The Heart And Mental Influence





The heart is an organ so vitally important that we might expect it to

be carefully protected by nature from any interference with its action

through mental influence, emotional conditions, or voluntary or

involuntary feelings. As a matter of fact, it is extremely susceptible

to mental influence, stimulant or depressive, and to emotions of all

kinds. Psychotherapy, that is, the removal of inhibiting influences

originating in the mind, and the suggestion of favorable mental

influences, is probably more important for the heart than for any

other organ in the body. The law of reserve energy has its most

noteworthy applications with regard to it. When we are apparently so

completely fatigued that we cannot do anything more, a purely mental

stimulus may so enliven the heart as to give the body a new supply of

strength and energy. A man wandering through a desert, or swimming for

his life at sea, may be so exhausted as to be quite ready to give up

entirely, and be brought to the conviction that he has absolutely no

strength left for further effort, when a flash in the distance, or a

sound that indicates that help is near, or some other mental

incitement, will give renewed energy. It is probably through the heart

that there comes to us most of our power to accomplish things when we

are already so tired as to seem exhausted. On the other hand, it is

the failure of circulation in muscles, because of a slacking heart,

that produces the sense of exhaustion. Muscular work is easy or even

pleasant when we are in good spirits, while, whenever exertion is

undertaken in the midst of discouragement, we cannot accomplish nearly

so much as when conditions are so framed as to give stimulus and

encouragement.



If a perfectly normal heart can be so affected by mental conditions

and emotions as to be seriously disturbed in its work on the one hand,

or greatly stimulated into new activity on the other, it is to be

expected that a heart affected by disease will be similarly affected

and probably even to a greater degree. It is clear, then, that our

cardiac patients have to be guarded against unfavorable mental

conditions, and have to have all their reserve energy called out for

them by encouragement and by the best possible prognosis for their

reflection. This is especially true as regards the removal of the many

unfavorable suggestions which, because of ignorance, have in the past

gathered round most forms of heart disease.







Emotion and the Heart.--The mental and emotional influence over the

heart's action was the truth that lay at the basis of the old fallacy

with regard to the physiology of the heart. The literature of all

countries testifies that the heart was long supposed to be the seat

and origin of the emotions. Every one has experienced how the heart

jumps when something unexpected happens. People have fainted from

excess of joy as well as of grief. The physical side of emotion is so

generally associated with some modification of the heart beat that it

is no wonder that emotions were directly connected with the organ.

When people are in depressed states the heart is apt to beat more

slowly than usual, while when in states of exhilaration, even those

dependent merely on mental factors, the pulse is more rapid.

Melancholic states have occasionally been attributed to the slowness

of the pulse, but the slow pulse seems to be a symptom connected with

the mental condition rather than a causative factor. In the maniacal

conditions, the rapidity of the pulse, which is sometimes quite

marked, must probably be explained in the same way, as due to the

mental excitement under which the patient is laboring.





The Heart and the Nervous System.--Prof. Von Leyden ten years ago

recalled attention to the fact that the heart is literally the primum

movens in man, and that before the central nervous system is laid

down, or there is any possible question of impulses flowing from

center to periphery, the heart, or at least its embryonic

representative, is beating as constantly, regularly, rhythmically, as

it is to do during all the subsequent life of the individual. Oliver

Wendell Holmes has expressed it poetically by stating that the angel

of life sets this heart pendulum going and only the angel of death can

break into the case and stop it.





Primitive Heart Action.--The original beating of the heart is

entirely automatic, and quite apart from any nervous initiative or

stimulus. The original bend in the primal blood vessel, which is to

represent the heart in the course of development, begins to pulsate

very early in the chick and evidently does the same thing in all other

living things. Notwithstanding this fact that the heart is thus easily

demonstrated to be the primum movens, the first exhibitor of

vitality, and might thus seem to be one of the organs or indeed the

one which should be safe from any nervous interference, later on

powerful connections with the nervous system are made, and heart

acceleration and inhibition become familiar phenomena. Every emotion,

as we have said, has its influence on the heart and even a certain

amount of voluntary control may be acquired. Indian fakirs are said to

be able to cause the heart to slow and almost to stop. The curious

phenomenon of suspended animation which they sometimes exhibit is said

to be due to this. Certain of the well-developed muscular subjects who

exhibit themselves at medical clinics are able to cause their hearts

to miss a beat, but this is said to be rather a result of will-power

over other muscles compressing the thorax, and interfering with the

heart, than direct influence upon the heart itself.





