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Skip to 0 minutes and 9 seconds Andrew, one of the texts our learners have been looking at is Robert Burton’s Anatomy of Melancholy, which was written in 1600s, and it’s fascinating to me because it seems to me just so contemporary with what we think of as heart break. He called it love melancholy, love sickness, and Shakespeare very much picks up on love sickness, love melancholy. So I just wondered if I could pop this down for a bit, but read some of the symptoms from love melancholy and just ask you as a doctor whether this is something that resonates. So symptoms are either of body or mind. Of body, paleness, leanness, dryness. As the poet describes lovers, love causes leanness, hollow eyed.

Skip to 0 minutes and 53 seconds Their eyes are hidden in their head. They pine away. They look ill with waking, cares, sighs, want of appetite, and so on. Does this resonate at all? I think it does resonate tremendously, and as you say, contemporaneously this could be written by someone nowadays, and in a way, why shouldn’t it be? Because we’re no different from our forebears. No, we’re human beings. Actually looking at this reminds me of one of our other key texts for this week, which is Sense and Sensibility, because again, reading that, they’re Marianne’s symptoms. She’s hollow eyed. She sleeps all the time. She sighs. She doesn’t eat. It seems to me that, again, even Jane Austen’s picking up on the same. I say we’re human beings.

Skip to 1 minute and 35 seconds These things don’t really change. And we’ve all felt that. We’ve all felt this, haven’t we? Yeah, of course, a love melancholy. It’s an amazing phrase, isn’t it? We say heartbreak. They say love melancholy. They’re wonderful metaphors for something we can’t name, can’t put your finger on. Talk to me about broken heart syndrome. Can people die of a broken heart? I think they can, and I think we’ve always known that.

Skip to 2 minutes and 2 seconds As a GP, we find there are couples who have been married for decades and decades, and the one - often it’s the one who’s not ill who dies first, but either way - the one who dies first and the one who’s left behind you suspect they’re going to live for a long time afterwards, and something happens. The phrase you often use is turning their face to wall. They just turn their face to wall, and then they can pine away. They can die within days sometimes of their life partner dying. It almost seems as if they’re withering on a vine. They’re part of the same tree.

Skip to 2 minutes and 36 seconds I know Louis de Bernieres talks about love being part of growing, becoming part of one tree, not two. And there’s something about the death of one leading to the death of the other, almost beautifully, passing away and then the other passing away. And I’ve got a poem that I think beautifully illustrates, and I often think of this poem when one finds a patient’s widow or widower has died. Poem written by Henry Wotton in the early 1600s. The title is ‘Upon the Death of Sir Albert Morton’s Wife’, It’s wonderfully deadpan. It’s quite a long poem, beautifully written. This extraordinary marriage, extraordinary union, and the closing couplet I think is wonderful and wanted to be memorable.

Skip to 3 minutes and 28 seconds And I think one of the things I love about poetry is that it lodges in one’s head. It stays there in its entirety. ‘He, first deceased. She, for a little, tried to live without him, liked it not, and died’. And the wonderful phrasing and the falling away at the end. Could read it again for me? ‘He, first deceased. She, for a little, tried to live without him, liked it not, and died’. That encapsulates beautifully what you talked about when you talk about turning your face to the world. You just give up. Liked it did not. Tried. Tried. Tried and said, it’s not for me. I don’t want this anymore. And that resonates today.

Skip to 4 minutes and 14 seconds I think that resonates with so many people and would. It’s universal. It’s timeless. It’s timeless. It’s certainly timeless. It speaks to everybody, doesn’t it? It’s so simple, as well. It’s very simply beautifully put. That’s a wonderful, wonderful poem. What I’m interested in as well is, do we associate broken heart syndrome with the elderly then? Are you saying it’s more common in people who typically have lived together for 50 years? One loses one, or do we ever see… I’m fascinated because one of our key texts is Sense and Sensibility, and it’s about the way in which two sisters are heartbroken, they’ve lost all hope.

Skip to 4 minutes and 48 seconds One behaves in a particular way, and the other sister behaves in another way, but they’re very young, and we sort of… I feel that sometimes we think people should get over heartache and get over heartbreak, and it’s part of life, but I’m sort of intrigued as to what that means. So this is why I came up with this question, can you die of it? Can a young person die of broken heart syndrome? I think they can. I think it’s unusual, and I think resilience, the human nature gives a certain resilience.

Skip to 5 minutes and 14 seconds There’s something about either later in life when one becomes frailer, there’s a condition called broken heart syndrome or takotsubo syndrome only described in the last 20 odd years, 25 years. And we’ve now got a possible mechanism for literally broken heart syndrome, where this surge of adrenaline can actually paralyse part of the heart, the left ventricle, the part of the heart that pumps all the oxygenated blood around the body. It paralyses it, and it can balloon up, and in ballooning up, the heart temporarily stops working. Usually that gets working again. It starts working, and the patient’s fine. But while it’s doing that, it mimics a heart attack. So we, the doctor, think this person is having a heart attack.

