How to mend a broken heart

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0:56I'm Manoush Zomorodi. And today, we are starting the show

Heartbreak Syndrome

1:00with a case of heartbreak. A patient of mine was admitted to the hospital. And weeks prior, her husband had died. And a couple of weeks after the funeral, she took a look at his picture, and all these emotions came back, flooded back. Sadness, the grief over their life together. This is cardiologist Sandeep Jahar. She developed chest pain.

1:32And she got short of breath. And by the time she was in the hospital, she had distended neck veins, water in her lungs. She was visibly panting. All signs of congestive heart failure. So, we suspected that she had actually had a heart attack, that she had blockages in the arteries that feed her heart. But when we checked with an angiogram,

2:03her coronary arteries were pristine. It wasn't a hint of blockage anywhere. But her heart had weakened to less than half its normal function. And it had a very unusual shape. And what we found was that it was the syndrome Takotsubo cardiomyopathy, or the broken heart syndrome. Wait, what is that? So, Takotsubo is a special pot

2:37that's used in Japan to trap octopuses. And it has a sort of wide base and a very narrow neck. And that's exactly the way her heart looked on the ultrasound that we did. The base was constricted. The apex of the heart had ballooned out into this distinctive shape. Whoa, that is crazy.

3:07So, her heart was, like, swollen. And this is what heartbreak can look like. Literally. Yeah. So, emotions and the responses that they engender can have a direct effect on the heart. And the heart can acutely weaken in response to heartbreak or grief, such as after the death of a loved one or the end of a romantic relationship.

3:39So, we told her that very likely this would improve. You know, once her emotional state had returned to normal and that's exactly what happened.

3:52You know, once the grief had subsided and she came back to a sort of baseline state, we repeated the ultrasound and her heart had returned to normal. So, you know, it's just a fascinating syndrome. We too often think of the emotional aspects of the heart as purely metaphorical or symbolic, but emotions can have a direct disruptive effect on the heart.

4:23And there really is such a thing as heartbreak. The average human heart beats nearly 3 billion times over the course of a life. But when stress, fear, or sadness weigh on us, the heart can suffer, sometimes even break. There are, however, ways we can mend it. And so today on the show, stories and ideas about soothing heartache.

4:54From the connection between our emotions and our health, to protecting our romantic relationships, and facing our anxiety about the future, we'll explore ways we can nurture our most vital organ.

5:10Sandeep Jahar's fixation on the heart stems back to his family history and a story about his grandfather from 1953 before Sandeep was even born.

5:22It was a summer day in July. My grandfather was working in a tiny shop in Kanpur, which was a rural community in North India, and he was bitten by a snake.

5:41Now, snake bite is fairly common in India. And when my grandfather came home for lunch, he was feeling fine. But some neighbors brought in the snake that they claimed had bitten my grandfather, and it was a shiny black cobra. And my grandfather took one look at it, and he slumped to the floor and died.

6:13At the hospital, a doctor pronounced him dead on arrival and said that it wasn't a snake bite that killed my grandfather, but it was a heart attack, probably induced by the sudden sort of tremendous fright of looking at the snake that had bitten him and the fear that he was not going to be able to survive the snake bite. So, it's not just grief

6:46or romantic heartache that can affect our hearts. It can be any really extreme emotion.

Cardiologist Sandeep Jauhar

6:51Right. Was this a story that you heard a lot when you were growing up? Yeah. That event was profoundly tragic in our family, and I sort of grew up with this fear that something would happen to my own father. and that fear translated into sort of an obsession. I remember I would lie in bed and sort of monitor the thudding of my heart

7:21in my chest. I would look up at the ceiling fan that was rotating and try to synchronize the rotations of the blades with my heartbeat, and I sort of became obsessed with this sort of dichotomous nature of the heart that it was constantly moving and yet so vulnerable and in the process made us vulnerable. In other words, there was such a thing

7:52as sudden death, and the fact is that sudden death almost always occurs because of the cessation of the heartbeat. Here's Sandeep Jahar on the TED stage. 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

8:23published 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 external force that could cause their demise and against which they were powerless to fight.

8:54This 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.

9:18Today, death by grief has been seen in spouses and in siblings. Broken hearts are literally and figuratively deadly. You know, Sandeep, I think we hear a lot these days about how stress is bad for us, it's bad for our health, but do you feel like people just don't take that seriously enough, or they don't understand the stakes of, like, how much stress and emotions are connected to our physical well-being?

