Cardiac preoccupations

The origins and development of mental representations of internal bodily organs are, in general, difficult to discern. This is so even in the case of an internal bodily organ such as the heart, which is more readily perceived than most other body organs since its beating can be felt and heard. It is even true in the case of individuals in whose psyche the heart comes to play an inordinately prominent role. It was so in the case presented in this paper, the case of a man who was preoccupied with the idea that he was going to die of a heart attack, as his father had. It required a great deal of analytic work to uncover some of the underlying conflict-laden factors which lay behind his cardiac preoccupations. Those conflicts and fantasies that were uncovered derived from many developmental layers, but seemed to be organized around a central bisexual conflict resulting from the threat of castration for both positive and negative oedipal wishes. The two main unconscious mental representations of the heart in his case were as an erect, pulsating penis and as a blood-filled vagina, although other representations such as a bloody anus also existed. A relatively accurate, realistic mental representation of the heart probably evolves slowly during the development of any individual and is probably always distorted somewhat by infantile unconscious concepts along the way. In a situation where a parent has had a cardiac illness, and particularly when this illness occurred during the individual's childhood, the mental representation of the heart can be even more distorted than usual by the developmental conflicts that are intensified by the parental illness.