The Type ‘A’ Personality and Heart Attacks

GUEST: Jane Brody
VTR: 12/26/80

I’m Richard Heffner, your host on THE OPEN MIND. Earlier today, after a busy yesterday in Los Angeles and a late night flight to New York, I realized how much I was acting out today’s OPEN MIND program, particularly when I sort of watched myself juggling two telephones at once while madly signaling for another rush call to be put through, right away of course, right away. For today’s program is about two types of people: the “A” type, and the “B” type. Actually, it’s about their behavior, particularly about type “A” behavior and what that behavior does to a type “A” person’s chance of having a heart attack. Now, some medical people have begun to research and to write about type “A” behavior and asking for heart trouble. Perhaps I’ve been just too frightened to tackle that subject before this on THE OPEN MIND. But recently I read science writer Jane Brody in The New York Times on “Rushing Your Life Away with Type “A” Behavior”, and I finally decided we had just better talk about the subject, particularly with someone who says she has changed that behavior.

Ms. Brody, thanks for joining me today on THE OPEN MIND. Is it true? Did you really change the behavior from type “A” to type “B”?

BRODY: Well, I certainly would not call myself a type “B”, nor would I even want to be a type “B”. But I have changed certain characteristics, certain parts of my type “A” behavior which I found most objectionable and actually frightening. And the kinds of things that made my life filled with anxiety and anger and made me a relatively unpleasant person to be around 24 hours a day.

HEFFNER: You mean that’s what we call a type “A”?

BRODY: Well, what we call type “A” are people who tend to try to do too many things in too little time, for one thing. They are afflicted with what you call “hurry sickness”. You squeeze in more and more in less and less time. And you schedule yourself so tightly that there’ no way in the world that any normal human being would be able to meet that schedule. And if anything should go wrong, such as the subway doesn’t work or the train is late or the red light doesn’t change, you are bound to be late and anxious as a result of being late.

HEFFNER: Is there someone who doesn’t fit into that description?

BRODY: Well, yes. There are lots of people who don’t run around quite to that extent and don’t feel the need to prove themselves over and over again by doing more and more. There’s a basic insecurity behind type “A” behavior. You’re never satisfied. You keep trying to win other people’s respect and your own self-respect by accomplishing more and more. And there is a limit. There is a point of diminishing returns where, in trying to be superefficient and a superperson, your really become less productive and your work is less good than it would be if you did fewer things in more time.

HEFFNER: Well, why we were waiting before the program, someone inside was asking about type “A” behavior and type “B” behavior – no, not behavior really – but about type “A” people and type “B” people. And I quipped, and I had heard this before, you know, “Type “A” people, they’re dead people”. Maybe I’m being a little too cynical, because you really seem to feel that you can scratch around and find any number of these people. I haven’t met them.

BRODY: You haven’t met type “A” people?

HEFFNER: No, type “B”.

BRODY: Oh, type “B” people.

HEFFNER: I’m sorry if I said type “A”. I was asking what’s, who, if type “A” rushes around as you say and is so time conscious, or maybe unconscious about he realities, the limitations of time, then who are these “B” people?

BRODY: Well, for instance, the pediatrician who treats my children is a type “B” person. Now, when you think of a pediatric practice, you can imagine what that’s like. The phone rings constantly. In fact, you can’t even get through to him on the telephone because the line is always busy. He’s got three examining rooms and there’s a child in each room at all times. There’s always a baby crying or two, and it’s a constant harassment. And yet he is a supercool human being. He takes each problem as it comes. He always has a smile. He’s always cheerful and patient. And you come away from a visit, even if you’ve waited two hours to see him, you come away feeling somehow renewed because you’ve been exposed to a person who takes life in stride instead of pushing it all the time. That kind of tenseness, you don’t sense any of the tenseness. And you really get the feeling he’s taking care of your child even thought you child is relatively healthy and squeezed in amongst all these other screaming, sick babies.

HEFFNER: All right. Now, in terms of the medical researchers, the scientific research that has gone on in this question of type “A” behavior, type “B” behavior, are type “B” people born or are they made?

BRODY: Well, I think it’s a little bit of both. I think one needs to have a predisposition to be pushed into this maelstrom. But a lot of it is environmentally induced. I’m not the kind of person who was ever comfortable, as far back as I can remember, doing nothing. I’m not a sitter. I’m not the kind of person who sits and contemplates the stars, except on occasion when there’s something up there for me to look at that’s interesting. I always had the need to make good use of my time. But that’s not the same thing in my mind as squeezing so many things in. Now, let me try to give you an example. If I needed 20 minutes – this is the past Jane Brody – if I needed 20 minutes to get from one place to another, I left 15. There was no way I was going to be on time. And I’m very compulsive about being on time. Therefore, I was anxious for the whole time that I was trying to get there in less time than it really took. And of course that did not leave any expendable time for mishap, for any kind of normal, human event that can delay you and make you even more anxious. And so now instead, I leave 30 minutes to get to someplace that takes 20 minutes. And I have expendable time. I have time to unwind, I have time to look in a store window, I have time to collect myself, and also to accommodate those unforeseen circumstances which are almost inevitable in modern life.

