Historically Speaking: Broken Hearts and How to Heal Them

Modern medicine confirms what people have known for thousands of years: heartbreak is more than a metaphor.

The Wall Street Journal

September 30, 2023

A mere generation ago, “heartbreak” was an overused literary metaphor but not an actual medical event. The first person to recognize it as a genuine condition was a Japanese cardiologist named Hikaru Sato. In 1990, Dr. Sato identified the curious case of a female patient who displayed the symptoms of a heart attack while testing negative for it. He named it “Takotsubo Syndrome” after noticing that the left ventricle of her heart changed shape during the episode to resemble a takotsubo, a traditional octopus-trap. A Japanese study in 2001 not only confirmed Sato’s identification of a sudden cardio event that mimics a heart attack but also highlighted the common factor of emotional distress in such patients. It had taken the medical profession 4,000 years to acknowledge what poets had been saying all along: Broken Heart Syndrome is real.

The heart has always been regarded as more than just a pump. The Sumerians of ancient Mesopotamia, now part of modern Iraq, understood it performed a physical function. But they also believed it was the source of all emotion, including love, happiness and despair. One of the first known references to “heartbreak” appears in a 17th century B.C. clay tablet containing a copy of “Atrahasis,” a Babylonian epic poem that parallels the Old Testament story of Noah’s Ark. The words “heart” and “break” are used to describe Atrahasis’s pain at being unable to save people from their imminent doom.

The heart also played a dual mind-body role in ancient Chinese medicine. There was a great emphasis on the importance of emotional regulation, since an enraged or greedy heart was believed to affect other organs. The philosopher Confucius used the heart as an analogy for the perfect relationship between the king and his people: Harmony in the latter and obedience from the former were both essential.

Heart surgeon Daniel Hale Williams. ILLUSTRATION BY THOMAS FUCHS

In the West, the early Catholic Church adopted a more top-down approach to the heart and its emotional problems. Submitting to Christ was the only treatment for what St. Augustine described as the discomfort of the unquiet heart. Even then, the avoidance of heart “pain” was not always possible. For the 16th-century Spanish saint Teresa of Avila, the agonizing sensation of being pierced in the heart was the necessary proof she had received God’s love.

By Shakespeare’s era, the idea of dying for love had become a cliché, but the deadly effects of heartbreak were accepted without question. Grief and anguish kill several of Shakespeare’s characters, including Lady Montague in “Romeo and Juliet,” King Lear, and Desdemona’s father in “Othello.” Shame drives Enobarbus to will his heart to stop in “Antony and Cleopatra”: “Throw my heart against the flint and hardness of my fault.”

London parish clerks continued to list grief as a cause of death until the 19th century, by which time advances in medical science had produced more mechanical explanations for life’s mysteries. In 1893, Daniel Hale Williams—founder of Provident Hospital in Chicago, the first Black-owned hospital in the U. S.—performed one of the earliest successful heart surgeries. He quite literally fixed the broken heart of a stabbing victim by sewing the pericardium or heart sac back together.

Nowadays, there are protocols for treating the coronary problem diagnosed by Dr. Sato. But although we can cure Broken Heart Syndrome, we still can’t cure a broken heart.

Historically Speaking: When Royal Love Affairs Go Wrong

From Cleopatra to Edward VIII, monarchs have followed their hearts—with disastrous results.

ILLUSTRATION: THOMAS FUCHS

The Wall Street Journal, August 8, 2018

“Ay me!” laments Lysander in Shakespeare’s “A Midsummer Night’s Dream.” “For aught that I could ever read, / Could ever hear by tale or history, / The course of true love never did run smooth.” What audience would disagree? Thwarted lovers are indeed the stuff of history and art—especially when the lovers are kings and queens.

But there were good reasons why the monarchs of old were not allowed to follow their hearts. Realpolitik and royal passion do not mix, as Cleopatra VII (69-30 B.C.), the anniversary of whose death falls on Aug. 12, found to her cost. Her theatrical seduction of and subsequent affair with Julius Caesar insulated Egypt from Roman imperial designs. But in 41 B.C., she let her heart rule her head and fell in love with Mark Antony, who was fighting Caesar’s adopted son Octavian for control of Rome.

Cleopatra’s demand that Antony divorce his wife Octavia—sister of Octavian—and marry her instead was a catastrophic misstep. It made Egypt the target of Octavian’s fury, and forced Cleopatra into fighting Rome on Antony’s behalf. The couple’s defeat at the sea battle of Actium in 31 B.C. didn’t only end in personal tragedy: the 300-year-old Ptolemaic dynasty was destroyed, and Egypt was reduced to a Roman province.

In Shakespeare’s play “Antony and Cleopatra,” Antony laments, “I am dying, Egypt, dying.” It is a reminder that, as Egypt’s queen, Cleopatra was the living embodiment of her country; their fates were intertwined. That is why royal marriages have usually been inseparable from international diplomacy.

In 1339, when Prince Pedro of Portugal fell in love with his wife’s Castilian lady-in-waiting, Inés de Castro, the problem wasn’t the affair per se but the opportunity it gave to neighboring Castile to meddle in Portuguese politics. In 1355, Pedro’s father, King Afonso IV, took the surest way of separating the couple—who by now had four children together—by having Inés murdered. Pedro responded by launching a bloody civil war against his father that left northern Portugal in ruins. The dozens of romantic operas and plays inspired by the tragic love story neglect to mention its political repercussions; for decades afterward, the Portuguese throne was weak and the country divided.

Perhaps no monarchy in history bears more scars from Cupid’s arrow than the British. From Edward II (1284-1327), whose poor choice of male lovers unleashed murder and mayhem on the country—he himself was allegedly killed with a red hot poker—to Henry VIII (1491-1547), who bullied and butchered his way through six wives and destroyed England’s Catholic way of life in the process, British rulers have been remarkable for their willingness to place personal happiness above public responsibility.

Edward VIII (1894 -1972) was a chip off the block, in the worst way. The moral climate of the 1930s couldn’t accept the King of England marrying a twice-divorced American. Declaring he would have Wallis Simpson or no one, Edward plunged the country into crisis by abdicating in 1936. With European monarchies falling on every side, Britain’s suddenly looked extremely vulnerable. The current Queen’s father, King George VI, quite literally saved it from collapse.

According to a popular saying, “Everything in the world is about sex except sex. Sex is about power.” That goes double when the lovers wear royal crowns.