of our lived body rather than our ‘physical body’. It is
the heart experienced not as a biological organ but as the ‘heart’
of the lived body – understood as an
organ of feeling awareness.
“The Language of the
Heart”
‘a loving heart’
‘a passionate heart’
a ‘big heart’ / a ‘kind heart’
a ‘cold heart’ / ‘cold-hearted’
a ‘warm heart’ / ‘warm-hearted’
to be ‘open hearted’ or
‘closed-hearted’
to be ‘heart-broken’ or
‘broken-hearted’
to ‘go to’ or ‘get to’ the heart
of something’
to be ‘hard-hearted’ or to ‘harden
one’s heart’
to have or not have the ‘heart’ for
something
to suffer an ‘aching heart’ or
‘heartache’
to be ‘heartened’ or ‘disheartened’
to ‘lose heart’ or to ‘lack heart’
to have a ‘heart-to-heart’ talk
to feel ‘stabbed in the heart’
to ‘take something to heart’
to ‘strengthen one’s heart’
to speak ‘from the heart’
to feel one’s heart ‘sink’
a ‘heartfelt emotion’
to be ‘heartless’
a ‘frozen heart’
‘At the heart’ of Life Medicine lie three basic understandings all linking Language, Life and Illness:
- That everyday language referring to any of the parts, organs or functions of the human body does not merely make use of bodily ‘metaphor s’ to describe mental or emotional states, but instead indicates the way we live and experience such states in a bodily way – through our subjectively felt body or ‘lived body ’.
- That both bodily expressions such as ‘losing heart’ and bodily conditions such as heart disease and its symptoms are symbols of something else – states and experiences of the felt or lived body and of its organs and functions.
- That so-called ‘organic’ dysfunctions, disorders or diseases – for example heart diseases – are biological embodiments of basic dysfunctions, disorders or diseases of the lived or felt body: for example an incapacity to feel or love expressed through a hardened heart, or the felt experience of a ‘broken heart’ or ‘loss of heart’.
Life Medicine therefore, does not
claim that illness is ‘all in the mind’. On the contrary, it
understands illness – like the many everyday expressions that
symbolise its nature and symptoms – as an expression of our
subjective experience of life and of our subjectively felt body –
‘the lived body’.
No form of conventional medical testing
however, no matter how technologically sophisticated, can see, scan
or diagnose the felt or lived body – nor can it detect a felt sense
of dis-ease
in that
body – such as a ‘broken heart’ or a feeling of ‘loss of
heart’.
Similarly, no form of biomedical
treatment
for hardened arteries can cure ‘a hardened heart’, just as no
form of ‘open-heart’ surgery can cure someone with ‘a closed
heart’.
“The heart is often described as a type
of pump. With the latest developments in modern technology, there are
all kinds of heart operations that can be performed, even the use of
heart transplants. In many cases, even when hearts are repaired
through medical technology, the same trouble reoccurs at a later
date, or the patient recovers only to fall prey to a different,
nearly fatal or fatal disease. This is not always the case by any
means, but when such a person does recover fully, and maintains good
health, it is because [their] beliefs, attitudes and feelings have
changed for the better, and because the person ‘has a heart’
again; in other words because the patient himself has regained the
will to live.”
“Many people who have heart trouble
feel that they have ‘lost the heart’ for life. They may feel
broken-hearted for many reasons. They may feel heartless, or imagine
themselves to be so cold-hearted that they punish themselves
literally by trying to lose their heart.”
“With many people having such
difficulties, the addition of love in the environment may work far
better than any heart operation. A new pet given to a bereaved
individual has saved more people from needing heart operations than
any physician. In other words, a ‘love transplant’ in the
environment may work far better overall than a heart-transplant
operation, or a bypass, or whatever; in such ways the heart is
allowed to heal itself.”
“The condition of your heart is
affected, for example, by your own feelings about it. If you consider
yourself to be cold-hearted or heartless, those feelings will have a
significant effect upon that physical organ. If you feel
broken-hearted then you will also have that feeling reflected in one
way or another in the physical organ itself…. each individual also
has many options open. Everyone who feels broken-hearted does not
necessarily die of heart failure for example. The subject of health
cannot be considered in an isolated fashion … each person will try
to fulfil their own unique abilities, and to ‘fill out’ the
experience of life as fully as possible.”
from The
Way Toward Health by
Jane Roberts
(see appendix 6)
Case Example 3
A recently bereaved widow, whose husband
Harry died from a heart attack, finds herself suffering disturbing
chest pains at night and goes to see her physician. The physician
sees her symptoms only as signs of some possible organic disorder
which might be ‘causing’ them. He sends her to a consultant to
test for possible heart conditions. The tests proving inconclusive,
the consultant ends up diagnosing mild angina, and prescribes
beta-blockers. These in turn prove to have little effect on the
patient’s symptoms.
