Anxiety preceding a heart attack — Effect of person

Abstract

Recent reports illuminate a case of coronary infarction (“heart attack”) in a patient who had been observed analytically for years before and since the heart attack,—a case with a hallucinatory episode.

The reports include descriptions of: 1) “shell-shock” nightmares after cardiac arrest and resuscitation (Druss and Kornfeld); 2) the Effect of Person in transferring heart-attack patients from intensive-care units to ordinary medical wards (Klein and associates); 3) the absence of anxiety or adverse psychic effects after the implantation of artificial pacemakers which keep the heart beat regular and synchronized (Greene and Moss); 4) the importance of lack of education in coronary infarction among “driving” men (Hinkel); and 5) psychosis in coronary-care units (Grace). The case presented had these ingredients, particularly the Effect of Person. The patient was forced to confront every day a “big boss” he had avoided for many years, a confrontation with real and hostile power that shattered his magic death-defying control and his raging “drives.” His agitation and anxiety vanished as he was taken by ambulance—with a massive heart attack—to the hospital. There had been a brief period of hallucination under LSD treatments 90 days before the attack. This response is considered to be the culmination of an inner shock pattern of “regression” or “autokinesis”, carried forward from a shocking childhood, suggesting that heart attack is the final expression of an early traumatic neurosis beginning in the first years of life and showing schizomanic and agitated hysteric episodes.

The author previously had introduced the concept of an autonomous heart-monitoring level of consciousness, organizing all imagery in dream and fantasy—the paraconscious field—which Freud and Pavlov overlooked. The heart normally creates its own image in language and in the hallucinatory quality of dreams. These concepts have great potential for advances in brain-mind and mind-heart integration, of especial importance to heart attack, as well as to “nervous breakdown.” The total evidence suggests a disturbed heart-brain balance in neuropsychic catechplamine chemistry, in which the heart may act as though it were a hallucinogenic pump.