How your emotions change the shape of your heart

Sterling's theory, allostasis, is a new way to think about human physiology. It puts psychosocial factors front and center in how we think about and approach heart problems. The traditional theory taught in medical school, homeostasis, holds that organ systems work together to maintain physiological balance. Allostasis, on the other hand, is not about preserving constancy; it is about calibrating the body's functions in response to internal as well as external demands, including those of one's social circumstances. Heart disease, in this conception, is no longer strictly biological; it is cultural and political, as well.

Marmot conducted the Whitehall studies, in which early death and poor health were found to increase stepwise from the highest to the lowest levels of the British civil service hierarchy. Messengers and porters, for example, had nearly twice the death rate of higher-ranking administrators, even after accounting for differences in smoking, cholesterol, blood pressure and alcohol consumption. Marmot and his coworkers concluded that emotional disturbance — because of financial instability, time pressures, lack of advancement and a general dearth of autonomy — drives much of the difference in survival, which resonates with my own thinking on the subject.

The Framingham Heart Study, begun in 1948 in a small town in Massachusetts shortly after World War II, almost single-handedly defines the modern science of heart disease. Framingham publications have identified the traditional and by now well-known coronary risk factors, including diabetes, hypertension, smoking and high serum cholesterol. However, the Framingham study was "clinically narrow," as one researcher put it, "with little interest in investigating psychosomatic, constitutional, or sociological determinants of heart disease." This has turned out to be a major flaw, as I describe in my book Heart: A History, that has slowed our understanding of the many ways that the emotional heart intersects with its biological counterpart.