Anthropological and linguistics articles from University of Western Australia

Saturday, May 13, 2006

He Died of a Broken Heart essay by Marcia Hewitt Medical Anthropology UWA


Exploring medical diagnosis through folk

By Marcia Helene Hewitt
University of Western Australia

May, 2006

In this paper I will explore the concept of ‘broken-heartedness’ as an ethnomedical etiology, and how it relates to the biomedical condition of grief and separation. I will also touch on other conceptualizations of the heart that will give metonymic understanding (Barcelona, 2000) in English.
In the following speech act, a group of neighbors are standing in the middle of the street talking.
“Oh yeah, he was very close to that dog, and a few days before he died his dog had been run over by a car. I think he died of a broken heart, because he died a few days after his poodle died.” (People in Subiaco, just talking, 2005, participant observation).

HE MUST HAVE DIED OF A BROKEN HEART is the notion that I am exploring in this paper. Here, a few people are standing in the street in front of Mr. X’s house, talking about his death. One woman makes the above comment; she makes a connection between the French Poodle dying and the man dying…saying that the man was so attached to the poodle that he then died also, from a broken heart. What are they describing in this scenario? They are describing loss, separation, an affinity between the dog and his owner, so that the loss has affected the owner’s heart. What happens to our hearts when we lose something we are attached to? Even the word ‘attached’ gives a clue about the ethnomedical condition that I am addressing here. Ethnomethodology invites the examination of linguistic data to discover its transparency; how do we learn from talk those things that we do? (Sharrok & Watson, 1989).
John Steinbeck succinctly states in Travels with Charley that “A sad soul can kill you far quicker than a germ” (Steinbeck, 1962). Also in Proverbs: “A merry heart does good , like medicine, but a broken spirit dries the bones.” (Proverbs 17v.22) There are endless examples from literature, poetry and plays of which those are but a few.

First, what can we glean from the words themselves? A heart breaks. The heart is the seat of emotion, the heart is a container; it can break, or be filled, or be emptied. (Sharifian, 2005). The heart is also a substance; it can be hard or soft. The heart also has qualities of virtue: it can be pure or impure. In Hinduist literature, the atman (heart cave or Brahman) should have the ability to feel for others as we feel for ourselves (Bhagavad-Gita 18:42) , that is, then, the heart is also ‘trainable’ and should display certain qualities.

But the physical heart, or “biomedical” heart is different than the heart that I have described above. In biomedical terms, investigations into the heart were first made around 375 BC at the Alexandrian school. Physicians were engrossed largely in speculative views about what the heart and arteries did. Diocles the Carystian, Pliny, Galen, Praxagoras and Aristotle made no correlation between the veins and heart that they were exploring and metaphysical concepts such as virtue or sadness. (Osler, 1999). Greek physicians of this era simply saw the body as a type of machine, and did not try to “embody” concepts of emotion or virtue into it, at least not into anatomical parts. But in other instances, it is not so easy to draw the line between mind and body. For example Kubler Ross writes about people who have physical reactions to losing pets or loved ones. She also comments that grief has many faces and that the loss of a pet can be as intense as the loss of a person. The people in the street were sharing that the loss of the poodle might have been the cause of his owner’s death. His friends and neighbours were speculating on causality.

There are classificatory dimensions of ethnomedical phenomena, and there has also been a “reluctance on the part of anthropologists to explore the interface between biology and culture”... (Rubel, Hass, 1988 p215). The biomedical etiology then might be grief, which is an accepted medical condition. But it is a condition that has no physical locality and yet has physical symptoms. For example : “Daniel had been married for twenty-four years to Rachael, the love of his life. When she died, he felt lost and went back to work right away. Before the first week was over he began feeling pain in his chest and also the worst headache he’d ever had” (Kubler-Ross, p.128).). Grief is a medical condition that shows the fuzzy line between the physical heart and the metaphysical heart, or the place where the Cartesian duality breaks down. (Rene Descartes,1640). Kubler Ross goes on to explain that Daniel went in for tests, doctors thought it might be a tumour or internal bleeding, finally checked his scalp and diagnosed shingles. His entire body became a site of blisters and he was in such intense pain that he could not work. The doctor’s comment was that he had seen this many times after the loss of someone (Kubler-Ross, 2005).

