Want to read Slashdot from your mobile device? Point it at m.slashdot.org and keep reading!

 



Forgot your password?
typodupeerror
×
Medicine Science

Hearts Actually Can Break 136

DesScorp writes "It seems that there's a grain of truth to one old wives' tale; it turns out that you really can die of a broken heart, especially if you're a post-menopausal woman. The Wall Street Journal reports on a phenomena called 'broken-heart syndrome,' which often occurs after great emotional distress. Quoting: 'In a conventional heart attack, an obstructed artery starves the heart muscle of oxygenated blood, quickly resulting in the death of tissue and potentially permanently compromising heart function. In contrast, the heart muscle in broken-heart-syndrome patients is stunned in the adrenaline surge and appears to go into hibernation. Little tissue is lost.' In the article a doctor notes, 'The cells are alive, but mechanically or electrically disabled.' Documented cases track heart attacks in people with seemingly healthy hearts after the grief of the death of a loved one. Intense feelings can cause the heart actually to change shape. Doctors call this 'tako-tsubo,' after the Japanese phrase for 'octopus trap,' so called because the syndrome was first identified by a Japanese doctor who noticed the strange shape in the left ventricle. Doctors note that while strong emotions like grief are usually associated with the syndrome, stress or a migraine can also trigger such heart attacks."
This discussion has been archived. No new comments can be posted.

Hearts Actually Can Break

Comments Filter:
  • by ls671 ( 1122017 ) * on Wednesday February 10, 2010 @09:17AM (#31084596) Homepage

    Hmm... According to this 2005 article, Dr. Ilan Wittstein came to the same conclusion after conducting a study:

    http://findarticles.com/p/articles/mi_m1355/is_11_107/ai_n13452973/ [findarticles.com]

    Some might have conducted similar studies prior to his.

    • Re: (Score:3, Insightful)

      by santax ( 1541065 )
      Interesting. I have seen this more than once in my life. Especially with the elder indeed. One dies, not long after the other goes. Just like they just seem to give up. Makes one wonder if you can actually chose to stop living by giving up alone or really wanting to be with that other.
      • by ConceptJunkie ( 24823 ) on Wednesday February 10, 2010 @10:52AM (#31085668) Homepage Journal

        My grandmother was diagnosed with cancer around 1980 or so. They gave her 6 months to live, but she soldiered on for 5 years, with an indomitable attitude and relentless good cheer and a wicked sense of humor. Eventually, she made it her dream to get her and my grandfather and their two sons and their families together for a big beach trip to Florida. We had that beach trip in the summer of 1985 and it was a wonderful vacation we all cherish in our memories. She finally passed away a couple months later.

        While not a "broken heart" situation, I always believed that her will to see this plan through gave her much strength, and once it was over, she could accept the inevitable. Our minds can't completely control our bodies, but I'm convinced they do much more than we tend to believe. Either that or someone needs to patent "placebo" because it's potent stuff.

        • Actually you on to something here. I read a report a while back that January is the highest month for elderly to pass away. Originally this was thought as a consequence of the weather however this holds up in warmer climates too. New thinking is that people hold on to survive through the holiday season to see family, and finally cant hold on any more once the holidays are over. I was not able to find the report I read about this, but my own anecdotal evidence supports what you found.

          • My wife had another heart attack like this three weeks ago. It was her third. She was out of the hospital the next day. She's recovering rapidly. Previously she had been diagnosed as having 'Cardiac Syndrome X'. Sheesh.

            I often think that medicine still hasn't progressed very far. People in the future will look back on the days when Americans spent 16% of GDP on health and still suffered in ignorance of what ails them.
            • I often think the same way and I hope you're right. Nonetheless, there are many advances being made. Even something so relatively mundane as laparoscopic surgery. I had my appendix removed about 12 years ago and came out of the hospital after two days with a couple of band-aids. To this day it still amazes me what they can accomplish without cutting huge holes in people.

              I am very optimistic that mankind on the verge of major revolutions in medicine, particularly in the areas of the immune system. This

          • My great grandmother passed away within 30 days of her 100th birthday party. Huge affair with literally every living descendant of hers present except for one (my father). 4 generations of people crammed into a relatively small room just to see her. Just another anecdote for the anecdote pile. =p

        • Our minds can't completely control our bodies, but I'm convinced they do much more than we tend to believe. Either that or someone needs to patent "placebo" because it's potent stuff.

