It is a great pleasure for me to introduce to you a guest author on this blog, the psychologist and psychotherapist Martino Regazzi. Martino joined and reinforced the team of Cardiocentro Ticino about a year ago. He gives all of us (patients, nurses, cardiologists and cardiac surgeons) some precious help and structured insights on something right opposite of the spectrum of the highly specialized, cutting edge treatment we practice: the mind and soul. Although heart and soul are almost felt as a whole, we in the green and blue scrubs mostly take care of its somatic dimension. Of course, empathy and reassurance of both patient and family is an integral part of our attitude: however, it is not sufficient and sometimes we painfully feel it. The “other” dimension is not easy to handle as it is far more complex than we think! Therefore I am especially happy that Martino accepted my invitation to write the following post. A heartfelt thank you Martino!
(The artwork named “From the bottom of my heart” is exposed with permission of its creator David Munroe).
Emotions of the heart. Psychological aspects of heart surgery.
Being diagnosed with cardiovascular disease has a big emotional impact, characterised by conflicting and invasive feelings. Naming the disease allows the physician to identify the best possible cure and at the same time allows the patient to use his internal resources to process it. Even though it usually results in anxiety relating to the uncertainty of the medical steps to be taken, being able to name the illness before having surgery enables the patient to be partly reassured and even determined to fight knowing what needs to be fought.
When medical cure is needed and most of all if the indication for cardiac surgery is confirmed the patient can experience a heavy emotional load. Further proof of the inseparable connection between mind and body is that the heart is the organ that has the most symbolic references involving our affectivity. It is therefore inevitable that anxious feelings arise when the patient is faced with cardiac disease.
When faced to swallow the emotionally charged news of “open heart surgery” the patient’s mind cannot escape from defence mechanisms, both conscious and unconscious, to protect himself and face to his fears and anxieties. It will only be after surgery that the need will come to find space and time to effectively elaborate such an emotional experience. In some ways, it can be said that every patient needing cardiac surgery is metaphorically facing a journey into the unknown, full of doubts and uncertainties.
Emotionally, the patient is usually pervaded and dominated by a persecutory anxiety state expressed by an instinctive signal that tends to make him see the immediate future (and what needs to be done on him) as a potentially dangerous event. This emotional climate makes the patient come to terms with the uncertainty of the unknown, which, whether he likes it or not, takes up his imagination. However, should the patient not be able to relate realistically to what’s in store for him the imaginary can be a source of deep trouble. Even though some patients are able to face reality adequately, the majority of them welcome a helping hand in facing their own emotional storm instead of suffering it. Of course, having a positive attitude helps both the surgery and the following medical care.
In conclusion, the patient’s main job before cardiac surgery is to shape his internal background to be able to elaborate instead of suffering the highly emotional experience that he will go through.
This is indeed possible if the patient is able to brace his state of uncertainty without falling to pieces by developing what the poet John Keats first said about being able to sail into uncharted waters and called it “negative capability”, which is the essential ability that a person has to cope with mystery and doubt, enduring to remain in the uncertain as long as he possibly can. Essential, given the difficulty of the task, is to be able to carry it out with the help of somebody close to the patient.
Taking care of a patient does not only mean healing the muscle itself (i.e. the heart) but also taking care of his psychological aspects.
Bernard Lown , Nobel laureate and professor of cardiology at the Harvard School of Public Health, who developed the defibrillator and modern coronary units, wrote “loss of attention to the psychological aspect impoverishes core medicine dividing cure from healing”. To this, we can add that there is no point in healing the body without healing the mind as we know that there is a correlation between one’s emotions and his cardiovascular system.
Cardiac surgery inflicts the body a huge aggression and the impact on the body is rather foreseeable; the psychological relapses, on the other hand, are often less clear and catch the patient by surprise. The highly specialised environment and the surgeon’s competence can lead the patient to believe that everything he has to do is just sit back and be cared for by the specialists.
It is a fact, however, that after surgery several patients feel some emotions rarely felt before and they must be dealt with. The patient then realises that it’s up to him to start a psychological work and it is indeed important that both mind and body undergo some period of rehabilitation.
Cardiovascular and mental rehabilitation
Cardiovascular rehabilitation is advisable after surgery allowing time and commitment to recover. I also believe that the mind needs some kind of support. Should we represent metaphorically what the patient’s mind has to do to elaborate his hospital stay, we could compare it to digestion: the mind is fed a rather stodgy food that needs digesting  as external and internal stimulus cannot back out of the necessary complex elaboration and transformation.
The intensity of the emotional experience of heart surgery loads the mind of several contents that acquire meaning only when appropriately processed. This transformation-digestion is however not automatic and can fail, forcing the mental system to adopt an evacuative function discharging the excess somewhere else. The body itself is primarily exposed to suffer the discharge and paying the consequence by, among other things, somatizing it. To avoid it, the patient has to allow sufficient time not only to heal the organic wounds but also to transform the input given to his mind and, if necessary, not on his own.
The target is to give some sense to this experience, giving value to thoughtful and introspective moments, thinking about his illness and finally accepting the physical change.
 Lown B., L’arte perduta di guarire. Garzanti, 1997
 Bion W., Elementi della Psicoanalisi, Armando, Roma, 1973