TEDSummit 2019
Sandeep Jauhar: How your emotions change the shape of your heart
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"A record of our emotional life is written on our hearts," says cardiologist and author Sandeep Jauhar. In a stunning talk, he explores the mysterious ways our emotions impact the health of our hearts -- causing them to change shape in response to grief or fear, to literally break in response to emotional heartbreak -- and calls for a shift in how we care for our most vital organ.
Sandeep Jauhar - Physician, writer
Sandeep Jauhar is a practicing cardiologist passionate about communicating medicine in all its glorious, quirky, inescapable humanity. Full bio
Sandeep Jauhar is a practicing cardiologist passionate about communicating medicine in all its glorious, quirky, inescapable humanity. Full bio
Double-click the English transcript below to play the video.
00:13
No other organ,
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perhaps no other object in human life,
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is as imbued with metaphor
and meaning as the human heart.
and meaning as the human heart.
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Over the course of history,
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the heart has been a symbol
of our emotional lives.
of our emotional lives.
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It was considered by many
to be the seat of the soul,
to be the seat of the soul,
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the repository of the emotions.
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The very word "emotion" stems in part
from the French verb "émouvoir,"
from the French verb "émouvoir,"
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meaning "to stir up."
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And perhaps it's only logical
that emotions would be linked to an organ
that emotions would be linked to an organ
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characterized by its agitated movement.
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But what is this link?
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Is it real or purely metaphorical?
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As a heart specialist,
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I am here today to tell you
that this link is very real.
that this link is very real.
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Emotions, you will learn,
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can and do have a direct
physical effect on the human heart.
physical effect on the human heart.
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But before we get into this,
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let's talk a bit about
the metaphorical heart.
the metaphorical heart.
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The symbolism of the emotional heart
endures even today.
endures even today.
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If we ask people which image
they most associate with love,
they most associate with love,
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there's no question that the Valentine
heart would the top the list.
heart would the top the list.
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The heart shape, called a cardioid,
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is common in nature.
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It's found in the leaves,
flowers and seeds of many plants,
flowers and seeds of many plants,
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including silphium,
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which was used for birth control
in the Middle Ages
in the Middle Ages
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and perhaps is the reason why
the heart became associated
the heart became associated
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with sex and romantic love.
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Whatever the reason,
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hearts began to appear in paintings
of lovers in the 13th century.
of lovers in the 13th century.
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Over time, the pictures
came to be colored red,
came to be colored red,
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the color of blood,
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a symbol of passion.
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In the Roman Catholic Church,
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the heart shape became known
as the Sacred Heart of Jesus.
as the Sacred Heart of Jesus.
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Adorned with thorns
and emitting ethereal light,
and emitting ethereal light,
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it became an insignia of monastic love.
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This association between the heart
and love has withstood modernity.
and love has withstood modernity.
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When Barney Clark, a retired dentist
with end-stage heart failure,
with end-stage heart failure,
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received the first permanent
artificial heart in Utah in 1982,
artificial heart in Utah in 1982,
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his wife of 39 years
reportedly asked the doctors,
reportedly asked the doctors,
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"Will he still be able to love me?"
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Today, we know that the heart
is not the source of love
is not the source of love
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or the other emotions, per se;
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the ancients were mistaken.
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And yet, more and more,
we have come to understand
we have come to understand
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that the connection between the heart
and the emotions is a highly intimate one.
and the emotions is a highly intimate one.
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The heart may not originate our feelings,
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but it is highly responsive to them.
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In a sense, a record of our emotional life
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is written on our hearts.
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Fear and grief, for example,
can cause profound cardiac injury.
can cause profound cardiac injury.
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The nerves that control unconscious
processes such as the heartbeat
processes such as the heartbeat
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can sense distress
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and trigger a maladaptive
fight-or-flight response
fight-or-flight response
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that triggers blood vessels to constrict,
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the heart to gallop
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and blood pressure to rise,
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resulting in damage.
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In other words,
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it is increasingly clear
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that our hearts are extraordinarily
sensitive to our emotional system,
sensitive to our emotional system,
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to the metaphorical heart, if you will.