HEFFNER: How come you were late getting there?

BRODY: (Laughter) Because I had someone on the telephone who is a type “A” who…

HEFFNER: Ah ha!

BRODY: …who has a worse schedule than I have. And I had prevailed upon this person to talk to me. And when he finally called, I couldn’t get him off the phone.

HEFFNER: You know, I had the feeling in reading our pieces on type “A”, type “B” behavior that I read at the suggestion of your article, the book that Friedman and Rosenman had written on “Type “A” Behavior and Your Heart”…I wondered, is this something new? It seems so obvious that you run and run and run and run and that heart is going to run out faster than it would otherwise.

BRODY: I don’t know that the heart runs out, because the heart does not wear out, it rusts out. I mean, your body rusts out. The more you work it, the more efficiently it works. So you don‘t wear yourself out by running around. What you do is you create a chronic stress situation and your body responds to stress by putting out certain hormones which close the blood vessels, which can cause abnormal heart rhythms, which can raise blood pressure, and perhaps encourage the formation of cholesterol plaques in your arteries and make the opening in your arteries smaller. And in that way encourage your body’s tendency to have a heart attack at an early age.

HEFFNER: Is it true though, that doctors have not dealt with this phenomenon until comparatively recently?

BRODY: Yes, it is true. It’s true, what is known about the risk factors, the factors that increase your chances of having a heart attack has been developed through what we call epidemiological studies. You study a large population and find characteristics that seem to prevail in that population that are associated with a greater risk of heart attack. And what have epidemiologists who studied this thing isolated? They’ve isolated high blood pressure, they’ve isolated high blood cholesterol levels, cigarette smoking, overweight, sedentary living. Those were measurable factors, easy to measure in a population. And those were considered the major risk factors of heart disease. Stress, or various components of the personality that may contribute to it were relatively ignored because nobody knew how to measure them, and because they seemed in the dichotomy that we’ve made in American medicine where we separate mind and body, you know, we’ve just begun to bring mind and body back together again. But for many, many years it was separated, and the cardiologists, the scientific doctors who study how your body works really didn’t know very much about how the mind works and what effect the mind has on the body, which is considerable. I mean, we are in fact one integrated organism.

HEFFNER: And now with the greater and greater practice of holistic medicine, is there a greater awareness in your estimation on the part of not just cardiologists, but physicians generally?

BRODY: Well, I think so. And I think it will grow. There’s certainly a greater recognition from the top down, from the establishment, the people who, for instance, run the National Institutes of Health are beginning to recognize that there is something here that is not just hoping that not only can the mind help to heal the body, which has long been known. I mean, after all, that’s what witch doctors and general practitioners of yore had to go on. They didn’t have anything…

HEFFNER: Putting them together?

BRODY: Yes. Absolutely. All they had was a bedside manner until very recently. Bloodletting certainly didn’t cure anybody, and that’s what they used to do in medicine. Until the advent of, until the 20th century really, there ws no such thing as a positive medical measure that promoted healing. It was all kind of the laying on of hands and the authority of the wise physician and whatever you had going for you inside you that helped to heal you. These days, I n fact, the advent of scientific medicine detracted form the value that doctors of yore place on the mind. So now we’re coming back in the cycle. And holistic medicine has forced the issue. People have begun to realize that not only does the mind help to heal a person, but the mind can make a person ill.

HEFFNER: I was interested with one particular thought as I read your material and this volume on “Type “A” Behavior and Your Heart”. This has been a generation of increasing stress upon an awareness of feminine rights, privileges, prerogatives. And they seem to be rights, privileges and prerogatives to imitate what men have done. Is there any evidence that women are now beginning to kill themselves with type “A” behavior as we men have?

BRODY: No, there isn’t. In fact, thus far, it looks as if so-called executive women live longer than the ones who stay at home and take care of babies.

HEFFNER: How will you figure that in these terms?

BRODY: Well, first of all, the rate of heart disease in women before menopause is very much lower for biological reasons. The hormones protect us against, the feminine hormones protect us against heart disease to a very great extent. And what we need to look at, which we haven’t yet because there aren’t that many who’ve reached that age, are the women in executive stress positions who are past the age of 50 and whose heart attack rate in the general population just starts soaring after that. Whether women will ever catch up and at certain age groups have the same death rate as men remains to be seen. But to me there is no question that that kind of stressful life is a relatively undesirable way to live. I mean, some people seem to thrive on constant activity. Sometimes you begin to think that maybe they don’t want to stand still long enough to find out what they’re about.

