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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 everyday 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 people with Type B personality. 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 died in 2001 after a short illness at UC San Francisco Medical Center and was survived by a daughter, Joyce Libeu, of Rohnert Park, California; two sons, Joseph, of Mill Valley, California and Mark, of Rohnert Park; and five grandchildren.
- Friedman, M, and Rosenman, R.H. (1974) Type A Behaviour, New York: Alfred A. Knopf.
- Friedman, M. (1996).Type A Behavior: Its Diagnosis and Treatment. New York, Plenum Press (Kluwer Academic Press),
- Rosenman, R.H., Brand, R.J., Jenkins, C.D., Friedman, M., Straus, R. and Worm, M. (1975) Coronary heart disease in the Western collaborative group study: final follow-up experience at 81/2 years, Journal of the American Medical Association 233: 872-7.
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