Diagnosing a broken heart

Heartbreak isn’t just an adolescent experience, but a body and mind altering process

Uncontrollable crying fits. Shortness of breath. Loss of appetite, inability to stay focused, chronic rumination…Being diagnosed with a broken heart is more likely to come from a friend over a bottle of red wine than in a doctor’s office, but those experiencing the symptoms aren’t likely to dismiss the severity so easily. Whether it’s the loss of a loved one, a long- overdue breakup, or the announcement of Trinity Ball’s lineup, heartbreak and grief can tear your life asunder. Clinicians designing the Diagnostic and Statistical Manual of Mental Disorders (DSM) encountered this problem when defining depression. Viewing the list of symptoms necessary to be diagnosed with a disorder, it became clear that many suffering from grief would meet the criteria. Adding a clause in the manual for clinicians to consider this, the pathologisation of mourning has been avoided, yet it speaks to the severity of the experience. Heartbreak is something we’d all like to avoid, yet will experience. So how can science help in our understanding of its dramatic and multi-faceted effects?

All in your head?

“Practises that had been tried and tested in the US were not only ineffective when transferred, but sometimes harmful.”

It doesn’t take a scientist to see that the psychological effects of heartbreak will inevitably cause certain physical manifestations. Interestingly, our separation of mind from body isn’t a universally shared concept. While we may not always claim belief in a soul, much of Western thought is still driven by Rene Descartes’ concept of dualism. We consider mind and body to be two separate entities and expect these experiences to be distinct. Other cultures don’t share this. This became readily apparent when American psychologists rushed to the aid of those traumatised by the Sri Lankan tsunami in 2004. When natives reported physiological symptoms to a far greater extent than their recorded Western counterparts, researchers and practitioners alike were baffled. As time went on, it became apparent that response to grief didn’t share universal traits but was instead largely culturally dictated. Expectations of what constitutes “normal” mourning molded not only what the healing process should consist of, but the very experience of pain. Practises that had been tried and tested in the US were not only ineffective when transferred, but often harmful.

While our cultural expectations play a huge role in heartbreak and grief, other scientists have isolated the role of individual hormones in our biology in the hopes of better understanding the processes. For example, a breakup leads to a rapid increase in the level of the stress hormone, cortisol, as well as epinephrine, which leads to symptoms such as anxiety, nausea, headache, and weight gain. Chest pain is also a common physical response to heartbreak. A study done in part by the University of Michigan scanned the brains of 40 people who went through unwanted breakups. In one part of the study, the participants were shown photos of their exes and were asked to think about the breakup. As they were doing this, the region of the brain associated with physical pain also lit up. Researcher Ethan Kross explained: “These findings are consistent with the idea that the experience of social rejection, or social loss more generally, may represent a distinct emotional experience that is uniquely associated with physical pain.” This means that people going through heartbreak may experience physical symptoms such as sharp chest pain or heart palpitations.

Those going through a breakup may wish that there was a painkiller available to ease their suffering, but it turns out that over-the-counter medication for physical pain may work just as well. In a paper published in the journal, Psychological Science, it was found that people who took paracetamol for three weeks are less likely to experience feelings of hurt and social pain on a daily basis than those who took a placebo. Brain scans of the participants confirmed their reports, as when feelings of social rejection were induced, the region of the brain associated with physical pain lit up in those who took a placebo, while those who took paracetamol showed significantly less brain activity in that region.

It won’t kill you…

“The Broken Heart Syndrome is more likely to occur in women than men, with the average age of patients being between 61 and 76 years.”

In even more stressful situations, like a particularly difficult breakup or the death of a loved one, a condition known as “Broken Heart Syndrome” may occur. Also known as takotsubo cardiomyopathy, the underlying cause of this temporary heart condition is not fully understood. What is known is that this syndrome causes a temporary enlargement of the heart, where the left ventricular apex bulges, resembling octopus traps found in Japan after which the condition is named. The patient experiences sudden, intense chest pain and shortness of breath, with dramatic changes in cardiac rhythm and blood substances that mirror that of a heart attack. The condition can lead to severe, short-term heart muscle failure, but is usually treatable, with patients recovering within weeks. The Broken Heart Syndrome is more likely to occur in women than men, with the average age of patients being between 61 and 76 years.

Heartbreak can also cause muscle aches and pains due to the aforementioned hormones, cortisol and epinephrine. In normal situations, the purpose of these hormones is to ensure that we respond effectively to threat, triggering our fight or flight response by providing the body with glucose and, therefore, energy. However, during a breakup, these hormones accumulate, causing muscles to tense up, but with nowhere to expend that energy. This results in muscle swelling and may cause headaches and a stiff neck. In order to ensure that the muscles have an adequate blood supply, cortisol diverts blood away from the digestive system which can cause cramps, diarrhea, or appetite loss. The constant release of cortisol can also lead to sleep problems, which leads to impaired judgement.

We’ll always have the memories…

“It means our memories are in fact ever-evolving, not only shaping our future experiences but we are being shaped by them.”