          Indeed it is. There's a reason the effectiveness of drugs is always compared to placebo, and not just because you have to administer placebos to have a valid double-blind study. It's because the placebo group often receives a measurable benefit. So even outside of study design, to have an effective drug it can't just be bet

    • Comment removed based on user account deletion
    • by jhoegl ( 638955 )
      So, is this a form of suicide? Seems weird the body would be able to "kill" itself.
      • by Amorymeltzer ( 1213818 ) on Wednesday February 10, 2010 @11:56AM (#31086494)

        Not particularly. Apoptosis is available on the cellular level, and while this isn't an analogous situation there is a certain similarity. Sometimes it's a cell that made a serious DNA replication error, or sometimes it's a man or woman so overcome with grief that his or her heart fails. In both cases, continued survival (of the cell or heart) is perceived as "not worth it" by some underlying process.

    • by Cylix ( 55374 )

      One of the interesting experiences I had during a visit to the ER was such a similar question. They wanted to evaluate my stress levels and determine if I was in emotional turmoil.

      I eventually posed the question regarding how precisely being "sad" would manifest in physical pain and suffering.

      I don't recall his precise wording, but I remember what I said after his statement.

      "Ting, tang, walla, walla, bing bang. Ooo eee ooo ah ah. I told the witch doctor you didn't love me true."

      I'm pretty sure I pissed him

  • by Anonymous Coward

    ...they may say she died from a burst ventricle, but I know she died of a broken heart.

    • by Anonymous Coward

      ...to never fall in love.

      You think you need to be in love to be happy? This limiting belief was probably programmed into you early in your childhood. Remember that every emotional experience you have ever had was created by your own brain. Your lover didn't inject neurotransmitters into your skull...you created them.

      True fulfillment always comes from within.

      Also, if a pill existed that did to the brain what falling in love does to the brain, it would be illegal.

      • Re: (Score:3, Insightful)

        Also, if a pill existed that did to the brain what falling in love does to the brain, it would be illegal.

        It's called Ecstasy.

        Makes you happy and warm and fuzzy, then you crash and are left depressed and stupid (which doesn't totally wear off).

        • Re: (Score:3, Informative)

          by TheCarp ( 96830 )

          > It's called Ecstasy.
          >
          > Makes you happy and warm and fuzzy, then you crash and are left depressed and stupid (which doesn't totally wear off).

          Actually, thats not always the case. I, and several others, have experienced "ecstasy afterglow" where the next 2-3 days after the experience were actually quite pleasant. In fact, I was in a much happier mood than normal, and less depressed for that period.

          Now, when you say ecstasy do you mean MDMA or do you mean "pills called ecstasy". I have had it offere

      • Re: (Score:3, Insightful)

        by kdemetter ( 965669 )

        Well , you don't need to be in love , but you certainly need someone to talk to (intimately) every now and then.
        But a good friend may be sufficient for that.

        Note : if that good friend breaks contact with you , I'm pretty that will also break your heart.

        In other words : you need some sort of commitment to be happy , and that commitment leaves you vulnerable.

        • by tftp ( 111690 ) on Wednesday February 10, 2010 @05:48PM (#31091350) Homepage

          you need some sort of commitment to be happy

          That is not true. There are plenty of unmarried people out there. If they weren't happy they are free to marry. They don't. Therefore they are happy.

          that commitment leaves you vulnerable

          Very true.

          • You have a point, i guess it depends on the type of person you are ( extroverted or introverted).

            An extroverted person will probably have a lot of shallow friendships , and then it won't matter if some of them break contact.

            Introverted people tend to have fewer friends, but which deeper relationships. In that case, it will surely hurt if they break contact.

  • I am 31, had my heart broken 2 times. Really really broken. When my mom died and when I lost a girl I thought would become ms. Santax. I think everyone already knew this. It really hurts and it hurts where your heart is. Big time.
    • Re: (Score:2, Funny)

      by Anonymous Coward

      I misread your note and thought I understood why your girl decided she didn't want to become Ms. Tampax.

    • by mcgrew ( 92797 ) * on Wednesday February 10, 2010 @09:45AM (#31084824) Homepage Journal

      Try being married for 27 years to a serial adulteress. That's REAL pain.

      A man can hit me, punch me, kick me, stab me, cut me, shoot me, but only a woman can hurt me.