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There is a heart disorder
first recognized about two decades ago
first recognized about two decades ago
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called "takotsubo cardiomyopathy,"
or "the broken heart syndrome,"
or "the broken heart syndrome,"
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in which the heart acutely weakens
in response to intense stress or grief,
in response to intense stress or grief,
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such as after a romantic breakup
or the death of a loved one.
or the death of a loved one.
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As these pictures show,
the grieving heart in the middle
the grieving heart in the middle
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looks very different
than the normal heart on the left.
than the normal heart on the left.
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It appears stunned
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and frequently balloons into
the distinctive shape of a takotsubo,
the distinctive shape of a takotsubo,
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shown on the right,
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a Japanese pot with a wide base
and a narrow neck.
and a narrow neck.
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We don't know exactly why this happens,
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and the syndrome usually resolves
within a few weeks.
within a few weeks.
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However, in the acute period,
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it can cause heart failure,
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life-threatening arrhythmias,
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even death.
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For example, the husband
of an elderly patient of mine
of an elderly patient of mine
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had died recently.
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She was sad, of course, but accepting.
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Maybe even a bit relieved.
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It had been a very long illness;
he'd had dementia.
he'd had dementia.
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But a week after the funeral,
she looked at his picture
she looked at his picture
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and became tearful.
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And then she developed chest pain,
and with it, came shortness of breath,
and with it, came shortness of breath,
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distended neck veins, a sweaty brow,
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a noticeable panting
as she was sitting up in a chair --
as she was sitting up in a chair --
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all signs of heart failure.
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She was admitted to the hospital,
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where an ultrasound confirmed
what we already suspected:
what we already suspected:
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her heart had weakened
to less than half its normal capacity
to less than half its normal capacity
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and had ballooned into
the distinctive shape of a takotsubo.
the distinctive shape of a takotsubo.
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But no other tests were amiss,
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no sign of clogged arteries anywhere.
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Two weeks later, her emotional state
had returned to normal
had returned to normal
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and so, an ultrasound confirmed,
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had her heart.
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Takotsubo cardiomyopathy has been linked
to many stressful situations,
to many stressful situations,
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including public speaking --
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(Laughter)
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(Applause)
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domestic disputes, gambling losses,
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even a surprise birthday party.
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(Laughter)
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It's even been associated
with widespread social upheaval,
with widespread social upheaval,
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such as after a natural disaster.
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For example, in 2004,
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a massive earthquake devastated a district
on the largest island in Japan.
on the largest island in Japan.
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More than 60 people were killed,
and thousands were injured.
and thousands were injured.
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On the heels of this catastrophe,
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researchers found that the incidents
of takotsubo cardiomyopathy
of takotsubo cardiomyopathy
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increased twenty-four-fold in the district
one month after the earthquake,
one month after the earthquake,
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compared to a similar
period the year before.
period the year before.
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The residences of these cases
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closely correlated with
the intensity of the tremor.
the intensity of the tremor.
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In almost every case,
patients lived near the epicenter.
patients lived near the epicenter.
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Interestingly, takotsubo cardiomyopathy
has been seen after a happy event, too,
has been seen after a happy event, too,
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but the heart appears
to react differently,
to react differently,
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ballooning in the midportion,
for example, and not at the apex.
for example, and not at the apex.
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Why different emotional precipitants
would result in different cardiac changes
would result in different cardiac changes
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remains a mystery.
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But today, perhaps as an ode
to our ancient philosophers,
to our ancient philosophers,
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we can say that even if emotions
are not contained inside our hearts,
are not contained inside our hearts,
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the emotional heart overlaps
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its biological counterpart,
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in surprising and mysterious ways.
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Heart syndromes, including sudden death,
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have long been reported in individuals
experiencing intense emotional disturbance
experiencing intense emotional disturbance
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or turmoil in their metaphorical hearts.
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In 1942,
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the Harvard physiologist Walter Cannon
published a paper called "'Voodoo' Death,"
published a paper called "'Voodoo' Death,"
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in which he described
cases of death from fright
cases of death from fright
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in people who believed
they had been cursed,
they had been cursed,
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such as by a witch doctor
or as a consequence of eating taboo fruit.
or as a consequence of eating taboo fruit.
