TY - JOUR T1 - A farewell to heart sink? JF - British Journal of General Practice JO - Br J Gen Pract SP - 584 LP - 585 VL - 57 IS - 540 AU - Gwenda Delany Y1 - 2007/07/01 UR - http://bjgp.org/content/57/540/584.abstract N2 - To sum up what went before: I would like to suggest that the ‘heart-sink’ patient's behaviour and attitude begin to make sense, and are entirely appropriate and consistent, if we bear in mind the strong possibility of a past history of abuse, in the widest sense of the term: emotional, physical, and sexual. We could decide to see the ‘heart-sink’ patient as someone for whom things went seriously wrong early on in life: in a relationship of trust, at a vulnerable stage in development.Our hearts sink for the best of reasons. Feelings are always true and always rational, that is, they are always appropriate and proportional to their original cause. They can therefore be trusted even when it may be impossible to link them to anything in the patient's present circumstances; and even though their original cause remains undiscovered during all our consultations together. Our difficulty in ‘getting the picture’ may indicate we are dealing with a patient's repressed experience, re-enacted in exact but obscure ways, using the listener/doctor as a ready-to-hand and convenient figure of transference.Such terms may be of little help for some doctors, or may actively put them off; and perhaps they are not essential. But they are a map, a theoretical ground-plan of where the action is at: I offer them in that light, with examples that may be of use.RepressionRepression occurs whenever an experience during childhood and development gives rise to feelings that are not fully lived through and assimilated: because these feelings are forbidden/too painful/too confusing for the child, and because there is no one more experienced available to help the child identify and deal with them. Today more experimental evidence is becoming available that supports this hypothesis, for example, in accessible books on the overlap of child psychology and neurophysiology, … ER -