中英文稿

沒有其他器官，?可能在整個人生中 也沒有其他的東西，?像人類的心臟一樣充滿隱喻和意義。?在歷史的長河中，?心是我們情感生活的象征。?它曾被很多人視為靈魂的座駕，?情感的倉庫。?“emotion（情感）”這個詞部分 源自法語動詞“emouvoir”，?意思是“攪動”。?也許將情感和以跳動為特征的器官?聯(lián)系在一起是唯一的正確邏輯。

但這個聯(lián)系是什么？?它是真實的還是純粹隱喻？?作為心臟專家，?我今天在這里要告訴你們， 這個聯(lián)系是真實的。?你將了解到，情感?能夠，也實會對人類心臟 產(chǎn)生直接的物理影響。

但在我們深入之前，?讓我們來談?wù)勲[喻意義上的心。?即便在今天，情感之心 的象征意義仍然存在。?如果問人們哪一個圖片可以讓人 聯(lián)想到愛，?毫無疑義，戀人之心會高居榜首。?心臟的形狀，稱為心形，?在自然中很常見。?它存在于樹葉，鮮花和 很多植物的種子中，?包括串葉松香草，?曾經(jīng)在中世紀被用于生育控制，?這也許就是為什么心會與?性愛與浪漫聯(lián)系在一起。

出于某種原因，?13世紀，情人的畫像中 開始出現(xiàn)心形圖案。?隨著時間的推移， 這些畫被涂成紅色，?鮮血的顏色，?激情的象征。?在羅馬天主教會，?心的形狀被稱為耶穌的圣心。?裝飾著荊棘，散發(fā)著縹緲的光芒，?它成了修道院之愛的象征。?這種心與愛之間的聯(lián)系 經(jīng)受住了現(xiàn)代的考驗。?1982年，患有末期心力衰竭 的退休牙醫(yī)巴尼·克拉克?在猶他州接受了首例永久性 人工心臟移植手術(shù)，?他39歲的妻子曾向醫(yī)生咨詢，?“他還會愛我嗎？”

今天，我們知道心臟不是愛?或其他情感的源頭，?古人弄錯了。?然而，我們開始越來越多地了解到?心臟和情感的聯(lián)系是 極為親密的整體。?心臟可能不是我們感覺的起源，?但它對感覺非常敏感。?在某種意義上，我們情感生活的記錄?就寫在我們的心臟上。?例如，恐懼和悲傷會導致 嚴重的心臟損傷。?控制無意識過程，如心跳的神經(jīng)?可以感覺到痛苦，?并引發(fā)適應(yīng)不良的“戰(zhàn)斗或逃跑”反應(yīng)，?導致血管收縮，?心跳加速?和血壓上升，?導致?lián)p傷。?換句話說，?越來越清晰的是，?我們的心臟對我們的 情感系統(tǒng)，對隱喻的心，?極度敏感。

大約20年前， 人們首次發(fā)現(xiàn)了一種名為?“應(yīng)激性心肌病”的心臟病， 即“心碎綜合癥”，?在這種情況下，心臟在面對巨大 的壓力或悲傷時急劇衰弱，?比如跟愛人分手或愛人去世后。?就像這些照片顯示的，中間悲傷的心?跟左邊正常的心看來很不同。?它看起來像是被打暈了，?往往會膨脹成章魚壺的獨特形狀，?如右圖所示，?一種有寬的底座和窄的日本鍋。?我們還不知道這個發(fā)生的確實原因，?這種癥狀通常會在幾周內(nèi)消失。?然而，在急性期，?它可能會導致心臟衰竭，?危及生命的心律失常，?甚至死亡。

比如，我的一個老年病人的丈夫?最近去世了。?她很悲傷，當然， 但接受這個現(xiàn)實了。?也許松一口氣。?這是一場持續(xù)了多年的疾病， 他患有老年癡呆。?但在葬禮結(jié)束的一周后， 她看著他的照片，?變得淚眼模糊。?然后她出現(xiàn)了胸痛， 隨之而來的是呼吸急促，?脖子上青筋膨脹，額頭出汗，?當她坐在椅子上時， 明顯地感到氣喘吁吁——?這些都是心臟衰竭的跡象。?她被送進了醫(yī)院，?醫(yī)院超聲波驗證了我們的懷疑：?她的心臟已經(jīng)衰弱到只有 不到一半的正常功能，?并且膨脹成明顯的章魚壺形狀。?但檢查不出其他問題，?沒有動脈阻塞的現(xiàn)象。?2周后，她的情感狀態(tài)恢復(fù)正常，?并且，超聲波檢測確認，?心臟也恢復(fù)了健康。

