How heartbreak is a real physical thing, and how to deal with it

Who hasn’t suffered from a broken heart, or supported a friend whose heart has been broken? Heartbreak is a common phenomenon.

Lisa Shulman, a neurology professor at the University of Maryland School of Medicine, knows all about that. She has written a book born of her own experience of grief following her husband’s death.

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“The emotional trauma of loss has profound effects on the mind, brain and body”, Shulman writes in Before and After Loss: A Neurologist’s Perspective on Loss, Grief, and Our Brain – due for publication this month.

“The recent death of US ex-president George Bush less than eight months following the loss of his wife, Barbara Bush, highlights the serious consequences of emotional trauma,” Shulman says. “In fact, there’s a pronounced increase in accidents, illness and death of the surviving spouse in the year following loss.”

She adds: “As our understanding of physical traumatic brain injury has expanded to include concussions in sports, it’s time to expand the definition to include emotional traumatic brain injury.

“It wasn’t so long ago, that concussions were considered harmless; athletes were routinely returned to the field after they appeared to recover from being dazed or unconscious. We now understand that although no injury is seen on MRI or CAT scans of the brain, brain injury has occurred.

“In the same way, the emotional trauma of loss results in serious changes in brain function that endure.”

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While hearts don’t physically break in a shattered-heart-emoticon way, Shulman says that the physical effect of emotional trauma on the heart can manifest in an especially pronounced manner; broken heart syndrome occurs when stress hormones result in abnormal heart movement and symptoms of chest pain and shortness of breath. This may result in an actual heart attack, although, more often than not, it resolves without lasting heart damage.

The syndrome was first noticed in Japan in 1990, when physicians discovered that people were presenting with the symptoms of a heart attack which, on further testing, proved not to be heart-related. They called the condition takotsubo cardiomyopathy, stress-induced cardiomyopathy, or broken heart syndrome.

Cardiomyopathy is a weakening of the heart muscle. Takotsubo is the Japanese term for a type of pot specifically designed to catch octopuses. When the Japanese doctors who first identified the syndrome examined the hearts of patients, they witnessed a change in the shape of the heart so that it mimicked the appearance of the takotsubo bowl; the tip of the heart balloons while the base contracts normally.

It’s this syndrome that is believed to develop in the surviving partner of a long time couple – like the Bushes, and like American actress Carrie Fisher, who died the day after her mother, Debbie Reynolds.

But, of course, not all emotional heartbreak results in death. Nor does all heartbreak affect the heart physically. Nor, indeed, does it only follow the death of a loved one. Break-ups frequently cause heartbreak.

Dr Guy Winch is a New York-based psychologist and writer who advocates “integrating the science of emotional health into our daily lives, workplaces, and education systems”, an approach he describes in his books including Emotional First Aid: Healing Rejection, Guilt, Failure, and Other Everyday Hurts and How To Fix A Broken Heart. He is recognised as an expert on healing post-relationship pain after heartbreak.

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Winch says that being in love is like being hooked on a drug and that breaking up simulates withdrawal – and that’s why it’s felt so acutely; you crave that person in much the same way as an addict craves their preferred substance.

Winch says studies corroborate this: when we are heartbroken our brains respond the same way to addicts withdrawing from drugs such as heroin.

An addict has to fight the urges to use, and the heartbroken need to learn to think rationally. We mustn’t just stop thinking about them, we must stop analysing, trying to find reasons why a relationship ended (just accept the reason given or make up your own he says – don’t pick over old bones); resist the urge to stalk them on social media; delete their phone number.

He does not minimise the enormity of the emotions experienced the broken-hearted; like Shulman, he recognises that they manifest physically. Our bodies are often flooded with the stress hormone cortisol, which suppresses our immune system, interferes with our sleep and derails our coping mechanism.

Forty per cent of people who have their heart broken suffer with “clinically detectable depression” and so distracting is heartbreak that it actually lowers our IQ.

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London-based Nicola Cleaver (not her real name) recalls when her fiancé dumped her – unceremoniously and months before their wedding. Her dress was bought, the venue selected and the church booked.

“When he told me it was over, I just went blank, numb. I remember driving back to my own flat across town in such a state of shock,” she recalls. When she went out a few days later she had to trawl the streets around her block to find her car, as she had no recollection where she’d parked it.

“I had a complete void of memory,” she says. For weeks afterwards she hoped he’d come back, on bended knee, to apologise and beg her back again. He didn’t. Winch says that sort of hope isn’t just hopeless, it’s dangerous; he advocates accepting things are over and moving on as fast as you can – and that we “stop idolising”.

Nobody’s perfect – so your ex certainly wasn’t either. Cleaver says it was with some comic relief she began to consider months later that, in fact, her ex’s confidence may actually have been arrogance, that his reluctance to travel may have frustrated her, that, in the end, their very different hopes, dreams, aspirations would have undone them in the end anyway, so better sooner than later. In fact, he was a bit boring.

But whether a person’s heart is broken because they’ve been dumped or because of the tragic loss of a partner, it’s important, says Winch, that they carve out a new identity, a new shape for themselves. At the same time, it’s important not to avoid old haunts; according to Winch, failure to find ourselves exacerbates the distress of a broken heart.

Instead he urges us to “cleanse” our associations with old, shared places by creating new memories around them.

Shulman says the brain kicks into action to protect us during traumatic experiences. “To sustain function and survival, the brain acts as a filter, sensing the threshold of emotions and memories that we can and cannot handle. Recovery depends upon gradually reconnecting with these suppressed memories – the emotions and memories that we’re not ready to face.

“Disturbing dreams by night and intrusive thoughts by day are evidence of traumatic memories that are buried in the subconscious, and were never properly integrated with past memories and emotions, our previous life experience,” she says.

To move forward, she says, to begin to repair our broken hearts, “we need to find tools that will help us reconnect with suppressed memories. Equally important is the need to find activities that are diverting to refresh the mind.

“Tools for reconnection may include keeping a diary, faith-based practices, meditation, or seeing a counsellor. Keeping a dream journal may gradually uncover repetitive themes; mysterious at first, over time the symbols in our dreams begin to reveal themselves.”

For some light relief, Shulman advocates creative immersion – art, music, dance and “the healing powers of the great outdoors”.

Even in the worst of times, she says, “it’s empowering to understand the basis for our experience of loss and to learn steps we can take to enhance recovery and healing. It’s true that healing will come with time, but post-traumatic growth requires insight”.