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Synergy, 'a working together of all the components of survival', is the neuropsychic force determining survival and longevity. The psychic image of the heart depends on an awareness of its sounds and rhythm and changes of volume in the chest. The heart has its own set of symbols in dreams, and is sometimes confused in interpretation with uterine symbols or fantasies. Since the first postnatal act has to do with the establishment of an independent circulation, the image of the heart exists at the root of the ego and keeps pace with the growing ego. Anxiety is defined as dyssynergy between the image of the heart and the rest of the ego. Psychosomatic syndromes are seen as 'defenders of the heart'.
'Premature coronary death in relatively young men is the result of … pressures which produce too organized, too invasive and pervasive an image of the heart and its derivatives.' Such patients have strong underlying transvestitism and very primitive oral impulses. Their character traits, primary defenses against deep conflict, are controlled tensions, physical hurry, self-purification or 'immunity from accusation', and 'superrealism and super-paternalism'.