應(yīng)激性心肌病跟很多壓力環(huán)境有關(guān)，?包括公共演講——

家庭爭分，賭博損失，?甚至一個驚喜的 生日派對都包括在內(nèi)。

它甚至與廣泛的社會動亂有關(guān)，?比如一場自然災(zāi)害后。?例如，2004年，?一場大地震摧毀了日本 最大島嶼上的一個地區(qū)，?超過60個人死亡，幾千人受傷。?在這場災(zāi)難之后，?研究者發(fā)現(xiàn)跟一年前同期相比，?該地區(qū)在大地震后 一個月的應(yīng)激性心肌病?發(fā)病率增加了24倍，?這些病例發(fā)生的位置?與地震的強度密切相關(guān)。?在幾乎每個病例中， 病人都是住在震中附近。

有趣的是，應(yīng)激性心肌病也曾在 一些愉快的事件后被發(fā)現(xiàn)，?但心臟反應(yīng)似乎不一樣，?在中部膨脹，而不是在頂部。?為什么不同的情緒會 導致心臟的不同變化?仍然是個迷。?但今天，也許是作為對 我們古代哲學家的贊歌，?我們可以說即便情感 不存在于我們的心臟中，?情感的心跟它的?生物體依然是以一種?驚人和神秘的方式相對應(yīng)的。

心臟綜合癥，包括猝死，?長期以來，在個人隱喻之心經(jīng)受了 強烈的情感干擾或混亂后的猝死?廣泛見諸報端。?1942年，?哈佛生理學家沃爾特·坎農(nóng)發(fā)表了一篇 名為《巫毒教的死亡》的論文，?在文中，他描述了一些 相信自己被詛咒的人?因為恐懼而死亡的案例，?比如被巫醫(yī)或食用禁果后。?在很多案例中，犧牲者 絕望至極，當場猝死。?這些案例的共同之處在于 犧牲者們絕對相信?有一種外部的力量 會導致他們的死亡，?并且他們無力反抗。?坎農(nóng)假定，這些明顯的失控?引發(fā)了全面的生理反應(yīng)，?血管收縮到使血容量?急劇下降的程度，?血壓下降，?心臟急劇衰弱，?并且因為缺少氧氣的輸送 而導致大規(guī)模的器官損壞。

坎農(nóng)認為巫毒教的死亡?僅限于土著或“原始”人。?但許多年來， 這些類型的死亡也出現(xiàn)在?各種各樣的現(xiàn)代人身上。?今天，因悲傷而導致的死亡 出現(xiàn)在配偶和兄弟姐妹上。?破碎的心在生理上和 隱喻上都是致命的。

這種聯(lián)系甚至在動物身上也成立。?在1980年發(fā)表在《科學》期刊上 的一個有趣研究中，?研究人員給籠養(yǎng)的兔子 喂食高膽固醇食物，?以研究其對心血管疾病的影響。?出乎意料的是，他們發(fā)現(xiàn)一些 兔子患的病就是比其他兔子多，?但他們無法解釋為什么。?這些兔子的飲食結(jié)構(gòu)， 環(huán)境和基因構(gòu)成都是類似的。?他們認為可能和?技術(shù)員跟兔子互動頻率有關(guān)。?所以他們重復(fù)了這個研究，?把這些兔子分成兩組。?兩組都吃高膽固醇的食物。?但其中一組，兔子被帶出籠子，?被人們抱著，愛撫著， 和它說話，和它玩耍，?另一組的兔子則被留在籠子里?不聞不管。?一年之后，在對兔子進行解剖時，?研究者發(fā)現(xiàn)第一組的兔子，?那組有人類互動的兔子，?主動脈疾病比另一組少60%，?盡管有相似的膽固醇水平， 血壓和心率。

今天，對心靈的關(guān)懷已不再是 哲學家們的專利，?他們專注于心靈的隱喻意義，?并且越來越多的進入 像我這樣的醫(yī)生領(lǐng)域，?運用著甚至1個世紀前的技術(shù)，?因為心臟在人類文化中的崇高地位，?被認為是禁忌。?在這個過程中，心臟?從充滿隱喻和意義的超自然的物體?轉(zhuǎn)變成了可以操縱和控制的機器。?但這里有個關(guān)鍵點：?我們現(xiàn)在明白，這些操縱?必須輔以對情感生活的關(guān)注，?畢竟數(shù)千年來，人們認為 情感生活包含在心臟之中。