    • by sznupi ( 719324 )

      And at the same time that fabulous feeling there, showing up in connection to the loved one...is essentially identical. Yet somehow interpreted as pleasent.

      Perhaps so we can't have it too easy, perhaps just because both are putting the brain and the body in overdrive.

    • Mrs.

      The point of the whole thing is to turn Misses into Mistresses. :P

      • by santax ( 1541065 )
        Aye, thank you, English isn't my first language so I am happy to have learned something today ;) Won't make that mistake again! Thanks.
  • Octopus? (Score:5, Funny)

    by zepo1a ( 958353 ) on Wednesday February 10, 2010 @09:26AM (#31084658)
    Leave it to the Japanese to somehow work tentacles into the ailment!

    :)
    • Re:Octopus? (Score:5, Funny)

      by AdamThor ( 995520 ) on Wednesday February 10, 2010 @02:33PM (#31088748)

      Doctors call this 'tako-tsubo,' after the Japanese phrase for 'octopus trap,' so called because the syndrome was first identified by a Japanese doctor who noticed the strange shape in the left ventricle.

      Can you imagine the patter in the ER / OR if we were to adopt more Japanese names for common ailments?

      Doctor, the patient is suffering from the Octopus Trap!
      What? He's fibulating! Set us up the bomb!
      The Bomb is ready!
      Activate! *WHUMP*
      GASP... Beep... beep... beep...
      Doctor, he's stabilizing!
      Good! Keep an eye on him... There's a case of Giant Robot I need to address, and after that room 223's Frozen Devil Injury seems to be getting worse...

  • Over hill, over dale, did the black Raven go.
    Many autumns, many springs
    Travelled he with wandering wings:
    Many summers, many winters---
    I can't tell half his adventures.

    At length he came back, and with him a She,
    And the acorn was grown to a tall oak tree.
    They built them a nest in the topmost bough,
    And young ones they had, and were happy enow.
    But soon came a woodman in leathern guise,
    His brow, like a pent-house, hung over his eyes.
    He'd an axe in his hand, not a word he spoke,
    But with many a hem! and a sturdy s

    • On top of old Smokey
      All covered with snow
      I lost my true lover
      For courting too slow.

      Courting's a pleasure
      And parting is grief
      A false hearted lover
      Is worse than a thief.

      A thief will just rob you
      And take what you have
      But a false hearted lover
      Will lead you to the grave.

      -------

      On top of Old Smokey
      All covered with hair
      Of course I'm referring
      To Smokey the Bear!

  • "You may say she died from a ruptured ventricle. But I know she died of a broken heart."

  • The ended up frying his brain so he would forget the woman--and all sorts of other stuff like his job. I think in the end it was actually something different and they fried his brain for nothing.

    • by santax ( 1541065 )
      Yes that House looks a lot smarter than he actually is. I have seen him make many mistakes before and only in the end - when the patient is almost dead - the insensitive clod decides to really look into it and finds the textbook-solution. Bit of a prick that fellow.
      • Re: (Score:3, Funny)

        by hey! ( 33014 )

        You want to know what a *real* prick acts like?

        Well, once years ago I had a job that included administering the company's minicomputer system. I screwed up a routine OS update, which was easy to do back in the closed source days when package Unix was up to each hardware vendor. The vendor gave us this crappy utility to run and I answered one of the questions wrong and before I knew it the company's databases were hosed.

        Fortunately I had backups. Lots and lots of backups. Daily backups going back two week

    • This is slashdot. You think any of us have women in our lives that can break our hearts? Pfft!

      No, Mom doesn't count.. and if she did... eeewww!

  • by Anonymous Coward on Wednesday February 10, 2010 @09:34AM (#31084708)

    Liquid N2 can also break your heart. Shatter it actually

    • Actually, the N2 doesn't break the heart, the hammer does.

      Some would argue that the N2 is actually superfluous in that situation.
      • It really depends on what you define as breaking it. I'm fairly sure that immersion in liquid nitrogen would stop it functioning. The hammer would, presumably, be for comedic effect, or possibly for reducing the heart into little pieces that could, more easily, be turned into jerky.
        • It really depends on what you define as breaking it.

          If it's still beating, it's not broken.

          Further, you probably shouldn't be "applying" a hammer to a beating heart. The owner might become irritated.

