Heart and Soul at Apothecaries Hall by Fay Bound Alberti

Apothecaries Hall, Blackfriars, London

On Thursday 29 June I gave a keynote lecture at the Geoffrey Flavell symposium, held at the Worshipful Society of Apothecaries, in Blackfriars, London. If you haven't visited, do check out the website and learn about the activities of the Society. It is 400 years old, having been founded as a City Livery Company (incorporated by royal charter in 1617); a major centre for the manufacture and sale of drugs at the Hall (1671-1922); the founder of Chelsea Physic Garden (in 1673) and a medical examining and licensing body since 1815. The beautiful building was partly burned down in the Great Fire of London and rebuilt; as an early modernist by training, I was delighted to discover that the symposium itself was being held in the space where Oliver Cromwell's armies had once bedded down for the night. Apparently, they made quite a mess. 

To get back to the theme of the symposium, Geoffrey Flavell was a highly respected cardio-thoracic surgeon. Born in New Zealand, he completed his training at Bart’s in London. In 1939, he became the resident surgical officer at the Brompton Hospital. And he worked, during the Second World War with Sir Archibald Mcindoe, of Guinea Pig fame, in treating severely burned patients. Flavell was appointed consultant at the London Hospital in 1950, where he worked for 30 years.

In keeping with Flavell's specialism, the title of this year's Symposium was ‘The Heart, Health and Culture: An Exploration in Medicine and the Humanities’. It gave me a chance to revisit my earlier work on the history of the heart, in health and disease. My book Matters of the Heart: History, Medicine and Emotion (Oxford University Press, 2010) explored the meanings of the heart as both symbol and organ. It looked at why we have two very different ideas about the heart in our culture: the heart as a Hallmark symbol sold on millions of cards every year and the heart as a pump, responsible for the circulation of the blood.


In my book, and in my paper, my theme was this: for centuries, medical practitioners in the West held the heart to be the centre of emotion, thought and feeling. Before the rise of the brain qua mind, the heart was the most important organ of the body, which was frequently viewed in cardiocentric ways: the heart was all that mattered in the end. With the rise of scientific medicine and neuroscience, the decline of religious explanations for our existence (and the decline of the soul in the material tradition), the heart became a material object. It might beat excitedly when we see a loved one, but not because our soul was moving through the heart. It might feel like our hearts would break, but not because our hearts were overwhelmed by the melancholic humours of the ancient world. Hormones began to offer a new explanation; hormones produced by the new emotional centre of the body: the brain.

Of course, the heart still continues to thrive at the level of popular culture. The brain governs emotions in name only. Nor is the brain the only contender for the title of emotional organ par excellence, as my book This Mortal Coil: The Human Body in History and Culture (Oxford University Press, 2016) argues. Other organs – notably the gut – are coming into their own. Like the heart, they are seen as sites of hormone production (and even, more controversially as systems of cellular memory). We are listening to the body more and more, though as we do, we must acknowledge the gaps in scientific medicine; the ways in which narratives of healing are leaving holism behind.

These are the themes I talked about at the symposium, reflecting my enduring interests in the history of the body and the history of emotion. How do we explain what we feel, and how has that changed over the centuries? Why are some organs given more importance than others? Why do heartfelt emotions and gut feelings have so much sway? Or really: why shouldn’t they? We feel with our gut and our heart, after all.

One of the most fascinating aspects of the symposium for me – a day that brought together historians and theologians, surgeons, GPS and ethicists – was how emotional our attitudes towards the body are, even for surgeons. Making a choice as a transplant specialist for instance - to operate or not operate - involves all the surgeon's clinical training, of course, but it also impacts on his and her emotional experience. Patients are not just bodies, but living, breathing people with families and loved ones. We want surgeons to be coolly efficient, but we also need them to be human.

The ways we intellectualise the body in medicine, talk about it, take it apart physically and metaphorically, doesn’t take away from the fact that we exist and experience the world, for good and ill, in our bodies. We feel emotional about what happens to our bodies (and those of our loved ones) just as we did in the past, albeit for different reasons. One of the themes that crosses boundaries between scientists and non-scientists is the question of what makes us quintessentially human. We might talk about the word ‘soul’ (and most of us believe we have one), though there is no agreement on what it is, or what it does.

In the 17th-century philosopher Rene Descartes’ time (he of the 'I think therefore I am' doctrine), things were simpler: the soul lurked behind the eyebrows. It was the space where the physical body met the emotional and spiritual body. It was also why so many emotional expressions involved the raising or furrowing of the brows. Today the soul is often placed in the brain (and sometimes seen as synonymous with the mind and consciousness). Far more often it exists as a nebulous, free-floating entity that is, and yet is not, linked to our religious beliefs.

Sometimes, the soul is still placed in the heart. When I ask people to point to their minds, more often than not they point at their heads. When I ask them to point to their ‘selves’, they point to their heart. The heart remains an emotional centre, then, and not just in language. The heart remains a symbol of our inner selves, of truth, of passion. Outside the narrow confines of medical textbooks, it can’t ever be reduced to a pump.