比如，《生活方式心臟試驗》，?1990年發(fā)表于英國《柳葉刀》雜志。?48名患有中度或重度 冠狀動脈疾病的患者?被隨機分配到常規(guī)護理?或一組包括低脂素食， 適度有氧運動，?群體社會心理支持?以及壓力管理建議的?密集生活方式小組。?研究者發(fā)現(xiàn)密集生活組病人?冠狀動脈斑塊減少了近5%。?控制組，反之，?一年后冠狀動脈斑塊增加了5%，?并且5年后增加了28%。?他們患心臟病的幾率翻倍，?比如心臟病發(fā)作，冠狀動脈搭橋手術(shù)?和心臟病相關(guān)的死亡。

有一個有趣的事實：?對照組的一些患者采用 的飲食和鍛煉計劃?幾乎與生活方式密集組 的患者一樣多。?他們的心臟疾病仍然在持續(xù)。?單靠飲食和運動不足以促進 冠狀動脈疾病的消退。?在1年和5年的隨訪中，?人們發(fā)現(xiàn)相比鍛煉，壓力管理?與冠狀動脈疾病的逆轉(zhuǎn)?更加緊密相關(guān)。

毫無疑問，這項研究和 類似的研究規(guī)模都很小，?當然，相關(guān)性并不能證明因果關(guān)系。?當然可能壓力導致不健康習慣，?是心血管風險增加的真正原因。?但就像吸煙和肺癌的關(guān)系一樣，?當如此多的研究都顯示了同樣的事情，?當存在解釋因果關(guān)系的機制時，?否定一個可能存在 的說法是不負責任的。?許多醫(yī)生得出的結(jié)論，也是我近20年?作為心臟專家了解到的：?情感之心與它的生理對應(yīng)物以一種?驚奇和神秘的方式相交叉。

然而，今天的醫(yī)學繼續(xù)將 心臟概念化為一臺機器。?這種概念化有很大的好處。?心臟病學，我的領(lǐng)域，?毫無疑問是過去100年最具成就的?科學領(lǐng)域之一。?支架，起搏器，除顫器， 冠狀動脈搭橋手術(shù)，?心臟移植——?所有這些都是在二戰(zhàn)后 發(fā)展或發(fā)明的。

然而，我們可能?已經(jīng)接近了科學藥物在對抗?心臟疾病上的極限。?事實上，在過去的十年中， 心血管疾病死亡率?的下降速度已經(jīng)明顯放緩。?我們需要轉(zhuǎn)向新的模式?去繼續(xù)取得我們已經(jīng)習慣的進步。?在這種模式下，心理社會因素 將需要成為我們思考?心臟問題的前提和中心。

這將是一場艱苦的戰(zhàn)斗，?在很大程度上它仍然 是一個尚未被探索的領(lǐng)域。?美國心臟學會仍然沒有把情感壓力?作為心理疾病的一個可改變危險因素，?部分原因可能是因為血壓中的 膽固醇相比情感和社會混亂?更容易降低。

也許，有更好的方式。?如果我們知道當人們說 “破碎的心”時，?他們說的確實是一顆 真的破碎的心臟。?在照看我們的心臟時， 我們就必須更加關(guān)注?情感的力量和重要性。

我認識到，情感壓力?往往是生死攸關(guān)的問題。

謝謝。

No other organ,?perhaps no other object in human life,?is as imbued with metaphor and meaning as the human heart.?Over the course of history,?the heart has been a symbol of our emotional lives.?It was considered by many to be the seat of the soul,?the repository of the emotions.?The very word "emotion" stems in part from the French verb "émouvoir,"?meaning "to stir up."?And perhaps it's only logical that emotions would be linked to an organ?characterized by its agitated movement.

But what is this link??Is it real or purely metaphorical??As a heart specialist,?I am here today to tell you that this link is very real.?Emotions, you will learn,?can and do have a direct physical effect on the human heart.

But before we get into this,?let's talk a bit about the metaphorical heart.?The symbolism of the emotional heart endures even today.?If we ask people which image they most associate with love,?there's no question that the Valentine heart would the top the list.?The heart shape, called a cardioid,?is common in nature.?It's found in the leaves, flowers and seeds of many plants,?including silphium,?which was used for birth control in the Middle Ages?and perhaps is the reason why the heart became associated?with sex and romantic love.

