Friedman and colleague Dr. Ray Rosenman began to write about the association between behavior and heart disease in scientific papers during the 1950s. They used their observations for a popular 1974 book,
Type A Behavior and Your Heart. "Type A personality" soon became a popular term, used for people who are chronically impatient and exacting. The work of Friedman and Rosenman began new inquiry into the association between mental states and heart disease, still being debated and investigated. Friedman "put the whole issue on the map and generated a lot of research around it. He was groundbreaking in that sense," said Dr. Stephen Fortmann, a
Stanford University professor who directs its Center for Research in Disease Prevention. Friedman and Rosenman shared a cardiology practice in San Francisco during the 1950s, when they began to question the conventional wisdom about the major risk factors of heart disease. The classic risk factors, such as diet and cholesterol, "could not explain the relative epidemic of coronary disease in Western countries," said Rosenman, now dead, "because [diet] really hadn't changed. Nor had cholesterol."
Observation of chairs The discovery of the Type A behavior was accidental and it involved furniture. In the waiting room of the practice run by the two doctors, the chairs badly needed
reupholstering. What was unusual was that the chairs were worn down on the front edges of the seats and armrests instead of on the back areas, which would have been more typical. The doctors later observed that those chairs were chosen by coronary patients, who tended to sit on the edge of the seat and leaped up often, typically to ask how much longer they would have to wait for their appointments to begin. They were evidently both tense and had heart problems. After some initial observations, the doctors hypothesized that there was an association. Friedman began some studies. In one, he observed 40 accountants, to see if their
cholesterol levels increased as a result of the
stress of tax season. "In March, their cholesterol shot up," said Dr. Gerald W. Friedland, a Stanford University professor
emeritus of
radiology who collaborated with Friedman on ''Medicine's 10 Greatest Discoveries'', a 1998 book.
Reaction Other doctors reacted skeptically to the Type A theory. "A lot of physicians, particularly cardiologists, are severe Type A's," said Rosenman, who rated himself a "Type A-minus." But the concept was endorsed gradually by the popular culture, with "Type A personality" becoming a cliche'—one that irritated its authors. "You can't change personalities," Friedman often said. "We just try for more B-like behavior." During the decades ensuing, Friedman would casually diagnose public figures as Type A or B from photographs, seeing such telltale signs as a clenched jaw or pinched look between the eyes. He said
Lyndon Johnson was Type A and
Ronald Reagan was B. Friedman developed a therapy regimen to modify Type A behavior. During the 1980s, he managed a study that showed that risk of
heart failure could be decreased dramatically when Type A sufferers learned, essentially, to become more relaxed (see details, below, in Research section). He wrote a 1984 book based on those findings,
Treating Type A Behavior and Your Heart, that described how the people of the treatment group had new heart failures at about half the rate of those of the control group. It included a chapter concerning women, whom he found were not immune to the syndrome.
Treatment of Type A In treatment programs, Friedman used a series of exercises to teach Type As to emulate the mellower, more thoughtful behavior of people with Type B personality. He would ask them to leave their watches home for a day, to drive in the slower lanes, to choose the longest lines in grocery stores, and consciously to observe and talk to other people. To force Type As to relax, he prescribed reading
Marcel Proust's
Remembrance of Things Past—all seven volumes. "He encouraged people to read any and all of the classics. He saw it as a way for people to re-energize or strengthen their right brain"—the creative side—"which he felt atrophied in people with Type A behavior," said Dr. Barton Sparagon, medical director of the Meyer Friedman Institute at
San Francisco's Mount Zion Medical Center. Other sessions concentrated just on smiling because Type A's more typically had a hostile grimace. "Sweetness is not weakness," Friedman would often tell his patients. When he encountered resistance, he quoted
Hamlet: "Assume the virtue even if you have it not . . . for its use almost can change the stamp of nature."
Friedman as Type A personality Friedman was classic Type A and he often cited this in his lectures, emphasizing that he had two
coronary bypass operations at an early age. Friedman suffered an
angina attack in 1955 when he was 45 years old and had the first of two heart failures 10 years later at age 55. As a result of this, Friedman attempted to alter his own type A personality to reduce stress. He would observe that the frantic drive in people with this behavior is not always the sign of a successful person. "Type A personalities who succeed do so in spite of their impatience and hostility," he said, listing among the more notable Type Bs
Winston Churchill,
Harry Truman,
Gerald Ford and
Jimmy Carter. In his own case, formulating the theory of Type A behavior was just one of many achievements. Friedman contributed important discoveries to the study of
gout and cholesterol and helped develop the
angiogram. ==Research==