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.
Nijedan drugi organ, a možda i nijedan drugi predmet u životu ljudi, nije toliko obuhvaćen metaforom i značenjem kao ljudsko srce. Kroz tijek povijesti, srce je bilo simbol naših emocionalnih života. Mnogi su ga smatrali sjedištem duše, skladištem emocija. Sama riječ "emocija" dijelom potječe od francuskog glagola "émouvoir," što znači "pobuditi". I možda je doista logično da se emocije povezuje s organom za kojeg su tipične pobuđene kretnje.
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.
Ali što je ta veza? Je li stvarna ili samo metaforična? Kao stručnjak za srce, ovdje sam danas da bih vam rekao kako je ta veza vrlo stvarna. Emocije, naučit ćete, mogu imati i imaju izravan tjelesni učinak na ljudsko srce.
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.
Ali prije nego što se upustimo u to, popričajmo malo o metaforičnom srcu. Simbolika emocionalnog srca živi čak i danas. Ako pitamo ljude koju sliku najviše povezuju s ljubavlju, neupitno je da će valentinsko srce biti na vrhu popisa. Oblik srca, zvan kardioid, uobičajen je u prirodi. Nalazimo ga u lišću, cvijeću i sjemenju mnogih biljaka, uključujući silfij, koji se koristio za kontrolu začeća u srednjem vijeku i mogao bi biti razlog zbog kojeg smo srce počeli povezivati sa spolnim odnosom i romantičnom ljubavi.
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?"
Koji god razlog bio, srca su se počela pojavljivati na crtežima ljubavnika u 13. stoljeću. S vremenom, počelo se bojati slike u crveno, boju krvi, simbol strasti. U rimokatoličkoj crkvi, oblik srca postao je poznat kao sveto srce Isusovo. Ukrašeno trnjem i isijavajući blagu svjetlost, postalo je oznaka skromne ljubavi. Povezivanje srca s ljubavlju preživjelo je do suvremenosti. Kada je Barney Clark, umirovljeni zubar u zadnjem stadiju zatajenja srca, dobio prvo trajno umjetno srce u Uti 1982. godine, njegova supruga u 39-godišnjem braku navodno je pitala liječnike, "Hoće li me i dalje moći voljeti?"
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.
Danas znamo da srce nije izvor ljubavi a ni ostalih emocija, samo po sebi; preci su se zabunili. A ipak, sve više dolazimo do saznanja kako postoji vrlo bliska veza između srca i emocija. Srce možda nije mjesto gdje nastaju naši osjećaji, ali je visoko reaktivno na njih. U određenom smislu, dosje našeg emocionalnog života zapisan je na našim srcima. Strah i tuga, primjerice, mogu izazvati jaku srčanu povredu. Živci koji upravljaju nesvjesnim procesima poput kucanja srca mogu osjetiti uznemirenost te radi brze prilagodbe izazvati reakciju "borba-ili-bijeg" koja čini da se krvne žile stežu, srce počne galopirati, krvni tlak se diže, a to sve završi štetno. Drugim riječima, sve više postaje jasno da su naša srca iznimno osjetljiva na naš emocionalni sustav, na metaforično srce, možemo reći.
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.
Postoji srčani poremećaj koji smo prvi put zapazili prije dva desetljeća zvan "takotsubo kardiomiopatija", ili "sindrom slomljenog srca", u kojem srce osjetno slabi u reakciji na snažan stres ili tugu, kao nakon prekida romantičnog odnosa ili nakon smrti voljene osobe. Kako slike pokazuju, žalujuće srce u sredini izgleda znatno drugačije od normalnog srca lijevo. Djeluje zapanjeno i često se napuhuje u oblik takotsuba, koji vidimo desno, a to je japanska posuda širokog dna i uskog grla. Ne znamo točno zašto se to događa, a sindrom obično prolazi za nekoliko tjedana. Međutim, u akutnom razdoblju, može izazvati zatajenje srca, aritmije opasne po život, čak i smrt.
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.
Primjerice, suprug moje starije pacijentice nedavno je umro. Naravno, bila je tužna, ali pomirena s tim. Možda joj je malčice i laknulo. Bila je to vrlo duga bolest; bolovao je od demencije. Ali tjedan dana nakon pogreba, pogledala je njegovu sliku i spopale su je suze. Tada se razvila bol u prsima, a s tim je došlo i do gubitka daha, natečenih vratnih vena, znojenja, vidljivog uzdisanja dok se ispravljala u stolici -- sve su to znakovi zatajenja srca. Primljena je u bolnicu, gdje je ultrazvuk potvrdio ono na što smo već bili sumnjali, srce joj je oslabilo na manje od polovine normalnog kapaciteta i napuhalo se u izražajan oblik takotsuba. Ali drugi testovi nisu ništa otkrili, nigdje nije bilo ni traga začepljenim arterijama. Dva tjedna poslije, njezino emocionalno stanje se normaliziralo, a ultrazvuk je potvrdio da se to dogodilo i sa srcem.
