Sanctuary for the Abused

Monday, October 22, 2018

Heartbreak, Heartache, and Cardiac Pain

A Study of Coronary-Prone Behavior

by Dr. Stephen T. Sinatra, M.D.

Coronary heart disease is the most common cause of in the industrialized world. Over the years, and particularly within the last decade, a considerable amount of research has been undertaken in an effort to discover the causes of arteriosclerotic cardiovascular disease -- a unique phenomenon of twentieth century people. This research has been mostly of a statistical nature. Risk factors such as cigarette smoking, hypercholesterolemia, and hypertension are significant variables in the relationship between life style and cardiovascular disease. Additional research studies, however, have disclosed that certain individuals are more prone to heart disease than others.

Such disease-prone individuals have a special pattern of behavior (Friedman 1984, 3-70; Eliot 1984, 35-92; S 1980). This behavior may be described as ambitious, competitive, aggressive, and hostile. Coronary-prone individual driven by achievement and performance, strive to succeed but gain no satisfaction or fulfillment from the effort. They suppress feelings; thinking becomes more important than feeling. They frequently have an over-commitment to work and a profound sense of time urgency and impatience. They project an positive self-esteem and success.
The reality of their poor esteem, depression, and various forms of sexual inadequacy are frequently hidden from the outside world. Subconsciously have a strong desire to control events, and many of them expertence a need to accomplish out of a profound sense of panic (Lowen 1980, 1-29).
It can be asked: Why is there an inordinate drive for success? How did this behavior develop? What function does it serve in personalities? If one does not know drives one, one cannot act effectively to limit the drive to a reasonable level. If one can understand how these forces act in one's personality, specific actions can be taken to diminish their power and so protect one's heart from their harmful effects.

For the past three years, I have been collaborating with Al-exander Lowen in a project to arrive at a bioenergetic under-standing of cardiac disease and the individuals who are prone to it (Lowen and Sinatra, 1988). The formulations in this paper are based on our research.

It is well known that mind and body influence each other. What one thinks can elicit an emotional response in which the body participates. Thus, psychosomatic issues are key elements found in almost every illness. In general, psychosomatic illness represents suppressed emotion that eventually damages the body and its physiological system. In hypertension, the major suppressed emotions are anger, hostility and rage (Rosenman 103-135; Sinatra and Chawla 1986, 197-199). In addition to suppressing anger and hostility, coronary-prone individuals have also struggled with the heart-breaking experience loss of love and subsequent loss of a vital connection. Such feelings of heartbreak, and the great sorrow, grief, and anguish which are part of them, are subsequently expressed in one's evolving behavior, character, and body. Although the childhood injury of heartbreak may be repressed, in adulthood the body holds these experiences in its physical expression. Such individuals display an over-inflated, high-held chest, mechanical breathing, a contracted pelvis, and a general state of rigidity.

Few people would admit that they were unloved as children. Even patients undergoing analvsis have considerable difficulty accepting this possibility. Generally, it is only after thev have ex-perienced the pain of their heartbreak that they are willing to recognize that one or both parents felt negatively towards them.
Parental love is a critical component of development in humans. But unfortunately, it is withheld from some children.
Type A coronary-prone behavior develops in a family situation in which love for the child is conditioned upon the child's accomplishments and achievements (Sinatra and Lowen 1988). In western culture, success has become the most important "virtue." Many parents are excessively involved in their children's status and performance in and out of school, in studies and in sports. Love conditioned upon performance is not love at all.

Conditional love always carries with it the possibility that, at some time or another, children will experience the withdrawal of love if their behavior has not fulfilled parental expectations. True love surrounds people with warmth and affection for who they are and not for what they do. If young children receive the message, "You are not acceptable the way you are," basic insecurities develop. These are the bases for the Type A personality, the drive to achieve as a way to overcome early rejections.

