What's Love Got
To Do with It?
Dr. Paul Pearsall was a neuropsychologist who counseled patients before and after they underwent heart transplant surgery. In his 1999 book, The Heart's Code, Dr. Pearsall described the profound effects a new heart can have on a transplant recipient. He found that many of the heart transplant patients he worked with experienced a significant and inexplicable change in their personality - - - or, as I think of it, the essence of their being - - - following the receipt of a new heart. Shockingly, this new essence often reflected the essence of the organ donor.

There could be many explanations for this change of heart, so to speak. Receiving a heart transplant is a terrifying and traumatic experience that forces people to confront their own mortality in a direct, even brutal, way. And patients are given powerful medications before, during, and after surgery, including medications to prevent their bodies from rejecting a new organ; these drugs can have short and long-term psychological effects. Patients may also experience profound relief after they receive a new, healthier heart - - - the heady and overwhelming feeling of having a new lease on life that can alter someone's entire perspective on life. Profound emotional and psychological upheaval in a patient could be considered a very normal and healthy reaction to the intensity of undergoing and surviving a heart transplant operation.

But this can't fully explain what Dr. Pearsall heard from his patients. In The Heart's Code, he tells the story of a white, middle-aged man who worked all his life in a factory, espoused racist beliefs, and had no interest in what some might refer to as high-brow culture such as opera and classical music. Then this man received a new heart from an anonymous donor. In the weeks and months that followed, as the man recovered, his wife began to witness profound changes in him - - - describing a husband who seemed almost like a new man. He wasn't simply relieved and grateful and shaken by the experience of having undergone a heart transplant. He started to hang out in places that were mostly frequented by African Americans. He became friends with African American coworkers whom he had previously shunned and found no common ground with. He even seemed to walk differently. And eventually, mostly in secret, he began to listen to classical music, especially violin concertos.

For months, this man attempted to hide these personality changes, conflicted between the man he had been and the man he had become. Inevitably, the change of heart prevailed and he was able to embrace a new life, a new essence. Deeply curious, the man and his wife began to investigate the identity of the donor. They discovered that he was a young African American male who had been shot and killed while walking to school. This was mysterious and fascinating to them, but their profound awe came years later when they learned further details - - - that the young man was shot and killed on his way to the music academy at which he was studying to be a classical violinist.

There are many other stories like this. And because organ donations often come from people who are otherwise healthy and suffer a violent death, there have also been cases in which a heart recipient has been able to help the police solve a crime based on their intimate knowledge of how events unfolded on the day "they" died. The recipient, of course, wasn't there, had never met or heard of the previous heart's "owner," and had no "earthly" way of knowing how events transpired. But he or she is - - - somehow - - - able to provide accurate and verifiable details as leads for the investigators.

In The Heart's Code, Dr. Pearsall explains that his approach in helping transplant patients adjust to their new heart is to try to help them stop listening to their conscious, logical reasons and to try to just "flow" with their actual, present experience. Most of us have had this experience and know the difference between the state of consciousness when your mind is constantly going, analyzing, thinking, worrying, planning and those profound, if rare, moments when you are in the moment, just being, when the relentless machinations of your mind seem to have fallen away.

Dr. Pearsall describes some transplant recipients who are never able to achieve this in a meaningful way. They seem to have no new memories or "essence." Often these patients never stop struggling to cope with their posttransplant reality. The patients who either naturally or, through Dr. Pearsall's counseling accept or even embrace new memories and a new essence often have the best health outcomes. At that point, many even revel in their change of heart - - - and their whole new life.

These changes have not been observed in patients with kidney, liver, or lung transplants. It seems that only with a new heart do you get a new "personality." And this new personality comes with a choice, the freedom to choose between suppressing or embracing it. Some people suppress it, and often the rest of their lives are full of tremendous struggle and conflict. Others choose to accept this change of heart, flow with it, eager - - - if fearful - - - to see where it takes them. Although this phenomenon is most dramatic among heart transplant recipients, who among us has not had an experience like this? Standing at a crossroads, often after a tragic, traumatic, or terrifying experience such as a chronic illness or accident, you are faced with the choice between desperately trying to hang on to life as you knew it - - - a life that, while familiar and therefore comfortable, may no longer be right for you - - - and a frightening but exhilarating leap of faith where you are guided only by something powerful inside of you, something that seems to reside in your heart and that gives you the courage to move forward in an unknown direction without fear.