    • Re: (Score:3, Informative)

      Or perhaps not [straightdope.com].

    • Liquid N2 can also break your heart. Shatter it actually

      Yeah, I hate it when that happens. Wait, what were we talking about again?

    • by hey! ( 33014 )

      However it does allow you to drive a nail with your banana.

    • by sorak ( 246725 )

      They may say she died from a burst ventricle, but I know she died of a broken heart.

  • " the heart muscle in broken-heart-syndrome patients is stunned in the adrenaline surge and appears to go into hibernation. Little tissue is lost."

    I am not (as is probably abundantly obvious) a doctor; but that sounds substantially more treatable than the normal kind, albeit with all the same caveats about how serious each minute without a heartbeat will be for all your other systems, particularly the brain. It sounds like you wouldn't need to deal with the stents and shunts and bypasses and things, just
    • Re:Hmm... (Score:5, Informative)

      by Dunbal ( 464142 ) * on Wednesday February 10, 2010 @10:07AM (#31085018)

      I am a doctor.

      The problem is recognizing that there actually is a problem. So many patients come in complaining of chest pain. However medicine is never about what the patient "says" is the problem (subjective data) but rather what we can objectively observe to be the problem. That's because medicine is about science, not speculation. The clinical history orients us to a range of possibilities (chest pain can be anything from muscular to pulmonary to digestive to cardiac/great vessel to neurological problems). We then ask further questions and perform tests to exclude/include certain conditions.

      Because chest pain is so vague and also so common, we rely on EKGs and cardiac enzyme tests to confirm a diagnosis. Now there's a whole argument that the consequences of a heart attack are so severe that if there is doubt, we will treat it as a heart attack solely on strong clinical findings even when tests are inconclusive. However what usually happens is that the clinical history (heart disease in the family, patient age, blood pressure, cholesterol, diabetes, obesity, smoking, previous heart attacks) doesn't point to a heart attack, nor is the type of pain consistent with angina, and therefore the pain is "written off" as Treitze syndrome [wikipedia.org], either correctly or incorrectly. The patient is sent home. And usually NOTHING HAPPENS. It's very rare that patients are sent home to die of a heart attack.

      However a study like this (provided it receives more supporting studies) opens up a few more possible diagnoses. However I would argue that the actual "mortality" (how many people die) or "morbidity" (how many people are permanently damaged) of this "broken heart" syndrome is very very low. So now do we treat anyone with chest pain as a heart attack "for the benefit of the doubt"? How much will this cost both the patient and the tax-payer in public health systems? Hell, if we're going to treat everyone, we don't even need doctors anymore, right?

      No - medicine is still about evaluating a patient and the risks and benefits of treating versus telling them "take 2 tylenol and call back in the morning". As far as I am concerned this type of information changes nothing as there is no significant evidence that people actually die this way. While this so called "broken heart" syndrome can degenerate into dysrhythmias and/or plaque rupture and heart attacks, well, we already know about those.

      • Re:Hmm... (Score:4, Interesting)

        by MMC Monster ( 602931 ) on Wednesday February 10, 2010 @12:01PM (#31086570)

        I am an interventional cardiologist, and I see a new case of Takotsubo cardiomyopathy about once every 3-4 months.

        It really is strongly associated with high levels of stress, and most individuals (who reach the hospital) recover within a month.

        Unfortunately, when they present to the hospital, they appear as a very large heart attack, with chest pain, shortness of breath, congestive heart failure (fluid in the lungs due to a weak heart), low blood pressure and EKG changes consistent with a heart attack. The coronary arteries are normal, and the heart muscle has a pathonemonic shape. The nice thing is that if you can support them over the first couple days in the hospital, they do recover and go back to normal.

        The wikipedia article on the topic is quite good, by the way.

        • Re:Hmm... (Score:4, Interesting)

          by Dunbal ( 464142 ) * on Wednesday February 10, 2010 @12:18PM (#31086806)

          when they present to the hospital, they appear as a very large heart attack, with chest pain, shortness of breath, congestive heart failure (fluid in the lungs due to a weak heart), low blood pressure and EKG changes consistent with a heart attack.

