Monday, April 20, 2009
To Begin: Hearts is Trump
I've referred to myself in my main journal, at least a couple of times, I think, most recently here, as experiencing a broken heart resulting from the death of my mother on December 8, 2008. Serendipitously, on April 18, 2009, through a USA network TV rerun of a 2007 episode of House I watched entitled Words and Deeds [click here for an interesting review containing a "ridiculous" check of this episode and a brief rundown of fairly reliable (inasmuch as can be had at present, anyway) information regarding the diagnosis discussed in the program], I was treated to some intriguing information on Broken Heart Syndrome (sometimes abbreviated as BHS). Despite the maddening antics of the episode, the information contained was curious enough to prompt me to further exploration.
What we are now calling "Broken Heart Syndrome" has gathered centuries of anecdotal information: A widowed spouse, usually elderly, dying within a year of the deceased spouse is primary. There are tons of other examples, some of which don't involve death of survivors to someone deceased, but do involve prolonged grief and marked changes in sufferers' outlooks and lives. Often, as cited here, the condition involves physical pain in the chest region (it hasn't with me). Study of the condition as it might be related to physiological (vs. metaphorical) heart problems began only recently, in the 1990s, in Japan. This link, misnamed as it is (the condition "can be" but is not necessarily fatal), discusses in fairly good depth the Rhode Island Takotsubo Cardiomyopathy Registry as it was used to study this complaint. This link directs to an article published a year after the previously mentioned study commenced that gives an accurate overview of the condition and the questions that arise from considering it.
I was surprised to discover from the House episode that broken hearts are currently more than an emotional consideration and have become the subject of respectable scientific study. There is a bit of conversation in the above mentioned episode that was especially shocking (pun intended) regarding a treatment decision made that was specific to the suffering character's situation. The dialogue, below, taken from the show (all spelling follows CC spelling) traces the decision and, as well, gives what is currently considered a decent, though not thorough, explanation of the physiology of BHS:
The popularity of twists such as these is the reason I stopped watching House much earlier last year. I'd begun an obsession with the show when it was mentioned to me by an online acquaintance while my mother was in the hospital and rehab last spring. I sought it out and became almost immediately hooked for a period of a few weeks, until it dawned on me that the fictional arrogance portrayed (chiefly through Dr. House) in the show was mimicking the real arrogance I was, daily, fighting in every medical staff with whom I had to work as I advocated for my mother's health. Instead of calming me, watching the show was working me up to fever pitch every night before retiring.
Be that as it may, when Jessica Knapp posted about a House character's death at her website, after watching that episode in arrears I became, again, entranced with the show. I'm not sure why and an explanation doesn't yet matter enough to me to seek one. I still find the show maddening and frustrating. The issue of broken hearts becoming a medical syndrome, though, well, I can't quite let go of this, considering my recent use of the label. I think it's interesting, and probably worthwhile, that, as a species, we are attempting to study broken hearts from an objective, physiological point of view. Although the research doesn't yet conclusively indicate whether, when or why they are fatal, certainly, broken hearts are life changing. I'm not one to campaign for a cure for, or even the medical eradication of the physiology that accompanies broken hearts. Although the condition I'm labeling as my own broken heart is extremely uncomfortable and is, indeed, changing my attitudes toward life and, thus, I expect, will change my life, I'm not sorry it's happening and I'm not keen to avoid the condition. I hope, and think, that, eventually, living with my broken heart will reveal new ways of perceiving and approaching life that will be much more compatible with who I am, now, and will be much more effective and life-enhancing.
There was a time, immediately after my mother died, when I hurt so much, emotionally, that I confided to one of my sisters that, at least for a few weeks after everyone left, I hoped that family members would set up a schedule of checking on me daily by phone to make sure that I remained alive. I worried, I told her, based on all that anecdotal evidence I mentioned previously in this post (evidence with which I doubt any of us escapes familiarity, a familiarity which begins when we are young, before we are able to understand the concept of the effects of a broken heart), that, without ulterior intention I might die of a broken heart. My extended family did, indeed, set up such a schedule, including a back-up plan in case one of them happened to call when I was out, which set a time limit on lack of answering or responding, after which local police would be called. The plan played out for about three weeks. After that, I reported that it no longer was necessary. I'm sure I was right about that.
