In 1959, a paper by Meyer (Mike) Friedman and Ray Rosenman appeared in the Journal of the American Medical Association entitled "Association of specific overt behavior patterns with blood and cardiovascular findings: Blood cholesterol level, blood clotting time, incidence of arcus senilis and clinical coronary artery disease." (Friedman & Rosenman, 1959) The subtitle linking specific behavioral traits with things like blood cholesterol, clotting time, arcus senilis and coronary disease that had no apparent relationship to each other must have seemed strange to many readers. Neither of these two cardiologists had any expertise in psychology, which may have been fortuitous, since they had no preconceived notions. What they did have was an unusual combination of curiosity, diagnostic acumen and a bio-psychosocial approach to the patient as a person, rather than someone to be treated in a cookbook fashion based on laboratory tests, symptoms or signs.
As noted, psychiatrists and others interested in psychosomatic disorders had previously described certain personality characteristics in heart attack patients. However, it was not possible to prove that these had any causal relationship since such idiosyncrasies could have resulted from the illness rather than vice versa. Friedman and Rosenman were the first to explain why specific behaviors could cause heart attacks and contribute to coronary artery disease.
At the time, animal studies had led to the widespread assumption that heart attacks were due to occlusion of a coronary artery by atherosclerotic deposits resulting from elevated blood cholesterol levels. This, in turn, was primarily the consequence of increased fat and cholesterol intake. Support for this was reinforced by research showing that the significant variation in mortality rates from coronary heart disease in different countries showed a clear correlation with fat consumption. The greater the amount of saturated fat and cholesterol in the average diet the higher the blood cholesterol and death rate from heart disease in that country. Such individuals exhibited certain characteristic activity patterns, including.
1. Self-imposed standards that are often unrealistically ambitious and pursued in an inflexible fashion. Associated with this are a need to maintain productivity in order to be respected, a sense of guilt while on vacation or relaxing, an unrelenting urge for recognition or power, and a competitive attitude that often creates challenges even when none exist.
2. Certain thought and activity styles characterized by persistent vigilance and impulsiveness, usually resulting in the pursuit of several lines of thought or action simultaneously.
3. Hyperactive responsiveness often manifested by a tendency to interrupt or finish a sentence in conversation, usually in dramatic fashion, by varying the speech, volume, and/or pitch, or by alternating rapid bursts of words with long pauses of hesitation for emphasis, indicating intensive thought. Type A persons often nod or mutter agreement or use short bursts of laughter to obliquely indicate to the speaker that the point being made has already been anticipated so that they can take over.
4. Unsatisfactory interpersonal relationships due to the fact that Type As are usually self-centered, poor listeners, often have an attitude of bravado about their own superiority, and are much more easily angered, frustrated, or hostile if their wishes are not respected or their goals are not achieved.
5. Increased muscular activity in the form of gestures, motions, and facial activities such as grimaces, gritting and grinding of the teeth, or tensing jaw muscles. Often there is frequent clenching of the fist or perhaps pounding with a fist to emphasize a point. Fidgeting, tapping the feet, leg shaking, or playing with a pencil in some rhythmic fashion are also common.
6. Irregular or unusual breathing patterns with frequent sighing, produced by inhaling more air than needed while speaking and then releasing it during the middle or end of a sentence for emphasis.
It was also noted that coronary prone patients tend to be very competitive and often overly aggressive. They are usually in a hurry and consequently eat, talk, walk and do most other activities at a more rapid pace. Type A's are generally more concerned with the quantity rather than the quality of their work, try to do too many things at once, are frequently preoccupied with what they are going to do next, and tend to have few interests outside their work.
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