By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
“It is the repressed experience of early childhood heartbreak that sets the stage for heart disease…” – Heartbreak and Heart Disease (1999)
We can’t put our fingers on it, but we know that love is good for us, whether it be romantic love, or love for family members, friends, or pets, that open-hearted feeling simultaneously fills us with vitality and peace. Most of us, at one point or another, also experience a tragic side of love… heartache, or the emotional pain we feel when we lose a vital connection with another being.
Whether it be the sudden death of a loved one, a difficult break-up or divorce, or the realization that our love for another is unrequited, heartbreak and even broken heart syndrome may strike us at any time. The stressful effects of a broken heart can even begin in childhood when one or both parents are physically and/or emotionally unavailable or abusive, or give love only when certain conditions are met.
Sometimes heartbreak can be so powerful that we begin to consciously or unconsciously shut ourselves off from vital heartfelt connections with others. We may develop physical defenses like restricted breathing and muscular tension in our chests (both are cardiac stressors), and mental defenses like denial, which helps us “control” our feelings. We may become unable to take in life-sustaining love.
We might look, instead, to behaviors and / or substances to distract us from being truly present, and thus vulnerable, in our relationships with others. Such distractions can become a way of life (addictions). Years of trying to control our feelings in this way can lead to the literal breakdown of our hearts, which manifests as symptoms of heart disease.
The Broken Heart-Disease Connection
“The heart [is] the ultimate organ of pulsating muscle, engaging the energies and interactions of mind, body and spirit… whatever one thinks affects what one feels…whatever one feels affects the heart rate: how fast the heart beats and how well the heart pumps.” – Heartbreak and Heart Disease (1999)
It’s no secret that the heart’s role is not just that of a mechanical pump. Our hearts are dynamically influenced by our feelings, fantasies, passion and connections to other people. The passion of love or the pain of loneliness may be physically felt in our hearts,and may affect our blood pressure as well as heart rate and pumping action.
While poets, writers and other “romantics” have, for centuries, conveyed this intuitive knowledge, doctors and nurses traditionally aren’t trained to treat “heartbreak.” Physicians and nurses, however, who attend to people having heart attacks and hear their personal stories, tend to have little doubt about the connection between psycho-emotional states and cardiac events.
What Is Broken Heart Syndrome?
“Broken heart syndrome,” which has recently gained mainstream recognition as an acute medical condition, is perhaps the most compelling evidence that emotional stress can impact our physical health. Also known as stress-induced cardiomyopathy, broken heart syndrome is a temporary heart condition where heart muscle in the left ventricle enlarges and compromises the heart’s ability to pump life-sustaining blood through the body. It usually occurs after the sudden loss of a loved one, as well as after other situations of intense emotional stress, like being held up at gunpoint. The sudden release of stress hormones in response to severe emotional stress literally stuns the heart, and can cause symptoms like chest pain, shortness of breath and even heart failure.
Broken heart syndrome differs from a classic heart attack in that it is a profound, acute physical reaction, and can occur in people without symptoms of heart disease or other heart attack risk factors. The symptoms are treatable, and the condition reversible.
The recognition of broken heart syndrome represents a big step in mainstream medicine. However, most cardiologists have yet to acknowledge a more subtle link between heartbreak experienced without a debilitating surge of stress hormones and the slow progression of heart disease.
Broken Hearts, Stress and Heart Disease Risk
“Even though anger, hostility and rage are legitimate components of our personalities, most of us are hesitant to acknowledge this ‘shadow’ or ‘dark side’ of ourselves. As a result, we often deny or suppress these feelings, or are not even aware of them. But I think that getting in touch with these powerful hidden emotions and becoming aware of their contribution to heart disease is critical to healing and protecting the heart.” – Heartbreak and Heart Disease (1999).
Suppressed anger, rage, loss of a vital connection (heartbreak), and emotional isolation / lack of intimacy with others all are “hidden” emotional risk factors that can contribute to the development of heart disease. Many cardiologists fail to recognize these psycho-emotional factors which often underlie other commonly recognized risk factors such as excessive smoking, inappropriate diet, and even high blood pressure and cholesterol levels.
Psycho-emotional risk factors also can affect our breathing patterns and how we retain muscular tension. Denial of unpleasant emotions experienced in infancy, childhood and even adulthood may eventually result in energy blocks in the adult body which manifest as muscular rigidities, or “character armoring.” Energy blocks in the chest, diaphragm and throat can lead to chaotic, shallow breathing patterns which deprive the body of enough vital oxygen necessary for healthy functioning. An “armored” person can become more susceptible to degenerative disease, especially heart disease.
Take the “type-A” or “coronary-prone” personality type, for example. People who have “type-A” qualities often show rigidity in their facial and bodily structures, as well as in their breathing patterns. Characterized as having “short fuses,” type-A personality types tend to easily become impatient, irritated, aggressive or hostile.
From a psychotherapeutic standpoint, type-As have experienced some early rejection, abandonment or other pain that set in motion a deep, unconscious fear of love and emotional expression. This fear drives the need to prove self worth through excessively performance-oriented or competitive behaviors. Type As unconsciously focus on outward accomplishments to avoid giving and receiving love. Sometimes they push themselves to a breaking point and suffer heart attacks.
Ultimately, there are many factors behind the development of heart disease, including uncontrollable ones like heredity and advancing age, and those that are controllable: smoking, diet, weight, sedentary living, hypertension, and high (small-particle LDL) cholesterol. Acknowledging “hidden” psychological and emotional risk factors and cultivating awareness of how they may contribute to the more obvious controllable risk factors can help us develop healthier lifestyle patterns.