9:49Yeah. You know, the American Heart Association for the longest time did not list psychosocial stress as a key modifiable risk factor for heart disease. Now, why is that? I think the reason is that it's so much easier to lower blood pressure than it is to lower emotional stress. You can take a pill to lower your cholesterol

10:20or your blood pressure, but psychosocial stress is just an entirely different beast, and, you know, it's interesting that I went through a three-year training program in cardiology, and not once did we talk about the effect of stress or the emotions on the heart.

10:41And so, how do we, what do we do, Sandeep? How do we get to this middle place where we feel,

10:51I mean, is it, you know, you open a magazine and you'll be told to meditate, basically, but I think what you're talking about is both on an individual way managing our own stress and also a systemic way that we need to care for ourselves differently. So, there are a lot of ways to go about it, but I think the first step is to recognize that there's a problem. Do you know how long a typical

11:21American doctor allows a patient to speak before interrupting them? About 16 seconds. I was one of those doctors.

11:32But nowadays, I'll walk in and I'll let the patient talk.

11:39And increasingly, I see that if I let the patient really describe what's bothering them, you can get deeper. You can get to the sort of root cause of things. I've just recently, actually, learned about a patient who was having heart failure symptoms and, you know, all sorts of physical trouble. And it turned out that he had a tremendously disrupted relationship with his two daughters.

12:09And that grief over that disrupted relationship just came out in the office visit. He was weeping. So we actually reached out to the daughters, you know, and talked to them about what was going on at his request. And, you know, the improvement in that relationship with his daughters had tremendous effects on his physical health. So I would say that this is a very fertile area.

12:41And, you know, I think we would do well to act in ways, change our lifestyles, to pay, you know, respect to the intense sort of effects of emotions on, you know, this organ that we need to survive.

13:04That's cardiologist Sandeep Jahar. He's the author of the book Heart, A History. You can see his full talk at TED.com. On the show today, heartache. I'm Mnusha Zamarodi, and you're listening to the TED Radio Hour from NPR.

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15:07Hey there, listener. Did you know that NPR's app is better than ever? With live radio, digital stories, podcasts and new videos, you can get everything in one place on the NPR app. It's the TED Radio Hour from NPR. I'm Manoush Zomorodi and on the show today, heartache. Okay, let's sit down. So, one of our producers, James, Test, test. and his partner, Joanne, Test, test. How does that sound? It looks good. Well, they just got married

15:38last year. And so we gave them an assignment. So, are you ready? Yeah, let's do it. We asked them to peer into the future and talk about what issues, relationship issues, they think might come up. I mean, we're about to move to a really expensive part of the country. Money, childcare, careers, buying a home, the big issues that can cause

16:08a lot of heartache for couples. Yeah, I mean, I don't know when we'll be able to afford to buy a house there. I mean, we want to have kids soon and daycare is also really expensive. My mom was a stay-at-home mom, so it's going to be tough. We're moving close to your family, but my family lives all over the place. Yeah, and one of us might have to give up our career to be a parent full-time. It's a lot. Yeah, it's a lot. So we weren't just

16:38being callous by pushing James and Joanne to have this difficult conversation. We asked them to do this

Preventing Heartache in Relationships

16:44because our next guest says discussions like these are crucial to preventing heartache later on. I think it's fair to say that most people live marriages without thinking about divorce. This is Harvard Law Professor Jeannie Suk Gerson. She teaches family law. In fact, at the height of your love for somebody, when you're really looking forward to the life that you're going to build with this person, that is the best time to start thinking about these relationships

17:15in a way that is divorce conscious. Jeannie continues from the TED stage. The reason that I think this is so important is that I think everyone should be having some of these very painful conversations that divorced people experience. These are painful conversations about what we contributed, what we owe, what we are willing to give, and what we give up.

17:45Those conversations should be happening in a good marriage, not after it is broken. Because when you wait until it's broken, it's too late. But if you have them early on, they can actually help build a better marriage.

18:04In your TED Talk, Jeannie, you actually break things down into three examples, three principles that you think couples need to consider. That's right. First, marriage is an exchange of sacrifice. and that that sacrifice has to be thought of as a fair exchange. The second one is the idea that there's no such thing as free child care. And the third is what is starting out as each person's property

18:35probably is going to become part of the general property of the marriage. The first one, sacrifice should be a fair exchange. Take the example of Lisa and Andy. Lisa decides to go to medical school early in the marriage and Andy works to support them. And Andy works night shifts in order to do that and he also gives up a great job in another city. He does this out of love but of course he also understands

19:05that Lisa's degree will benefit them both in the end. But after a few years, Andy becomes neglected and resentful and he starts drinking heavily. And Lisa looks at her life and she looks at Andy and she thinks this is not the bargain I wanted to make. A couple of years go by she graduates from medical school and she files for a divorce.

