America the Heartless

America is suffering from an epidemic of heart-sickness.

Modern medicine correctly assigns great importance to the prevention and treatment of heart disorders, as they are a major source of death and suffering in the United States. However, the heart-sickness that is afflicting the citizens of our nation is much more than just disease of the heart muscle: more than just valvular heart disease: and more than just vascular disease.

Moreover, despite the fact that these forms of heart disease in all their various manifestations are rampant in every part of our country and kill more Americans every year than every disease except cancer, our heart-sickness is even more threatening to the welfare of our society and our culture.

This terrible scourge is spreading through our country. The number of heartless people and their acts of repulsive cruelty are increasing, and their influence is endangering the well-being of everyone they contact.

They are unfit to live with human beings and insensitive to the needs of animals and the natural world. Their proliferating numbers represent a threat to the fabric of any society and perhaps, to all life on Earth.

Heartless Behavior Increasingly Common

On a daily basis, all of us learn about acts of such cruelty and insensitivity that any person with any sense of humanity at all feels a sense of "heart-breaking", or perhaps, "heart rending" distress upon finding out about them. Acts of incredible ferocity between strangers, among family members, coworkers, students, and committed against animals assault our consciousness from every direction.

A rapidly expanding cadre of coldhearted and experienced career criminals is certainly one source of these vile developments. However, such horrible crimes have also become commonplace at other levels of our society.

Even among parents and children, acts of abominable viciousness have become routine.

The stories of these crimes all have a shocking common factor: the callous disregard for suffering that suggests the complete absence of even a particle of compassion. Cruelty of this level is so extreme that even experienced law enforcement and justice system professionals regularly express surprise and incredulity.

To understand such levels of depravity, it is necessary to analyze what is missing from these increasing numbers of heartless men, women, and children that makes it possible to act in such incomprehensible ways.

Having Heart-Spirit is the Defining Attribute of Human Beings

There is a broader traditional concept of the heart and its importance to humane qualities than that accepted by the modern cardiologist. In the practice of older and wiser traditional medicines, such as in the Chinese and Tibetan traditions, the function and influence of the heart still reflects this reality. In Oriental concept and practice, the matrix of influence of the heart reflects this deeper and more pervasive understanding of the place of the heart-spirit in human health.

Before exploring the various causes and treatments for heart sickness, it is useful to consider how Oriental medicine describes the healthy emotional function of the heart. However, instead of using unfamiliar Tibetan or Chinese terms, I will use the term "heart-spirit" to indicate that this more comprehensive territory of the heart is included.

From the perspective of Oriental medicine, having "heart" is the equivalent to having "heart-spirit". It is odd that our literary tradition is more comprehensive than our medical sophistication, but this is one cost of our industrialized and simple-minded model of medical care: When an individual has "heart", even in the West it means the quality underlying compassion and sensitivity. When heart-spirit is extinguished, the result is monstrous insensitivity and capacity for cruelty.

In the tradition of Chinese medicine, having "heart" is not that far different than the popular meaning of such expressions that we use to define warmth, sincerity, sympathy and compassion such as big hearted, heart-felt, kind-hearted, warm-hearted, and so on.

Heart-Spirit, Compassion, and "Warmth"

Within the Chinese five-phase theory of physiology, where the relationships between the internal organs and bowels are understood in terms of elemental metaphors, the heart and its associated bowel are considered to have the nature of fire. This is a familiar concept to us in the West where it is common to associate a quality of "heat" or emotional "warmth" with the heart.

In this paradigm, a "fire" that is generated by a sufficiency of qi and blood fuels the "spirit" of the heart. The healthy digestive process generates both of these factors, which are simple to understand if perhaps somewhat complex in effect.

The qi is a force in the body that maintains order. Physicists have a concept that they refer to when they are speaking of their theories of thermodynamics, known as "entropy". In one sense, entropy is the tendency for things to become more chaotic and disarrayed as time goes by.

Think about your garage, or your desktop. In the normal course of things, piles of stuff, papers, and garbage accumulates. This happens with no ordered process, and it takes a determination and effort to put things back in order. This work overcomes chaos.

Although physicists have not come up with a specific name for this directed and order-restoring work, Oriental medical convention identifies this type of work in the body as the qi.

Even disease processes have an order, making it imperative that physicians understand the nature of chaos, and the way in which diseases progress, as well as the ways to restore order, or health.

The Chinese perspective of blood (known as xue, pronounced "chuay") also implies a warming quality. In simple terms, having sufficient bloodand qi creates physical warmth.

