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May 25, 1970

Open-Heart Surgery and the Psyche

JAMA. 1970;212(8):1370. doi:10.1001/jama.1970.03170210074016

Our approaches to psychiatric disorders often reflect a bias which derives from views on the perplexing mind-brain relationship. If our outlook is reductionist-materialistic, and we see the brain as an organ which generates thoughts and emotions much as a gland secretes a hormone, then we tend to implicate a biochemical or anatomical mechanism for the psychic derangement. An abnormal serum magnesium concentration in a cyclothymic individual becomes more meaningful than his disordered personality. The latter, however, becomes paramount if we incline to allow for the mind's autonomy or even primacy. Morbid psychology rather than morbid anatomy and the physiology then assumes the greater importance.

This difference in approach is reflected in the theories on the nature of the psychiatric disturbances which often follow open-heart surgery. Ranging from mild transient confusion to catastrophic schizophrenic reactions, these disturbances appear between the second and seventh postoperative days and rarely outlast the patient's stay