-IBIS-1.7.6-
tx
cardiovascular system
myocardial infarction sequelae
Psychospiritual Approaches

Metaphors and correlations

• Unlike neurotics, people with physical illnesses complain little, because this means experiencing emotions and revealing a vulnerable part of themselves. By not complaining, they tend to suppress their inner lives, they adapt themselves to the environment (usually through denial), and their self-assertion is underdeveloped. Cardiac infarction patients often disregard symptoms, and in a self-destructive manner, internalize their depression. Psychosocial therapy calls for strengthening the patient's conscious self. In this process, the doctor cannot be neutral, uninterested, or 'abstinent', but must become involved in a social situation that he, as well as the patient, has to master. (Locke, 1985, p. 113)
• There are 3 critical psychological times for the patient: arrival at the hospital, end of acute stage of the illness, and departure from the hospital. (Locke, 1985, p. 114)
• Maintenance of defense mechanisms of denial in convalescence leads to non-compliance with medical advice and rejection of rehabilitation efforts, increasing the risk of reinfarction. Recommendations for management include early recognition, supportive psychotherapy, education, and mobilization in the acute phase of coronary care. (Locke, 1985, p. 114)
• Associated with excessive stress; people who work hard in order to be accepted by parents, and have no parental permission to slow down and change direction if a job no longer suits them; may be an acceptable way of confirming to oneself and to others that he's had enough. (Harrison, p. 140)
• People with hypertension have a good deal of aggression which they repress through exercising self-restraint. It is this blockage of aggressive energy that is released in a heart attack; it literally tears the heart apart. The heart attack is the sum of all the 'attacks' and 'beatings' that the patient has failed to mete out in the past. Only a hard heart can break, as the ego and dominance of the will are overvalued, and the heart is cut off from the flow of life. (Dethlefsen, p. 201)
• Need to maintain control, fear of losing it and having responsibilities taken away; inability to acknowledge and process emotional stress; fear and anger related to disappointments and demands of personal relationships, sense of failure. (Shealy, p. 161)
• Coronary patient differs from the average population by marked extroversion and by a compulsive and impulsive addiction to hard work. When under stress, there is a regression to aggressive activity, i.e. rapid acceleration, which switches to brooding and a passive masochistic attitude when stress increases. Intensive mental deceleration through narcissistic tendencies may further compromise arterial and coronary circulation. (Locke, 1985, p. 111)
• Heart represents center of love and security. Heart problems are associated with longstanding emotional problems; lack of joy; belief in strain and stress; hardening of the heart. Heart attack is squeezing all the joy out of the heart in favor of material possessions or position. (Hay, 1984, p. 168)
• Rehabilitation goals should include improving the patient's ability to participate in chosen activities and facilitating return to work, improving psychologic adjustment, preventing or reversing deconditioning, and reducing risk factors. (Locke, 1985, p. 112)
• All actions of therapeutic work at coronary units, of both the physicians and nurses, must contain psychotherapeutic messages. It is important to consider the anxiety that appears at the same time with infarction and which may cause the disturbance of rhythm and possibly fatal outcome; the problem of informing the patient about the degree of illness; and the nurse's relationship with the patient. (Locke, 1985, p. 112)
• Patients gather strength more quickly and so avoid post-operative shock when there is an affinity between the patient, a doctor, and a particular nurse. There is a reason why patients seem to get better more easily under one nurse than another. (Locke, 1986, p. 215)

Reduce stress and maintain regular exercise: Stress reduction and regular exercise contribute to higher levels of HDL cholesterol and reduce the risk of heart disease. Individuals over 40 and those who have not been engaged in vigorous activity on a regular basis should consult with their physician and consider starting with less strenuous activities such as walking.
(N Engl J Med 1988;318:110-112; Jiang W, et al. JAMA 1996;275:1651-1656; Kawachi I, et al. Circulation 1996.)

Chinese psychophysiology:
Heart ~ Xin houses the Shen (Spirit) and reveals itself through the brightness in the eyes; governs Fire and Heat; rules the Xue (Blood) and its vessels and directs the circulation; opens into the tongue and controls speech; and relates to the integration of the organs and the personality.
» Healthy expressions are warmth, vitality, excitement, inner peace, love, and joy.
» Heart Xu (Deficiency) signs include sadness; absence of laughter; depression; fear; anxiety; shortness of breath (Seem, p. 28); cold feeling in the chest and limbs; palpitations; cold sweat; inability to speak; memory failure; nocturnal emissions; and restless sleep. Chronic Yin Xu (Deficiency) predisposes to Empty Fire, acute and chronic.
» The Heart is the Emperor of the bodily realm so that when the Heart is disturbed all the other organs will be disrupted.
» Mental signs of Heart channel disorders include insomnia, anxiety, and all Shen disturbances. (Seem, p. 28)

Pericardium ~ Xin Bao is the Minister who protects the Heart, the Emperor, and maintains the order of the Heart energy; and as such may be adversely affected by emotional stresses internally or invasion of Heat externally. The Pericardium is said to be the origin of joy and sadness.
» Healthy expressions are joy, happiness, and healthy relationships.
» Weakness, dysfunction, and illness are associated with confusion, delirium, nervousness, and psychosis.