Skip to 5 minutes and 57 seconds Rush him to hospital, but you don’t find the usual blocked coronary arteries that you’d find in a heart attack, but you do see this ballooned left ventricle. And the Japanese first discovered this, and they looked at x-rays and ultrasound images of the left ventricle ballooned up like an octopus trap, and their word for these little fishing pots they catch octopuses is a takotsubo, T-A-K-O, and then T-S-U-B-O. That is fascinating. Now, people do recover from takotsubo, then? They usually do recover from that. They do recover. Most do. What’s interesting is it seems to have a female preponderance, probably, we think we don’t know for sure, to do with lack of oestrogen post menopausally.

Skip to 6 minutes and 34 seconds So the common age is, I think, 58 to 75. So it’s later in life, but it’s predominantly in women. Most recover. Most recover completely, but a very small number, again, we don’t know why, but a very small number could have… it can stop the heart pumping completely. It could rupture the heart. It could cause an arrhythmia, which means the rhythm just goes completely haywire, and that could stun the heart and cause a heart attack or even a cardiac arrest. So one of our contributors, who is a poet, had a broken heart, and he said the thing that absolutely got him through was reading Philip Sidney’s poems.

Skip to 7 minutes and 13 seconds Have you ever prescribed poems or poetry to people who you felt were stressed or heartbroken? I have. I think as a general rule I try and prescribe self prescription, so getting them… so getting literature as a currency so we can talk about it. See what they’ve read. See the sorts of things… I think it’s… one can’t just say, here, read this, but if you know the sort of things they read, knowing a patient as we do as general practitioner, we have this continuity as we get to know some people very well and see them through the worst times. You get to know what might be helpful.

Skip to 7 minutes and 49 seconds One very useful tool is an anthology, because it gives them a chance to choose what they want. I think agency and choice is very important. So Sylvia Plath’s Bell Jar might be life changing to someone and actually very unhelpful and possibly destructive to another. So you’ve got to gauge very carefully by offering them the possibilities. So there was a situation where I did recommend a poem when one of my patients was completely heartbroken over her husband’s death, and he was very young. They were both in their, I think, 30s, early 40s at most. He had this terrible cancer, and he had the tumour growing out of his head. It was just appalling. He got very aggressive at the end.

Skip to 8 minutes and 32 seconds This was not him at all, but the cancer and the illness made him aggressive, hard to treat, hard to live with, I imagine, and then he died. And I remember thinking about all this bustle, and this difficultness, and this awfulness, and then the calm, and that the sweeping up afterwards and everything being calm again. And I thought of this poem so much I gave it to his widow, who I knew very well. I’ll just read it, it’s an Emily Dickinson poem. ‘The bustle in a house the morning after death is solemnest of industries enacted upon earth. The sweeping up the heart and putting love away. We shall not want to use again until eternity’. That’s incredible. That’s brilliant.

Skip to 9 minutes and 20 seconds I didn’t talk to her directly, nor should I have. I think it’s too crass to say, did that help or something. One doesn’t know, and she’s entitled to it. I gave it to her in the spirit of, look, this might help. If it doesn’t, you know… Discard it. It doesn’t matter. Discard it and I can say, you know, it’s scrap paper to other people, but I think people do with it what they want, it can become an extraordinarily prized bit of paper. They could keep it decades afterwards, or it can just be discarded, or it can be remembered.

Skip to 9 minutes and 43 seconds There’s a variety of things they can do, but I think the important thing is they choose to do with it what they will.

Physiology of heartbreak: Discussion with Andrew Schuman GP

We asked general practitioner Dr Andrew Schuman to talk to us about the symptoms of heartbreak, and to tell us whether he thinks Burton’s description of ‘love melancholy’ is still relevant today.

We often think of heartbreak as a condition associated with younger people, perhaps those experiencing their first love or broken heart. However, while heartbreak can affect teenagers and young people, Andrew also emphasises the profound impact of heartbreak upon older people, particularly those who lose a life partner.

Andrew describes a condition known as ‘Takotsubo’ or ‘Broken Heart Syndrome’, which is a physiological response to extreme emotional stress, such as the break-up of a relationship or the loss of a loved one. The symptoms of ‘Broken Heart Syndrome’ mimic those of a heart attack, demonstrating that a ‘broken heart’ is not just a metaphor or symbol for disappointment in love: it is also a real, medical condition.

In the video Andrew reads a couple of poems. The first is Henry Wotton’s poem ‘Upon the Death of Sir Albert Morton’s Wife’:

Upon the Death of Sir Albert Morton’s Wife

He first deceased; she for a little tried
To live without him, liked it not, and died.

Sir Henry Wotton (1568–1639)

Andrew’s second poem is Emily Dickinson’s ‘The bustle in a house’:

The bustle in a house

The bustle in a house
The morning after death
Is solemnest of industries
Enacted upon earth, –

The sweeping up the heart,
And putting love away
We shall not want to use again
Until eternity.

Emily Dickinson (1830–1886)
COLLECTED POEMS OF EMILY DICKINSON, edited Mabel Loomis Todd and T. W. Higginson.

With Dr Sophie Ratcliffe, who features later in the course, Andrew runs a project called ‘The Poetry of Medicine’. This is a workshop initiative aimed at doctors, nurses and anyone who works in the NHS. We invite you to find out more by following the link.

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