Neurotics at Heart

With seeming good reason, the New England train conductor worried about his heart. For ten years he had lived with a diagnosis of coronary artery disease, "confirmed" by several doctors. He was retired and lived on workmen's compensation. But the diagnosis was deceptive. The conductor happened to be one of an unknown number of Americans who so fear heart trouble that they feel the symptoms without ever having the disease. In fact, the conductor's "illness" meant so much to him that he lived for nothing else. When doctors later could find no heart disease and cut off his compensation, the patient died suddenly--apparently a suicide.

"Cardiac neurosis" is more widespread than laymen--or many doctors--realize. In the A.M.A. Journal three specialists report on a six-year study of 27 New England patients (including the conductor). All complained of chronic chest pains; all were exhaustively studied and found free of physical heart disease. To most of them, neurotics at heart, this was not really news; they had already had this word from several doctors. Such unsatisfactory verdicts sent them to still other doctors until they got the grave diagnoses they wanted.

In contrast with patients who had real heart disease but often denied any pain, the neurotics persistently described the most severe symptoms. They identified themselves with genuine heart-disease victims ranging from relatives to President Eisenhower. They also showed "a high degree of secondary gain"--profiting from their imagined ailments, they got warm family sympathy and financial help, which released them from pressures and responsibility.

When told the bad news that their health was good, the neurotics angrily refused to believe it. One man went so far as to collect notarized statements from numerous friends to prove his continued pain. Another rushed off to a second VA hospital, succeeded in getting back his angina pectoris status (and Government compensation). Advanced cardiac neurotics, concluded the doctors, cannot give up their way of life. It may even be dangerous to disillusion them, and best to go on treating them as real heart patients. In fact, "their eventual incapacity equals [that from] the most serious type of heart disease."

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