THOMAS LARSON

Languages of the Heart (Sanctuary Outtakes) April 2014

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As a heart patient, I’m hypersensitive to the languages that characterize this disease. I’ve noticed heart-focused authors speak in self-help, clinical, and cliché-ridden tongues. The problem is, these languages are so embedded and so simplistic that they make us think we have caused our disease and we, in turn, have to cure it. Like being poor, those afflicted with heart disease (we might add cancer as well) are responsible for their own ills. It begins when a culture personifies the heart with clichés, from pop song to religious tract.

A heart is true, it’s pure, it’s achy/breaky; a heart is San Francisco where you left it, Christmas within, that which goes on after the Titanic sinks; a heart is worn on your sleeve, a lonely hunter, made of stone; where one’s home is, where you know he’s Mr. Right, the thing you gotta have, miles and miles of it, and that which possesses the hero in spades. Heart connotes courage, emotion, core belief, mystery, spirit, kindness, deceit, fragility, all maddeningly interchangeable. We have good hearts and evil hearts, so say the lyricists, apt to turn at any moment. The tattle-tale of “Your Cheatin’ Heart” (Hank Williams), the mystification of “the heart has its reasons” (Biblical verse), and the place where, according to President Jimmy Carter, one commits adultery. This realm of the heart’s representation—as a gateway to addle the patient—is unalterable because it’s so inbred.

Under the clinical is the medical trade’s millions of clumsily written brochures, academic articles, websites and comment threads, advice columns, and so on. This analytic sphere buoys oceans of information and, worse, misinformation, spoken so often with scientific authority—“peer-reviewed journals” and “facts never lie”—that fearful patients have to give it credence.

Listen to this WebMD article about heart disease’s price tag: “Cardiovascular illness costs $273 billion a year to treat; the tab for each patient is $1 million over a lifetime. Moreover, if heart sufferers would eat less salt, a half teaspoon less per day, they would have between 54,000 and 99,000 fewer heart attacks per annum.” Such stats fascinate us by their simplicity and bewilder us by their enormity. Who, other than bureaucrats, can grok $1 million of care? Is this a value because it’s expensive and doable or because it’s kept me alive? And yet such mammoth numbers (today, thirty-six percent of adult Americans are obese) echo across the Web as “news you can use,” the de facto means of dumbing complex issues down.

The third, and most crazy-making, tongue forced upon us is self-help talk. Such testimonial encouragement sounds good—from Dr. Phil and Oprah to heart-healthy eating programs, exercise regimens, and bullet-pointed guidebooks. But such aid gives patients no more than a dollop of false hope. Something like ninety percent of all diets fail. The failure becomes a syndrome, promoting worthlessness and guilt. We fall for the catch-phrases: “life without bread,” “the vegetarian myth,” “the coconut oil miracle.” These gimmicks market the author’s or advertiser’s point-of-view much as a politician beats his chest for an unevidenced position or belief.

The fix-yourself fantasy reaches its nadir with TV ads from Big Pharma. The “health beat” segments of local news instruct you where to get your cholesterol checked for free. However, the segment is sponsored by Pfizer whose cholesterol medicine is really what’s being sold. The portrayal of health obliterates fact. No one is fat or miserable, depressed or suicidal on TV. Not since he joined a treatment plan. Participants reveal neither breathlessness nor diabetes despair—only the mawkish face of a tummy ache. The sixty-year-olds exercise against the red-sand cliffs of Sedona, a self-satisfied smile in tow. Why not. They’re marvelously fit. Pill/program = behavioral change.

What’s sold as self-help, weekend seminar plus DVDs, is not self-help. It’s a program of neediness and blame. The plan’s authority works on you because you’re sick with high blood pressure or low self-esteem, and, because of this vulnerability, you’re wooable. This is key. Only the wooable believe the woo-woo. Study, for example, Deepak Chopra’s Healing the Heart: A Spiritual Approach to Reversing Coronary Heart Disease. Already, the subtitle should warn you. Chopra soft-brains the sufferer to think spirituality befriends science, faith toggles miracles. Trust in a transcendent being, give into what you can’t control—which is never identified so that you shape it as you like. Chopra dumps all this “spiritual healing” onto the victim. His solution is a belief in “the hidden power of the true self.” Such guru-licensed advice keeps us enthralled to—and infantilized by—the “caring” industry.

One more thing. The debate over Obamacare musters its own irrelevant rhetoric, centered on publically-funded versus privately-controlled medicine. No one in these debates ever discusses disease and nutrition—just the cost of disease. “Health” is contextualized as treatment over prevention, life-saving over life-altering. The health we are told we desire, we seldom get, in part, because palliative medicine works. As a result, we’re precluded from participating in our recovery and almost never challenge doctrinal authority. Medical dependency becomes institutional addiction.

Most explanations for heart disease fail to capture what the malady truly is. Thus, my irritation with its many languages. This has everything to do with how such imprecise and misleading expressions burden an already disease-burdened author. What a shock it is to find that the heart attacks you’ve just endured and are trying to end arrive already colonized by a speaking-in-tongues culture, a formidable opponent which may be greater than the illness itself.