A Victorian Valentine's card from the Wellcome Images collection

Why the (Western) World loves an Extrovert, by Fay Bound Alberti

On New Year's Eve my friend and I sat in a busy venue, gently grumbling at all the bonhomie involved in the celebrations: strangers hugging, singing and optimistically making predictions for 2017. We were the obligatory introverts - the spectres at the feast, commenting on the party that was erupting around us, rather like Statler and Waldorf, those grumpy old men from the Muppets. 

I thought a lot about introversion and extroversion over the festive period, and its social history. The overwhelming narrative of the season is the good humour and geniality of friends and family, and yes, strangers, in the spirit of man's humanity to man - though it always seems to be women who are landed with the practicalities. Those who are not swept up in the spirit are the Scrooges and the Grinches of the world, preferring their own company to that of others. The pressure on all of us to grab the hands of strangers for a rousing rendition of Auld Lang Syne is considerable. 

So where does it come from, this association of introversion with hostility and unfriendliness? What got me thinking about this is the history of loneliness, a subject that I am researching for a forthcoming book. Today, loneliness seems to be an ever growing concern, variously linked to adolescent depression, middle-age suicide and elderly dementia. To be separated from society, the story goes, is to fail to function in it. Loneliness has become shorthand for a pathological isolation from the outside world, made all the more challenging by the rise of social media. Sites like FaceBook are said to encourage isolation at the same time as they make us more 'social' - lurking on social media websites and seeing everyone else leading apparently 'perfect' lives, leads to introspection and depression. 

It is introverts who most commonly report, or are more willing to report being lonely, but the term introvert is itself a modern one,coined by the Swiss psychiatrist and psychoanalyst Carl Jung (pictured below) in 1921. At the time of Jung's research, many of our current working ideas about the self and society, emotions, the mind and the role of the individual were being formulated with the rise of the mind sciences. Scientific explanations for human personality and behaviour were being discussed, especially in relation to the structuring and working of the brain. 



In the new mind sciences, extroversion was characteristic of talkative, outward-facing personalities who were energetic and enlivened by being around other people. By contrast, introversion was associated with isolation and reserve, and by the need to spend time alone. Most personality models in history since Jung have worked with this basic understanding of differences between extroverts and introverts. In 1962 Myers-Briggs created a workable model of Jung's theories (the Myers-Briggs Type Indicator or MBTI) which is still in common usage. Curious? There is even a free online test, adapted from Myers-Briggs that you can take at home. 

The MBTI 'personality inventory' uses Extroversion and Introversion as one of its main categories of analysis. Despite changing models of psychology since the 1960s, concepts of introversion and extroversion continue to dominate, and have acquired a moral loading. Extroverts are generally seen to be open and agreeable, and introverts thoughtful as well as neurotic. The basic idea of personality (or temperament) types is not new; it has been around since the classical period. Following Galen, men and women were divided into melancholic, phlegmatic, choleric or sanguine individuals, depending on how much of a particular humour they possessed within their bodies. These differences are represented rather nicely below by the seventeenth-century painter Charles Le Brun's allegorical depiction of different personality types. 

Today, there is more moral loading about different personalities, and the value of introversion and extroversion. In the Western world we place higher stock on being extroverted, as identified by Susan Cain in Quiet: The Power of Introverts in a World that Can't Stop Talking  Many organisations and institutions (I have worked for at least one) celebrate noise and activity over quietness and consideration. Introversion, despite its necessity in many of the creative arts, has acquired something of a pathology; shyness a failing. Why is this? 

Part of this association (extroversion = good and introversion = bad) can be rooted in the social context of the psychological models that emerged after Jung. In the early twentieth century, European and American models of the self valued self-help, self-reliance, hard work and the rise of the individual. Being able to stand out, being willing to be vocal and outward-facing, being able to demonstrably lead others was a measure of success in presenting the self, as in business. On 21st century social media, vloggers like Zoella sell not only books and make up but a particularly modern form of aspirational extroversion that would have been unthinkable in an earlier time. 

Above: Zoe Sugg (Zoella) speaking at the 2014 VidCon, 28 June 2014. Credit: Gage Skidmore.

There are global differences in the desirability of extroversion. While it is taken as the norm in the UK and US, it has been argued, extroversion is less acceptable in traditionally social-orientated traditions of Japan and Buddhist cultures. Of course these are stereotypes, and differences are often surface, rather than core. But part of the reason for introversion in Buddhist cultures is the emphasis on looking inwards, in stillness and mindfulness, characteristics that arguably retain a different value in the West.  

In the real world, of course, we need introverts just as much as extroverts. And most of us are neither entirely one thing or the other. It is common for each of us to feel introverted or extroverted at different times depending on our mood, company and environment. Extroversion is just one of the 'big five' that psychologists now use to measure personality and aptitudes. In addition to extroversion, the characteristics that matter are neuroticism (emotional stability); conscientiousness, agreeableness, and openness. The vast majority of people fit somewhere in the middle on most of these rankings. There are always exceptions. In a recent study, The Atlantic magazine found that Donald Trump, America's new President, scored extremely low on agreeableness and unusually high on extroversion: a 'combustible' combination whose effects have yet to be seen.