For those who are familiar with the concept that passion or love is associated with the heart, the concept of the "heat" of passion is both familiar and common. We label a person who easily emotionally connects with others as "warm-hearted", reserving the term "cold-hearted" for those who are aloof or difficult to reach.

"Cold hearted", in common with the expression that someone has "no heart", suggests the ability to commit acts of unusual cruelty.

A Strong Heart-Spirit Overcomes Heartlessness, Enables Courage and Warriorship

In both Chinese medicine and Western usage, heart-spirit is associated with fortitude and courage, as in "heart-strong"; Richard I of England is known as the "Lion Heart" for precisely this reason.

Often it is the capacity to feel deep affection and love which makes this depth of feeling possible: "To love someone deeply gives you strength. Being loved deeply by someone gives you courage." (Lao Tzu)

Warriorship also requires sufficient heart-spirit. Both the warrior and the predator use force to attain their goals, but with a vast difference in intent. The warrior defends and protects, while the predator violates.

Although this quality of warriorship in citizens has diminished in the present day, American once held the ideal of protecting the weak, and standing against predators and tyrants. Presently fashionable "hide-under-your-desk" teaching to children when danger threatens has resulted in two generations of Americans who lack the ability to discern and effectively oppose bullies, thugs, and predators of all sorts.

The predictable result has been an unprecedented increase in bad character and criminal behavior throughout society.

Warriors do not lack the compassion that accompanies heart-spirit; they in fact deeply feel and often regret the necessity for the actions they take. It is because they have compassion they are sometimes haunted by those violent memories. Nevertheless, like a mother who must defend her children, or a man who must defend his family, there are situations that require a fierce or wrathful response.

People with no heart-spirit have no sense of compassion and cannot feel any distress when they inflict suffering on other sentient beings. They are unable to feel remorse later, upon reflection on their actions, because they are unlike people who "in the heat of passion" might resort to violence.

Heart-Spirit and Fear

The relationship of courage to fear is one of great importance in Oriental medicine. People who have been terrorized, or exposed to repeated trauma will often "lose heart" and develop excessive fearfulness or inability to discriminate between real and imaginary threats. This is a common finding for physicians who treat posttraumatic stress syndromes.

One of the emotions most dangerous to the heart is fear, and, in a fashion exactly parallel to the association of warmth and compassion at the heart, fear is associated with cold. In English, one might say, "my blood ran cold", if a sufficient level of fear is experienced.

In addition, as with warmth, which tends to flow upward and impart lightness, a threat to the heart-spirit, is often described in terms such as "my heart sank" in my chest, or "my heart feels heavy".

There are certainly situations where fear can stimulate both courage and/or cruelty, but pathological heartlessness is associated with no feelings whatsoever. These killers do not show any signs of mercy, nor do they have any remorse or any conception that their actions are in any way reprehensible. Such criminals typify a total absence of heart-spirit.


Heart-Spirit, Loss, and Sorrow

For normal people, emotional loss or sorrow affects the heart-spirit in a way that people sense in physical terms. Despite the Western obsession with the brain as the center of thoughts and feelings, human beings speak "heartache" or "heart-breaking" feeling: no one ever speaks of their "brain-ache"!

It is also evident that emotional stress can also influence the physical heart in ways that are medically significant. Fear can certainly create an arrhythmia, or raise blood pressures to dangerous levels. Recent research has linked anxiety with risk of heart disease, and Chinese, Tibetan, and Japanese medicine all associate this emotional state with channels that connect with the physical heart.

Sorrow and depression has been associated with increased risks of physical heart disease, and the reverse is commonly also observed. Doctors trained in Chinese or Tibetan medicine will always attend to the higher risk of depression after a heart attack or resuscitation from cardiac arrest, or following any cardiac surgical procedure.

Heart-Spirit and Personal Responsibility

Another aspect of heart-spirit is a willingness to take responsibility for one’s actions. Those who have sufficient heart-spirit take on responsibility for others’ well being, and are not inclined to blame others for their own failings.

In contrast, those lacking heart-spirit always blame others for their own failings and actions. They are likely to passively expect help, and display an attitude of entitlement rather than a determination to achieve their goals and expectations.

As a physician, I have seen how many people who have tremendous heart-spirit can take responsibility even for problems for which they are not responsible. This enables them to overcome the fear and suffering of disease, and so heal even if they are not completely "healthy". In addition, the courage and determination of loved ones to care for an ill family member, along with the steadfast loyalty that this requires, demonstrates the enormous power of heart-spirit.

Those who have heart-spirit are the creators, the builders, and the visionaries who contribute to society and create culture. They are the musicians, artists, and inventors. In contrast, those without heart-spirit are at best consumers, and at worst, parasites.

