Gerry suddenly clutched at his chest. His heart was racing, and he could barely breathe. Ten minutes after the call to 911, he was on his way to the nearest emergency room in an ambulance. There an electrocardiogram and blood tests provided the big shock: Gerry hadn’t suffered a heart attack at all. The hospital doctor reassured him: “Physically, you are fine. Your problems are psychological in origin.” Gerry’s experience is not unusual. For at least a quarter of all patients who enter hospitals with suspected heart attacks, physicians can find no physical cause for their symptoms. But it is a mistake to dismiss such occurrences as “just psychosomatic,” because that minimizes the importance of the mind’s effects on the body’s well-being. Studies in psychosomatics, the area of medicine that deals with diseases and complaints that are at least partly psychologically based, find that one everyday aspect of modern life stands out in a startling variety of physical ailments: stress. [For a list of related ills, see box on page 71.] Worse, extreme emotional distress–caused by the death of a spouse, a furious quarrel, a natural disaster such as an earthquake, even looming heavy deadlines at work–can trigger a real heart attack in a person who is already at risk. In the U.S. alone, 1.5 million people suffer heart attacks every year, and more than 200,000 die. It is difficult to determine how many of those incidents might be attributed to stress, but it is clear that duress plays a role. Andrew Steptoe and Philip C. Strike of University College London recently reviewed a number of medical studies conducted between 1974 and 2004 that examined what people were doing and feeling in the hours before they had a heart attack. Emotional stress was one of the most common triggers, they reported in the March/April issue of Psychosomatic Medicine. For example, in one study of 224 patients, more than half said they had been very upset or under stress in the 24 hours before their heart attack. Mind over Matter How can your head hurt your heart? To answer that question, it helps to take a look at what happens in the body when you are experiencing stress. Imagine you are ambling across a street when a car unexpectedly rounds the corner without stopping, barreling toward you. Heart pounding, legs pumping, you dash out of harm’s way. What just happened? As your brain recognizes imminent danger, your body undergoes several changes. Stress hormones–epinephrine, norepinephrine, glucocorticoids–pour into your bloodstream, preparing you for a “fight or flight” response. To conserve energy for your leg muscles, nonessentials such as your digestive tract shut down. Your heart rate increases, to deliver oxygen and energy to your thighs and calves. Veins throughout the circulatory system constrict, as when you squeeze a water hose, propelling blood back to the heart more vigorously. That returning blood slams into heart walls, which in turn snap back with greater force, like a stretched rubber band. Arteries relax, increasing blood flow from the heart to those needy muscles. Such physical reactions are helpful when you are bolting from a careless driver–or when early humans had to flee a hungry predator. And small stresses actually have an upside, because they sharpen our attention, making us feel focused and alert. (Think of playing a challenging quiz game or watching an exciting whodunit.) But stress also arises frequently from the everyday hassles of modern life, as we run late to that meeting, fret about getting the kids to a play date across town or worry about getting all the details just right in time for tonight’s dinner party. We are especially susceptible when we feel that conditions are out of our control despite our struggles. The result is that our bodies keep working in overdrive far more than our evolutionary history has shaped us to do. Chronic stress can lead to high blood pressure. This hypertension, in turn, adds to a vicious cycle of physical changes that can tip the balance for people at risk, contributing to the onset of arrhythmia (irregular heartbeat, in which distended muscle chambers cannot efficiently pump out blood) or heart attack. In a heart attack, a clump of plaque lodges in a small vessel in the heart. The resulting blockage deprives nearby cells of nutrients and oxygen, starving them [see box above]. Stress experiments have revealed the mental mechanisms involved. In the 1990s James E. Skinner, now at the Vicor Technologies laboratory in Bangor, Pa., investigated which brain regions play a role. He worked with pigs, beginning by tying off one coronary artery to imitate the condition of a patient with coronary artery disease. Then he implanted cooling elements at specific spots to block nerve impulses running from the frontal lobe, the location of higher-reasoning centers in the brain, to areas involved in emotional reactions and in mediating excitatory hormones: the amygdala, hypothalamus, brain stem and sympathetic nervous system. When the pigs without nerve blocks were exposed to severe psychosocial stress–such as being put in entirely new, alarming surroundings–they often experienced fatal fibrillation, a condition in which the heart contracts erratically and does not pump blood. Similarly, electrical stimulation of certain parts of the frontal lobe in the pigs elicited a rapid heart rate and arrhythmias, in some cases leading to cardiac arrest. The pigs whose nerves had been blocked by cold, however, were spared. Head to Heart So what are the important emotional factors? In the early 1900s Hungarian-American psychoanalyst and psychiatrist Franz Gabriel Alexander, now often called the father of psychosomatics, played a leading role in identifying emotional tension as a significant cause of physical illness. Alexander and other pioneers in the field believed that disorders such as ulcers, high blood pressure, neurodermatitis and asthma were the body’s reaction to chronic tension and psychological stress. Following