Takotsubo cardiomyopathy has been linked to many stressful situations, including public speaking --
Takotsubo kardiomiopatiju možemo povezati s mnogim stresnim situacijama, uključujući javno govorenje --
(Laughter)
(Smijeh)
(Applause)
(Pljesak)
domestic disputes, gambling losses, even a surprise birthday party.
obiteljske razmirice, gubitke na kockanju, čak i zabavu iznenađenja za rođendan.
(Laughter)
(Smijeh)
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.
Čak je se povezuje s društvenim nemirima širih razmjera, kao, primjerice, uslijed prirodne katastrofe. Na primjer, 2004. godine snažan potres razorio je pokrajinu na najvećem japanskom otoku. Poginulo je više od 60 osoba, a tisuće su zadobile ozljede. Ubrzo nakon te nesreće, istraživači su otkrili da su se slučajevi takotsubo kardiomiopatije udvadesetčetverostručili u toj pokrajini mjesec dana nakon potresa, u usporedbi sa sličnim razdobljem prethodne godine. Lokacije ovih slučaja bile su blisko povezane s jačinom potresa. U gotovo svim slučajevima, pacijenti su živjeli blizu epicentra.
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.
Zanimljivo, takotsubo kardiomiopatija zamijećena je i nakon sretnog događaja, ali čini se da srce reagira drukčije, napuhuje se u središnjem dijelu, primjerice, a ne na vrhu. Zašto različito pobuđene emocije daju različite srčane promjene, ostaje tajna. Ali danas, možda kao posvetu drevnim filozofima, možemo reći da čak iako se emocije ne nalaze unutar naših srca, emocionalno srce se isprepliće sa svojim biološkim kolegom, na iznenađujuće i tajanstvene načine.
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.
Srčani sindromi, uključujući iznenadnu smrt, već dugo su zapaženi u osoba koje prolaze kroz snažne emocionalne poremećaje ili nemire u svom metaforičnom srcu. 1942. godine, fiziolog s Harvarda Walter Cannon objavio je članak "Smrt od vudua", u kojem je opisao slučajeve smrti od straha kod ljudi koji su vjerovali da ih je netko prokleo, primjerice vrač, ili kao posljedica jedenja zabranjenog (tabu) voća. U mnogim slučajevima, žrtva je nakon gubitka svake nade pala na mjestu mrtva. Zajedničko tim slučajevima bilo je žrtvino nepokolebljivo vjerovanje da postoji vanjska sila koja može uzrokovati njihovu kob, i protiv koje su bespomoćni boriti se. Ovaj umišljeni manjak kontrole, tvrdio je Cannon, doveo je do neizbježne fiziološke reakcije pri kojoj su se krvne žile stegnule do takve mjere da je volumen krvi osjetno opao, krvni tlak odletio u visine, srce snažno oslabilo, a teško oštećenje organa nastalo je zbog manjka prenesenog kisika.
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.
Cannon je vjerovao kako su vudu smrti ograničene na urođeničke ili "primitivne" narode. Ali tijekom godina, ovakvi tipovi smrti pojavljuju se i kod najrazličitijih suvremenih ljudi. Danas, smrt od tuge bilježimo kod životnih partnera te braće i sestara. Slomljena srca su doslovno i metaforično smrtonosna.
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.
Ovi zaključci pokazuju se točnima čak i kod životinja. U zapanjujućoj studiji objavljenoj u časopisu "Science" 1980. godine, istraživači su hranili zečeve u kavezima hranom bogatom kolesterolom kako bi proučili njegov utjecaj na bolesti krvožilnog sustava. Iznenađujuće, otkrili su da su neki zečevi pretrpili jače oboljenje od ostalih, ali nisu mogli objasniti zašto. Zečevi su jeli gotovo identičnu hranu, dijelili isti okoliš i genetski zapis. Mislili su da to ima veze s tim koliko često su tehničari bili u kontaktu sa zečevima. Pa su ponovili studiju, razdijelivši zečeve u dvije skupine. Objema skupinama davana je hrana bogata kolesterolom. Ali u jednoj skupini, zečeve se puštalo iz kaveza, držalo ih se, mazilo, pričalo im se, igralo se s njima, a u drugoj skupini, zečevi su ostajali u kavezima i ostavljalo ih se samima. Nakon godine dana, radeći autopsiju, istraživači su otkrili kako su zečevi iz prve skupine, koji su imali kontakt s ljudima, imali 60 posto manje aortnih oboljenja od zečeva iz druge skupine, usprkos podjednakim razinama kolesterola, krvnog tlaka i srčanog pulsa.
