Psychodynamic Factors in Acute Myocardial Infarction1

This study contains a description and psychodynamic interpretation of personality factors and stress behaviour found in a series of thirty male patients under 56 years of age suffering from acute myocardial infarction. The data are obtained from psycho-analytically oriented psychiatric examinations and psychotherapy (Groen et al., 1965). Due to the intense conflicts about drive impulses with passive aims, so common in coronary patients, it was unfortunately impossible to apply analysis. The dynamic and genetic propositions therefore remain more or less speculative. We shall not here refer to all the relevant literature, but confine ourselves to a mention of Arlow's (1945) findings concerning the pseudo-masculine identifications in coronary patients, which we corroborate, and which confirm the ideas already put forward by Dunbar (1943).

The patients can rarely tolerate feelings of dependence or inactivity. These are readily experienced as too childish or feminine. To have 'passive' feelings is for them the same as to be very inferior. The most striking features in their manifest behaviour are: a passionate urge for very hard work ('work addiction'); a burning ambition and tendency to dominate others in their work, in their family, in their love and social life; and, finally, a rapid oscillation between feelings of independence and activity on the one hand and dependence and inactivity on the other. The principal outlet for aggressive feelings is motor activity in the sense of working still harder. This happens especially when the patients' dominant position on the verbal level is threatened and he has to keep his countenance. Also in the psycho-sexual sphere they often turn out to be compulsively hyperactive. The emphasis is on achievement: the partner has to be satisfied. This behaviour has a pseudo-masculine quality, just like the rather frequently found promiscuity. The sexual partners are often experienced as inspiring envy and admi