Fearing to love, children close their hearts to avoid subsequent rejection and heartbreak. They then pay the price loneliness and new connections are not made. If approval is based on performance alone, there is avoidance of intimacy, contact, and commitment. Children who falsely assume that successful endeavors buy them love, hope to gain acceptance and acknowledgment first at home, then at school, and later at the work place.
In the pursuit to gain lost parental love and overcome such feelings of heartbreak, children sacrifice their true self for an illusion --success. The narcissistic character develops in this way. Work and performance become newly substituted passions that replace lost love. When there is an exaggerated involvement in one's image at the expense of one's self (i.e., emphasizing what one would wish to be as opposed to be as opposed to what one actually is), the person loses the capacity to feel. With denial of feeling and without a solid sense of self, one becomes vulnerable to pushing and striving beyond normal levels. It is this tendency towards denial that is so characteristic of those who develop heart disease. It is the sacrifice of true, deep feeling, the denial and suppression of feelings, that contributes to coronary-prone behavior and subsequent cardiovascular risk.
This pattern, es-tablished in childhood, is typical of the coronary-prone personality. (Sinatra and Lowen, 1988).

The heartbroken child who fears love as an adult will have a personality and character structure typical of those who develop cardiac symptoms and eventually coronary pathology (Sinatra and Lowen, 1988).
This rigid, narcissistic character structure, a survival mechanism for the child, is a bodily defense against love and heartbreak.
It is characterized by immobilization - and rigidification of the chest wall. Thus the denial of the loss becomes a chronic negative factor in the body by limiting respiration and creating a condition of muscular tension, which, in itself, is a cardiac stress. As one's breathing is limited by such chronic tension, one's energy is also limited, and there is less available to deal with other stresses. Variations of the rigid narcissistic character type, in which one's image is more important than one's self leaves one vulnerable to unexpected cardiac events. This is exemplified in the following case study.

Tim came in for therapy following an extensive negative car-diological evaluation for chest pain. He had a history of resting and exertional chest pain and considerable fear about the possibility of heart disease. As -a young boy, he witnessed his father having a myocardial infarction at the age of 34. Although Tim was resistant in the first few sessions, he had considerable awareness that his chest pain had a lot to do with the feelings of heartbreak that he experienced as a young child. At the time of his therapy, his marriage was in trouble. He was experiencing little emotional feeling and was suffering from a low-grade depression. He also lived in constant fear of dying.

The initial period of therapy focused on his hurt as a child. He was the youngest of four children. He resented the fact that he had never really experienced his childhood. His childhood was full of criticism and lack of love and acceptance. He admitted to being very lonely. In order to get approval for love, Tim became a good boy and sacrificed anger and all his negative feelings. As a good boy, he did the chores, the yard work folded his clothes, counseled and listened to his mother. He recalled that his mother had constantlv corrected him in toilet training. He was alwavs told that he was a very, very good boy. In therapy, Tim had memories of being terrorized bv his father and mother. The parents split up on numerous occasions and they had many arguments in the presence of the children. Although Tim saw his father on occasion, there was no real closeness to him. Tim's recollection of his mother was one of horror and disgust. He described his mother as having a "ghoulish quality." In therapy, he also sensed the strong possibility of incestual relationship between them. Tim described his mother as sad, depressed, and not available to him. Although he felt sorrow for her, he felt that he needed her and, as any little boy would, wanted to care for her and make her feel good. Since his mother was beaten by his father and was depressed, Tim could not really experience any negative feeling toward her. His mother forbade him to express anger because this was "acting like the crazy father."
The inability to express anger and rage a child left him with considerable guilt, which was eventual reflected in his sexuality.
At age four, he swallowed a bottle of aspirin as a suicidal gesture and made the false connection that "illness will buy me affection." At around that time, this feeling was reinforced since his father was hospitalized with a myocardial infarction. Throughout his childhood, Tim continued to avoid feeling. He did not cry, and he held in his anger. If he experienced true feeling, he had the fear that his father would kill him. Thus, he ran the risk of full rejection by his mother and annihilation by his father. In therapy, however, he had the awareness that his body contained an enormous amount of rage. He related two stories of loss of control and rage. On one occasion, he flung a cat across the room in a fit of rage. On another occasion, during karate class, he almost "killed someone" as a result of losing his composure. In therapy, he was able to own his rage and held in anger. This was easily facilitated with the intervention of kicking the mattress and using the word "why?" After experiencing anger in therapy, he admitted that some passion was re-awakened in his marital relationship. Communication with his wife improved, and he was able to experience more sexual feeling. The more anger Tim experienced, the better he felt. It gave him a true sense of strength and a feeling of being alive and free.