Mental Influence over Diseased Hearts.--Worry produces much more

serious symptoms in heart patients than in others. Anxiety about the

heart itself is often a source of serious detriment to a heart

patient. Most people have such a terror of having anything the matter

with their hearts that the haunting thought of such calamity is likely

to have a definite influence in preventing the development of such

compensation as will enable the heart to do its work to the best

advantage. It used to be the custom to refrain from telling patients

suffering from tuberculosis that they had the disease. On the other

hand, people with heart disease were usually informed of that fact.

The reason given for the latter course was that heart disease may in

many cases be the forerunner of sudden death, and the warning

knowledge was supposed to enable a man to get his affairs in order. No

worse policy for either disease could well have been imagined. The

pulmonary patient should be told at once, the heart patient should, as

far as possible, be saved the depressing knowledge of his condition.



Dr. MacKenzie, whose practically illuminating studies of heart disease

give him a right to express opinions with regard to it (and when those

opinions concern the influence of the mind they are doubly valuable

because of the absolute objectivity of his studies), has some rather

strong expressions with regard to the importance of modifying the

mental state in heart cases. He says:



The consciousness of heart trouble has often a depressing effect on

people, whether the trouble be slight or serious. When such people

become convinced that the trouble is curable or not serious, their

condition at once becomes greatly improved. Cures by faith, whether

in drugs, baths, elaborate methods or religion, act by playing upon

the mental condition. But our employment of this element in

treatment should not be the outcome of blind unreasoning faith in

some rite or ceremony, bath or drug, but in the intelligent

perception of the nature of the symptoms. The reassurance of the

patient of the harmless nature of the complaint goes a great way in

curing him. The reassurance that with reasonable care no danger need

be feared is extremely helpful. Even in serious cases when there is

reasonable hope of recovery or a certain degree of recovery, the

encouragement of the patient may and does help forward his

improvement.





Heart Remedies and Suggestion.--Probably the best evidence we have for

the influence of the mind over the heart in diseased conditions, that

is, when there is definite organic change in the heart valves or

muscle, is to be found in the history of the many remedies that have

come and gone in heart therapeutics during the past generation.

Strophanthus, for instance, was very popular a quarter of a century

ago, and it seems as though in many cases it not only replaced, but

was more efficient than digitalis. How few there are who use it now

with confidence, and how general is the impression that it does not

affect the heart to any extent! The confidence with which the remedy

was given by the physician was conveyed to the patient and he "took

heart," as the expression is, and proceeded to get better. Even more

striking is the evidence afforded by other remedies. For a while it

seemed that cactus provided a heart stimulant and regulator of value.

Convalaria also gained a reputation as a heart remedy. Both are now

practically abandoned. Here, once more, the real remedy, when these

substances were employed, was, undoubtedly, the suggestion to the

patient in connection with the regulation of his habits of life, so

that his heart got a chance to catch up with its work. There are other

remedies with which we had similar experiences.



Even digitalis has had phases of confidence and distrust in it, that

are interesting to study in the light of what we now know with regard

to the influence of the psyche on the heart. One hears at medical

society meetings reports of the favorable action of digitalis within a

few hours of its administration. These are not examples of digitalis

action, but of mental influence. Any heart patient after the

first visit of a physician in whom he has confidence is sure to

brighten up at once, heart action is ever so much better and symptoms

of mental depression, and even of circulatory disturbance, disappear.

It is this that has made the study of even the efficiency of digitalis

so difficult. There were times when most physicians employed it in

rather large quantities for all forms of heart disease. In some heart

cases it is absolutely contra-indicated. Fortunately many of the

preparations of digitalis used in the past were quite inert, and so no

harm was done. The results obtained were psychotherapeutic.





Cardiac Inhibition.--The importance of the role of the nervous system

and of the mental influences which control it in all functions is well

illustrated by what we have learned during the last half century with

regard to inhibition in the animal organism. We used to think that

while the nervous system sent down positive impulses--that is, nervous

stimuli which brought about the accomplishment of certain

activities--it had nothing to do with the stoppage of those

activities. Such interference was supposed always to be due to

external influences of various kinds, potent for the time, in the

organism. We have learned, however, that inhibition is one of the

important functions of the nervous system. The idea has now become so

familiar that sometimes we are apt to forget how great is its

significance. Lauder Brunton, in his article on "Inhibition," set

forth its role as we have come to know it.



