THE WILL AND THE HEART
"For what I will, I will, and there an end."
_Two Gentlemen of Verona_.
The heart is the _primum movens_, the first tissue of the body that
moves of itself in the animal organism, doing so rhythmically and of
course continuously before the nervous system develops in the embryo.
This spontaneous activity would seem to place it quite beyond the
control of the will, as of course it is, so far as the continuance of
its essential activity goes, but there is probably no organ that is so
much influenced by the emotions and comes indirectly under the
influence of the will as the heart. There are a series of expressions
in practically all languages which chronicle this fact. We talk about
the encouragement and discouragement or in Saxon terms that are
exactly equivalent to the French words, heartening and disheartening
of the individual. At moments of panic the {228} heart can be felt to
be depressed, while at times when resolve is high there is a sense of
well-being in connection with the firm action of the heart that flows
over into the organism and makes everything seem easy of
accomplishment.
There are a number of heart conditions that depend for their existence
and continuance on a sense of discouragement, that is oversolicitude
with regard to the heart. If something calls attention to that organ,
the fact that it is so important for life and health and that anything
the matter with it may easily prove serious, will sometimes
precipitate a feeling of panic that is reflected in the heart and adds
to the symptoms noted. The original disturbing heart sensation may be
due to nothing more than some slight distention of the stomach by gas,
or by a rather heavy meal, but once the dread of the presence of a
heart condition of some kind comes over the individual, all the
subjective feelings in the cardiac region are emphasized and the
discouragement that results further disturbs both heart and patient.
Palpitation of the heart is scarcely more than a solicitous noting of
the fact that the heart is beating. In certain cases, under the {229}
stress of emotion, the heart beat-rate may be faster than normal, but
in a number of people who complain of palpitation, no rapid heart
action is noted. What has happened is that something having called
particular attention to the heart, the beating of the organ gets above
the threshold of consciousness and then continues to be noted whenever
attention is given it. This is of itself quite sufficient to cause a
sense of discomfort in the heart region and there may be, owing to the
solicitude about the organ, a great deal of complaint.
Just one thing is absolutely necessary in the treatment of these
cases, once it is found that there is no organic condition present.
The patient's will must be stimulated to divert the attention from the
heart and to keep solicitude from disturbing both that organ and the
patient himself. It is not always easy to accomplish this, but where
the patient has confidence in the diagnosis and the assurance that
nothing serious is the matter, a contrary habit that will overcome the
worry with regard to the heart can be formed. For it must not be
forgotten that in these cases a series of acts of solicitous attention
has been performed which has created a habit that can only be overcome
by the opposite habit. {230} It is surprising how much discomfort this
simple affection, due to a functional disturbance of the heart and
overattention to it, may produce and how much it may interfere with
the usual occupation. It is a case, however, simply of willing to be
better, and nothing else will accomplish the desired result. At times
the mistake is made of giving such patients a heart remedy, perhaps
digitalis, but this only emphasizes the unfavorable suggestion and
besides, by stimulating heart action, sometimes brings it more into
the sphere of consciousness than before and actually does harm.
There is a form of this functional disturbance of the heart which
reaches a climax of power to disturb and then is sometimes spoken of
as spurious _angina pectoris_. In these cases the patient complains
not only of a sense of discomfort but of actual pain over the heart
region and this pain is sometimes spoken of as excruciating.
Occasionally the pain will be reflected down the left arm which used
to be considered the pathognomic sign of true _angina pectoris_ but is
not. Sometimes the pain is reflected in the neck on the left side or
at times is noted at the angle of the scapula behind. When these
symptoms occur {231} in young persons and particularly in young women,
there is no reason to think for a moment of their being due to true
_angina pectoris_, which is a spasm of the heart muscle consequent
upon the degeneration of the coronary arteries, the blood vessels
which feed the heart itself, and occurs almost exclusively in the old,
and much more commonly in old men.
The pain of true _angina pectoris_ is often said to be perhaps the
worst torture that humanity has to bear. As a rule, however, it is
very prostrating and so genuine sufferers from it are not loud in
their complaints. Their suffering is more evident in their faces than
in their voices. Indeed, it has come to be looked upon as a rule by
the English clinicians and heart experts that the more fuss there is
made, the less likelihood there is of the affection being true _angina
pectoris_. When there is pain in the heart region then, especially in
young or comparatively young women, of which great complaint is made,
it is almost surely to be considered spurious _angina_, even though
there may be reflex pain down the arm as well as the impending sense
of death which used to be considered distinctive of the genuine
_angina pectoris_.
{232}
The treatment of true _angina_ depends to some extent on inspiring the
patient with courage, for it is needed to carry him through the very
serious condition to which he is subjected. The psychic element is
important, though the drug treatment by the nitrites and especially
amyl nitrite is often very effective. In spurious _angina_, the will
is the all-important element. There is some irritation of the heart
muscle but it is mainly fright that exaggerates the pain and then
concentration of attention on it makes it seem very serious. The one
thing that is all important is to relieve patients from the solicitude
which comes upon them with regard to their hearts and which prevents
them from suppressing their feelings and diverting their minds to
other things. Sometimes the will is needed to bring about such a
change in the habits of the individual as will furnish proper
nutrition for the heart. Very often these patients are under weight,
not infrequently they have been staying a great deal in the house, and
both of these bad habits of living need to be corrected. Good habits
of eating and exercise are above all important for the relief of the
condition.