Tim's body was tight, coiled and rigid, reflecting his lack of feeling. His perpetual smile was a cover-up for his hurt and rage. His voice was constricted and at times high-pitched. His chest was over-inflated and his breathing was shallow. The pectoralis was heavily armored to protect the heart. The illusion of power and control was seen in his armored, over-inflated chest and mechan-ical way of breathing. This, too, was a cover-up for the great sorrow and anguish that he experienced as a child. The waist was tight and contracted, and he admitted to little sexual feeling. His hostility towards women was locked in severe tensions of the upper back. The musculature was prominent, however, and the shoulders rounded as if he were burdened by women. The source of Tim's guilt was his inability to feel angry toward a helpless, pathetic mother.
His underlying deep fear of women led to his fear of castration and, therefore, to the absence of sexual feeling. Although he admitted to having tremendously low self-esteem, being unlovable, and mentally and sexually inadequate, Tim's body had the stance, "I can take it."
Even though his father was the president of a large corporation, Tim's oedipal situation surfaced; he had the idea that he could do better than his father. Fortunately for Tim, his bioen-ergetic therapy opened up feeling and awareness. As he lay over the bioenergetic stool, he broke down quickly into sobbing. Crying released some of his tension. Although he always felt better after crying, he frequently had episodes of intense chest and arm pain following his sessions. Tim had difficulty in utilizing his voice in therapy. Frequently he needed to extend his neck and open up the throat. Soft pressure on the diaphragm enabled the voice to break through and release feeling. At times, his soft cries had an anguished quality.

The pain of reopening the heart with subsequent release of feeling is perhaps the greatest resistance the patient can offer. Tim did not reallv want to examine the pain. He did not want to get in touch with the feeling of heartbreak he had experienced as a child. As a child he felt that he could die. The patient was confronted with a seemingly life-threatening dilemma by reexamining such feeling (Sinatra and Lowen 1986). By utilizing voice, he was able to break through into deep emotion. The hostilitv towards women was expressed by hitting and striking mattress with his fists. By using the words "leave me alone," and by connecting the voice with the hitting motion of the arms, Tim was able to get into true, deep, anger. At times, his anger assumed a theatrical quality; i.e., he tried to do with his therapist what was done to him as a child. As his therapist, I felt as if he were testing me with his anger and rage.

Tim's lack of sexual responsiveness to his wife was seen an expression of his hostility towards and fear of women. Unable to get back at his mother, he retaliated by withholding sexual feeling from his wife. His unconscious negative feeling toward women was expressed in an inability to give himself fully to sexual pleasure with his wife. His premature ejaculation was a manifestation of his deep pelvic tension. Tim was engaged in a power struggle with his wife on two levels -- sex and business. Although he felt inferior to his wife on a sexual level, he felt even more castrated on an economic level, particularly when she was making more money than he was. As a boy, he felt powerless with his mother, and as a man he felt powerless with his wife. After having repressed his memory of those experiences with his mother, he reexperienced them with his spouse, feel powerless and sexually inadequate. As Tim worked through his unconscious conflicts, he realized that his wife, as his mother, was cold and critical. When he realized that he had chosen a wife like his mother, he abruptly ended the marriage.

