After the Valentine’s Day service at St Andrew’s Church, Cincinnati, Father John Agbaje asked me if I would give a talk about the heart. On 3/6/16 during the announcements part of the service, I gave the following talk to the congregation:
Father John often thanks us for coming to church. One of his refrains in his sermons is that coming to church is good for the soul. I want to show you, with a little help from science, that church is also good for the heart. I’m going to read you a short vignette, ask you to think about the anatomy and physiology of the heart and the brain, and then talk about the effects of stress on the heart. That will lead us to a few tips for minding the heart. In less than 10 minutes.
For those of you who know me as a psychiatrist, I may appear to be an imposter talking about the heart, since my field is the mind and my organ is the brain. Let me explain how a psychiatrist ends up preaching about the heart. About twenty years ago I started wondering how it happens that people with depression die younger than people without depression. This question turned into a four-year long project with a mentor of mine, George Vaillant, and the epidemiologist I sleep with, Victoria, that resulted in our publishing a review in 1999 called The Mortality of Depression. The main finding of this review was that depression roughly doubles the rate of early death, and most people with depression die from early heart disease and other chronic illnesses, much more often than from suicide.
Since then a lot of research by others has clarified the pathways by which depression and other forms of chronic stress lead to the early development of heart disease, and how depression accelerates the rate at which existing heart disease leads to early death. I published a book in 2007, Treating the Aching Heart: A Guide to Depression, Stress, and Heart Disease, to spread the word to non-medical readers about this research. More recently it has become clear from sound epidemiologic studies that all the major chronic mental illnesses cut about 20 years off the expected life span in our country. That is, if you have the good fortune to live into your 80’s, your brother or sister with bipolar disorder or schizophrenia or severe depression is more likely to die in their 60’s. How does this happen?
A reading from the Gospel according to Lawson: Chapter 1, p 1-2:
Paula Volk, sixty-two, spends most of her time in the front bedroom of her two-bedroom house near the flood plains of the Ohio River, watching the clock, as she says. Her father died at sixty-two from his second heart attack. Her mother died at sixty two of a stroke. For eight years Paula Volk’s heart has been troubling her with chest pains, shortness of breath, and exhaustion. She’s sick enough now to need a heart transplant, but too sick to be eligible for the operation. How did she, the daughter of a nurse and an engineer, come to this?
Her mother ate too much, drank too much, and spent too much time in bed with depression, Paula says. Determined to defy her mother’s genes and her example, Paula skipped the booze, and worked hard as a social worker and later as the owner of a small courier business. Aside from carrying some extra weight most of her life, Paula usually felt pretty good and considered herself pretty healthy. She smoked a couple of packs a day for forty years and quit in the spring of 1995, when she was fifty-five and the chest pains began. Within the year she developed congestive heart failure and (like her father) diabetes. And then she had a coronary bypass operation. After the operation she slid into a funk, stopped taking care of her house, kept to her bed, and ruminated about suicide day after day.
For most of the next eight years she remained depressed and disabled, untreated for anxiety or depression in spite of frequent treatments for her heart disease.
These pathways between depression and heart disease are partly genetic, but they also include some high risk health behaviors, like smoking and overeating and insomnia and slouching on the couch all day, which are common habits of the chronically depressed. Depression also contributes to the risk for arrhythmias of the heart by reducing heart rate variability, a measure of resilience to stress. In some people depression disrupts the whole stress response system, making them feel fragile not only in their minds but in their cardiovascular systems too. In the six months after a heart attack, depression doubles the rate of sudden death, mostly by arrhythmias because of reduced heart rate variability. And depression disrupts diet, exercise, and glucose regulation, accelerating the onset of diabetes, which also contributes to heart disease. And feeding this vicious cycle, heart disease can increase the risk for depression, as it did for Paula Volk.
One way to understand how stress and depression wear and tear at the heart is to think about how the central nervous systems and the cardiovascular systems are anatomically connected. The heart and all the blood vessels are enervated by two kinds of nerves that balance each other—the sympathetic and the parasympathetic branches of our autonomic nervous system. Our heart rate and our blood pressure are the result of the balance of activity between these two branches, the accelerator and the brake. One serves the fight-or-flight response and the other the conservation and relaxation response.
When we get excited, when Jerome Johnson and our Gospel Choir belt it out, our adrenalin kicks in and our sympathetic nerves light up and our heart rates rise. Later when we’re kneeling calmly during communion, some of us yawning, that other branch, the parasympathetic branch, takes over and we feel quiet and at peace. It’s a good sign when someone in the congregation yawns, a sign of that peace of mind and body.
During the rest of the week, when we’re not attending church, most of us lead lives that are overly stimulated and relentlessly activated. Excitement and stress are easy to come by. They seem to seek us out. On the other hand, deep relaxation and a quiet mind and a sense of safety are harder to come by. For many of us church offers a place to practice restoring the balance.
Think of our church service rituals and their effects on our nerves. The sense of harmony when we sing together. The resonant vibrations as we read the Psalms responsively. The physical contact when we pass the peace. The deep knee bends we call genuflecting. The lulling effects of our communion rituals. The counting of our blessings. The affirmations of affection from God and from each other.
Wouldn’t it be interesting to see what our average resting heart rates are at the end of the service compared to the beginning? No wonder churchgoers tend to live longer. One of the functions of church is to help us clarify our spiritual purposes. No wonder people who have a clear sense of purpose in life have fewer cardiovascular disease events and live longer. Think of church at its best as a gentle but sophisticated mind, body, and soul workout.
So I want to leave with a few key points.
First, the heart and the brain are tightly connected. How we think and feel has a powerful effect on how resilient our hearts are.
Second, as with building our faith, building our resilience against the toxic effects of stress requires practice. Stress management works if you practice it most days: make time to sing, dance, pray, shake hands, shake a leg, bend your knees, laugh, count your blessings, affirm your affections, reconcile and forgive.
And third, the components of our church service are good not only for our spiritual growth but also for tuning up the connection between our central nervous systems and our cardiovascular systems. Church is good for the heart.