The heart is the ideal target for psychosomatic pathology, since if this ‘motor’ stops, death follows. In coronary disease, the evil reputation of which has been made public by the news media, the patient wants the cardiologist to take over his fear of death, whereas the cardiologist is faced with his own death in the form of sudden death in general. His narcissism towards his therapeutic powers and his domination of the patient, upon whom he imposes a new way of life, is accompanied by a certain sadism which serves to conceal his vulnerability. In cardiac surgery, more spectacularly, the patient’s narcissistic wishes are fulfilled, as well as his masochism, for he will have to undergo difficult times (in reanimation); he will take advantage of this to tyrannize those around him. The cardiologist will find his anxiety concentrated on the choice of the correct moment for the operation, at which he will be confronted, not by sudden death but by the risk of death he himself determines – a veritable ‘Russian roulette’ with all the macabre attraction of suicide.

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© 1972 S. Karger AG, Basel
1972
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