Heart-Spirit and Fulfillment

When food is sustaining, or capable of filling us up, we refer to it as "hearty". Indeed, when it comes to health, one of the most important supporting factors is our connection to others.

In both Oriental and Western tradition we envision the heart as being the organ most associated with love, even though it is clear that the brain and some other areas of the body are secondarily involved. The association of joy and love with health and well-being is well established: "There is only one happiness in life: to love and be loved." (George Sand)

The capacity for a sincere relationship or a sense of true connection and understanding of another, as in heart-to-heart communication is a function of heart-spirit.

Also as in popular use, the heart is the center of emotions of attachment and desire, so that loss of a loved one or empathetic pain for someone who you care about causes heartache or a "broken" heart. Sometimes we speak about those afflicted in this way as being "heartsick".

This is not just a metaphor, as clinical experience substantiates that people actually feel a sensation in their chest often described as pain or a pulling feeling, or even an "empty, hollow" feeling. It is frequent to hear a patient describe how they felt their heart "sink" when they heard or contemplated bad news or loss.

Moreover, as the term "heartsick" implies, emotional damage to the heart does indeed associate with other physical and emotional illnesses familiar to physicians everywhere. Research has supported an association between mortality and significant emotional loss or traumatic experience.

Heart-Spirit and Eating Disorders

Each of the phases in the five phase theory is associated with an emotional territory, and an elemental energy, as well as many other associations and observations that have been made over the centuries. As the elemental energy of the heart is fire, so is the emotion that is usually translated as "joy". However, Matsumoto-sensei points out that the Chinese characters for this emotion actually translate to "joy of eating".

Indeed, as suggested in the previous section, when the nourishing and hearty aspect of food seems to be lacking, a disorder of heart-spirit may be present. Most patients with eating disorders have a complex relationship with food, but it is certainly true in many cases that they do not "enjoy" eating.

The issues of appetite and hunger in patients with eating disorders are more conflicted and complex, and often wrapped up with other imbalances beyond the heart. Nevertheless, addressing the heart spirit whenever an eating disorder is part of the overall pattern of imbalance is the best and most holistic option for these multifaceted and complex problems.

For Western physicians as well at those trained in Oriental medicine, the association of depression with lack of appetite and weight loss is well known, and searched for whenever a patient complains of depression, or the physician suspects this. Unfortunately, in cases where a disorder of heart spirit is present, the prevailing Western treatments are either ineffectual or can actually contribute to disorders of heart-spirit.

Cruelty is the Manifestation of Absent Heart-Spirit

When a person is without heart, or heartless, the result is cruelty. Worse, it is cruelty without any feeling or any sense of remorse. For this reason, these sociopaths are extremely resistant to "rehabilitation". This type of cruelty tends to feed on itself, resulting in progressively increasingly cruel behavior, eventually reaching a level that is incomprehensible to anyone with even a little heart feeling. People with heart describe such events as "heartrending".

Cruelty, or the absence of "heart-spirit", is also exactly the absence of compassion as defined in Tibetan medicine. This "compassion" is the feeling that arises in a person who has it, which impels them to take some action to relieve suffering that they observe in sentient beings.

The heartless have no connection to other sentient beings and cannot connect heart to heart. They are alienated and isolated. Children who never had, or lose heart-spirit tend to manifest a lack of compassion and indifference to suffering at an early age, often progressing from verbal attacks and a delight in destroying ants and small animals, to animal torture, to actual vicious violence against other children. Many become career criminals.

Even hearing about atrocities of unbelievable heartlessness damages the heart-spirit, and long clinical experience treating those who have "lost heart" teaches that this is one of the most dangerous of imbalances to health and longevity.

Inhumanity, Not Brutality

When a human being has no heart-spirit, it is possible to say that they have lost the very essence of humanity. They are no longer capable of human feelings. Nevertheless, this does not mean they are like animals. It is incorrect and inaccurate to describe such persons and their actions as "brutal". An animal may wound or kill in order to survive, but there is no such survival motivation for the heartless.

Animals act out of instinctual self-interest, but never show the methodical viciousness that characterizes humans lacking heart-spirit. Animals take no delight in torture. They do not plot methods for causing the greatest amount of pain, humiliation, and suffering possible. Such methodical mayhem is unique to the heartless.

The reason for determining the source of heart-spirit disorders is of vital importance, as treatment is possible for those who have lost heart as a result of terror, sorrow, or internal imbalances of the qi or blood. Unfortunately, treatment of the advanced condition of the completely heartless is generally impossible.

In part 2: the causes and solutions for heartlessness.