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In many cases, the victim, all hope lost,
dropped dead on the spot.
dropped dead on the spot.
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What these cases had in common
was the victim's absolute belief
was the victim's absolute belief
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that there was an external force
that could cause their demise,
that could cause their demise,
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and against which
they were powerless to fight.
they were powerless to fight.
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This perceived lack of control,
Cannon postulated,
Cannon postulated,
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resulted in an unmitigated
physiological response,
physiological response,
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in which blood vessels
constricted to such a degree
constricted to such a degree
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that blood volume acutely dropped,
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blood pressure plummeted,
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the heart acutely weakened,
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and massive organ damage resulted
from a lack of transported oxygen.
from a lack of transported oxygen.
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Cannon believed that voodoo deaths
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were limited to indigenous
or "primitive" people.
or "primitive" people.
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But over the years, these types of deaths
have been shown to occur
have been shown to occur
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in all manner of modern people, too.
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Today, death by grief has been seen
in spouses and in siblings.
in spouses and in siblings.
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Broken hearts are literally
and figuratively deadly.
and figuratively deadly.
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These associations hold true
even for animals.
even for animals.
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In a fascinating study in 1980
published in the journal "Science,"
published in the journal "Science,"
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researchers fed caged rabbits
a high-cholesterol diet
a high-cholesterol diet
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to study its effect
on cardiovascular disease.
on cardiovascular disease.
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Surprisingly, they found that some rabbits
developed a lot more disease than others,
developed a lot more disease than others,
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but they couldn't explain why.
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The rabbits had very similar diet,
environment and genetic makeup.
environment and genetic makeup.
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They thought it might have
something to do with
something to do with
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how frequently the technician
interacted with the rabbits.
interacted with the rabbits.
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So they repeated the study,
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dividing the rabbits into two groups.
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Both groups were fed
a high-cholesterol diet.
a high-cholesterol diet.
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But in one group, the rabbits
were removed from their cages,
were removed from their cages,
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held, petted, talked to, played with,
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and in the other group,
the rabbits remained in their cages
the rabbits remained in their cages
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and were left alone.
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At one year, on autopsy,
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the researchers found
that the rabbits in the first group,
that the rabbits in the first group,
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that received human interaction,
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had 60 percent less aortic disease
than rabbits in the other group,
than rabbits in the other group,
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despite having similar cholesterol levels,
blood pressure and heart rate.
blood pressure and heart rate.
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Today, the care of the heart has become
less the province of philosophers,
less the province of philosophers,
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who dwell upon the heart's
metaphorical meanings,
metaphorical meanings,
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and more the domain of doctors like me,
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wielding technologies
that even a century ago,
that even a century ago,
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because of the heart's exalted
status in human culture,
status in human culture,
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were considered taboo.
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In the process, the heart
has been transformed
has been transformed
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from an almost supernatural object
imbued with metaphor and meaning
imbued with metaphor and meaning
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into a machine that can be
manipulated and controlled.
manipulated and controlled.
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But this is the key point:
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these manipulations, we now understand,
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must be complemented
by attention to the emotional life
by attention to the emotional life
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that the heart, for thousands of years,
was believed to contain.
was believed to contain.
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Consider, for example,
the Lifestyle Heart Trial,
the Lifestyle Heart Trial,
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published in the British journal
"The Lancet" in 1990.
"The Lancet" in 1990.
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Forty-eight patients with moderate
or severe coronary disease
or severe coronary disease
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were randomly assigned to usual care
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or an intensive lifestyle
that included a low-fat vegetarian diet,
that included a low-fat vegetarian diet,
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moderate aerobic exercise,
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group psychosocial support
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and stress management advice.
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The researchers found
that the lifestyle patients
that the lifestyle patients
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had a nearly five percent reduction
in coronary plaque.
in coronary plaque.
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Control patients, on the other hand,
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had five percent more
coronary plaque at one year
coronary plaque at one year
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and 28 percent more at five years.
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They also had nearly double
the rate of cardiac events,
the rate of cardiac events,
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like heart attacks,
coronary bypass surgery
coronary bypass surgery
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and cardiac-related deaths.