Whatever the reason,?hearts began to appear in paintings of lovers in the 13th century.?Over time, the pictures came to be colored red,?the color of blood,?a symbol of passion.?In the Roman Catholic Church,?the heart shape became known as the Sacred Heart of Jesus.?Adorned with thorns and emitting ethereal light,?it became an insignia of monastic love.?This association between the heart and love has withstood modernity.?When Barney Clark, a retired dentist with end-stage heart failure,?received the first permanent artificial heart in Utah in 1982,?his wife of 39 years reportedly asked the doctors,?"Will he still be able to love me?"

Today, we know that the heart is not the source of love?or the other emotions, per se;?the ancients were mistaken.?And yet, more and more, we have come to understand?that the connection between the heart and the emotions is a highly intimate one.?The heart may not originate our feelings,?but it is highly responsive to them.?In a sense, a record of our emotional life?is written on our hearts.?Fear and grief, for example, can cause profound cardiac injury.?The nerves that control unconscious processes such as the heartbeat?can sense distress?and trigger a maladaptive fight-or-flight response?that triggers blood vessels to constrict,?the heart to gallop?and blood pressure to rise,?resulting in damage.?In other words,?it is increasingly clear?that our hearts are extraordinarily sensitive to our emotional system,?to the metaphorical heart, if you will.

There is a heart disorder first recognized about two decades ago?called "takotsubo cardiomyopathy," or "the broken heart syndrome,"?in which the heart acutely weakens in response to intense stress or grief,?such as after a romantic breakup or the death of a loved one.?As these pictures show, the grieving heart in the middle?looks very different than the normal heart on the left.?It appears stunned?and frequently balloons into the distinctive shape of a takotsubo,?shown on the right,?a Japanese pot with a wide base and a narrow neck.?We don't know exactly why this happens,?and the syndrome usually resolves within a few weeks.?However, in the acute period,?it can cause heart failure,?life-threatening arrhythmias,?even death.

For example, the husband of an elderly patient of mine?had died recently.?She was sad, of course, but accepting.?Maybe even a bit relieved.?It had been a very long illness; he'd had dementia.?But a week after the funeral, she looked at his picture?and became tearful.?And then she developed chest pain, and with it, came shortness of breath,?distended neck veins, a sweaty brow,?a noticeable panting as she was sitting up in a chair --?all signs of heart failure.?She was admitted to the hospital,?where an ultrasound confirmed what we already suspected:?her heart had weakened to less than half its normal capacity?and had ballooned into the distinctive shape of a takotsubo.?But no other tests were amiss,?no sign of clogged arteries anywhere.?Two weeks later, her emotional state had returned to normal?and so, an ultrasound confirmed,?had her heart.

Takotsubo cardiomyopathy has been linked to many stressful situations,?including public speaking --

domestic disputes, gambling losses,?even a surprise birthday party.

It's even been associated with widespread social upheaval,?such as after a natural disaster.?For example, in 2004,?a massive earthquake devastated a district on the largest island in Japan.?More than 60 people were killed, and thousands were injured.?On the heels of this catastrophe,?researchers found that the incidents of takotsubo cardiomyopathy?increased twenty-four-fold in the district one month after the earthquake,?compared to a similar period the year before.?The residences of these cases?closely correlated with the intensity of the tremor.?In almost every case, patients lived near the epicenter.

Interestingly, takotsubo cardiomyopathy has been seen after a happy event, too,?but the heart appears to react differently,?ballooning in the midportion, for example, and not at the apex.?Why different emotional precipitants would result in different cardiac changes?remains a mystery.?But today, perhaps as an ode to our ancient philosophers,?we can say that even if emotions are not contained inside our hearts,?the emotional heart overlaps?its biological counterpart,?in surprising and mysterious ways.

Heart syndromes, including sudden death,?have long been reported in individuals experiencing intense emotional disturbance?or turmoil in their metaphorical hearts.?In 1942,?the Harvard physiologist Walter Cannon published a paper called "'Voodoo' Death,"?in which he described cases of death from fright?in people who believed they had been cursed,?such as by a witch doctor or as a consequence of eating taboo fruit.?In many cases, the victim, all hope lost, dropped dead on the spot.?What these cases had in common was the victim's absolute belief?that there was an external force that could cause their demise,?and against which they were powerless to fight.?This perceived lack of control, Cannon postulated,?resulted in an unmitigated physiological response,?in which blood vessels constricted to such a degree?that blood volume acutely dropped,?blood pressure plummeted,?the heart acutely weakened,?and massive organ damage resulted from a lack of transported oxygen.