in the footsteps of psychoanalysts, they held that certain individuals–who suppressed conflicts and emotions–were predisposed to develop ailments as a result. This point of view has fallen out of favor today, as purported links between certain personality types and diseases have been refuted. For example, many studies have shown that the melancholy “cancer personality” is just a myth. On the other hand, a given person’s style of dealing with problems does matter. That is what heart specialists Meyer Friedman and Ray Rosenman concluded in 1974, after conducting a multiyear study of people with so-called Type A personalities. They claimed these individuals–whose behavior is characterized by ambition, competitiveness and impatience–have a considerably higher risk of heart attacks. In several additional studies, researchers sought a comprehensive evaluation of Friedman and Rosenman’s belief; they were not able to provide confirmation. Yet the aggression and hostility exhibited by Type As contribute to higher levels of stress and its deleterious effects. And although Type As do not necessarily have an increased lifetime risk of having a heart attack, their short-tempered, impatient behavior makes it more likely that they will have a heart attack sooner, according to a study in the May/June 2003 issue of Psychosomatic Medicine by John E. J. Gallacher of the University of Wales College of Medicine. Many top executives may be Type As, but simply being a Master of the Universe does not raise the risk of heart attack, perhaps because those at the pinnacle of the corporate hierarchy have greater control over their day-to-day working lives than their minions. Middle-ranking employees are more likely to suffer a special kind of stress, called the negative affect. People with this sensitivity disorder exhibit above-average levels of anxiety and depression. After a multiyear study of the negative affect in men and women, Bruce C. Jonas and James F. Lando of the Centers for Disease Control and Prevention reported in the April 2000 Psychosomatic Medicine that such chronically stressed people are twice as likely to have hypertension as normal individuals. Men who explode with anger or expect the worst from people may punish their own bodies as well. Such men are more likely to develop a type of arrhythmia, says an article in the March 2004 issue of Circulation. Feelings of hostility, for example, made men 30 percent more likely to develop the condition. Other studies have shown that a strong adverse emotion such as anger doubles the risk of heart attack during the next couple of hours. [See box on page 68 to find out if hostility might be a problem for you.] Irritation and fury are not the only threats to diseased coronary arteries. Nancy Frasure-Smith of McGill University believes that depression also seriously prejudices the chances of heart patients for recovery. Depression, in turn, can result from chronic uncontrollable stress, as well as from a previous heart attack. Victims often suffer from inner hopelessness, such as fears of being unable to meet challenges in their work or personal lives. And loss of a beloved and trusted partner can literally break someone’s heart: as long ago as 1969 Colin Murray Parkes, a British doctor, showed that widows and widowers suffered greatly increased mortality. Looking on the Bright Side As the work with the pigs showed, the frontal brain seems important in fibrillation and apparently is connected to the nerve cell bodies of the sympathetic nervous system in the spinal cord. Through this connection, the human mind ought to be able to influence heart function in a positive manner. Relaxation techniques such as autogenic training may possibly utilize this mechanism. Along with targeted stress management, such methods may improve the survival chances of heart patients more than daily exercise, as suggested by James A. Blumenthal of the Duke University Medical Center in 1997. Psychotherapy’s positive influence on bodily processes is especially evident in studies of pain patients. Neuropsychologist Pierre Rainville of the University of Montreal set up a therapeutic study based on suggestion, called guided imaging. Using positron-emission tomography (PET) imaging, he discovered that a brain region responsible for the conscious awareness of pain, the anterior cingulate gyrus, would become less active–merely because of spoken words. Another means to break free of the self-reinforcing cycle of heart disease, stress and depression is cognitive behavioral therapy. Patients learn to give more weight to positive events in their lives than to negative ones [see “Treating Depression: Pills or Talk?” by Steven D. Hollon, Michael E. Thase and John C. Markowitz; Scientific American Mind, Premier Issue, 2004]. A strong social network, as well as contact with trusted individuals, helps people to overcome stress, too. Heart disease patients who are married or in stable relationships have longer average life expectancies. Two other important ingredients to reversing cardiovascular disease are developing more healthful eating habits and exercising regularly. Dean Ornish and his colleagues at the University of California at San Francisco tracked the progress of patients with coronary artery disease who ate low-fat vegetarian diets and got regular exercise. The subjects stopped smoking, and they sought to bring calm to their lives through stress management training and group therapy. After a year, the condition of their coronary arteries had improved noticeably. Is the power of the brain supreme when it comes to affecting physical well-being, or does the body’s health sway our mental states? Both usually go hand in hand: body and mind are bound up, inseparably, in a continual feedback loop. The scientific knowledge gained in recent years teaches us that just as corporeal phenomena can change our minds and spirits, it works in the other direction as well: thoughts and emotions can cause real changes to our bodies.