You’ve survived the experience. You’ve gone through the gut-wrenching nights of sobbing sessions with diligent friends. You’ve done everything you can to move on, and assigned the past to what it is – the past – and now it’s time to move on. Ariana Grande has comforted over 300,000,000 listeners with the wisdom “I’ve loved and I’ve lost/But that’s not what I see”, yet the insight in these lyrics goes deeper than some might imagine. How we decide to remember is just as important as the reality of the relationship. Memory is often conceptualised as a recalling of the past, when a reconstruction is more accurate. Regardless of how heavily you subscribe to the postmodernist view of a subjective reality, memory has been shown to be not only inaccurate and unreliable between subjects, but also within individuals. Everytime we “remember”, we’re in fact rebuilding the experience in our mind. While this distinction may seem arbitrary, what it means is our memories are in fact ever-evolving, not only shaping our future experiences but being shaped by them. Elizabeth Loftus, one of the most prominent researchers in memory research, has worked extensively in court cases regarding the fallibility of memory, particularly with regards to eyewitness testimony. While sometimes accused of disregarding or disputing lived experiences, Loftus has shown that our memory isn’t the record keeper we often take it to be. The sense of discomfort caused by the realisation that our memory isn’t a steady ground but shifting sands is disturbing, yet is an essential mechanism in maintaining our life’s narrative.

One of the most important factors in how we remember is the avoidance of cognitive dissonance. Coined by Leon Festinger, cognitive dissonance is the feeling of discomfort created when we’re presented with two conflicting facts about our beliefs. This feeling of discomfort can be anywhere from mild to extreme upset, with some researchers linking inability to resolve dissonance with depression; whether this is a cause or a symptom is unclear. Let’s say you pass someone begging on the street. You’re presented with conflicting information – you believe yourself to be a good person, you believe that good people help those in need, and yet you passed this person and didn’t help. This generates dissonance – are you a good person? This can be resolved in a number of ways – perhaps you think that you can’t afford to help every person you see and the problem needs to be addressed in a more systematic manner. Perhaps you justify it by saying it would only be spent on drugs or alcohol. Perhaps you remember the time that you helped a different person on the street, and use that to justify your temporary apathy. All are effective forms of quelling this dissonance, but the last is the one we’re interested in.

While the beggar scenario showed plenty of ways to resolve the conflict, not every case is so straightforward. Following on from Festinger’s theories, social psychologist Elliot Aronson has written at length about the phenomenon, and how we may unconsciously change our recollection of experiences in order to subdue dissonance in our personal narratives. Let’s take an ex-partner. Post-break up, those petty arguments may go from being recalled as a result of them having a bad day to being indicators of their narcissistic and vicious personality. Equally, while pining for their love, we may recall their text messages not as friendly good-mornings but as signs of their everlasting devotion and how they were the only ones who will ever love you and please God that they take you back…What is important here is that it isn’t solely how we view the event that changes. It’s not just the meaning behind the texts that is shifting, but the very recollection of the texts. When looking back over the chat logs, we might be surprised to find they actually only sent these once or twice, not every morning as we seemed to recall. They may in fact have sent a word or two, not the Shakespearean sonnet that we’ve now assigned as being characteristic of their personality. Fact-checking is all well and good for concrete messages over Facebook, but without constant records of a lived experience, our need to construct a coherent narrative in our lives can distort and alter our record as we see fit. Aronson’s work highlights the need to recognise how fallible our recollections are, and how deluding ourselves with constructed fictions is less a deliberate process, and more a natural and unconscious mechanism.

Thank you, next

Distraction, on the other hand, did not change love feelings, but helped in making the participants feel happier in the short-term.”

A study published in the Journal of Experimental Psychology: General analysed 24 participants between the ages of 20 and 37, all of whom had been in long-term relationships that averaged 2.5 years and were suffering from heartbreak. The participants were asked to try four cognitive strategies that may or may not help them move on from the ex-partners. The first cognitive strategy, called “negative reappraisal”, involved thinking negatively about their ex. The second was dubbed “reappraisal of love feelings”, where the participants were instructed to accept without judgement that they still loved their exes by reading statements like “it’s okay to love someone I’m no longer with”. The third strategy focused on distraction, where the participants thought of positive things not connected to their exes, and in the fourth strategy, the participants were instructed not to think about anything in particular. The subjects’ brains were then analysed while they looked at photographs of their exes and answered a questionnaire about their feelings.

The researchers found that the first three strategies helped in decreasing the participants’ emotional response towards their exes. However, the three affected the participants in different ways. Although decreasing love feelings towards their exes, negative reappraisal made the participants feel more unpleasant, while love reappraisal did not change how in love, pleasant, or unpleasant the subjects felt. Distraction, on the other hand, did not change love feelings, but helped in making the participants feel happier in the short-term. The researchers concluded from the study that “negative reappraisal is an effective love down-regulation strategy, whereas distraction is an effective positive emotion up-regulation strategy”.

Too-often reduced to the subject of young adult fiction and inconsequential experience, heartbreak deserves recognition in all of its forms. Able to disrupt hormones, alter your recollected narratives, and even imitate cardiac events, grief is an experience that varies for us all but is never pleasant. Joan Didion wrote, “grief turns out to be a place none of us know until we reach it”. While losing a husband or loved one are far from a bad breakup, taking a more sympathetic and understanding view to how effecting personal loss is can only be a good thing. So take a breath and give yourself the treatment you deserve – there’s no need for a doctor’s diagnosis.

Danielle Olavario

Danielle Olavario is a former SciTech Editor of Trinity News. She is a Microbiology graduate.

Sam Cox

Sam Cox is a Staff Videographer at Trinity News. He is a Senior Sophister Psychology student, and a former Crossword Editor, Features Editor and Assistant Features Editor.