Cannon believed that voodoo deaths?were limited to indigenous or "primitive" people.?But over the years, these types of deaths have been shown to occur?in all manner of modern people, too.?Today, death by grief has been seen in spouses and in siblings.?Broken hearts are literally and figuratively deadly.

These associations hold true even for animals.?In a fascinating study in 1980 published in the journal "Science,"?researchers fed caged rabbits a high-cholesterol diet?to study its effect on cardiovascular disease.?Surprisingly, they found that some rabbits developed a lot more disease than others,?but they couldn't explain why.?The rabbits had very similar diet, environment and genetic makeup.?They thought it might have something to do with?how frequently the technician interacted with the rabbits.?So they repeated the study,?dividing the rabbits into two groups.?Both groups were fed a high-cholesterol diet.?But in one group, the rabbits were removed from their cages,?held, petted, talked to, played with,?and in the other group, the rabbits remained in their cages?and were left alone.?At one year, on autopsy,?the researchers found that the rabbits in the first group,?that received human interaction,?had 60 percent less aortic disease than rabbits in the other group,?despite having similar cholesterol levels, blood pressure and heart rate.

Today, the care of the heart has become less the province of philosophers,?who dwell upon the heart's metaphorical meanings,?and more the domain of doctors like me,?wielding technologies that even a century ago,?because of the heart's exalted status in human culture,?were considered taboo.?In the process, the heart has been transformed?from an almost supernatural object imbued with metaphor and meaning?into a machine that can be manipulated and controlled.?But this is the key point:?these manipulations, we now understand,?must be complemented by attention to the emotional life?that the heart, for thousands of years, was believed to contain.

Consider, for example, the Lifestyle Heart Trial,?published in the British journal "The Lancet" in 1990.?Forty-eight patients with moderate or severe coronary disease?were randomly assigned to usual care?or an intensive lifestyle that included a low-fat vegetarian diet,?moderate aerobic exercise,?group psychosocial support?and stress management advice.?The researchers found that the lifestyle patients?had a nearly five percent reduction in coronary plaque.?Control patients, on the other hand,?had five percent more coronary plaque at one year?and 28 percent more at five years.?They also had nearly double the rate of cardiac events,?like heart attacks, coronary bypass surgery?and cardiac-related deaths.

Now, here's an interesting fact:?some patients in the control group adopted diet and exercise plans?that were nearly as intense as those in the intensive lifestyle group.?Their heart disease still progressed.?Diet and exercise alone were not enough to facilitate coronary disease regression.?At both one- and five-year follow-ups,?stress management was more strongly correlated?with reversal of coronary disease?than exercise was.

No doubt, this and similar studies are small,?and, of course, correlation does not prove causation.?It's certainly possible that stress leads to unhealthy habits,?and that's the real reason for the increased cardiovascular risk.?But as with the association of smoking and lung cancer,?when so many studies show the same thing,?and when there are mechanisms to explain a causal relationship,?it seems capricious to deny that one probably exists.?What many doctors have concluded is what I, too, have learned?in my nearly two decades as a heart specialist:?the emotional heart intersects with its biological counterpart?in surprising and mysterious ways.

And yet, medicine today continues to conceptualize the heart as a machine.?This conceptualization has had great benefits.?Cardiology, my field,?is undoubtedly one of the greatest scientific success stories?of the past 100 years.?Stents, pacemakers, defibrillators, coronary bypass surgery,?heart transplants --?all these things were developed or invented after World War II.

However, it's possible?that we are approaching the limits of what scientific medicine can do?to combat heart disease.?Indeed, the rate of decline of cardiovascular mortality?has slowed significantly in the past decade.?We will need to shift to a new paradigm?to continue to make the kind of progress to which we have become accustomed.?In this paradigm, psychosocial factors will need to be front and center?in how we think about heart problems.

This is going to be an uphill battle,?and it remains a domain that is largely unexplored.?The American Heart Association still does not list emotional stress?as a key modifiable risk factor for heart disease,?perhaps in part because blood cholesterol is so much easier to lower?than emotional and social disruption.

There is a better way, perhaps,?if we recognize that when we say "a broken heart,"?we are indeed sometimes talking about a real broken heart.?We must, must pay more attention to the power and importance of the emotions?in taking care of our hearts.

Emotional stress, I have learned,?is often a matter of life and death.

Thank you.