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The Sublime Engine

The Sublime Engine

By Stephen Amidon and Thomas Amidon
Rodale, 242 pages, $24.99

Reviewed by PAUL MCHUGH

An emblem of passion, love, religious spirit, life itself-and the object of ever more sophisticated scientific study. We live in a time of quadruple bypasses and transplant surgeries that emphasize what a remarkable little motor the heart is, but somehow-especially on Valentine's Day-the heart is still widely regarded as the seat of love and emotion. With "The Sublime Engine: A Biography of the Human Heart," Thomas Amidon, a cardiologist, and his brother Stephen, a novelist, consider both the scientific and cultural aspects of the life-giving muscle in our chests.

In the book's poignant fictionalized vignettes, people sick with heart disease seek care from the doctors of their era. A Greek man of 400 B.C. with a failing heart, for example, goes to the Temple of Asklepios, where magical therapies fail him. But then, with the help of the empirical Hippocrates, he finds relief through dietary treatment and modest blood- letting.

Other sections of the book, also touched with the novelist's brush, describe the doctors and scientists across the centuries who studied how the heart functions in health and disease. Readers are introduced to many of the researchers who produced the knowledge we have, but the authors also lead us to appreciate how these researchers worked in the context of their times, when the heart was regarded as the core of human existence-the site of passion, love and religious spirit.

Thus we are told how, in 1628, William Harvey explained the way blood circulates through the body driven by the pumping action of the heart-one of the foundational events of the Enlightenment. But the authors note that Harvey made his discovery essentially at the same time that Shakespeare was composing verses depicting the heart as the site of our most secret feelings and thoughts-virtuous in King Lear's Cordelia (whose very name can mean pure of heart) and villainous in Othello's Iago.

In this way the authors carry their readers through history right to the present day, describing how perceptions about "heart and mind" changed as medical science advanced and occult beliefs receded. "The Sublime Engine" also discusses the odd disconnect between science's demystification of the heart as the center of emotion and the public's stubborn affection for the heart as a symbol of these feelings, from the valentines of February to the "I [heart] New York" campaign.

I wish I could say that I wholeheartedly enjoyed "The Sublime Engine." I am certainly grateful for the bypass surgery that relieved my own coronary artery disease, and I rejoice with several friends whose heart problems were alleviated by modern methods, such as drug treatments and stent placements. The book is a readable account of how such treatments have come to pass and how today we can look forward to even more progress in keeping our hearts working. But I am a psychiatrist and therefore a doctor interested in the feelings and passions that have been largely demoted from the heart in this "biography."

Two points need emphasis-one physiological, the other cultural. The physiological point rests on the fact that, even though feelings are certainly centered in the brain, the heart is ever a "felt" organ. Sensory nerves bring information to the brain about the beating heart, and, in situations of emotion and stress, these nerves report on how the heartbeats change in rate, power and even rhythm. The brain's sense of the heart's activity extends and amplifies the emotions it accompanies, often giving the emotions a coloring and extra power.

The great American psychologist William James believed that most of emotional life was directed by sensations from the heart and the body. He went so far as to claim that the quickened heartbeat of fear and the "suffocation" of the heart in grief demonstrated that emotions "follow" upon the heart's expressions rather than drive it.

Although James's theory of emotion has few subscribers nowadays, neuroscientists such as Antonio Damasio do give it much credit for having identified a crucial aspect of emotional experience. And pianists and violinists who suffer from performance anxiety know well that if they dampen their heart's quickening with the "beta-blocker" propranolol, their playing will be steadied and their recitals improved. Heart and mind, feelings and skills, interact there onstage.

My cultural point of departure with the brothers Amidon concerns the beating heart as a vivid sign of life itself. It is a major theme of the book. The authors describe how the romantic poets saw the heart's beating as the "fountain of life" and note how Harvey's famous book on the heart emphasized in its very title, "De Motu Cordis," the contractile motions that are a key to its function. But the authors neglect to mention perhaps the most common source of meaning in heart-motion today: namely, the picture of the beating heart of the fetal child revealed by ultrasound technology in the first weeks of pregnancy, seen in countless examining rooms across the country every day. The display of new life brings joy abounding to parents as they pray that its rhythm can continue for years to come.

This addition to the technological arsenal of contemporary cardiology has been of matchless benefit to the pro-life cause. For how can one behold this tiny beating, living thing, this breath of life in structured form, without believing that it captures in itself the words of Deuteronomy 30:19-"I've set before you Life and Death, blessing and cursing. Choose life."

"The Sublime Engine" aims to consider the human meaning of the heart alongside the march of technology, but the authors missed this sublime wedding of the two. I don't know how.

----Dr. McHugh, a University Distinguished Service Professor of Psychiatry at Johns Hopkins University, is the author of "Try to Remember: Psychiatry's Clash Over Meaning, Memory, and Mind."

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