On visiting her physician a second time
however, the latter recalls her recent bereavement and, as a result,
begins to read the bodily ‘text’ of her symptoms in a different
way, understanding them in the life context of her loss and the pain
it may be causing her. Rather than seeking a purely clinical
‘diagnosis’ of the patient’s symptoms he himself listens to his
patient in a genuinely patient way. As a result an insight flashes
through his mind which he shares with her. He ‘sees’ that she may
be suffering from a doubly broken
heart: “the one that killed
Harry, and the one you’re left alive with, that hurts when you’re
most alone in the middle of the night…the broken heart that gave up
and the one that has to carry on painfully.” This heartfelt
hearing of the patient and the heart-to-hearttalk
that ensue are the first time anyone has ever acknowledged the pain
of her grief. It gives her the strength
of heart to acknowledge and
bear it in a new way. Her symptoms disappear. The patient’s heart
symptoms disappear as bodily symbols and metaphorical signifiers of
her pained heart, not through an intellectual understanding of their
significance alone but through a memory arising from the feeling
heart of the physician.
This paradigmatic case vignette, cited by
Dr David Zigmond in an article on different modes of
patient-physician communication, goes to the heart of the contrast
between biomedical diagnosis and what could be called ‘life
diagnosis’.
The root meaning of the term ‘diagnosis’
actually is ‘through knowledge’ (dia-gnosis).
Yet the Greek verb, gignostikein,
from which the word gnosis
(knowledge) derives did not mean merely knowledge of or about
something – (for example biomedical knowledge of the body). Instead
it denoted the sort of knowing we refer to when we speak of being
‘familiar’ with people, of ‘knowing’ them well or intimately
as human beings – in much the same way that family doctors used to
know or be familiar with their patients, as if a part of their
families.
It was this type of ‘knowing’ that
the doctor in Zigmond’s case study brought to bear in relating to
the widow – not just his standard body of medical knowledge ‘about’
the heart as a biological organ and the type of ‘diagnosis’ to
which it can lead. His method consisted simply of having the patience
to listen to his patient in a different way – not seeking a
diagnosis of a possible heart ‘condition’ but affirming her
heartbreak
in a heartfelt way.
By ‘bearing with’ his patient in this way, helping to bear the
burden of her pained heart with her – she no longer felt herself so
painfully alone in bearing it – and was able to find a new
bearing towards the
bereavement that occasioned it.
The paradox that Zigmond notes however,
is that despite the inconclusiveness of the initial medical tests,
had the physician himself not embodied this new and different bearing
towards his patient – had he not heard her in a heartfelt
way as a human being but simply treated her as a potential ‘case’
of angina – then the patient herself might well have found herself
in the position of having no way to express the heartbreak of her
loss except through
actual and perhaps increasingly acute cardiac symptoms – using her
biological heart as an instrument of what Freud called ‘organ
speech ’.
The physician’s capacity for a
different type of listening – one that did not merely serve as a
prelude to some form of purely biomedical diagnosis was therefore
‘preventative medicine’ in the deepest sense. For it may well
have forestalled a process whereby this patient might well have ended
up as a genuine ‘heart case’ requiring serious medical
intervention. Alternatively, she might have found herself seen as a
so-called ‘heart sink’ patient – someone who repeatedly
‘bothers’ her doctor, but whose medical tests continue to reveal
no conclusive, measurable signs of any organic disorder or heart
disease – thus suggesting some form of malingering. Yet such
‘heart-sink’ patients are not a marginal group. In their
persistence, they are simply unconsciously reacting to the absence of
a type of listening that most patients actually seek – the type of
listening required for ‘life diagnosis’ and ‘life doctoring’.
This one single case described by Zigmond
is therefore ‘paradigmatic’ – for in its simplicity it
nevertheless reveals in full clarity the sharply opposing frameworks
or ‘paradigms’ of Biological Medicine and Life Medicine,
Bio-medical Doctoring and Life Doctoring. Indeed recent research has
shown that many older widows die within three years of their
bereavement – not due to arterial disease but principally through
an enlargement of the heart’s pumping chamber – in other words a
(painfully) ‘throbbing heart’.
Zigmond also offers us a study in the
very meaning of ‘diagnosis’ as such – showing how different
ways of listening to and coming to ‘know’ a patient can
themselves have a direct bearing on the patient’s health and
medical condition itself. Our
biology has
its basis in our biography,
and in that larger body of
awareness that
is our life world as
a whole. For it is always within the specific contexts of our life
world that we experience a felt ‘dis-ease ’, just as it is
capacities of
awareness
that allow us to relate to and
respond to our life world in a healthy way – with
awareness.
Illness can and has been understood in
many ways: in a purely objective and biomedical way, as a mechanical,
neurophysiological ‘effect’ of psychical stress or trauma, as a
relation to our life world and other people in it, as a form of
silent bodily communication
or even protest, as blocked action or communication, and/or as a
metaphorical language through
which we give silent bodily expression
to any subjectively
felt ‘dis-ease ’. Understanding organic illness as a language
of awareness embraces
all other understandings of it. More importantly it provides us with
an understanding of illness that affirms its innate meaningfulness
in the life of the individual – as an expression and embodiment of
their lived experience of themselves and of their life world as a
whole, as an expression and embodiment of the degree of awareness
they bring to their experience, and as an expression and embodiment
too, of the specific capacities or ‘organs’ of awareness that
they do or do not exercise in relating and responding to their
experienced self and world – for it is these specific capacities
that offer new keys to diagnosing illness as
a language. (see The Language of Illness and Illness as a Language)
Reference:
