The research showing that people who feel loved are more likely to enjoy healthier hearts than those who feel unloved is important. It puts real science behind something we all know personally: Love is the healthiest of all emotions. It sustains life at a level of trust, joy, and compassion unrivaled by anything else. A great poet from India, Rabindranath Tagore, declared that love was no mere emotion but a cosmic force. To be raised in a loveless household is the cruelest fate a child can endure, as the following story poignantly illustrates.
Patrick, now in his early thirties, didn’t believe that he had suffered emotional damage as a child. He only knew that when his mother said she loved him, he couldn’t expect her to hug him or even touch him. Her distance was a constant from an early age.
“I was hospitalized when I was five to get my tonsils taken out,” Patrick recalls. “It was Valentine’s Day, and I was in a ward with other kids. Their mothers came by with cards and candy, but my mother didn’t. But that’s the funny thing. What I remember is turning my face to the wall and holding a pillow over my ears so I couldn’t hear the other kids and their moms. I carried a grudge around for years, and then a peculiar thing happened. One day my mother and I were having lunch, and my curiosity got the best of me. I asked her why she never came to see me in the hospital, and you know what she said?
“She told me she arrived a bit late when visiting hours started, and she found me curled up in the bed crying. She comforted me, she said, but that part I don’t remember, only the feeling of being alone and forgotten.”
Young children, as many psychologists attest, form powerful beliefs about their upbringing that don’t always match the facts. It has taken medical science a long time to stop believing that only facts, as measured by medical tests and diagnoses, are the sole component of being healthy. Beliefs matter, even when those beliefs are totally subjective—we all believe the stories we tell ourselves. This story begins with the messages our parents send in childhood.
Patrick’s parents sent a message that told him he was on his own. Being aloof and unaffectionate themselves, they treated this as normal. But children need to feel closely connected to a parent who is loving and protective. This is an evolutionary trait millions of years old. In a famous experiment baby monkeys were separated from their mothers and soon became restless, anxious, and insecure in their behavior. When given an artificial mother constructed out of wire mesh with padding around the torso, the babies immediately attached themselves to it, clinging for comfort.
In humans the effects of poor bonding are just as devastating, even though we have superior abilities to adapt even to the worst conditions. In Patrick’s case, believing that he was on his own led to what is known psychologically as “loose attachment.” In layman’s terms he didn’t feel safe, valued, and protected. In his mind, true or not, if he was in trouble no one would be there for him. That’s an exaggerated, black-and-white notion—no doubt his parents would have been shocked to hear it—but kids’ ideas tend to be like this, based on indelible emotional experience.
“I was lucky in a way,” Patrick recalls with a faint smile. “I got very good at being independent. Everyone commented on how I was like a little adult even when I was seven or eight. I was proud of it. I became a superachiever because that’s what adults do, and this went on for a long time.”
When he started dating in his teens Patrick didn’t fill the hole in his heart; he had no idea how to. Getting close to someone felt alien, in fact. Keeping true to his story that he had to look out for himself, he was motivated mainly by his growing sexual urges. Girls tended to go along with this, and if they started to want more and the relationship verged on getting serious, Patrick found excuses to start a fight or act so cold that the girl, bewildered and hurt, walked away.
By the time he got to college, studying computer science, Patrick’s isolation, emotionally speaking, was baked in. His ability to take care of himself was unquestioned. What he didn’t realize was this: He took care of himself because he believed that nobody else would. He had no model for a nurturing, protecting love.
The story could have stopped there. Fortunately for him, it didn’t. In graduate school he met a girl, and she was different. Patrick’s totally rational worldview collided with love at first sight.
“To be honest,” he says, “I thought those words were just clichés. The first time I met Fran, I saw her for only a second outside the department while she was talking to some friends, but I was riveted. There was just something about her. I got up my nerve and introduced myself. She was friendly and smiled. Nothing else happened, but I went home, and Fran was all I could think about.