Thus, Tim's fear of love and his mistrust of women can traced back to the experience of heartbreak that he suffered as a small child. In trying to find love, he sets up a vicious cycle. Tim wants women to love him; however, he cannot reach out for love or experience it. He wanted his mother to love him. He wished his wife would love him. He spends his whole life trying to have people love him. Although he wants to be in a relationship with a woman and wants a woman to need him, when a woman finds him attractive and has feeling for him, he then hates her.
This powerful unconscious negative transference has had a tremendous psychological and physical life. The psychic pain of his heartache and heartbreak manifests itself in true cardiac pain from coronary artery spasm.
For all practical purposes, Tim possesses a coronary-prone personality. As an engineer, he is aggressive, ambitious, and successful. He also has experienced the pain of rejection and subsequent fear of love, which places undue stress upon the heart. Unfortunately, Tim does not see his striving for success as an expression of his need for love. He does not reach out for love since he is frightened by the possibility of rejection. He strives to earn love by achievement and success, but this is a desperate striving tinged with hostility, aggressiveness, and bitterness, all of which prevents others from loving him. However, even though Tim is coronary-prone, the experience of therapy has brought him into true, deep feeling. Is Tim prone to cardiac illness? Will Tim fulfill the family tradition and face the same demise as his father who recently died of congestive heart fail-ure? The answer to these questions is negative. Although Tim has the personality, character type, and drive associated with coronary heart disease, the fact that he is feeling the pain of heartbreak and experiencing his depression and despair protects him from the perils of this disease. The mobilization of his anger and the release of his deep sadness through crying and sobbing will alleviate the tensions associated with heartbreak, and free him to the path to heart disease. In a therapeutic relationship, he is able to have profound feeling and experience his true self.

Tim's bioenergetic analysis frees up muscular rigidity and tension. Opening up breathing induces feeling. And feeling reduces rigidity in the thoracic cage. The chronic effects of sup-pressed emotions, energetic blocks, and muscular tensions set the stage for the coronary disease process. The attenuation of the coronary-prone behavior pattern with bioenergetic analysis allows the patient to experience spontaneity of feeling, and the patient can gain emotional and physical well-being. The body can feel, soften, and become truly alive.

Acknowledgement: The author wishes to thank Alexander Lowen, M.D. for participating in the study. He also wishes to thank Leslie Case, Ph.D., for supervision.

Eliot, R. and Breo, D. 1984. Is It Worth Dying For? NY: Bantam.
Friedman, M. and Ylmer, D. 1984. Treating Tvpe A Behavior and Your Heart. NY: Alfred A. Knopf, Inc.
Lowen, A. 1980. Stress and Illness: A Bioenergetic View. New York: IIBA.
Lowen, A. and Sinatra, S. 1988. Anticipated Title: Love, Sex and Your Heart. NY: Macmillan Publishing. In press.
Rosenman, R. 1985. "Health Consequences of Anger and Implications Treatment." In: Chesney, M. and Rosenman, R., eds. Anger and Hostility in Cardiovascular and Behavioral Disorders. Menlo Park, CA: Hemisphere Pub. Co.
Sinatra, S. and Chawla, S. 1986. "Aortic Dissection Associated with Anger, Suppressed Rage and Acute Emotional Stress." Journal of Cardio-Pulmonary Rehabilitation, v.6.
Sinatra, S. and Lowen, A. 1986. "Heartbreak and Heart Disease." British Holistic Medical Journal. In press.
Sinatra, S. and Lowen, A. 1986. "Cultural and Bioenergetic Applications Individuals with Heart Disease." In Proceedings from the 8th International Bioenergetic Congress. Brussels: Societe Belge D'Analyse Bioenergetique.

Stephen T. Sinatra, M.D., F. A.C.C., is a board certified cardiologist and certified bioenergetic analyst with more that 20 years of experience in helping patients precvent and reverse heart disease.

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