Gerry’s experience is not unusual. For at least a quarter of all patients who enter hospitals with suspected heart attacks, physicians can find no physical cause for their symptoms. But it is a mistake to dismiss such occurrences as “just psychosomatic,” because that minimizes the importance of the mind’s effects on the body’s well-being. Studies in psychosomatics, the area of medicine that deals with diseases and complaints that are at least partly psychologically based, find that one everyday aspect of modern life stands out in a startling variety of physical ailments: stress. [For a list of related ills, see box on page 71.] Worse, extreme emotional distress–caused by the death of a spouse, a furious quarrel, a natural disaster such as an earthquake, even looming heavy deadlines at work–can trigger a real heart attack in a person who is already at risk.
In the U.S. alone, 1.5 million people suffer heart attacks every year, and more than 200,000 die. It is difficult to determine how many of those incidents might be attributed to stress, but it is clear that duress plays a role. Andrew Steptoe and Philip C. Strike of University College London recently reviewed a number of medical studies conducted between 1974 and 2004 that examined what people were doing and feeling in the hours before they had a heart attack. Emotional stress was one of the most common triggers, they reported in the March/April issue of Psychosomatic Medicine. For example, in one study of 224 patients, more than half said they had been very upset or under stress in the 24 hours before their heart attack.
Mind over Matter How can your head hurt your heart? To answer that question, it helps to take a look at what happens in the body when you are experiencing stress. Imagine you are ambling across a street when a car unexpectedly rounds the corner without stopping, barreling toward you. Heart pounding, legs pumping, you dash out of harm’s way. What just happened?
As your brain recognizes imminent danger, your body undergoes several changes. Stress hormones–epinephrine, norepinephrine, glucocorticoids–pour into your bloodstream, preparing you for a “fight or flight” response. To conserve energy for your leg muscles, nonessentials such as your digestive tract shut down. Your heart rate increases, to deliver oxygen and energy to your thighs and calves. Veins throughout the circulatory system constrict, as when you squeeze a water hose, propelling blood back to the heart more vigorously. That returning blood slams into heart walls, which in turn snap back with greater force, like a stretched rubber band. Arteries relax, increasing blood flow from the heart to those needy muscles.
Such physical reactions are helpful when you are bolting from a careless driver–or when early humans had to flee a hungry predator. And small stresses actually have an upside, because they sharpen our attention, making us feel focused and alert. (Think of playing a challenging quiz game or watching an exciting whodunit.)
But stress also arises frequently from the everyday hassles of modern life, as we run late to that meeting, fret about getting the kids to a play date across town or worry about getting all the details just right in time for tonight’s dinner party. We are especially susceptible when we feel that conditions are out of our control despite our struggles. The result is that our bodies keep working in overdrive far more than our evolutionary history has shaped us to do. Chronic stress can lead to high blood pressure. This hypertension, in turn, adds to a vicious cycle of physical changes that can tip the balance for people at risk, contributing to the onset of arrhythmia (irregular heartbeat, in which distended muscle chambers cannot efficiently pump out blood) or heart attack. In a heart attack, a clump of plaque lodges in a small vessel in the heart. The resulting blockage deprives nearby cells of nutrients and oxygen, starving them [see box above].
Stress experiments have revealed the mental mechanisms involved. In the 1990s James E. Skinner, now at the Vicor Technologies laboratory in Bangor, Pa., investigated which brain regions play a role. He worked with pigs, beginning by tying off one coronary artery to imitate the condition of a patient with coronary artery disease. Then he implanted cooling elements at specific spots to block nerve impulses running from the frontal lobe, the location of higher-reasoning centers in the brain, to areas involved in emotional reactions and in mediating excitatory hormones: the amygdala, hypothalamus, brain stem and sympathetic nervous system. When the pigs without nerve blocks were exposed to severe psychosocial stress–such as being put in entirely new, alarming surroundings–they often experienced fatal fibrillation, a condition in which the heart contracts erratically and does not pump blood. Similarly, electrical stimulation of certain parts of the frontal lobe in the pigs elicited a rapid heart rate and arrhythmias, in some cases leading to cardiac arrest. The pigs whose nerves had been blocked by cold, however, were spared.
Head to Heart So what are the important emotional factors? In the early 1900s Hungarian-American psychoanalyst and psychiatrist Franz Gabriel Alexander, now often called the father of psychosomatics, played a leading role in identifying emotional tension as a significant cause of physical illness. Alexander and other pioneers in the field believed that disorders such as ulcers, high blood pressure, neurodermatitis and asthma were the body’s reaction to chronic tension and psychological stress. Following in the footsteps of psychoanalysts, they held that certain individuals–who suppressed conflicts and emotions–were predisposed to develop ailments as a result. This point of view has fallen out of favor today, as purported links between certain personality types and diseases have been refuted. For example, many studies have shown that the melancholy “cancer personality” is just a myth. On the other hand, a given person’s style of dealing with problems does matter.
