- Personality and Illness
Many believe that we have reached an age of diminishing returns in which more medical care and expenditure will probably only contribute marginally to better health. More important than medical treatment for the ability to resist disease, is lifestyle, the way that people behave, if you like, their personalities.
For example a study in Almeda county near San Francisco of 7000 adults first established their health in an initial survey, measuring also the presence or absence of certain health behaviours, then measured them again seven years later. Those who remained healthy showed more of habits like, not smoking, drinking moderately or not at all, exercising regularly, eating breakfast, maintaining a normal weight, eating regular meals, and getting adequate sleep. Not surprisingly public health efforts are becoming more concerned with preventing sickness by changing poor health behaviors.
Sir William Osler, a leading physician, wrote at about the turn of the century, "It is much more important to know what sort of patient has the disease than what sort of disease the patient has." Perhaps this is the lead we need; an assessment of personality characteristics to see if they are related to good health. This might lead to some more useful interventions. Despite knowing what the risk factors are we cannot make very good predictions about exactly who is going to get sick. Most people in the high-risk groups stay well. It would be nice to know why.
Personality may affect health through unhealthy behaviors. For example, anxiety may lead some people to smoke, and we know that smoking leads to lung cancer. In general, many personality problems make unhealthy habits more likely. Depressed or neurotic persons are more likely to have eating problems, alcohol consumption problems etc. The problem is there are so many potentially relevant unhealthy behaviors.
In the 1950s cardiologists Howard Friedman and Professor R. H. Rosenman (1974) noticed a special feature of the behaviour of patients in their waiting rooms. Most seemed to sit on the front of their chairs wearing out the upholstery in this area. Friedman and Rosenman went on to study more about the personalities of their patients, in particular studying what came to be called Type A and Type B behaviour patterns or personalities. Type A people seem to be those involved in a constant struggle to do more and more things in less and less time, and they were sometimes quite hostile or aggressive in their efforts to achieve them. They always seemed to be under the pressure of time, constantly having deadlines to meet.
Extreme type As live a life characterised by competitiveness, and they are always striving for achievement. They are hasty, impatient, impulsive, hyper-alert, and very tense. Not just occasionally, but most of the time, turning even the most potentially relaxing situation into a high-pressure event.
Their opposites are Type B. These people are more easily able to relax, do not worry about time, and are less concerned with accomplishment and more content with themselves.
Research has shown that more of those people who suffer from coronary heart disease (CHD) are Type A than groups who are disease free. Recently there have been some large prospective studies, starting before people had the disease. The Western Collaborative Group Study, in the U.S.A., which lasted almost ten years, showed that being Type A was an important risk factor for first second and third heart attacks and hardening of the arteries. This finding was confirmed by other major prospective studies, including the Framingham Heart Study and the French- Belgium Collaborative Group study. The increased risk of heart disease for Type As was independent of and comparable in importance to other risk factors such as smoking, high blood pressure, and genetic endowment. Later research has shown that hostility, competitiveness and other chronic negative emotional states are the really troublesome characteristics rather than other Type A characteristics like being a non-stop worker, and this hostility may lead to even stronger predictions of CHD.
It seemed pretty clear that we had a personality characteristic that predicted Cardiovascular disease. In the late 1980s through the 90s another group of researchers proposed that there was a kind of personality that predicted cancer. They called this the Type C personality. Its major feature was the suppression of emotions. If you asked these Type C people about emotions they would speak as though they hardly ever experienced anger or anxiety or sadness. But the move towards thinking about particular personality types for particular diseases was shaken up by further research by one of the “discoverers” of the Type A personality pattern.
Howard Friedman participated in a review of a large number of studies relating personality factors to disease. Friedman and his colleagues took several important and commonly studied aspects of personality, including depression, anxiety and anger/hostility, and reviewed the relationship to five chronic diseases using quantitative techniques called meta-analysis. This is a way of combining the results of different studies, which is very helpful for revealing overall patterns. Their findings suggest that it may be a false lead to look for a different personality for each different disease.
The five diseases selected for study were asthma, headaches, ulcers, arthritis, and heart disease. The relationships found were generally moderate or high compared to other risk factors such as cigarette smoking. For instance, the average relationships between CHD, on the one hand, and anxiety, depression and anger/hostility on the other, were equal to or higher than those previously found for cholesterol and cigarette smoking. Furthermore, these personality effects were as great as had been found with Type A research.
Thus there seem to be several identifiable psychological characteristics that are important for physical health. Overall the degree of consistency across diseases seems quite remarkable, supporting the idea that there may be a general disease-prone personality. We take the health risks posed by cigarette smoking and cholesterol very seriously, and rightly so. It seems to be time to do something about the health risks posed by those other patterns of behaviour that we call personality. We might follow Friedman’s example and try and change our personalities.
More readings will be added to my blog from time to time. Have a quick look now to see the first posting on my blog PSYC1PLUS