Kidney ~ Shen stores Jing (Essence) and governs birth, growth, reproduction, development, and aging; houses the Zhi (Will); expresses ambition and focus; provides the nourishing and stabilizing qualities of Yin and Water that balance the Yang and the Fiery qualities of the Heart; nourishes the brain to sustain concentration, clear thinking, and memory; carries the constitutional endowment from the parents; and displays the effects of sexual dissipation, overwork, chronic debilitation, and extreme stress.
» Healthy expressions are gentleness, groundedness, and endurance.
» Kidney Xu (Deficiency) signs include indecisiveness; confused speech; dreams of trees submerged under water; cold feet and legs; abundant sweating (Seem, p. 28); fearfulness; apathy; chronic fatigue; discouragement; scatteredness; lack of will; negativity; impatience; difficult inhalation; low sex drive; lumbago; sciatica; and musculoskeletal irritation and inflammation, especially when worse from touch. As always, chronic Yin Xu (Deficiency) predisposes to Empty Heat and/or acute inflammation.
» Intense or prolonged fear depletes the Kidney. Often chronic anxiety may induce Xu (Deficiency) and then Fire within the Kidney. (Maciocia, p. 250) Overwork, parenting, simple aging, and a sedentary or excessively indulgent lifestyle all contribute significantly to Kidney Xu (Deficiency).


Therapies

behavior modification:
• Autogenic training (related materia medica listings: relaxation technique) as part of comprehensive rehabilitation care in post MI period. (Locke, 1985, p. 106)
• Modification of type A behavior pattern and reduction in recurrences. (Locke, 1985, p. 107)
• Biofeedback: assisted heart rate modification. (Locke, 1985, p. 108)
• Meditation/yoga as method of relaxation. (Locke, 1985, p. 111)
• Brief group therapy (4-6 sessions) in early phase of rehabilitation. (Locke, 1985, p. 110)

imagery:
related materia medica listings: imagery for heart conditions

affirmation:
• I bring joy back to the center of my heart. I express love to all. (Hay, 1984, p. 168)
• Joy, joy, joy. I lovingly allow joy to flow through my mind and body experience. My heart beats to the rhythm of love. (Hay, 1984, p. 168)

theotherapy:
(heart disease) Atlas, Poseidon, Prometheus, Typhon (Lemesurier, p. 99)

hypnotherapy:
• Hypnosis was supplemented with endurance exercise and activity program five times a week. Substantial gains in aerobic power and muscle force were recorded in the first year of combined therapy. (Locke, 1985, p. 110)

psychotherapy:
• With heart disturbances and heart conditions, the following questions are possibly worth exploring:
» Are my head and heart, my intellect and feelings, in harmonious balance?
» Am I giving enough scope to my feelings and trusting myself to express them?
» Am I living and loving 'heartily', or only 'half-heartedly'?
» Is my life borne along by a living rhythm, or am I subjecting it to a rigid way?
» Does my life still contain enough combustible materials and explosives?
» Am I listening to, seeing, feeling, moving my heart? (Dethlefsen, p. 202)

process paradigm:
• What is the symptom preventing me from doing? What is the symptom making me do? (see process interview: cardiovascular system)

related materia medica listings:
the shadow and physical symptoms
converting a symptom to a signal
behavior modification techniques (see also relaxation, biofeedback)
healing power of meditation
type A behavior pattern
imagery for heart conditions
imagery: precautions
imagery: techniques
affirmations: guidelines and precautions
theotherapy
hypnotherapy
process paradigm


Footnotes

[No author listed.] A perspective on type A behavior and coronary disease. N Engl J Med 1988;318:110-112. (Review)

Jiang W, Babyak M, Krantz DS, et al. Mental stress-induced myocardial ischemia and cardiac events. JAMA 1996;275:1651-1656.

Kawachi I, Sparrow D, Spiro II A, et al. A prospective study of anger and coronary heart disease. Circulation 1996.