That is what heart specialists Meyer Friedman and Ray Rosenman concluded in 1974, after conducting a multiyear study of people with so-called Type A personalities. They claimed these individuals–whose behavior is characterized by ambition, competitiveness and impatience–have a considerably higher risk of heart attacks. In several additional studies, researchers sought a comprehensive evaluation of Friedman and Rosenman’s belief; they were not able to provide confirmation. Yet the aggression and hostility exhibited by Type As contribute to higher levels of stress and its deleterious effects. And although Type As do not necessarily have an increased lifetime risk of having a heart attack, their short-tempered, impatient behavior makes it more likely that they will have a heart attack sooner, according to a study in the May/June 2003 issue of Psychosomatic Medicine by John E. J. Gallacher of the University of Wales College of Medicine.
Many top executives may be Type As, but simply being a Master of the Universe does not raise the risk of heart attack, perhaps because those at the pinnacle of the corporate hierarchy have greater control over their day-to-day working lives than their minions. Middle-ranking employees are more likely to suffer a special kind of stress, called the negative affect. People with this sensitivity disorder exhibit above-average levels of anxiety and depression. After a multiyear study of the negative affect in men and women, Bruce C. Jonas and James F. Lando of the Centers for Disease Control and Prevention reported in the April 2000 Psychosomatic Medicine that such chronically stressed people are twice as likely to have hypertension as normal individuals.
Men who explode with anger or expect the worst from people may punish their own bodies as well. Such men are more likely to develop a type of arrhythmia, says an article in the March 2004 issue of Circulation. Feelings of hostility, for example, made men 30 percent more likely to develop the condition. Other studies have shown that a strong adverse emotion such as anger doubles the risk of heart attack during the next couple of hours. [See box on page 68 to find out if hostility might be a problem for you.]
Irritation and fury are not the only threats to diseased coronary arteries. Nancy Frasure-Smith of McGill University believes that depression also seriously prejudices the chances of heart patients for recovery. Depression, in turn, can result from chronic uncontrollable stress, as well as from a previous heart attack. Victims often suffer from inner hopelessness, such as fears of being unable to meet challenges in their work or personal lives. And loss of a beloved and trusted partner can literally break someone’s heart: as long ago as 1969 Colin Murray Parkes, a British doctor, showed that widows and widowers suffered greatly increased mortality.
Looking on the Bright Side As the work with the pigs showed, the frontal brain seems important in fibrillation and apparently is connected to the nerve cell bodies of the sympathetic nervous system in the spinal cord. Through this connection, the human mind ought to be able to influence heart function in a positive manner. Relaxation techniques such as autogenic training may possibly utilize this mechanism. Along with targeted stress management, such methods may improve the survival chances of heart patients more than daily exercise, as suggested by James A. Blumenthal of the Duke University Medical Center in 1997.
Psychotherapy’s positive influence on bodily processes is especially evident in studies of pain patients. Neuropsychologist Pierre Rainville of the University of Montreal set up a therapeutic study based on suggestion, called guided imaging. Using positron-emission tomography (PET) imaging, he discovered that a brain region responsible for the conscious awareness of pain, the anterior cingulate gyrus, would become less active–merely because of spoken words.
Another means to break free of the self-reinforcing cycle of heart disease, stress and depression is cognitive behavioral therapy. Patients learn to give more weight to positive events in their lives than to negative ones [see “Treating Depression: Pills or Talk?” by Steven D. Hollon, Michael E. Thase and John C. Markowitz; Scientific American Mind, Premier Issue, 2004]. A strong social network, as well as contact with trusted individuals, helps people to overcome stress, too. Heart disease patients who are married or in stable relationships have longer average life expectancies.
Two other important ingredients to reversing cardiovascular disease are developing more healthful eating habits and exercising regularly. Dean Ornish and his colleagues at the University of California at San Francisco tracked the progress of patients with coronary artery disease who ate low-fat vegetarian diets and got regular exercise. The subjects stopped smoking, and they sought to bring calm to their lives through stress management training and group therapy. After a year, the condition of their coronary arteries had improved noticeably.
Is the power of the brain supreme when it comes to affecting physical well-being, or does the body’s health sway our mental states? Both usually go hand in hand: body and mind are bound up, inseparably, in a continual feedback loop. The scientific knowledge gained in recent years teaches us that just as corporeal phenomena can change our minds and spirits, it works in the other direction as well: thoughts and emotions can cause real changes to our bodies.
