From our December special issue, The Failing Heart: Semantics and science.
Science today understands the heart as muscular ball whose mechanical job is to pump blood at sufficient pressure, and which can be replaced if needed. Yet in literature and conversation we still refer to the heart as part of what makes us the person we are – a place where our emotions and judgement lie. Could it be that this view, which is thousands of years old, is just wrong? To answer this, we need first to step outside medical science to understand what it is that makes us a person. We attach great importance to the notion that we continue to be the same ‘person’ over time yet our bodily parts and thinking parts (physical and psychological parts) change all the time. How can we change and stay the same thing? Most philosophers accept that the persistence of enough brain to allow the thinking part to continue is sufficient. For John Locke, writing in the 17th century the thinking (psychological) part is our consciousness whose contents are derived solely from experience. Contemporary versions of Locke’s ideas emphasise that, when our survival is at stake, it is possibly the continuity of the psychological alone part that may matter most to us. If we now look again, in the neuropsychological literature, at what constitutes experience we find that alongside what we perceive from outside us runs a system of interoception – an internal sense system. Together internal and external sensation inform out mental activity and behaviour. One of the largest contributors to interoceptive experience is the heart. Perhaps the scientific view is only partly right. The heart is indeed a pump, but for us as persons it is not the pump that matters. The heart is a central part of internal awareness that, with external experience constitutes the thinking part of us. Maybe if we are just the persistence of our thinking parts it is only the constitutive heart that matters? But you may ask – what about heart transplantation? What happens to the person there? Heart transplantation is a ‘life-changing’ procedure with many associated psychological problems. Fixing the pump yes, but will the same person continue? – the best answer may be that we don’t know.
Here more about Hugh’s work in these short audio clips:
Audio part 1
Audio part 2
Hugh F McIntyre, MA MBBS MD FRCP FESC FRSA DPMSA, is a physician with a clinical interest in heart failure and a personal interest in philosophy.
Graduate of Oxford University with a Masters in Cardiovascular Physiology. Currently Chair of NICE Quality Standards Advisory Committee, CCG Governing Body member with advisory roles in regional system reform groups and Journal Editorial Board member. Previously various International, National and NICE Guidelines Committees and Steering Groups. Publications and opinion pieces on cardiovascular medicine, heart failure and on quality improvement.