HEFFNER: When you say thought that some people seem to thrive on constant activity, that doesn’t work against the general notion that constant activity and time consciousness and doing too many things at the same time, that those help produce the situation that produces heart attacks. I mean they may look well, and I suspect that what has been discovered is that they may keel over also.

BRODY: That’s right.

HEFFNER: The thriving doesn’t mean living longer, does it?

BRODY: Not necessarily. Not necessarily. But thriving, I mean, you can fill your time and enjoy every minute of it and not have that constant pressure, that constant stress and that anxiety, and there is another dimension which we haven’t discussed, the anger and underlying hostility that is very common in the type “A” personality. It’s anyone who tries to get in your way, someone who looks at you crosseyed or says something sort of snide or nasty or, it may have nothing to do with you whatsoever, but you tend to get angry very easily, you have a short fuse. And in people who are, you know, afflicted with “hurry sickness” who are trying to do so much, well, lots of things are going to get in their way and going to appear as if they’re trying to thwart them.

HEFFNER: Well, “hurry sickness”. I guess as a journalist you’re not going to say that our times have been marked by a decrease in hurry, hurry, hurry, and that the nature of American life seems to put a greater and greater, not a lesser, emphasis upon “hurry up”.

BRODY: That’s right. And it’s more than just “hurry up”. It’s being accomplished. The whole American society is geared toward what I would call “The Little League Syndrome”. You know, you have to get in there, and the parents are in there rooting for those little seven-year-olds, “By golly, you’ve got to win, you’ve got to win”. The emphasis is on being number one, on being the best. Even things like the gifted children programs which focus attention on accomplishment, on being tops right early on in life, and put a lot of pressure on people. There’s only one person who can be at the top.

HEFFNER: But then what does that say about longevity in this country?

BRODY: Well, it says, for one thing, this country’s leading cause of death is chronic disease and heart disease, particularly the disease we’re talking about. And that the increase in life expectancy in the United States in this century has been, prior to the age of 40, has been through the accomplishment of the ability to cure infectious diseases and to keep children alive, to keep infants alive. The increase in life expectancy for people aged 50 and above has only been four years. It’s very, very, very slight, whereas the whole American lifespan has moved from 47 to 70, approximately. Once you’ve reached the age of 50, you’ve only gained four years since the beginning of the century. That’s not very much.

HEFFNER: Well, you know, the phrase “quality of life” comes up so frequently. And I know in your articles and in this little volume there’s reference to enjoying a better life if you start acting like “B” instead of like an “A”. But for many people it must be burning bright, burning the candle at both ends that it makes such a lovely, lovely light while you do it. Are physicians saying that the quality of life is better by becoming a “B”? Or do we give up something by moving from this frenetic activity, this “A” activity?

BRODY: Don’t you think the quality of life is improved by the feeling that you have that on Friday night you can go to a concert and have dinner after the concert and not be anxious about a report that you have to get read by the end of the weekend?

HEFFNER: Yes, but you’re describing something that I guess so many of us feel is a description of who we are and what we are and that it’s a description of what has enabled this nation, certainly in this century, vastly to increase its productivity.

BRODY: Ah. Well, here’s a very interesting point. Because there have been measurements made of this. And patients, these are mostly patients who have had heart attacks. It’s very difficult to get someone who hasn’t’ been scared to death to change and to give up some of his type “A” characteristics. But the interesting thing is that people who thought that their productivity was inexorably tied to pushing, pushing, pushing, constantly being on top of everything, being in control of every situation, that when they learn to modify their behavior, when they learn to delegate responsibility a little bit, when they learn to do a little bit less in more time, that their productivity actually increased, that so much was lost in this rushing, they thought they were getting a lot done but they actually didn’t. They got less done than when they took things at a slower pace.

HEFFNER: Is type “A” behavior essentially an economic phenomenon, or a phenomenon of being part of an upper achieving class?

BRODY: Well, it hasn’t been studied in lower classes. It has not been studied in the working class. Whether the factory worker has this same motivation, you know, the circumstances don’t really allow him to express that motivation. A factory worker is not rewarded for doing more in less time. A factory worker is punished by being given more to do.

HEFFNER: Well ten doesn’t that indicate that there is some connection between achievement and being a type “A” person?

BRODY: Yeah.

HEFFNER: Well then, if you take away, take the type “A” out of the type “A” person…

BRODY: Okay, but you’re trying to throw out the baby with the bathwater. And I‘m suggesting that we keep a little bit of both of them. There are parts of the type “A” behavior pattern that are really counterproductive. And I think those are the things that need to be changed. I’m not suggesting, and I certainly, I would be the last one to suggest because I live my life doing, I mean, I get my kicks out of accomplishment. I’m not happy when I don’t have several projects going at the same time. I sort of feel, well, my mind should be used more constructively. But there are, there’s just a limit. And you have to learn where the limits are and how to adapt your mentality so that you’re not frantic.

