Health – Where do emotions come from?

Early Greeks thought that illness was due to an imbalance of the four ‘humours’ – black bile, phlegm, blood and yellow bile. They also thought that the basic temperaments arose from a preponderance of one of these fluids, hence melancholic from black (melan) bile, phlegmatic, sanguine and choleric.

Ancient Hebrews sometimes said that the deepest feelings came from the kidneys or the womb. I understand the phrase “Let not your heart be troubled”, when translated into an Inuit language, became literally “Let not your liver shiver”! 

These are all examples of interoception, the process of perceiving signals from our internal organs. “Butterflies in my tummy”, “it felt like a kick in the guts”, “my blood boiled” or the old-fashioned “I feel it in my waters”, are all expressions of an awareness of our visceral responses. 

But perhaps most consistent in our culture is the association between the heart and the emotions. Everybody knows what a heart emoji means, even though it is anatomically far from correct. We can be half-hearted, cold-hearted, soft-hearted, faint-hearted, light-hearted and all the opposites. Our heart can sink or soar. Our heart can rule our head. We can follow our heart, and so on. 

No wonder than that a serious cardiac event can have a very significant emotional impact. After a heart attack, or surgery, up to 80 percent of patients will experience what is called ‘the cardiac blues’. This is understandable, considering these are potentially life-threatening events and often occur without warning. 

There may be a fear of recurrence, hypersensitivity to physical symptoms, withdrawal from others, loss of confidence, tearfulness, a sense of disorientation and all the stages of grief. Since these reactions are so common and mostly resolve within a few months, the best approach is supportive understanding and reassurance. Talking to people who have ‘been there’ is helpful as well.  

And in my experience, there can be positive emotional responses as well – a sense of the preciousness of life, a re-evaluation of priorities and an appreciation of friends and family. 

But a third of cardiac patients will experience clinically significant anxiety and depression and approximately 15 percent will be diagnosed with post-traumatic stress disorder (PTSD). Besides the emotional distress, these patients tend to neglect their rehabilitation programmes and have poorer outcomes. This is more common if there is a history of previous mental problems, social isolation, financial strain, other health problems, smoking or a concurrent bereavement. 

Fortunately, there are hospital and community-based resources for this situation. Cardiac rehabilitation programmes explore all aspects of recovery, including physical and psychological, and have been shown to improve quality of life, readmission rates and mortality. Heartbeats Charitable Trust, founded by local Trent Lash, has been particularly successful in this area. 

There is also evidence that exercise and optimisation of diet can help, as well as formal counselling and medication. 

Keeping in touch with your GP, especially in the year after a heart event, gives them an opportunity to monitor your wellbeing and access support. A lot of the time they will be able to reassure you and your family that what you are going through is normal but, if not, there is help out there.