How to Be Your Own Worst Enemy

Type A Behavior and Your Heart

by Meyer Friedman MD and Ray H. Rosenman MD
Knopf, 276 pp., $7.95

It is not very surprising that, pounding away as they do, day and night, the muscles of the heart need a rich supply of blood. One might be tempted to think that with blood sloshing around in the heart all the time, nothing much more was needed, but nothing could be farther from the truth: special arteries, the coronary arteries, supply the musculature of the heart; indeed, about 5 percent of the heart’s output of arterial blood is appropriated to its own nourishment. The coronaries are thus the most important arteries in the body and coronary heart disease (CHD) is proportionately important as a cause of distress, ill health, or death—nowadays affecting people in their mid-thirties and early forties as well as in later life. The menace of CHD is fully recognized and fearfully acknowledged in the form of the many jujus by means of which people try to propitiate the angry god; among their number Friedman and Rosenman report: take no animal fats / soft water / sugar; jog / jog not; so perhaps we should not be surprised to learn that abstention from sexual intercourse is included in this collection, for it is part of the Puritan ethic that any activity so pleasurable must be harmful.

The authors’ own message is a much simpler one: CHD is of behavioral origin and in particular is associated with the behavior pattern they classify as Type A:

In the absence of Type A Behavior Pattern, coronary heart disease almost never occurs before seventy years of age, regardless of the fatty foods eaten, the cigarettes smoked, or the lack of exercise. But when this behavior pattern is present, coronary heart disease can easily erupt in one’s thirties or forties. We are convinced that the spread of Type A behavior explains why death by heart disease, once confined mainly to the elderly, is increasingly common among younger people. [Page ix]

Many newspapers and periodicals offer occasional quiz features in which readers are invited to score their answers to a list of impertinent and sometimes offensive questions. By comparing their marks with a table of norms decided upon by a panel of experts—perhaps a fashionable hairdresser, baseball pitcher, Pulitzer prize winner, and psychiatrist—a reader can decide whether he is a truly great or a merely ordinary husband/lover/cook/ judge of claret/etc., or whether he is just a regular guy. For some time to come such quizzes are likely to turn on whether a reader is of Type A or Type B.

We probably first recognize Type A behavior in prep school when a master asks round a class a question to which one boy knows the answer—a boy who waves his arm to and fro in a real agony of superior knowledge, saying, “Oh, please sir, ask me sir, ask me.” Type A behavior, we are told, refers to a complex of personality traits including:

…excessive competitive drive, aggressiveness, impatience, and a harrying sense of time urgency. Individuals displaying this pattern…

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