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Among the major factors in all forms of ill-health, we believe that psychology is ever-present. We recognize the close inter-relationship between psychology and physiology; so close that one could say that most of the premature deaths from cardiac disease are due to psychological causes — and the same is true of much cardiac invalidism. The situation is strikingly peculiar. No organ in the body possesses a wider margin of safety and recuperative power than the heart; at the same time, no other organ can be so hurt by psychological distress. As Dr Wilhelm S.tekel observed in Conditions of Nervous Anxiety and Their Treatment:

Neurotics have a wonderful ability to express their mental states in a symbolic language of the bodily organs. Such heart troubles as palpitations, aches, irregularity of rhythm, etc., may be the consequences of disturbances of the emotions.

However, that refers mainly to the early stages of what one may call 'routine' cardiac disorders, and in which the patient inflicts his own psychological punishment. Much more significant are the effects produced by outside influences, such as the ill-advised opinions of onlookers. Unfortunately, such remarks may be made by those whose position should imply a recognition of the dangers inherent in careless suggestion, and whose judgment is sadly over-esteemed by the patient. In already-established heart cases, the grave pronouncement of the cardiac specialist may do incalculable harm; his prognosis is a self-fulfilling prophecy.