“She agreed to go out with me, and things just unfolded from there. Without warning I had become a fool in love. I died inside if she had a change of plans and couldn’t see me. I kicked myself every day to make sure it was true—I’d fallen in love with the most beautiful woman in the world.”
Despite the undoubted experience of falling in love at first sight, and abundant evidence that love creates powerful physiological changes, the whole phenomenon remains mysterious. Do chemical changes in neural activity mean that Patrick’s brain fell in love, or did he? In a whole-system approach the two are inseparable. Where healing is concerned, there are some deep issues that cross the mind-body boundary:
How and why does love promote physical health?
When infatuation turns into lasting love, what can this do for our well-being?
If love becomes deep enough, does it open the door for higher consciousness?
The human experience testifies that love has a unique power in all these areas, and if we investigate deeply enough, there are answers for why this is so.
We live in an age in which such an overwhelming experience, one that transforms someone’s entire being, is explained as biochemistry. But even with sophisticated brain scans and measurements of hormone levels and the like, what’s missing is the meaning of falling in love. That meaning is all embracing. In the terms we’re using, love is a whole-system event. The studies that indicate how coronary arteries respond to love, or the lack of it, are only the tip of the iceberg. We carry a deep evolutionary imprint at a genetic level. To quote psychologist Barbara Fredrickson, “Somewhere in our brains we carry a map of our relationships. It is our mother’s lap, our best friend’s holding hand, our lover’s embrace—all these we carry within ourselves when we are alone. Just knowing that these are there to hold us if we fall gives us a sense of peace.”
What’s most significant is that even when someone is alone, sitting quietly and passively, they aren’t really alone. Inside they carry a map constructed from all the relationships experienced since infancy. This, too, is a whole-system phenomenon. Each moment in a relationship is a tiny piece being fitted into the whole map as it changes and shifts.
To see how this works, give the first answer that comes to your mind when you read the following statements:
| My mother loved me enough. | YES | NO |
| I’m glad I had the father I had. | YES | NO |
| I trust where I am right now. | YES | NO |
| My current relationship is in a very good place. | YES | NO |
| I have a good friend I’m closely bonded with. | YES | NO |
| I like being emotional. | YES | NO |
| I tend to show how I feel. | YES | NO |
| Others feel safe confiding in me. | YES | NO |
| I am a nurturer. | YES | NO |
| I feel as if I belong. | YES | NO |
There are no right or wrong responses to these statements. But if you answer quickly without pausing to give what you believe is the “right” answer, your responses come directly from your inner map of love and relationship. You may be happy or shocked by your responses, and we will be showing you how to improve your inner map in many ways. Here just be aware of how an inner image you probably never think about is affecting you, not incidentally but as the story of who you are, involving the whole person.
A whole-system approach would predict that love, or the lack of it, would have multiple effects, and it does. In terms of biochemistry, a number of significant changes take place when someone falls in love. Levels of brain neurochemicals such as dopamine and serotonin go up, together with hormones like cortisol and follicle stimulating hormone. These are the earliest changes of falling in love. Ironically, the last two are indicative of stress caused by the arousal between the sexes. In other words, there’s a chemical basis for why romantic love brings joy and pain. Shakespeare intuited a fact of neuroscience in A Midsummer Night’s Dream with the famous line “The course of true love never did run smooth.” Even more intriguing is that testosterone levels go down in men and up in women as we age, leading to changes in temperament that render two members of the opposite sex just a bit more alike.
Even more far-reaching are the possible effects of love on the healing response. How well your immune system works is a crucial factor, and it is well documented that emotions change the immune system. Drs. Janice Kiecolt-Glaser and Ronald Glaser looked at couples who had been married for a long time, on average forty-two years, and found that those who constantly argued had a decreased immune response. If this finding seems to be a sad comment on older marriages, the same effect occurs very quickly, too. A study of couples who were on their honeymoon showed that newlyweds who showed hostile and negative behavior when asked to discuss the topic of marital troubles had a decreased immune response.