The recognition of the part inhibition plays in vital phenomena is

undoubtedly one of the most important discoveries which have been

made in physiology since Harvey discovered the circulation of the

blood. It throws light upon an immense number of phenomena

previously inexplicable and enables us to form theories of a

satisfactory nature about many vital problems. It offers an

explanation of the nature of hypnotic states, which is at least as

satisfactory as that we have of the action of many drugs.



The nervous mechanism of the heart affords the best and most

commonly cited example of inhibitory action, and here it was first

studied by Weber and Claude Bernard in 1848. The cardiac ganglia

derived from the sympathetic preside over the movements of the

organ, and in response to the stimulus of the intra-ventricular

blood-pressure cause rhythmical contraction of the cavities. Their

action is, however, controlled by the pneumogastric nerve, through

which impulses of an inhibitory nature are constantly traveling and

acting as a restraining force.



As noted by Lauder Brunton, the late Professor Czermak had a small

glandular tumor in close contact with the right pneumogastric nerve

and he was able by pressure on this to compress the nerve to any

extent he wished, and either "to completely stop the heart or simply

retard it." He often performed this experiment so that it is not

nearly so dangerous as might be thought. We have some instances,

apparently too well authenticated to be doubted, in which the power of

the human will to inhibit heart action has been as strikingly

manifested as this mechanical disturbance of Professor Czermak.

Sometimes these stories of cardiac inhibition through the will are

dismissed as unworthy of credence, and doubtless many of them are mere

fiction, or have been exaggerated for sensational purposes, but some

of them are very suggestive examples of the power of the will over the

heart. If only a modicum of such power were to be employed, it would

seriously hamper heart action, and it must be the aim of psychotherapy

to prevent such inhibition.







At least one instance of voluntary heart inhibition was observed by

thoroughly trained and properly accredited scientists. A report of it

has been published. As a bit of documentary evidence, on a subject

that is usually considered so vague as to be scarcely worth

considering, Dr. Cheyne's description of the remarkable power of

Colonel Tonshend over his heart should be in the hands of those who

wish to influence hearts through minds and wills.



He could die or expire when he pleased, and yet by an effort, or

somehow, he could come to life again. . . . We all three felt his

pulse first: it was distinct, though small and thready, and his

heart had its usual beating. He composed himself upon his back and

lay in a still posture for some time. While I held his right hand.

Dr. Baynard laid his hand upon his heart, and Mr. Skrine held a

clean looking-glass to his mouth. I found his pulse sink gradually

till at last I could not feel any, by the most exact and nice touch;

Dr. Baynard could not feel the least motion in the heart, nor Mr.

Skrine discern the least soil of breath on the bright mirror. Then

each of us by turns examined his arm, heart and breath, but could

not by the nicest scrutiny, discover the least symptom of life in

him. We reasoned a long time about this odd appearance, and finding

he still continued in that position, we began to conclude that he

had indeed carried the experiment too far; and at last we were

satisfied that he was already dead, and were just ready to leave

him. This continued about half an hour. . . . As we were going away

we perceived some motion about the body, and, upon examination,

found his pulse and the motion of his heart gradually returning; he

began to breathe heavily and speak softly.



Nor must it be thought that the inhibitory faculty can act only in

slowing the heart. Normally a certain amount of inhibition is

exercised over the heart's action. If by any chance this should be

decreased then acceleration of cardiac activity may take place. Lauder

Brunton called attention to that in discussing another phase of

pneumogastric function. He said:



Paralysis of the pneumogastric, of course, does away with its

action. And hence we have among other symptoms of this condition

increased rapidity of the contractions of the heart from withdrawal

of the inhibitory influence.



If slowing of the heart action can be produced through the mind by

this mechanism of inhibition, so also under other circumstances may

acceleration occur.