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After my father’s first heart attack, my mother would tell friends who had not heard, “This past Christmas, John had a coronary. He’s doing much better.” A coronary? Whence this usage? Is it from coronary thrombosis, the phrase for an arterial clot? How is it that the adjective which denotes the heart’s arteries is turned into a noun to describe a heart attack? How—and why—is the passage and its blockage the same?

The word coronate means to crown the head of a special person—a royal, an athlete, a winner: to coronate is to bestow the highest honor. The arteries coronate or encircle the heart muscle and supply it with blood. No wonder poets praise it. Its primacy in the metabolism of all organs and cells should be crowned—pedestaled and adored. We understand this so well we employ metaphors to replicate how our bodies live and die. The point of “my coronary arteries are having a coronary” is to use language to transform one sense into another and, thus, enable the paradox: That which most sustains human life is also that which most effectively ends it.

This ploy is what language is good at. Language mirrors the confounding intimacy our bodies have with our psychology. Or, we use language—the evolutionary linguists would say language uses us—to approximate our bodies because its definitions, actual and metaphoric, sharpen what we do not understand, intensify the necessity to be of two minds about so much. Language is a system whose imprecision stands for and enables what is imprecise in us. Language enables me to imagine I’m ill and to defend myself against illness. Simultaneously. Words free and imprison us. They free as they imprison. Note the shift from and to as, so subtle in sense to spring from correlative to coterminous to conditional. (Even free and imprison are not the right words here: perhaps clarify and confuse—words clarify as they confuse.)

This two-mindedness has its limits. Words are an essential means of communication. But we communicate most often and most meaningfully outside language, especially when, especially because, language is subordinate to our bodies, our voices, our touch, our feelings. Language, though it aims to be, is never as essential or as accurate or as befuddled as we are. Indeed, to stay close to us, the words themselves fashion ploys such as coronary or heartburn to prove they are not subservient or one-dimensional.

Does anyone believe that words, in particular, or the word-employing arts (film, music, drama, literature), in general, embody us better than our moment-to-moment stuttering, our querulousness, our braggadocio does? “Philosophy,” writes Wittgenstein, “is a struggle against the bewitchment of our understanding by the resources of our language.” Language, no more than a caged bestiary, no more than a Rupert-Murdoch corporation, embodies that which it cannot have and will never possess, yet like Narcissus smitten by what he beholds on the lake’s glossy surface, falls for what he believes he sees.

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I circle the metaphors that pop up (to my eye) in the opening two chapters of Sherwin B. Nuland’s 1993 book, How We Die. The first chapter, “The Strangled Heart” is focused on death from heart failure, heart attack, ischemia, and more. Nuland describes the end of life as “our final hours,” “our final moments,” “the final peace,” “the human spirit” as it separates itself from the body and “yields up the ghost.” Death possesses “remorseless eyes.” It arrives with its “tightening grip of mortality” and initiates an “inevitable journey.” During the medieval plagues one saw “the face of death everywhere.” Death from cardiac arrest is “the agonal act of a heart that is becoming reconciled to its eternal rest.” The combative metaphors of heart problems, familiar via those who “battle” cancer, include “not death but disease [as] the real enemy,” death as a “malign force” whose “battle” is “exhausting.” If we’re lucky, we get a “reprieve from the inevitable end.” If the heart’s “shrieking exhortations for more blood” are denied, the result is myocardial infarction, the “starvation of the heart.” Also personified are ischemia, the stopping of blood flow, which is Greek for “quench,” and angina pectoris, chest pain, which is Latin for “a throttling of the chest.”

But then in the second chapter, “A Valentine—And How It Fails,” Nuland pulls the metaphoric back so he can emphasize the scientific. Continual personification would deny Nuland his purpose: to describe the precise physiological events which bring on death. One example among many. After cardiac arrest, he writes, a man’s “brain died because the fibrillating and finally stilled heart could no longer pump blood to it. The ischemic brain was followed gradually into lifelessness by every other tissue in his body.” (Fibrillating means irregular pumping.) I prefer “lifelessness,” a ringer for “gradual” decomposition. It’s factual, accurate. And the style is not inelegant.

I want such facts to help me distinguish what is already jumbled, “dying” and “not dying.” I also want such facts to be expressed. I go to Nuland for his artful verity with death just as I go to the Ray Carver poem, “What the Doctor Said,” for the same: “He said it doesn’t look good / it looks bad in fact real bad / he said I counted thirty-two of them on one lung / before I quit counting them.”

In the past I have sought the “literature” of dying so I would think about, certainly feel the drama of loss, whether it’s the myth of glorious and vengeful death in an epic (see The Odyssey) or the annealing sorrow of a family whose eldest son dies (see Look Homeward, Angel). But I read those works when I was young, and revisiting them now does little for me. There’s another voice I’m looking for.

I want the words and their factuality to render death in actual and personal terms. By this I don’t mean a high-toned elegy pinned to an abstract occasion (see “Elegy Written in Country Churchyard” by Thomas Gray) or a pitiless story of a man whose heart attack stops his wife from leaving him (see “Epstein” by Phillip Roth).

What I do mean is rendering my death in a language from which I hope to disenthrall it.