For functional heart trouble, gentle exercise {233} in the open air
generally must be taken, for it acts as a tonic stimulant to the heart
muscle. Almost as a rule, when patients suffer from symptoms from
their hearts, they are inclined to consider them a signal that they
must rest and above all must not exercise to such an extent as to make
the heart go faster. Rest, if indulged in to too great an extent, has
a very unfavorable effect upon the heart, for the heart, like all
muscles, needs exercise to keep it in good condition. One of the most
important developments of heart therapeutics in our generation was the
Nauheim treatment. In this, exercise is an important feature. The
exercise is graduated and is pushed so as to make a definite call upon
the heart's muscular power. Nauheim is situated in a little cup-shaped
valley and patients are directed to walk a certain distance on one of
the various roads, distances being marked by signposts every quarter
of a mile or so. The walk outward, when the patient is fresh, is
slightly uphill, and the return home is always downhill, which saves
the patient from any undue strain.
The experience at Nauheim was so favorable that many physicians took
up the practice of having their heart patients exercise {234}
regularly and found that it was decidedly to their benefit. If this is
true for organic heart conditions, it is even more valuable for
neurotic heart cases, though it often requires a good deal of exercise
of will on the part of patients suffering from these affections to
control their feelings and take such exercise as is needed. In men, it
will often be found that the discomfort in the heart region,
particularly in muscular, well-built men who have no organic
condition, is due more to lack of exercise than to any other factor.
This is particularly true whenever the men have taken considerable
vigorous exercise when they were young and then tried to settle down
to the inactive habits of a sedentary life. Athletes who have been on
the teams at college, self-made men who have been hard manual laborers
when they were young, even sons of farmers who take up city life are
likely to suffer in this way. Their successful treatment depends more
on getting exercise in the open back into their lives than on anything
else, and for this a call upon the individual's will power for the
establishment of the needed new habits is the essential.
Former athletes who try to settle down to a very inactive life are
almost sure to have {235} uncomfortable feelings in their heart
region. At times it will be hard to persuade them that they have not
some serious affection consequent upon some overstrain at athletics.
In a few cases, this will be found to be true, but in the great
majority the root of the trouble is that the heart craves exercise. A
good many functional heart cases, like the neurotic indigestions, so
called--are due to the fact that the heart and the stomach are not
given enough to do. The renewal of exercise in the daily life--and it
should be the daily life as a rule and not merely once or twice a
week--will do more than anything else to relieve these cases and
restore the patient's confidence. We saw during the war that a number
of young men, officers even more than privates--that is, the better
educated more than the less educated--suffered from shell shock so
called. A good many university men may suffer from what might be
termed heart shock if they find any reason to be solicitous about
their hearts. These neurotic conditions can only be relieved by the
will and diversion of attention.
A certain number of people who suffer from missed beats of their
hearts become very much perturbed about the condition of that organ.
{236} Irregular heart action, and especially what has been called the
irregularly irregular heart, may prove to be a serious condition.
There are a number of regular irregularities of heart action, however,
consisting particularly of the missed beat at shorter or longer
intervals, which may have almost no significance at all. I know two
physicians, both athletes when they were at college, who have suffered
from a missed heartbeat since their early twenties. In one case it has
lasted now for thirty-five years and the physician is still vigorous
and hearty, capable even of running up an elevated stairway after a
train without any inconvenience. Some twenty years ago there was
question of his taking out a twenty-year life insurance policy and the
insurance company's physician at first hesitated to accept the risk
because of the missed beat. An examination made by three physicians at
the home office was followed by his acceptance and he has outlived the
maturity of the policy in good health and been given a renewal of it,
in spite of the fact that his missed beat still persists.
There is often likely to be a good deal of solicitude as to the
eventual prognosis in these cases, that is as to what the prospect of
{237} prolonged life is. The regularly irregular heart does not seem
to make for an unfavorable prognosis. Young patients particularly who
have learned that they have a missed heartbeat need to have this fact
emphasized. We have the story of an important official of an American
university in whom a missed beat was discovered when he was under
forty. This was many years ago, and the prognosis of his condition was
considered to be rather serious. The patient actually lived, however,
for a little more than fifty years after the discovery of his missed
beat. It is easy to understand what a favorable effect on a patient
solicitous about a missed beat such a story as this will have. It
heartens a patient and gives him the will power to throw off his
anxieties and to keep from watching his heart and thus further
interfering with its activities. There is even a possibility of life
to the eighties or, as I have known at least one case, to the
nineties, where the irregular heart was first noted under thirty.
But it is well recognized that close concentration of attention on the
heart will hamper its action. It has been demonstrated that it is
possible by will power to cause the missing of heartbeats and while
only those who have {238} practised the phenomenon can demonstrate it,
there are a number of well-authenticated examples of it. There is no
doubt, however, that anxiety about the heart will quicken or slow the
pulse rate. When a patient comes to be examined for suspected heart
trouble the pulse rate is almost sure to be higher than normal, even
though there may be nothing the matter with the heart; the increase or
decrease of the pulse beat is due to the anxiety lest some heart
lesion should be discovered. This makes it necessary as a rule not to
take too seriously the pulse rate that is discovered on a first
consultation and makes it always advisable to wait until the patient
has been reassured to some extent before the pulse rate is definitely
taken.
It is easy to see, then, what a large place there is for the will in
heart therapeutics. Courage is an extremely important element in
keeping the heart from being disturbed and maintaining it properly
under control. Scares of various kinds with regard to this
all-important organ are prone to get hold of people and then to
disturb it. Many a heart that is actually interfered with in its
activities by drugs of various kinds would respond to the awakening of
the will of the patient {239} so as to control solicitudes, anxieties,
dreads and the like that are acting as disturbing factors on the
heart. When taken in conjunction with the will to eat and to exercise
properly so often necessary in these cases, the will becomes the
therapeutic agent whose power must never be forgotten, because it can
always be an adjuvant even when it is not curative and can produce
excellent auxiliary effects for every form of heart treatment that we
have.
{240}