musingsonwomenshealth.com

Reflections on 40 years as a doctor in Women's Health

My body, myself


I have to admit that I have long considered that expressions like ‘I was just following my heart’, or ‘It just felt right’ were on the woo-woo side of the curtain -that they were attempts to justify an action for which no other suitable explanation could be found. As if we felt compelled to resort to poetry to explain ourselves, or legitimize the incarnation of a metonym. And yet, these references to bodily sensations as valid endorsement of feelings seem too universal to ignore.

Is it perhaps too facile merely to assume that the heart rate, say, is what causes an attribution, rather than being the result of it? To be flagrantly reductionist, one could point out that the heart muscles respond to signals from various sources -including other internal organs- and we are alerted by changes in their rhythm; we may attempt to link these changes to something happening external to us -and perhaps that is correct- but can we be sure which is the cause, and which the effect? Probably it is safer to say that multiple physiological processes play a role in heart rate, and question what it really means when you say you were following your heart.

But, I’ve been thinking a lot about that now that I’m retired, and I wonder whether it’s a recognition that the feeling of ‘self’ involves more than just the brain -that I do not merely exist behind my eyes, but am rather the sum of all of my component parts –all my organs. But my bodily identity includes more than what I can discern through the five senses we ordinarily list (touch, taste, smell, hearing, and sight); even the ones we seldom list such as balance (vestibular system) and spatial orientation are likely insufficient. Only recently have we begun to realize the contribution of other internal organs. The bowels, for example, play a role both in our sense of well-being as well as supplying signals and chemicals for neurotransmitters in our brains. Indeed, our lungs, our hearts and all of what’s inside us, likely contribute as well[i].

So, although we may still think the idea of any visceral contribution to our identities is, well, a remnant of Aristotelian thinking, or of the same era as phlogiston or miasma, I suspect we may be in for a surprise. The signals from our viscera -including lungs, heart, bowels, and so on- require sophisticated multisensory integration. I (meaning the part of ‘me’ that lives behind my eyes) am constantly being exposed to multiple steams of data from outside and inside my body and only if my brain manages to combine all of this seamlessly can I attribute it to me -make me believe that I am my body[ii]. Sometimes we can identify an endogenous hormone that facilitates this integration (oxytocin, for example), but often it is more of a mystery and thus the linkage remains part of the mythology of folklore.

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During Covid’s reign, it was often difficult to overhear conversations at other tables because of the pandemic social distancing required in coffee shops, but sometimes, people became so used to talking with their mouths covered that when they were eating without a mask, their naked words travelled further than they expected. And, let’s face it, compared to texting or Zoom-conferencing, eavesdropping became quite entertaining if you’re so inclined; given that I am usually alone at a table, I am always so inclined.

“I don’t know what’s got into my daughter,” a shrill, voice announced to the universe from a table not that far away.

“What do you mean, Judy?” asked an older, more sedate female voice.

“She’s left home and decided to live with some man she met online.” For some reason, she felt it was necessary to italicize ‘man’, so I naturally turned to stare at her; I’m not sure what I expected. She was a middle-aged woman dressed in a rumpled blue business suit and I was not surprised to see the bun into which she’d bundled her hair, was scattering like a haystack in the wind as she shook her head at the disclosure. “She said she was following her heart,” she continued, rolling her eyes in time with the rhythm of her words.

Her friend was older, and certainly the calmer of the two. She was dressed in what I assumed was an office outfit as well, but it was grey, and more kempt. They may have worked at the same firm because she smiled like a close colleague and reached for her friend’s hand either to console her, or to get her to lower her voice.

I think she saw me staring at them, because she moved her hand and I could hardly hear her reply. Judy seemed undeterred, and informed the room that she blamed her ovaries; when her friend blushed, she clarified that the ovaries in question were those belonging to her daughter, however. “She had to take all her university courses online, Wanda; she said something was telling her that she needed more than I could provide for her. I’m her mother for god’s sake…”

I gathered from Wanda’s lack of head nodding that those days were only memories for her, but she did rally in her role of support-person by finally smiling in reluctant agreement. “How old is your Randa?” she asked, almost as an afterthought.

“Twenty-eight,” Judy answered, still trembling with emotion.

Had I been at their table I would have asked a followup question about why her daughter was still living at home with her mother at that age, but, short of shouting at them across the void and blowing my cover, I decided just to smile.

Wanda ignored my unstated question, pretended she hadn’t noticed my grinning face, and merely observed that when she’d been that age, her hormones had also been raging. “Sometimes there are things going on inside a person that influence what they do, Judy. Don’t you remember those days…?”

Judy evidently disagreed and shook her head vigorously. “I taught her to use her head, not her hormones, and to think things through before she decided to act.”

I got the impression, that maybe Judy hadn’t. I could see Wanda smile, and when she glanced in my direction, our eyes met for a second. “The brain has many inputs, dear,” she said, reaching again for her hand. “And although we sometimes have trouble controlling them, they’re still part of who we are…”

“But…” Judy was still confused and continued shaking her head as they stood to leave.

Wanda reached for a coat hanging from an empty chair and pushed herself back from the table. “But Randa will be Randa, Judy. She’ll be careful, but I think she’s just going through a phase where her innards are currently speaking louder than her mother.” She handed Judy her coat. “ There’s more to us than just our brains…” She nudged Judy in her ribs, and smiled. “Thank goodness for that, eh…?”

[i] https://psyche.co/ideas/a-stable-sense-of-self-is-rooted-in-the-lungs-heart-and-gut

[ii] https://aeon.co/essays/touch-is-a-language-we-cannot-afford-to-forget

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