HEFFNER: Do you think this has to do with what Gail Sheehey had called “passages” and that we’re reluctant to see the need in passage from middle age or a younger, more vigorous period in our lives, into upper middle age, the need for changing those life patterns?

BRODY: Certainly we’re reluctant to do that. And I think that probably if you’re going to do a population survey by age that you would find the highest percentage of type “A” characteristics in people in their mid-twenties to mid-thirties. You know, the ones who feel that life has to, you know, they’ve got to get everything done now while they’re young and vigorous. And also…

HEFFNER: That doesn’t seem like such a bad idea, does it?

BRODY: …and also because that’s the age where you feel a definite need to prove yourself. It wasn’t until I turned 35, I think, that I began to let loose a little bit and say to myself – and I say this often to myself – “I’m good”. I don’t have to prove to anybody that I’m good. I don’t have to accept every assignment somebody thinks I should do just because I’m not confident in the quality of my work and that I have to prove to everybody that I can do anything anybody asks me to do. I no longer feel that.

HEFFNER: Well, what about the studies by cardiologists of those who have developed heart problems younger rather than older? Is there a feeling too that those heart difficulties are related to the behavior of the type “A” person?

BRODY: Yeah, it certainly is. I mean, that’s what Rosenman and Friedman have found in their studies, that the incidence of premature heart attack, you k now, those heart attacks that occur in the prime years of life, in the forties and fifties, are very much related to type “A” behavior. In fact, Friedman will tell you that 98 percent of people who have heart attacks in their forties and fifties show very, very, score very high on his rating system for type “A” behavior.

HEFFNER: Okay, now, is there any indication , any evidence that there is a movement away, since there is concern now and a recognition of this type “A” behavior on the part of physicians, is there any indication that there…You did indicate, you did say that they’re becoming more aware of this.

BRODY: Yeah.

HEFFNER: The cardiologists are.

BRODY: Well, cardiologists are, and there are psychologists who are trying to help people modify their type “A” behavior. This is a new business, and there are very few cardiologists who are yet instituting specific remedies the way you hand someone a diet, a low-fat diet when he’s had a heart attack. There are very few who hand their patients a list of type “A” characteristics and how to modify them. This is really just, we’re on the ground floor of this type of thing. But let me tell you about the response to these articles that I had in The New York Times. I got the most incredible mail. I got a letter from someone who said, “You saved my life”. I got another one that said, “You saved my marriage”. I got a frantic phone call from somebody who said, “Please help me! I read your article and I know that I am a candidate for tomorrow’s heart attack”. And, you know, I was so touched by the frantic nature of the call that I actually spent a half an hour on the phone with this person trying to, you know, guide him to a more reasonable way of life.

HEFFNER: That’s what puzzles me a bit, because, you know, I remember my grandmother telling me these things. Folk wisdom perhaps?

BRODY: Yes.

HEFFNER: That’s why I wonder whether this realization that you can run yourself to death, however you describe it, type “A”, type “B”, it is doing too many things. What real chance is there that there will be modification any more than there will be modification of the way this nation functions generally in terms of success, in terms of productivity, etcetera?

BRODY: Well, I think there will be. I don’t know how long it’s going to take, but there was an article in, I think it’s the December issue of Savvy Magazine about the time pressured life led by so-called “superwomen”. And I happen to be one of the people who was interviewed for that article. And boy, I came out smelling like a rose, because…

HEFFNER: They said, “That laid-back Jane Brody”.

BRODY: (Laughter) Compared to the other women in the article, you know, my life was at least filled with exercise and a concert and, you know, swimming and what have you. Whereas some of those others just didn’t even have time to say, “Good morning” to their husbands.

HEFFNER: But that’s because they’re in the midst of being very productive, right?

BRODY: Yeah. They were in the midst of being very productive. And I think I’m very productive, too, without having quit that level of constant activity, of canceling lunch dates and telling your husband no, you can’t go because you have too much work to do. I just don’t say that anymore.

HEFFNER: We’ve got a half-minute left, and we’re supposed to be very frantic about that. But I wondered about a nation that doesn’t even preserve its natural national resources about preserving its personal resources.

BRODY: Well, I think it’s up to the individual. And I suggest that people start thinking about how they lead their lives, and think about enhancing the quality, not just the quantity of life.

HEFFNER: Jane Brody, thanks very much for joining me on THE OPEN MIND. Maybe our viewers won’t rush their lives away with what you’ve called and others have called type “A” behavior. Thank you.

BRODY: Thank you.

HEFFNER: And thanks, too, to you in the audience. I hope that you will join us again on THE OPEN MIND. Meanwhile, as an old friend used to say, “Good night, and good luck”.