Analysts & Bartenders

The commonest form of heart attack is a coronary thrombosis: a blood clot in an artery supplying the heart muscle checks the blood flow and starves the muscle. To overcome this handicap, the heart must labor excessively; like a car on a steep grade in high gear, it pings alarmingly and may stall. A noted Canadian psychiatrist suggested last week that the basic cause of the trouble may be found, not where doctors have been looking, in the patient's physical exertions or his arteries, but in his emotional problems.

Ottawa's Dr. John P. S. Cathcart told the Canadian Psychiatric Association in Winnipeg that medical records have been "amazingly silent" on the emotional state of patients who have coronary attacks. But his studies have convinced him that the attacks nearly always occur at times of high emotional tension. In general, job and family stresses are the most important factors in attacks of this kind, Dr. Cathcart believes. The most common single strain which leads to thrombosis: loss or threatened loss of a loved one.

Psychiatrist Cathcart noted that the death rate from coronary attacks among psychoanalysts has been much higher than among doctors generally. "Recent statistics indicate that bartenders share the top rung of the mortality ladder with the analysts . . . Both are dealing constantly with the frailties of human nature and are witness daily to hostility in naked form, but are forced to restrain themselves . . . from taking issue . . . The incidence is low among manual workers, but the wives of laborers are more often affected than their husbands. The difference may be due to budget or family problems."

Coronary disease is an increasingly important problem, Dr. Cathcart said, both because it is becoming relatively commoner and because it is invading the younger age group. "It is no longer rare to see coronaries or coronary deaths in the early 305." What to do for a patient whose history shows that there is a danger of coronary attack? "The current accent on the avoidance of overexertion is some what misplaced, and in most cases, except those with severe heart-muscle damage, avoidance of emotional stress is more im portant." Or, as Dr. Cathcart put it for his professional audience: "A useful anticoagulant is peace of mind."

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