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Our lifestyles and past life experiences can promote or interfere with our being healthy. Type D Personality and Heart Attacks By Jerome Burne September 4, 1999
Well, they're dead, but it's not work that's done them in. They've been killed off by the inconvenient fact that many high achievers remain perfectly healthy as they elbow past the rest of us on their way to the top. In fact, they often flourish. The latest research suggests that a collection of rather less glamorous personality types are out there courting illness and premature death. And while Type A hurtled toward intensive care in the fast lane of life, the latest prime candidates for a bypass can barely get on the on-ramp. One newly identified heart attack magnet is the Type D personality, an anxious, gloomy and socially inept worrier: sort of a mixture of Eeyore and Marvin the paranoid android. The Type D personality was discovered by Professor Johan Denollet, of Antwerp University. "We gave personality questionnaires to a group of 87 men who had had a heart attack," he said. "After 10 years those who scored high on the traits of social ineptness and anxiety were four times more likely to have had further attacks." In other words, personality appeared to make a 400 percent difference to their chances of survival. Type D arrived on the medical scene to lukewarm approval -- the professionals say far more research is needed -- but he has already gained companions. A fellow in misery, who doesn't have a name yet -- Type P for pessimist would perhaps be appropriate -- was announced this month by Vicki Helgeson of Carnegie Mellon University. She found that heart attack patients who were pessimistic, had a low opinion of themselves and felt they had no control over their lives, were three times more likely to suffer a second attack. A rather erratic relative of these two is the ER -- which stands for "emotional responder." Dr. James Blumenthal of Duke University Medical Center says that ERs are highly volatile. When they're up, they're really up, but when they're down, they plumb the depths. Blumenthal tested over 100 ER heart patients and found their mood swings reduced blood flow to the heart, which increased their risk of another attack by four times. What Type D and friends do demonstrate, however, is that there is a dimension to treating heart attacks -- and probably many other illnesses -- that modern medicine is ill-equipped to handle. Doctors tend to treat the body as a machine. If you have heart problems you will be offered pills to regulate various body chemicals and, if that fails, surgery. A pill that reduced the chances of a second heart attack by 400 percent would have millions of research dollars thrown at it, but coronary patients are lucky to get a few words of advice on relaxation and lifestyle. The hope is that these findings about the link between illness and personality could lead to approaches that are not entirely mechanical. Type Ds, for instance, have a very negative style of thinking and constantly blame themselves, so instead of filling them up with beta blockers, why not give them cognitive therapy to help them think more positively? ERs might respond much better to being taught relaxation than swallowing a course of tranquilizers. But the real message from Type D and his friends goes much deeper. This research raises profound questions about the relationship between our minds and our bodies. Conventional medicine sees it as a one-way street. Our minds are seen as a kind of froth on top of our brains: if there is a problem with the mind you treat it by treating the brain. But then how do such insubstantial things as having low self-esteem or believing you are in control, have a direct effect on something as robustly physical as the heart? A few months ago some results came in which may shed some light on this. Dr. Dominique Musselman, of Emory University in Atlanta, studied a group of depressed patients, who have much in common with the Type Ds and Type Ps. Depression is known to be a strong predictor of heart attacks, increasing your risk four times. Musselman found that depressed people had 41 percent more sticky platelets in their blood than normal volunteers, making it more likely that their blood would clot. She then discovered that giving them Prozac, an anti-depressant, virtually returned the blood to normal. The big question then became: Was this because the drug was affecting the blood directly or because just feeling more cheerful make the patients' blood less sticky? Early results from her current work suggest that if you take an antidepressant and your mood doesn't change, then neither do your platelets, but if a placebo makes you feel happier, then your blood stickiness drops too. That's a powerful indication that your mood can have a big physical impact on your body. We don't yet know to what extent Ds and Ps and ERs are likely to have heart problems in the first place. Even so, the research does suggest that what is going on in patients' heads is at least as important as chemical levels in their bodies.
Journaling for Health After four months, patients with asthma or rheumatoid arthritis who were told to write about the most stressful event of their lives (for 20 minutes on three consecutive days each week) had fewer or less-severe symptoms of disease, while patients told to write about neutal events did not improve. J. Amer. Med. Assoc. 281: 1304,1328, 1999. |
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