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Now, here's an interesting fact:
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some patients in the control group
adopted diet and exercise plans
adopted diet and exercise plans
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that were nearly as intense
as those in the intensive lifestyle group.
as those in the intensive lifestyle group.
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Their heart disease still progressed.
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Diet and exercise alone were not enough
to facilitate coronary disease regression.
to facilitate coronary disease regression.
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At both one- and five-year follow-ups,
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stress management
was more strongly correlated
was more strongly correlated
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with reversal of coronary disease
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than exercise was.
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No doubt, this and similar
studies are small,
studies are small,
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and, of course, correlation
does not prove causation.
does not prove causation.
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It's certainly possible that stress
leads to unhealthy habits,
leads to unhealthy habits,
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and that's the real reason
for the increased cardiovascular risk.
for the increased cardiovascular risk.
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But as with the association
of smoking and lung cancer,
of smoking and lung cancer,
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when so many studies show the same thing,
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and when there are mechanisms
to explain a causal relationship,
to explain a causal relationship,
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it seems capricious to deny
that one probably exists.
that one probably exists.
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What many doctors have concluded
is what I, too, have learned
is what I, too, have learned
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in my nearly two decades
as a heart specialist:
as a heart specialist:
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the emotional heart intersects
with its biological counterpart
with its biological counterpart
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in surprising and mysterious ways.
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And yet, medicine today continues
to conceptualize the heart as a machine.
to conceptualize the heart as a machine.
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This conceptualization
has had great benefits.
has had great benefits.
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Cardiology, my field,
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is undoubtedly one of the greatest
scientific success stories
scientific success stories
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of the past 100 years.
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Stents, pacemakers, defibrillators,
coronary bypass surgery,
coronary bypass surgery,
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heart transplants --
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all these things were developed
or invented after World War II.
or invented after World War II.
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However, it's possible
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that we are approaching the limits
of what scientific medicine can do
of what scientific medicine can do
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to combat heart disease.
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Indeed, the rate of decline
of cardiovascular mortality
of cardiovascular mortality
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has slowed significantly
in the past decade.
in the past decade.
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We will need to shift to a new paradigm
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to continue to make the kind of progress
to which we have become accustomed.
to which we have become accustomed.
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In this paradigm, psychosocial factors
will need to be front and center
will need to be front and center
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in how we think about heart problems.
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This is going to be an uphill battle,
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and it remains a domain
that is largely unexplored.
that is largely unexplored.
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The American Heart Association
still does not list emotional stress
still does not list emotional stress
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as a key modifiable risk factor
for heart disease,
for heart disease,
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perhaps in part because blood cholesterol
is so much easier to lower
is so much easier to lower
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than emotional and social disruption.
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There is a better way, perhaps,
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if we recognize that when
we say "a broken heart,"
we say "a broken heart,"
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we are indeed sometimes talking
about a real broken heart.
about a real broken heart.
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We must, must pay more attention to
the power and importance of the emotions
the power and importance of the emotions
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in taking care of our hearts.
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Emotional stress, I have learned,
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is often a matter of life and death.
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Thank you.
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(Applause)
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ABOUT THE SPEAKER
Sandeep Jauhar - Physician, writerSandeep Jauhar is a practicing cardiologist passionate about communicating medicine in all its glorious, quirky, inescapable humanity.
Why you should listen
In addition to his medical practice, Dr. Sandeep Jauhar writes about medicine and its impacts on culture for a wide-ranging audience. He is a contributing opinion writer for the New York Times and has written three best-selling books.
His most recent book, Heart: A History (a finalist for the 2019 Wellcome Book prize), tells the little-known story of the doctors who risked their careers -- and the patients who risked their lives -- to understand our most vital organ. Weaving his own experiences with the defining discoveries of the past, Jauhar braids tales of breakthrough, hubris and sorrow to create a lucid chronicle of our life's most intimate chamber. The book also confronts the limits of medical technology, arguing that future progress will be determined more by how we choose to live rather than by any device we invent. Indeed, as the book explains, our emotional lives are absolutely key to our heart health. Jauhar is the Director of the Heart Failure Program at Northwell Health's Long Island Jewish Medical Center.
Sandeep Jauhar | Speaker | TED.com