When I met my wife Lynda, it was like getting a new heart. She was a gift from somewhere I didn't know existed and couldn't really understand. But I had a choice to make, too. I could reorient my life around this new reality or choose to not be bothered because the new way had so many uncertainties and so much uncharted territory ahead. I believe it is love that gives us the courage to make this choice, this leap of faith. And where we find love, we inexorably find the heart. It is the core of our being, the keeper of our essence.

What does the heart have to do with love? Probably nothing, according to your cardiologist. The heart is a finely innervated piece of specialized muscle. Nothing else exists but this physical stuff. Dissection of the heart reveals nothing one can call love. The heliocentric, modern, scientific, quantitative, double-blind research, mechanistic paradigm says there is no connection between the heart and love. And yet, across centuries and across cultures, so many countless people - - - poets, writers, lovers, mothers, fathers, children, even scientists - - - have experienced love and have connected it with the heart. What gives? Where lies the truth?

I can't define love or characterize it in a succinct way. But I do know that love, perhaps more than any other feeling, involves our essential self. You do not love something in a superficial way. Superficiality and love are mutually exclusive.

But what is meant by our essential self? Imagine yourself as a young child playing in a park. Then picture yourself as a teenager, as a young adult, and then as a middle-aged or elderly person walking with a slower, stiffer gait. It doesn't matter whether you've reached old age yet or not. Physically, the cells in your body - - - those things that scientists and doctors "believe" in - - - are different in each of those scenarios because your body replaces your cells over time. Nothing is the same between that young child playing in the park and that elder walking slowly and gingerly.

And yet we all know there is a thread, an essence, that runs through each of our lives. We know there is continuity between the child who was and the elder who will be. Although it's impossible to articulate a person's essence without it sounding glib, I believe Mozart's essence - - - and the reason he was able to give us so much - - - had something to do with the tension between his musical genius and his immaturity. Tiger Woods's essence has something to do with an almost mystical connection to golf and the natural consequences of a lost childhood. Dostoyevsky's essence had to do with justice and freedom; these ideas, those deeply held beliefs permeated everything he wrote and did throughout his life. For me, my essence has to do with trying to get to the heart of a matter, of a deep unease with answers that are served on a platter, an essence that has kept me company through my entire life. This essence seems to arrive at or before birth and travel with us at least until the day we die.

This essence is also revealed in the way we refer to ourselves spatially. If you want to make a gesture referring to yourself, you don't point to your foot and say, "This is me." You don't point to your genitals, or abdomen, or buttocks, or even your head and say, "This is me." Try it. It feels weird and wrong. Then point to your heart and see if you feel, "There do I dwell."

Scientific, maybe not. An actual experience, absolutely. And again there is the question of which do you trust as a way of knowing? When you want to connect with another person, do you hold them to your foot, your buttocks, or against your head. (Try this with a child or a beloved pet. I strongly suspect it will feel weird and wrong.) No, you hold your beloved against your heart. We have an instinct to represent deep connection with our heart - - - far and above the fact that it is convenient for our arms to reach that part of anatomy. Even cardiologists don't hold their children against their buttocks when their children feel sad or hurt.

If we want to convey a deeply held belief, we often hold our clenched fist - - - about the same size and shape as our heart - - - over our hearts. We don't hold it over our head or over our abdomen. (Again, try it and see how it feels.) When we want to make an emotional connection, convey our deep feelings, or demonstrate that we are dealing with our "essence" as a human, we rush to get our heart involved in the experience.

Love necessarily involves the deepest part of our being, our essence. Nobody, not even the most cynical among us, wants to be told, "I love you with all my foot," or "My brain loves you very much," or, even worse, "My genitals are in love with you." No one wants to hear that. We only accept expressions of the heart as meaningful.

Like essence, freedom is also necessarily part of the definition of love. For it to be love, a person needs to tell you - - - and, more importantly, show you through freely chosen actions - - - that being with you, fighting for you, protecting you, caring for you is a path they have freely chosen. There is no such thing as loving you because I had no choice, loving you because there was a gun to my head, loving you to impress my dad, or loving you because economically it was the soundest choice. This kind of "love" either doesn't last or becomes the worst kind of torture. For love, there must be choice. But perhaps more precisely, there must be choice within the inexorability of the connection. It is as if the world somehow presents you with the possibility, but you are then compelled to follow the path - - - as if something powerful inside guides you along it, whatever your brain may say.

---From Human Heart, Cosmic Heart
Thomas Cowan, MD
©2016Chelsea Green Publishing
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