The abandonment of the plan, though, doesn't mean that I am not continuing to experience a damaged and confused metaphorical heart. I can't say whether I am also (or ever was) experiencing a physical heart that is besieged by the physiological properties of a broken heart, but I seem to be healthy and have no reason to go to a doctor, so my guess is that, if I was ever in any physiological danger from my metaphorical heart break, I am no longer. Stress isn't ipso facto deleterious. In this case, I consider whatever stress my continuing "heart condition" is causing to be advantageous. It's prompting me to work through it. No, it's not easy. Yes, sometimes I vacation, putting the work aside to revel in life's pleasantries. I prefer, though, sometimes even relish, working it...considering the alternatives, at least those I am sure would apply to me.
One of the aspects of BHS that was briefly mentioned in the show and, as well, on a few of the sites to which I've previously linked in this post, is that middle-aged women seem to be a primary demographic within the category of sufferers of BHS. This makes sense to me. Menopause changes a woman's physiology in ways that remove protection from the heart and colors a woman's perception of the world so distinctly that it upsets mental apple carts all over the place. Creating and adjusting to a post-menopausal world view, as well as adjusting to physiological changes, continues after one finishes menopause and ushers in years of what Margaret Mead termed "post-menopausal zest". Stack a death on top of this process and the weight is probably enough to break even a sturdy heart. However, this oddity, which hasn't yet been medically explained, does not account for what has always been anecdotal wisdom and, according to at least one study, is a matter of scientific observation: That when a spouse dies, a widower is almost three times as likely to experience "excess mortality" (dying because one's spouse has died) than is a widow. It's interesting to note that conventional wisdom often connects this observation with the idea that, overall, women are better at taking personal care of themselves than men because husbands typically depend on their wives to not only prompt them to but to perform personal care for them; thus, women are more likely to survive after the death of a spouse than are men. This scientifically observable phenomenon is often what is conventionally referred to as death by broken heart. I wonder, though, if it wouldn't be more appropriate to refer to excess mortality in widowered husbands as due to broken lives.
I can't say that I don't understand people who die after the death of an intimate. From what I've experienced since my mother's death I feel bound to report that such fantasies don't emerge only from the sense of life devastation that follows the death of an intimate and the desire to physically dive into that devastation, complete it, so to speak. I've also experienced a haunting quality to being "left behind" which involves a need to know "where" the deceased "is"; to want to follow her in order to remain in touch with her; an agony in having to surrender the actuality, the presence of a relationship, to Death; all of which have caused me, at times, since Mom's death, to wish that I would die, not in order to really die, but to follow, and know, and once again be in real time touch with her. I understand how it would be very hard to resist this desire if one is perennially prone to thoughts of suicide or very ill or very old and perceives her or himself to be close to death aside from the deceased's stark absence. I can also report, though, that when one isn't suicidal or perceives oneself to be close, for whatever reason, to the end of one's life, when one, I think, too, isn't experiencing complicated grief (which I wondered, for awhile, if I was experiencing but have satisfied myself that I am not, at least not at this point), it is possible, hard, yes, but possible, to resist realizing The Follow Fantasy. It is, in fact, a bit more seductive to continue trudging through the devastation of one's heart in order to see, just to see, if something else, something interesting and vital, can be resurrected from the debris of Death's toppling. For me, on a day to day basis, this, alone, is a good enough reason to continue plodding from morning, to noon, to evening, to night, and not merely hope but expect to rise, again, another day.
For others, it's not. I wouldn't be surprised to discover that none among these others expected to find themselves of the "not" sort. Maybe, one day, in reaction to a death, I might find myself "notting" away...thus, my heart wonders about these others.
What we are now calling "Broken Heart Syndrome" has gathered centuries of anecdotal information: A widowed spouse, usually elderly, dying within a year of the deceased spouse is primary. There are tons of other examples, some of which don't involve death of survivors to someone deceased, but do involve prolonged grief and marked changes in sufferers' outlooks and lives. Often, as cited here, the condition involves physical pain in the chest region (it hasn't with me). Study of the condition as it might be related to physiological (vs. metaphorical) heart problems began only recently, in the 1990s, in Japan. This link, misnamed as it is (the condition "can be" but is not necessarily fatal), discusses in fairly good depth the Rhode Island Takotsubo Cardiomyopathy Registry as it was used to study this complaint. This link directs to an article published a year after the previously mentioned study commenced that gives an accurate overview of the condition and the questions that arise from considering it.