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.
Danas je briga o srcu postala manje domenom filozofa, koji promišljaju o metaforičnim značenjima srca, a više domenom liječnika poput mene, koji barataju tehnologijama koje bi čak i prije jednog stoljeća zbog uzvišenog statusa koji srce ima u ljudskoj kulturi, bile smatrane tabuom. U tom procesu, srce se promijenilo iz gotovo nadnaravnog predmeta uronjenog u metaforu i značenja, u stroj kojim se može rukovati i upravljati. Ali ovo je ključno zapažanje: takvim rukovanjima, sada znamo, moramo pridružiti posvećivanje pažnje emocionalnom životu za koji se tisućama godina smatra da je smješten u srcu.
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.
Promotrimo, primjerice, ispitivanje načina života i srca objavljeno u britanskom časopisu "The Lancet" 1990. godine. Četrdeset i osam pacijenata s umjerenom ili ozbiljnom bolesti krvnih žila proizvoljno su stavljeni pod uobičajenu njegu ili pod intenzivan način života koji je uključivao vegetarijanstvo s malo masti, umjerene aerobne vježbe, grupnu psihosocijalnu podršku te savjetovanje o upravljanju stresom. Istraživači su otkrili da je kod pacijenata s takvim načinom života došlo do čak 5-postotnog smanjenja naslaga na krvnim žilama. S druge strane, pacijenti kontrolne skupine imali su 5 posto više žilnih naslaga nakon godinu dana i 28 posto više naslaga nakon 5 godina. Također su imali dvostruko više pojava srčanih smetnji, kao što su srčani udari, ugrađivanje žilnih premosnica i smrti od srčanog uzroka.
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.
Evo zanimljivog podatka: neki od pacijenata iz kontrolne skupine proveli su plan prehrane i vježbanja gotovo jednako obuhvatan kao kod osoba u skupini intenzivnog načina života. Njihove srčane bolesti nastavile su napredovati. Samo prehrana i vježbanje nisu dostajali da omoguće povlačenje žilnih bolesti. Kod jednogodišnje i petogodišnje provjere, upravljanje stresom pokazalo se puno jače povezanim s povlačenjem žilnih bolesti nego što je to bilo vježbanje.
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.
Naravno, ovakve studije su malene, a korelacija ne dokazuje nužno i uzročno-posljedičnu vezu. Zasigurno je moguće da stres vodi k nezdravim navikama, a to je pravi razlog za povećani rizik od krvožilnih bolesti. Ali baš kao i kod povezivanja pušenja s rakom pluća, kada tolike studije upućuju na istu stvar, i kada postoje mehanizmi koji objašnjavaju uzročno-posljedičnu vezu, čini mi se hirovitim zanijekati da ona vjerojatno postoji. Brojni liječnici su zaključili nešto što sam i sam naučio u gotovo dva desetljeća bivanja stručnjakom za srce: emocionalno srce se isprepliće sa svojim biološkim kolegom na iznenađujuće i tajanstvene načine.
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.
A ipak, današnja medicina nastavlja pojmiti srce kao stroj. Takvo poimanje imalo je mnoge prednosti. Moje polje, kardiologija, je bez sumnje jedna od najuspješnijih znanstvenih priča u posljednjih 100 godina. Stent, elektrostimulatori srca, defibrilatori, operacije premosnice, presađivanja srca -- sve te stvari razvile su se ili su izumljene nakon 2. svjetskog rata.
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.
Međutim, moguće je da se približavamo granicama onoga što znanstvena medicina može učiniti da zaustavi oboljenja srca. Doista, stupanj pada kardiovaskularne smrtnosti osjetno se usporio u zadnjem desetljeću. Morat ćemo se prebaciti na novo poimanje kako bismo nastavili napredovati brzinom na kakvu smo se navikli. U ovom poimanju, psihosocijalni čimbenici morat će biti u središtu pažnje kada promišljamo o srčanim problemima.
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.
To će biti sizifovska borba, a i dalje u velikoj mjeri ostaje neistraženo područje. Američko udruženje za srce još uvijek nije uvrstilo emocionalni stres na popis ključnih promjenjivih čimbenika rizika za oboljenje srca, možda dijelom zbog toga što je puno lakše ublažiti razinu kolesterola u krvi nego emocionalni i društveni nemir.
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.
Možda postoji bolji način ako prepoznamo da kada govorimo o "slomljenom srcu", doista katkada govorimo o pravom slomljenom srcu. Moramo, moramo više pažnje posvetiti snazi i važnosti emocija kada brinemo o našim srcima.
Emotional stress, I have learned, is often a matter of life and death.
Emocionalni stres, naučio sam, često je pitanje života i smrti.
Thank you.
Hvala.
(Applause)
(Pljesak)