19:32That is rough, Jeannie. Yes. When you look at that situation which I think is extremely common you think to yourself did this couple, did these two people ask themselves and each other what they were exchanging and how fair that exchange was. What was each giving up? What was each giving to the other? What was each going to owe the other person? Right? And these of course this language of owing and giving and exchange is for many people

20:05anathema to a romantic connection. but that is I think a delusion to think that a marriage can be devoid of those things and in fact that is what a marriage ultimately is when you strip it down. It is an exchange. You know it's making me think of people I know and what they say like well we just have to get through these next few tough years and then like as though utopia will arrive once the degree does.

20:36Exactly. And maybe you know if you get through those tough years of course many marriages go through tough years and then they have a better period that's wonderful. But if those tough years end up harming the connection and the intimacy which sometimes it can that's when they're going to be forced to talk about these questions about exchange and who owes what and who gave what and who sacrificed what. And that is when Lisa's going to realize she is owing

21:07Andy financial support. And then of course Andy might get financial support from Lisa but is he going to truly feel compensated for the things he gave up? So if Lisa and Andy had followed Jeannie Gerson's rules what would they have thought about? What would they what would this what conversation would they have had prior to or early on in their marriage? Well if they had thought about this it's possible that Lisa would have looked at the situation

21:38that I mapped out and would have thought well maybe it's not a good idea for Andy to give up his job that he likes and it's better to take on loans now than to have Andy give up his career. That is a possibility or she might have thought let me see if I could get a part-time job in order to defray the costs so that Andy is not entirely responsible. It's more fair you're saying that's the part that yes we're both going to have

22:08to sacrifice but we're going to have to sacrifice equally. That's right and to understand what the sacrifices are which also breeds less resentment. Resentment. Yeah resentment is like the big killer. Resentment is the big marriage killer.

22:29So let's take another couple Emily and Deb. they live in a big city they have two children they both work. Emily gets a job in a small town and they decide to move there together and Deb quits her job to look after the children full-time. Deb leaves behind an extended family her friends and a job that she really liked and in that small town Deb starts to feel isolated and lonely

23:00and ten years later Deb has an affair and things fall apart. Now the marriage mediator who would have come in before they moved and before Deb put her job might have asked them what do your choices about child care do to the obligations you have to each other? How do they affect your relationship? Because you have to remember that there is no such thing as free child care.

23:29So Deb and Emily what specifically should they have talked about when planning to start a family? They might have thought about how much Deb relied on the network of family friends and work colleagues in terms of her general happiness and how that is precisely the kind of social context in which full-time parenthood actually works well.

23:59Maybe Emily the one who got the job in the small town that everyone moved there for she might have thought to herself on the one hand I love this new job offer it's so exciting on the other hand I have to factor in what the cost is for my partner and if Deb incurs this cost what will be owed to her right what will I owe to her so let's go back to Lisa and Andy Lisa had an inheritance from her grandmother before the

24:30marriage and when they got married they bought a home and Lisa put that inheritance toward a down payment on that home and then Andy of course worked to make the mortgage payments and all of their premarital and marital property became joined so in a split what's going to happen they're going to have to sell the house and split the proceeds or one of them can buy the other out so this marriage mediator if they had talked to them before all

25:00of this happened that person would have asked what do you want to keep separate and what do you want to keep together and how does that choice actually support the security of the marriage because you have to remember that what's yours probably will become ours unless you actually are mindful and take steps to do otherwise I can see Lisa thinking like this is incredibly unfair that's right that might

25:31seem incredibly unfair and in Andy's mind if a different role were to pertain he would think hey I made all that money and we were able to make mortgage payments so that it would seem unfair to him if somehow now the inheritance that went into the down payment got separated out and given to Lisa so there is a lot of potential for strife for resentment and for a feeling of being aggrieved you're you're sort of saying you

26:01should decide with your partner before you even get close to being in a position where the law might decide for you that is exactly what I'm saying Jeannie I feel I would not be doing my journalistic duty if I didn't point out that not only are you a family law expert but that you are also divorced I am I am divorced and I got divorced less than 10 years ago and

26:31then I got remarried