I was surprised to discover from the House episode that broken hearts are currently more than an emotional consideration and have become the subject of respectable scientific study. There is a bit of conversation in the above mentioned episode that was especially shocking (pun intended) regarding a treatment decision made that was specific to the suffering character's situation. The dialogue, below, taken from the show (all spelling follows CC spelling) traces the decision and, as well, gives what is currently considered a decent, though not thorough, explanation of the physiology of BHS:
Cameron: Broken Heart Syndrome. He's in love and it's killing him.In the episode, through a bizarre twist, after the electroshock is applied it is discovered that the suffering character's broken heart isn't based on reality but on a delusion which is evidence of a condition which hasn't been adequately diagnosed or treated. Oops!
Foreman: Thought that only happened to 80 year old widows.
Cameron: Thanks to his menopause and estrogen level, he basically is an old woman. BHS is an acute physical response to an emotional experience. Stress triggers a flood of catecholamines...
Chase: That's a plain old stress cardiomyopathy, not a heart attack.
Cameron: But if you're too worried about your job to get it treated, they can devolve into full on heart attacks. You think this is a coincidence this started when Amy got engaged?
House: No, I don't. But now that you know the why, what are you going to do to stop the how?
Foreman: We've already put him on beta blockers and nitroglycerin. No effect.
Cameron: We need to put him on anti-depressants.
House: Not if you're right. Anti-depressants would inhibit his autonomic nervous system which would only speed up the heart attacks.
Chase: We could try propylthiouracil, slow down his metabolic rate.
House: Thyroid effect would only weaken the heart.
Foreman: The only other option is blood thinners.
House: This is not a fat guy with plaque-filled arteries and a swollen heart. He's a guy whose brain is trying to kill his heart.
Chase: So, buy him a girlfriend. Make him happy.
Cameron: That might make you happy. The only thing that'll make him happy is Amy.
Chase: So, keep him away from her.
Cameron: He has a myocardial infarction every time she walks in the room. What do you think will happen to his heart when you tell him he can never see her again?
Chase: He needs a shrink.
Foreman: Chase's idea is as good as any, because, short of frying his brain and wiping Amy out, he's screwed.
House: We need Cuddy.
Foreman: Why?
House: So you can tell her why you need to fry a guy's brain.
Cuddy: They guy's heart isn't working and you want to shock his brain.
House: Electroshock therapy is the only way to erase his memories of Amy and stop the brain's chemical attacks on the heart.
Cuddy: This isn't 1940. The problem can be controlled with anti-depressants.
House: Cameron?
Cameron: Anti-depressants would inhibit his autonomic nervous system. Speed up the attacks.
House: LMNO, PTU, blood thinners, none of them will solve his problem. The man's got a real life Harlequin romance in his head. We're gonna pull out the 1940 playbook. Bilateral electrodes, high stimulus sine-wave intensity. Turning that dial all the way to 11. It's basic brain chemistry. We interrupt the protein synthesis, altering the neuro-transmitter system. End results, no memories, no Amy, no problem.
The popularity of twists such as these is the reason I stopped watching House much earlier last year. I'd begun an obsession with the show when it was mentioned to me by an online acquaintance while my mother was in the hospital and rehab last spring. I sought it out and became almost immediately hooked for a period of a few weeks, until it dawned on me that the fictional arrogance portrayed (chiefly through Dr. House) in the show was mimicking the real arrogance I was, daily, fighting in every medical staff with whom I had to work as I advocated for my mother's health. Instead of calming me, watching the show was working me up to fever pitch every night before retiring.
Be that as it may, when Jessica Knapp posted about a House character's death at her website, after watching that episode in arrears I became, again, entranced with the show. I'm not sure why and an explanation doesn't yet matter enough to me to seek one. I still find the show maddening and frustrating. The issue of broken hearts becoming a medical syndrome, though, well, I can't quite let go of this, considering my recent use of the label. I think it's interesting, and probably worthwhile, that, as a species, we are attempting to study broken hearts from an objective, physiological point of view. Although the research doesn't yet conclusively indicate whether, when or why they are fatal, certainly, broken hearts are life changing. I'm not one to campaign for a cure for, or even the medical eradication of the physiology that accompanies broken hearts. Although the condition I'm labeling as my own broken heart is extremely uncomfortable and is, indeed, changing my attitudes toward life and, thus, I expect, will change my life, I'm not sorry it's happening and I'm not keen to avoid the condition. I hope, and think, that, eventually, living with my broken heart will reveal new ways of perceiving and approaching life that will be much more compatible with who I am, now, and will be much more effective and life-enhancing.