          GP here. Perhaps I didn't express my point clearly enough:

                With such presenting signs, there is NO WAY such a patient is going to be "sent home" anyway. So frankly the original article is just a bunch of sensationalist writing trying to imply something new about things that we already know. OK, it's nice to have a name for it. Yes, there's probably a constellation of signs that differentiate it from the "non-Takotsubo" AMI which you as a specialist know all about. The prognosis is probably different, from what you imply. However my point is we've known that stress is one of many risk factors for AMI for years. What's new?

          The nice thing is that if you can support them over the first couple days in the hospital, they do recover and go back to normal.

                I should hope that any patient presenting dyspnea and left side heart failure gets all the support (s)he needs anyway, with or without elevated troponin levels and ST alterations...

                Me I'm thinking of the hordes of people who love to clog up emergency rooms because they've "discovered" a new disease and they think they have it. Kind of like the recent H1N1 epidemic. I bet more people died in the hallways of packed emergency rooms of (name your favorite common pathology) than H1N1 last year while medical staff screened everyone who claimed to be sick. I think some medical information should stay within the medical community. Like pilots are told on obtaining their license: "congratulations, now you know just enough to kill yourself".

          • Re:Hmm... (Score:4, Informative)

            by MMC Monster ( 602931 ) on Wednesday February 10, 2010 @03:57PM (#31089930)

            With such presenting signs, there is NO WAY such a patient is going to be "sent home" anyway. So frankly the original article is just a bunch of sensationalist writing trying to imply something new about things that we already know. OK, it's nice to have a name for it. Yes, there's probably a constellation of signs that differentiate it from the "non-Takotsubo" AMI which you as a specialist know all about. The prognosis is probably different, from what you imply. However my point is we've known that stress is one of many risk factors for AMI for years. What's new?

            What's different is that this isn't an AMI at all. Myocardial infarction quite literally means death of the myocytes (heart muscle). In this cardiomyopathy, there is little if any dead muscle. There's a lot of stunned muscle. The difference is that if the muscle dies, there's nothing that can be done to make it move again. If it is stunned, it will move again on it's own, given enough time to recover.

            The other thing is that the stress that causes Takotsubo cardiomyopathy causes a very different effect on the heart than the stress that causes an acute myocardial infarction. In AMI, the stress causes plaque rupture in one of the coronary arteries, leading to thrombus formation within the coronary artery and obstruction to the flow of blood. In Takotsubo, it's unclear what the stress actually did, but it certainly isn't causing a demonstrable plaque rupture. It's possible that it's causing transient spasm of the left main coronary artery, or possibly spasm of the entire capillary bed.

            Also, Takotsubo cardiomyopathy has been known about for more than a decade. It just gets in the news every Valentine's day or so. :-)

          • by sjames ( 1099 )

            I think I see the disconnect here. The concern is not that a patient who needs care will be sent home, the concern is that a patient who needs only supportive care will be aggressively treated for a heart attack unless the correct diagnosis is made.

      • However medicine is never about what the patient "says" is the problem (subjective data) but rather what we can objectively observe to be the problem. That's because medicine is about science, not speculation.

        It's fallacy to ignore the mental state of a patient. What they say and believe is very much relevant, though should probably be weighted lower than actual observable symptoms. To call such info speculation rather than science is an insult to those that that deal with mental health in a scientific manner. Just because you can't glean useful info from it doesn't mean another person can't, and doesn't mean it isn't science.

        Handwriting analysis... micro expressions... fiction is now being proved as science alm

      • by sjames ( 1099 )

        It's actually quite the opposite. It is condition that can look a LOT like a heart attack including abnormal EKG but calls for a less aggressive treatment if it can be distinguished.

        Of course, since it appears to be quite rare, it may not be at all significant in practice.

      • by Velex ( 120469 )

        That's because medicine is about science, not speculation.

        I have a bone to pick. Explain the treatment of transgenderism. Why is it that hard evidence such as brian scans are discarded in favor of armchair pontifications such as autogynephilia? Why is electroconvulsive therapy being added to the DSM again when it clearly doesn't work in treatment of homosexuality and transgenderism?

        I have another bone to pick. Explain routine male genital mutilation. Why is evidence that it is merely a cosmetic operation (if you can call a procedure performed by a nurse wi

    • That is still no comfort at all if you are an hour away from medical attention, but it seems like it could be quite valuable for the cases that do make it to hospital before their brains are irrecoverable mush.

      And for those whose brains are mush, they can get a job as a Windows admin.

