Definition of the problemA myocardial infarction is often a vitally and emotionally threatening situation for the affected. Unconscious coping mechanisms in dealing with the heart disease may result in, for example, complete denial or emotional decompensation.ArgumentAn understanding of myocardial infarction as a borderline situation may provide theoretical enrichment for clinicians and point to a third coping avenue, described as “posttraumatic growth”. Affected individuals often refer to the event as a “wake-up call”. Clinical knowledge of these different coping mechanisms may in (...) turn lead to a relativization of primarily subjectivist positions and substantively hedonistic or preferentialist notions of good life or “quality of life”. Such a position would in turn be compatible with the deliberative model of physician–patient communication.ConsequencesIn the light of such a broader understanding of disease coping, the task of (psychosomatic) physicians would thus to accompany persons with heart disease, to be aware of the teachable moment and to enable a process of development for the patients. (shrink)