The difference between biomedicine and ethnomedicine isn’t as clear as some university textbooks would lead us to believe. Indeed, Western biomedicine sprang from a form of Euro-American ethno medicine that spread to many other parts of the world. (Hahn, 1983, p.192). In terms of defining biomedicine, the label “cosmopolitan medicine” has come to be used, as opposed to university medicine which would have to include Ayurvedic medical universities, where thousands of physicians are trained. (Rubel & Hass, 1990). In Ayurvedic medicine, concepts such as ‘heart chakra’ are used, which from the Western biomedical tradition would belong only to the field of ethnomedicine.
And yet the theme of broken heartedness in Western culture is an unending theme of plays, book, movies, poetry and art. It is an observable phenomena that people comment upon.
In A Grief Observed C.S. Lewis describes his grief when his wife died:

“No one ever told me that grief felt so like fear. I am not afraid, but the sensation is like being afraid. The same fluttering stomach, the same restlessness, the yawning. I keep swallowing.” (Lewis, 2001,p.3).

There are other metaphors pointing to more understanding of heart conditions such as grief and broken hearted –ness. Let’s take some common usages, things that I will draw from the ‘top of my head’ (as the saying goes). The heart is a substance that can be light or heavy. For example, “she had a heavy heart when her mother passed away.”
Does the heart really increase in weight? What is meant by a heavy heart? Do we experience our hearts as heavy when we are grieving?
This is one of the symptoms of grief (Satyacenter,2005, health-plant-medicine center).

Dying of a broken heart could also be interpreted in terms of what we know about stress. We hear a lot about stress these is the quintessential buzz word of modern life. It hangs on everyone’s lips from morning traffic on the freeway to a burning roast in the oven in the evening. Numerous articles and studies tell the same story: lives controlled by unmanaged stress end early and not well. (Childre and Rozman, 2004).

Biomedical conceptual schema differs from ethnomedical conceptual schema inasmuch as biomedicine wants to locate symptoms in a specific organ. (Baer, 1997). Whilst broken-heartedness does not fall quite into the theories of magical causation, it does suggest an ‘unseen’ causation. (Baer, 1997) However even within the field of modern biomedicine there is now the study of “subtle energy research”, used in the context as Einstein used it, that is, to describe a type of energy that is at present not fully understood or measurable with today’s technology. This is similar to how electromagnetism was viewed only 250 years ago. Effects could be seen but not directly measured. (Institute of HeartMath , 1997). This fact presents another problem in defining ethnomedicine as opposed to biomedicine; what was once the unseen world, such as germs, can now be seen because of improved technology. Perhaps things we see as unseen in 2006 will be measurable in 2106!

John Steinbeck succinctly states that “A sad soul can kill you far quicker than a germ” (Steinbeck, 1962) We find in Proverbs “A merry heart does good , like medicine, but a broken spirit dries the bones.” (Proverbs 17v.22) “Concealed in the heart of all beings is the Atman, the Spirit, the Self; smaller than the smallest atom, greater than the vast spaces.” (Katha Upanishad from Alchemy of the Heart p. 164)

So we’re talking about non-visible stuff that has physical, visible symptoms. This idea of non-visible stuff is, for anthropologists, what differentiates biomedicine from ethnomedicine. However for Aryuvedic practioners, who are also university trained, the non visible world has always come into the equation of medical diagnosis.

In conclusion, the conceptualization of broken heartedness has roots in the English language and, if explored in a longer paper, across cultures. This shows that there is an ethnomedical basis for such expressions, and given some thought, can easily be interpreted in a biomedical sense. I have used Biblical references (which would have been originally in Hebrew) and literature to illustrate that this concept is widespread and therefore widely understood by a number of speech communities.. (Garro, 1986). Comparing this term to the biomedical etiology of grief is a way to bring biomedical concepts and ethnomedical conceptualization together. I have also illustrated this using some Hinduist concepts, showing that university trained physicians hold concepts in India that would not be held in Western countries, because the culture and speech community to which they belong includes this type of conceptualization, i.e. the assumption of non visible reality within the schema of medical practice. Western medicine, or what we have come to call biomedicine, does not fully embrace the concept of the non visible world. By using the phrase He Died of a Broken Heart I have illustrated that we, as a speech community in the English language, do in fact incorporate and ascribe these ‘unseen’ causes for medical conditions. I have also pointed out that what Westerners call biomedicine and anthropologists call ethnomedicine are sometimes overlapping narratives, and need to be looked at within cultural context; that is, the Eastern medical traditions, such as Ayurveda, also claim a biomedical status, being university trained disciplines (Hass, Rubel, 1990). In short, when people say ‘he died of a broken heart’ they are offering a speculative medical diagnosis, and this diagnosis is rooted in culture through folk etymology.