Meyer Friedman; Doctor Identified 'Type
A' Behavior
By ELAINE WOO, Times Staff Writer
Dr. Meyer Friedman, who developed with a colleague the theory that the
"Type A" behavior of chronically angry and impatient people raises their
risk of heart attacks, died April 27 after a short illness at UC San
Francisco Medical Center. The cardiologist and researcher worked until
his death at 90 as director of a medical institute that bears his name.
Friedman, who often characterized himself as
a "recovering Type A," and colleague Dr. Ray Rosenman began to write
about the link between behavior and heart disease in scientific papers
during the 1950s. They turned their observations into a popular 1974
book, "Type A Behavior and Your Heart."
"Type A personality" soon became part of the
national vocabulary, shorthand for the sort of driven individual who
feels oppressed by time. This is the person who honks and fumes in traffic,
barks at sluggish salesclerks, and feels compelled to do several things
at once--perhaps shave while paying bills and dialing a phone.
The work of Friedman and Rosenman opened up
a new field of inquiry into the mind-heart connection, still debated
and investigated today.
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 in the 1950s, when they began to question the conventional
thinking about the major risk factors in 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
80, "because [diet] really hadn't changed. Nor had cholesterol."
Then, there was the furniture.
In the waiting room of the practice the two
doctors ran, 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 frequently, usually to ask how much longer they would
have to wait for their appointments to begin.
They were as tense as racehorses at the gate.
And they had heart problems. Was there a link?
After some initial observations, the doctors
hypothesized that there was a connection. Friedman began some studies.
In one, he observed 40 accountants, to see if their cholesterol levels
rose under 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.
Other doctors reacted skeptically to Type A
theory. "A lot of physicians, particularly cardiologists, are severe
Type A's," said Rosenman, who rates himself a "Type A-minus." But the
concept was gradually embraced in the popular culture, where "Type A
personality" became a buzzword--one that irritated its authors. "You
can't change personalities," Friedman often said. "We just try for more
B-like behavior."
Over the ensuing decades, Friedman would casually
diagnose public figures as Type A or B from photographs, spotting such
telltale signs as a clenched jaw or pinched look between the eyes. Lyndon
Johnson was Type A; Ronald Reagan is B.
Friedman developed a therapy regimen to modify
Type A behavior. In the 1980s, he led a study that showed that heart
attack risks could be dramatically lowered when Type A sufferers learned,
essentially, to slow down and chill out. He wrote a 1984 book based
on those findings, "Treating Type A Behavior and Your Heart," that showed
how those in the treatment group had new heart attacks at about half
the rate of those in the control group. It included a chapter on women,
who he found were not immune to the syndrome.
In treatment programs, Friedman used a series
of exercises to teach Type A's to emulate the mellower, more thoughtful
behavior of Type Bs. He would ask them to leave their watches home for
a day, to drive in the slow lane, to pick the longest line in the grocery
store, and consciously observe and talk to other people. To force Type
A's to slow down, 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 wore 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."
The early Friedman was classic Type A. Even
before he finished junior high school he chose Yale University and Johns
Hopkins Medical School. In the Army he was dubbed "Cannonball," for
the way he charged down hallways to see patients, "as if they would
evaporate before I got there." If people didn't talk fast enough, he'd
break in with "Yup, yup, come to the point."
Much later he would observe that such frantic
drive is not always the hallmark 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 in the study of gout and cholesterol and helped
develop the angiogram.
Not surprisingly, perhaps, the doctor paid
a price for his productivity. He suffered an angina attack in 1955 when
he was 45. He had the first of two heart attacks 10 years later at 55.
He began to practice what he had preached.
He read Proust's masterpiece three times. He stopped trying to criticize
his wife or lecture his children. He cultivated a lively interest in
what he called the three Ps: "Pets! Plants! Persons!"
"He was finally very Type B. He took his own
advice," Friedland said.
Friedman is survived by a daughter, Joyce Libeu,
of Rohnert Park; two sons, Joseph, of Mill Valley, and Mark, of Rohnert
Park; and five grandchildren. Contributions may be made to the Meyer
Friedman Institute, 1515 Scott St., Suite 2, San Francisco, CA 94115.
