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From Robert Jandl, M.D., Director of Health Services:

"Whenever I feel sad, or broken-hearted," he wrote, "I get this aching pain in my chest. Why does that happen?"

This was a worthwhile question to ponder, and it reminded me that one of the great things about being a doctor is the amazing questions people ask you. How is it, indeed, that sadness or grief causes physical discomfort?

If that person were with me now, I would start by asking him a few questions. After all, in the practice of medicine, it is also possible to ask a patient just about anything you want and expect to get an answer. "What is it that makes you sad," I might ask. "Do you often feel down or depressed? Is there anything that helps you to feel better? Describe, for me, this pain." Soon, we would be in a very different realm of turbulent emotions, private thoughts, and formative experiences. Perhaps it was lost love for a partner; disappointment in one's children; anger at one's parents; disinterest in sex; infidelity; a sharp awareness of mortality; or perhaps the physical decline of aging.

These are heavy things to talk about. Yet choosing to not talk about them would be to miss a big part of life, let alone the fact that many of these issues are at the bottom of what brings people to doctors anyway.

This question reminds me, then, of what it means "to have heart." Of what it means, for example, to feel love or loss. Acting with heart means doing things according to personal beliefs and principles, however rational or irrational they may seem. The heart is a measure by which we know whether what we are doing is of true value. And it usually implies a consideration of what the consequences of one's actions are on other people. When the heart is not taken into account, thoughtlessness creeps into relationships; greed and ambition get out of control. Bad things happen.

Today it is fashionable to invoke mind/body theories relating the mind and its thought processes to physical well-being, disease, and perhaps even death. In an explosion of scientific knowledge, the immune system has emerged as the web through which the mind and body communicate. The body is awash in chemicals bearing bytes of information from place to place. One chemical can lift the spirits and boost the immune system; another induces a state of fear and causes the heart to race. Leaving nothing to chance, tiny neuronal hairs physically reach into the darkest recesses of every part of the body, providing a direct electro-chemical link to the inner workings of the brain.

The ancients, knowing nothing of "modern" scientific principles, understood this. In ancient Egypt and in pre-fourth century Greece, the heart was said to be the site of consciousness. More than 2400 years later we are still trying to locate and understand consciousness, while also trying to comprehend how emotions and thoughts affect the movement of chemicals and the health of the body.

We may be able to transplant a heart from one person to the next, but the ability to feel heartbreak will continue regardless of whose heart is in your chest. I like to think that the relationship between mind and heart will never be reduced to mere chemicals. It is a mystery better left unexplained.

Best regards,

"Dr. Bob" (1/17/97)
Rob Jandl, MD

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Read more "Letters from Tripod" in the archive.

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