By now, having read this far, you won’t be surprised that the body responds to positive and negative emotions. But the speed of this response may still surprise you. A pioneering study by psychologist David McClelland and his team at Harvard asked students to watch a film on the work being done in the slums of Calcutta by Mother Teresa, the Catholic nun who gained worldwide fame by caring for the poorest abandoned children. (As a control, a second group of students watched a neutral documentary on another subject.) On average the students who watched the Mother Teresa film showed increased levels of antibodies on the spot, along with decreased measures of stress like reduced blood pressure.
This finding is impressive for showing how the body responds here and now to emotional experiences, but McClelland wondered why some of these students actually had a decreased immune response to watching Mother Teresa’s good works. As a follow-up, all of the original study group were shown a photo of a couple sitting on a bench by a river. When asked to write a story about the couple, some students described them as loving, supportive, and respectful, while others wrote very different stories in which the couple was unhappy, manipulative, and deceitful. The students who showed the biggest decrease in immune response in the first study happened to be the same ones who wrote the negative stories in the follow-up. The implication is powerful: ingrained ideas we carry around inside us wind up defining what relationships are all about, even when those ideas aren’t aligned with the truth. They forcefully impose their own interpretation instead.
Going back to Patrick, he and Fran had entered the first phase of romantic love, which is infatuation. In that state, everything about love is so powerful that reality changes. Your beloved is the most beautiful person in the world. In the presence of the beloved you have entered paradise. Under love’s spell, the whole world looks brighter and is inhabited by wonderful people. To a strict rationalist, these are illusions. And in fact, infatuation is temporary; its intoxication wanes, giving way, if the person is lucky, to more stable stages of love. In these later stages other neurochemicals, such as endorphins (natural opiates), oxytocin, and vasopressin follow predictable patterns in response to the back-and-forth of lovers. But is falling in love just a set of chemical experiences?
There’s an important factor rationalists don’t consider. Falling in love gives a more realistic view of life by placing us in contact with our true self. We fall accidentally and temporarily into a state of expanded awareness that is exalted by the great mystic poets, who connect intense human love with divine love. The beloved Persian poet Rumi exults:
Oh God, I have discovered love!
How marvelous, how good, how beautiful it is!…
I offer my salutation
To the spirit of passion that aroused and excited this whole universe
And all it contains.
There is no doubt that love can expand into this higher dimension, where the whole person is healed in the most profound way. The connection between body and mind is undeniable, but that’s also true in an everyday instance of falling in love. The following experiences pertain to love wherever it is felt:
Feeling renewed
Bonding at the level of the heart
Feeling protected and safe
Emotions of joy, exhilaration, and upliftment
A more open heart, extending empathy and sympathy to others
Feeling physically lighter
Sensing energy or light coursing through the body
There’s no distinction here between what a saint would describe and a Patrick who discovers love for the first time. He and Fran didn’t last as a couple beyond a year. Like everyone who has passed through the stage of infatuation, they had ego needs that weren’t the same. Settling down to love while negotiating the demands of “I, me, and mine” poses its own challenges. But Patrick learned the most valuable lesson of his life, that he was lovable and, along with this, that he could love.
Humans are not biological robots. We live for meaning, for the personal value of every experience. The body metabolizes our experiences and sends the message to every cell, while the mind, in its own domain, processes experience in terms of sensations, images, thoughts, and feelings. Nothing fuses the whole-system effects of love and non-love like the human heart, which needs to be understood as more than a physical organ.
The heart offers one of the best examples of how the whole-system approach makes the most sense. Heart disease is the leading cause of death in this country for both men and women, which makes it a primary target for a healing lifestyle. Your heart is very responsive to how you feel emotionally and physically. There’s almost no choice you make that your heart doesn’t know about.
Yet very few people are really aware of this. Until they feel an alarming symptom like chest pain, they might think about heart health mainly in terms of cardio at the gym. Other disorders, such as breast cancer, attract more publicity and generate more fear among women, but statistically, this perception doesn’t conform to the actual situation. Out of total deaths among American women each year, breast cancer accounts for 1 in 31, while deaths from heart disease are 1 in 3. Depression and anxiety are associated with increased risk for exercise-induced heart attacks. In contrast, greater levels of positive emotions are associated with decreased risk. Being heart healthy is important. But in our whole-system approach, the physical organ is only part of the story. The other part has to do with one’s attitudes and outlook.