  • by Joe The Dragon ( 967727 ) on Wednesday February 10, 2010 @09:44AM (#31084816)

    new pre existing condition a bad relationship right next to rape on the list.

  • I'm sure I saw this in an episode of Scrubs or something.
  • ...told us all this a long time ago.
  • by bytor4232 ( 304582 ) on Wednesday February 10, 2010 @10:16AM (#31085132) Homepage Journal

    My great great grandmother went out that way. They immigrated from Scotland together, ran away to america as teenagers since her father wouldn't let them marry. Two days after my great great grandfather died, she passed away. They couldn't find a reason.

  • Padme really did die of a broken heart!
  • by iB1 ( 837987 )
    There was an episode of Scrubs which featured something like this. A woman who had broken up with her fiancé was admitted to hospital after fainting and other symptoms of a heart attack. Tests didn't reveal any heart abnormalities, but Dr. Cox diagnosed her as having a broken heart due to the stressful breakup.
  • First we're told that we actually can be bored to death [slashdot.org], and now we're being told that hearts can actually break. What's next, that a watched pot actually never boils? That you really do attract more flies with honey than vinegar? That you really can be up on cloud 9? That video games really do make you fat? That a spoonful of sugar actually helps the medicine go down?

    After a year, we'll find out that pigs can actually fly, and that Hell can actually freeze over! ;)

    • by Nidi62 ( 1525137 )

      After a year, we'll find out that pigs can actually fly, and that Hell can actually freeze over! ;)

      Im sure there's a bad H1N1 joke in there somewhere, but I cant find it.

    • After a year, we'll find out that pigs can actually fly, and that Hell can actually freeze over! ;)

      Well, last year swine flu - it was all over the news. Also, I'm pretty sure Hell [wikipedia.org] freezes over every winter.

    • 'That you really do attract more flies with honey than vinegar?'

      No, you don't (e.g. [xkcd.com])

      • 'That you really do attract more flies with honey than vinegar?'

        No, you don't (e.g. [xkcd.com])

        I knew that, actually. I was waiting to see how many replies it'd take before someone posted that exact link.

  • by GaryOlson ( 737642 ) <slashdot AT garyolson DOT org> on Wednesday February 10, 2010 @10:27AM (#31085284) Journal
    "You are so beautiful, if you don't talk to me I could die of stress-induced cardiomyopathy"
  • When this girl I was seeing in Wow left me, I became sick and was hospitalized for 3 weeks... I was hoping we would marry in real life.

    I still think of her sometimes...

    Oh, life sucks.
  • Reversed Knowledge (Score:3, Informative)

    by DynaSoar ( 714234 ) on Wednesday February 10, 2010 @11:04AM (#31085790) Journal

    "...while strong emotions like grief are usually associated with the syndrome, stress or a migraine can also trigger such heart attacks."

    Could someone please educate the author, and if necessary the researchers (though I doubt it necessary) that strong emotions like grief are stressors, as are physiological disorders like migraines? Stress is the set, grief a subset. TFA seems to imply otherwise.

    Any pressures to the system are stressors, and the system requires stress in order to function. Problems are due to poor handling of stress, which is called dis-stress. Turning stress to motivation is called eustress. Too much of the former (or too poor a job at handling it) can cause damage.

  • So, instead of G.U.I.L.T. [wikipedia.org], it's G.R.I.E.F.?

  • This was the diagnosis in episode 121 of Scrubs "My House" [wikipedia.org]

    Which was a parody of Dr. House by Dr. Cox in general but borrowed the following week's House diagnosis, episode 311 of the House MD "Words and Deeds" [wikipedia.org]

    back in good ole January 2007. WSJ is so behind the times. ;)
  • 'broken heart syndrome' is a phenomenon, not a phenomena.
  • It's best just not to feel anything.
  • Looking forward to liver-stealing lesbians coming to slashdot.

    Also, "a phenomena" - seriously?
  • Having worked on death claims on life insurance in the past I've seen plenty of cases of elderly couples where the wife dies first and the husband dies soon after, but I'm pretty sure that they don't die of a broken heart. Instead my theory is that they don't look after themselves properly, since if all of a sudden you have to cook for yourself all the time it's a bit of a struggle, and it may be that many of them are still used to the traditional roles of wife as homemaker, husband as breadwinner, so it's

For God's sake, stop researching for a while and begin to think!

Working...