Sometimes heart attack survivors and people diagnosed with heart disease are able to “reframe” their conditions as giving them a second chance in life or as being “messengers” of the need for change. Even though cardiac events or heart disease diagnoses can be frightening, seeing them as opportunities, rather than tragedies, can help jump-start our healing processes.
Of course, altering the many aspects of our lifestyles that have contributed to heart problems is not an easy feat. Changing our diets, losing excess weight, exercising more (or less), taking nutritional supplements, and quitting smoking and/or other harmful behaviors can be challenging and require a lot of patience and commitment.
Reducing stress may be a big part of making these lifestyle changes, and can be easier said than done. One approach is to try to understand what pushes our buttons and why, then re-habituate ourselves to deal with perceived stressors in a healthier manner. This is where mind-body practices like meditation, yoga, deep breathing, and journal writing can be very helpful; as “practices” they can assist us in developing the tools necessary to maintain our willpower and conviction as we tap into the psycho-emotional “stuff” underlying our stress.
“The re-experience of our own childhood is perhaps the most difficult task in our journey of healing the heart… To establish balance, the fragmented parts of the self must be reintegrated…the ultimate goal of reintegration of body, mind and spirit is the reopening of the heart to love and the development of a spiritual connection…” – Heartbreak and Heart Disease (1999)
Healing heartbreak involves recognizing and coming to terms with our past heartbreaks and “owning” the “shadow” qualities we developed as coping mechanisms. This is, by no means, an easy task. Facing our issues surrounding heartbreak, whether we experienced it as children, teens or as adults, can require lots of bravery and patience. We may have to delve into hidden memories that were, at the time, so painful and traumatic that our subconscious minds buried them away as a means of self-preservation.
Sometimes, heartbreak that begins in childhood has a domino effect; we may experience heartbreak throughout adulthood, as unconscious feelings of abandonment are awakened by recurrent experiences. A good therapist can be useful in learning how to recognizing such patterns. Once we acknowledge the patterns, we can start changing them and learning to better love ourselves and others as we heal our psycho-emotional wounds.
Finding a therapist may require “trying out” a lot of therapists and methods– it’s important that there be a good fit. Therapy may involve just talking or it may also entail bodywork; bioenergetic psychotherapists, for example, place clients in physical postures to help them release tensions in their bodies caused by emotional blocks or “armoring.”
Of course, therapy is not for everyone; healing is a journey particular to the individual. Regardless of the route taken, what matters is that we learn to acknowledge and reframe our feelings, that is, channel them in direction of healing. This may mean re-learning how to open our hearts to new feelings and love, how to relax and minimize stress, how to breathe deeply, and how to build strong emotional connections with other people.
It can mean finding positive forces within negative events or experiences, no matter how small: learning to laugh at ourselves and not take everything so seriously, learning not to internalize personal or work pressures, and learning to communicate more honestly with and reach out to others. Perhaps, most importantly, finding a positive force often means forgiving others and ourselves… over and over and over again.
Facilitating the Healing Process
For some, massage or other touch therapies may be useful in helping release trapped energy and discover emotional blocks, while deep breathing, visualization and/or transcendental meditation might be preferred methods for others. Acupuncture and/or chiropractic work can also help move trapped energy through the body. Some people might resonate best with an exercise program which helps them increase circulation of oxygen and blood through the body. Others may prefer to practice yoga, and become more “present” through awareness of their breath and stream of consciousness as they move through physical postures (asanas).
There’s also nothing like a good cry when it comes to healing. Crying frees our hearts of muscular tension and rigidity while enhancing oxygen delivery. I believe the ability to feel emotions deeply, to cry during times of intense sadness and heartbreak are essential in the prevention of heart disease. Like crying, laughing can also be a tremendous remedy for our hearts. It helps us breathe deeply and release tension in our chests, and if we laugh hard enough, we may even cry.
Playing, that is, engaging in an activity solely in pursuit of joy and pleasure in the present, can be another positive healing force. Playing with pets or children can get us back in touch with our spontaneous natures and “inner children” (we all have one). If “play” is a sports activity, it’s important that it remain non-competitive and friendly.
Spirituality also can help us find new growth and direction within ourselves. Having faith in something outside ourselves, however we choose to identify that greater power, gives us a place to turn to for courage and strength and helps alleviate pressures to perform perfectly. It may also help us develop a sense of “oneness” with others that can help us open up more to loving and being loved.
One theory behind stress cardiomyopathy is that free-radicals generated through the extreme release of stress hormones (catecholamines) damage myocite, or heart, cells – see Wittstein study (below).
References and Recommended Reading:
- Sinatra, S. Heartbreak and Heart Disease (Keats, 1999).
- Wittstein IS, Thiemann DR, et al. Neurohumoral Features of Myocardial Stunning Due to Sudden Emotional Stress. N Engl J Med 2005; 352:539-548.
- Lowen, A. Bioenergetics.
- Mayo Clinic Staff. “Broken Heart Syndrome.” Mayoclinic.com, accessed Aug. 15, 2011.
- Ruiz, Don Miguel. The Mastery of Love (Amber Allen Publishing, 1999).
- Hahn, Thich Nhat. True Love: A Practice for Awakening the Heart (Shambhala Publications).
- Hahn, Thich Nhat. Taming the Tiger Within: Meditations on Transforming Difficult Emotions (Riverhead Books)
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