Shock and the Heart--How large a role emotion plays in disturbing the

action of a heart that is already diseased, is illustrated by the

story told in serious histories, on what seems good authority, of the

dwarf of the French king, who was frightened to death by what he

thought were the arrangements for his execution. While we take great

pains as a rule to impress upon sufferers from organic heart disease

the necessity for their avoiding every kind of over-exertion, or

sudden movement of any kind, we do not always impress upon them the

even greater necessity for the avoidance of shock and fright, and

profound emotions. It must not be thought that emotional shocks have a

deleterious effect only in advanced cases of heart trouble. Almost any

physician will readily recall examples where emotion had much to do

with the break in compensation which indicates that the heart has for

a time been overworked.



A case in my own experience illustrates this: The patient, a student,

had suffered from severe so-called growing pains, undoubtedly

rheumatic, when he was about fourteen, and probably had acquired a

heart lesion at that time. It did not, however, disturb him in

the slightest degree. The patient had never noticed any fatigue on

running up stairs; he had no shortness of breath; there were no

symptoms pointing to his heart. One summer while his family were in

the country he came into town for the day, and missing the last train

out, he went to the family home to sleep, though it had been closed up

for the summer. He let himself in without difficulty and was preparing

to go to bed when he resolved to get a glass of water. There being no

tumbler nearer than the dining-room, he went there. As he entered the

dining-room he struck a match. With the flash of the light he found

himself looking into the barrel of a revolver and a hoarse voice said,

"Hands up!" His hands went up. The next minute he was in the hands of

two "plain clothes" policemen who had been watching the neighborhood

because of recent burglaries. Noticing the light upstairs, they had

made their way in for the purpose of catching what they thought a

burglar at work.



The young fellow, who had never before fainted, collapsed almost at

once, and was unconscious for some minutes. The next day he was rather

prostrated and tired on movement. By resting a good deal for the next

week this passed off to a considerable degree, but then his physician

found that he was suffering from a serious heart lesion, with a

decided break in compensation. I saw him several months later. His

heart had never regained its old power, and his mitral valve was quite

unable to fulfill its function. Just what the mechanism of the almost

sudden break in compensation was after he had been for so long quite

immune from any effects of the rheumatism, is hard to say, but the

lesson of the case is easy to understand.





Place of Psychotherapy in Treatment.--The role of psychotherapy, then,

in heart cases consists in the recognition of the part that the mind,

the will and the emotions play in their influence over this important

organ. These psychic factors may produce disturbed conditions of

various kinds. The more experience the physician has with cardiac

cases of all kinds, organic as well as functional, the more powerful

does he recognize the influence of the mind over the heart to be. The

expression that a man is living on his will is no mere figure of

speech. Some cases we have cited seem to show that a favorable

attitude of mind keeps up heart action, where an unfavorable attitude

would almost surely allow the heart to fail. It is this very potent

influence then that must be used to as great advantage as possible in

the psychotherapy of cardiac patients.



Undoubtedly the most important phase of it is in prophylaxis. As far

as possible we must save our heart patients from emotions. The effect

of emotion on the heart is known. When that organ is already crippled,

emotion may produce a serious strain on it. It is as important to save

heart patients from joyful emotions as from those of contrary nature.

Many a son who, after years of absence, thought to surprise a dear old

mother by suddenly presenting himself to her, has learned to his cost

that an old heart may break from joy, almost as easily as from sorrow,

and may be as unfavorably affected by the glad emotions as by terror

or fright. We must also save heart patients from the unfavorable

influence of a bad prognosis, and of too serious a diagnosis, both of

which may be quite unjustified, for the rule is that the longer a man

has been studying the heart, the less likely is he to be confident in

his diagnosis, or unfavorable in his prognosis.







The curative place of psychotherapy is in the obtaining, as far as

possible, of placid easy lives for these patients. This does not mean

that they are to give up their occupations, for very often the

internal emotional life, which develops when they have nothing to do

but think about themselves, will be more serious in its effect upon

the heart than the ordinary vocation. Exciting incidents in life work

must, however, be avoided. If men are in occupations that require

exposure to excitement, then it may be advisable to change their

occupations. Brokers, speculators, actors, sometimes public speakers,

on whom appearances in public in spite of apparent placidity are often

a severe strain, may have to be guided into quieter paths of life. In

general, in every attempt to treat heart disease, and the neurotic

symptoms which develop in connection with it, the patient's mind must

be considered as one of the most important therapeutic factors.





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