Even if someone holds that a purely physical approach is adequate, that side of the equation isn’t completely well understood. For example, a study in the early 1950s looked at the hearts of young soldiers who were casualties in the Korean conflict. America was just becoming aware of an epidemic of heart attacks afflicting men between the ages of forty and sixty. No one knew what was causing this alarming spike in premature heart attacks. The fashion for mainly blaming cholesterol hadn’t yet begun, and there were no drugs like cholesterol-lowering statins to prevent heart disease.
Into this baffling environment, the hearts of young soldiers told a grim story. A high percentage of them displayed considerable plaque blocking their coronary arteries. Plaque is hardened fat mixed with minerals and caked blood that can shut off the heart’s own oxygen supply. When an artery is strangulated, the heart muscle goes into convulsions, entering into a full-blown heart attack. It was assumed that plaque buildup took decades, gradually increasing the risk of heart failure.
However, these were men in their early twenties, and their arteries were sometimes blocked as badly as older men who suffered from heart disease. How did this happen? Just as mysteriously, why did the heart wait until a man was forty before a heart attack occurred? These questions remain unanswered today. The relationship between arterial plaque and all the possible factors that might cause it—diet, blood fats, stress, genetics, and microscopic changes in the walls of the coronary blood vessel—is extremely complicated.
The most obvious fact is that neither the soldiers nor the doctors who gave them a physical checkup had a clue that something serious was going on. (The advent of sophisticated tests like angiography lay decades in the future.) The typical chest pain associated with heart disease, known as angina pectoris, generally shows up late in the game, and it’s also possible to have blocked arteries with no pain—in such cases, a heart attack occurs out of the blue. A healing lifestyle needs to be followed whether pain exists or not.
Even with so many open questions, once heart disease has been diagnosed, after a brief visit with a cardiologist, a battery of tests, the typical first step is a prescription drug to combat high cholesterol or elevated blood pressure. Lip service is paid to lifestyle changes, sometimes not even that. A patient’s motivation to pursue diet and exercise generally isn’t strong in the first place. A lifetime of settled habits is hard to turn around. If the patient’s condition continues to worsen, some kind of surgical procedure is in the offing. The two most popular interventions are angioplasty and coronary artery bypass graft. Here’s a thumbnail sketch of the “simplest” intervention, angioplasty, which in the United States is performed more than 600,000 times annually.
WHAT IS IT? Angioplasty involves inserting a tiny balloon into a blocked artery of the heart to expand the artery. The theory is that by opening up the artery, better blood flow will be achieved to the heart, decreasing the risk of a heart attack. Routinely a wire-mesh stent (a short, narrow tube) is inserted to keep the artery open after surgery. The relatively low risk of angioplasty helped to fuel a dramatic increase from 133,000 procedures in 1986 to more than 1 million annually by the 2000s, leading to a $100 billion industry today when you include heart bypass surgery. As with all surgical interventions, however, angioplasty has pros and cons.
PROS: The intervention is not severe physically, involving a tiny wire over which a balloon is slid into the artery. Many times, one has no choice but to have this surgery for survival—after a heart attack, for example.
Angioplasty is quick and not terribly uncomfortable.
After a night of observation in the hospital, recovery is rapid. Patients generally resume their normal lifestyle.
The main purpose of angioplasty, to make heart patients feel better by relieving chest pain or offering psychological relief from anxiety, is often achieved.
CONS: Angioplasty doesn’t cure the underlying disease, which continues to progress. The procedure must often be repeated, and stents replaced.
Significant extension of life expectancy is not generally the case, especially in older patients. (A strong exception in extreme circumstances is with patients who have recently suffered a heart attack.) The first clinical trials of angioplasty, in the early 1990s, revealed no survival benefit of elective angioplasty as compared with medication.