There was a time, immediately after my mother died, when I hurt so much, emotionally, that I confided to one of my sisters that, at least for a few weeks after everyone left, I hoped that family members would set up a schedule of checking on me daily by phone to make sure that I remained alive. I worried, I told her, based on all that anecdotal evidence I mentioned previously in this post (evidence with which I doubt any of us escapes familiarity, a familiarity which begins when we are young, before we are able to understand the concept of the effects of a broken heart), that, without ulterior intention I might die of a broken heart. My extended family did, indeed, set up such a schedule, including a back-up plan in case one of them happened to call when I was out, which set a time limit on lack of answering or responding, after which local police would be called. The plan played out for about three weeks. After that, I reported that it no longer was necessary. I'm sure I was right about that.
The abandonment of the plan, though, doesn't mean that I am not continuing to experience a damaged and confused metaphorical heart. I can't say whether I am also (or ever was) experiencing a physical heart that is besieged by the physiological properties of a broken heart, but I seem to be healthy and have no reason to go to a doctor, so my guess is that, if I was ever in any physiological danger from my metaphorical heart break, I am no longer. Stress isn't ipso facto deleterious. In this case, I consider whatever stress my continuing "heart condition" is causing to be advantageous. It's prompting me to work through it. No, it's not easy. Yes, sometimes I vacation, putting the work aside to revel in life's pleasantries. I prefer, though, sometimes even relish, working it...considering the alternatives, at least those I am sure would apply to me.
One of the aspects of BHS that was briefly mentioned in the show and, as well, on a few of the sites to which I've previously linked in this post, is that middle-aged women seem to be a primary demographic within the category of sufferers of BHS. This makes sense to me. Menopause changes a woman's physiology in ways that remove protection from the heart and colors a woman's perception of the world so distinctly that it upsets mental apple carts all over the place. Creating and adjusting to a post-menopausal world view, as well as adjusting to physiological changes, continues after one finishes menopause and ushers in years of what Margaret Mead termed "post-menopausal zest". Stack a death on top of this process and the weight is probably enough to break even a sturdy heart. However, this oddity, which hasn't yet been medically explained, does not account for what has always been anecdotal wisdom and, according to at least one study, is a matter of scientific observation: That when a spouse dies, a widower is almost three times as likely to experience "excess mortality" (dying because one's spouse has died) than is a widow. It's interesting to note that conventional wisdom often connects this observation with the idea that, overall, women are better at taking personal care of themselves than men because husbands typically depend on their wives to not only prompt them to but to perform personal care for them; thus, women are more likely to survive after the death of a spouse than are men. This scientifically observable phenomenon is often what is conventionally referred to as death by broken heart. I wonder, though, if it wouldn't be more appropriate to refer to excess mortality in widowered husbands as due to broken lives.
I can't say that I don't understand people who die after the death of an intimate. From what I've experienced since my mother's death I feel bound to report that such fantasies don't emerge only from the sense of life devastation that follows the death of an intimate and the desire to physically dive into that devastation, complete it, so to speak. I've also experienced a haunting quality to being "left behind" which involves a need to know "where" the deceased "is"; to want to follow her in order to remain in touch with her; an agony in having to surrender the actuality, the presence of a relationship, to Death; all of which have caused me, at times, since Mom's death, to wish that I would die, not in order to really die, but to follow, and know, and once again be in real time touch with her. I understand how it would be very hard to resist this desire if one is perennially prone to thoughts of suicide or very ill or very old and perceives her or himself to be close to death aside from the deceased's stark absence. I can also report, though, that when one isn't suicidal or perceives oneself to be close, for whatever reason, to the end of one's life, when one, I think, too, isn't experiencing complicated grief (which I wondered, for awhile, if I was experiencing but have satisfied myself that I am not, at least not at this point), it is possible, hard, yes, but possible, to resist realizing The Follow Fantasy. It is, in fact, a bit more seductive to continue trudging through the devastation of one's heart in order to see, just to see, if something else, something interesting and vital, can be resurrected from the debris of Death's toppling. For me, on a day to day basis, this, alone, is a good enough reason to continue plodding from morning, to noon, to evening, to night, and not merely hope but expect to rise, again, another day.
For others, it's not. I wouldn't be surprised to discover that none among these others expected to find themselves of the "not" sort. Maybe, one day, in reaction to a death, I might find myself "notting" away...thus, my heart wonders about these others.
Labels: Broken Heart Syndrome, Complicated Grief