The serious immediate risk is that arterial plaque may be dislodged by the balloon, leading potentially to a heart attack (or a stroke if the stent has been placed in a blocked carotid artery in the neck), occurring in 1 to 2 percent of procedures. Arteries can rupture if the balloon is inflated too much. Various possibilities of infection are present.
Angioplasty is expensive, with costs varying widely. The cost is often not worth the results. A 2008 presentation at the annual conference of the American Heart Association (AHA) concluded that angioplasty relieves chest pain in some heart patients but “at a cost generally considered to be prohibitive as a routine initial management strategy.” Despite this conclusion, more than 1 million Americans receive heart stents every year.
A far more serious intervention, heart bypass surgery, involves putting the patient on an external pump to maintain circulation while the heart is being operated on. This increases all the risks just covered with angioplasty and is even more expensive. We won’t go into detail except to offer some highlights:
• Heart bypass surgery is more painful, takes longer for complete recovery, and still doesn’t significantly increase life expectancy except in specialized cases where the primary coronary artery is severely blocked.
• Even then, because few patients heed the advice to improve their lifestyle, plaque can begin to damage the grafted blood vessel in a matter of a few months. (The first patient to successfully receive a bypass graft in 1960 was relieved of his angina symptoms for just one year.)
• The inventors of the procedure predicted, wrongly, that bypass surgery would be a rare intervention, useful in patients with imminent risk of heart failure. At present, however, more than half a million coronary artery bypass surgeries are performed in this country every year.
Of the many cons involving angioplasty and heart bypass surgery, the one that stands out is the first: the underlying disease isn’t cured. In the 1980s, pioneering studies by Dr. Dean Ornish at Harvard Medical School conclusively showed that positive lifestyle changes can do more than prevent heart disease; they can heal it. Ornish’s program of diet, exercise, meditation, and stress reduction, then considered revolutionary, actually opened up clogged coronary arteries, the first success in any form in reversing heart disease.
A lifestyle-based approach remains the only proven way to reverse the plaque that lines the coronary arteries in people at high risk for heart attacks. The inclusion of meditation in the program was considered daring and controversial at the time—the medical profession still harbored the prejudice that meditation was an esoteric Eastern religious practice and therefore had nothing to do with “real” medicine. Now it’s become accepted therapy to recommend meditation for high blood pressure, anxiety, insomnia, and other disorders. But the original Ornish program was absolutely strict, demanding adherence to stringent dietary rules. For example, one rule limited all fat intake to, at most, a couple of tablespoons a day.
For the vast majority of people who have not been diagnosed with heart disease or suffered a heart attack, the search for an ideal lifestyle, one that heals and not simply prevents, remains open ended. Dr. Ornish has published many books and articles that explore healing in body-mind terms. Medicine will continue to compartmentalize mind and body, but as individuals seeking healing, we can’t afford to. The original lifestyle research broke down the wall separating mind and body. Without them, the whole-system revolution couldn’t have taken place.
The emotional states associated with the heart include some that every life would benefit from:
Empathy, which makes us feel what someone else is feeling
Compassion, which motivates us to extend lovingkindness
Forgiveness, which wipes the slate clean of old grievances and wounding
Sacrifice, which allows us to put someone else’s good above our own
Devotion, which inspires reverence for higher values
None of these states is a term in cardiology, yet they have medical consequences. In the next chapter, we’ll discover how recent breakthroughs are transforming matters of the heart. But here we want to reinforce the healing value of love. People thrive when they feel loved and languish when they don’t. Love increases one’s sense of self-esteem, which leads to taking better care of oneself. Love also alleviates stress, anxiety, and depression, which reduces chronic inflammation and risk for many age-related disorders, such as heart disease, diabetes, and Rudy’s specialty, Alzheimer’s disease. Love is a state of awareness, not a lifestyle choice. Ultimately what counts aren’t the choices you make but the consciousness that keeps those choices going in a constant state of healing.