Personality, Heart Disease and Cancer: A Chequered History

Type A and B Personality

We discuss here the chequered history of the claims by Psychologists and others about the links between personality and illness, particularly heart disease and cancer. The research has been marred by dirty money and allegations of fraud.

Speculation about ‘Type A’ and ‘Type B’ personalities and coronary heart disease (CHD) has existed for at least 70 years. The distinction between the two personalities was introduced in the mid-1950s by the cardiologists Meyer Friedman and Ray Rosenman (1974) Type A behavior and your heart.  Their ideas can be traced to Franz Alexander one of the ‘fathers’ of psychosomatic medicine.

The Type A personality is described this: highly competitive and achievement oriented, not prepared to suffer fools gladly, always in a hurry and unable to bear delays and queues, hostile and aggressive, inclined to read, eat and drive very fast, and constantly thinking what to do next, even when supposedly listening to someone else. Type A was thought to be at greater risk of CHD,

The Type B personality is: relaxed, laid back, lethargic, even- tempered, amiable and philosophical about life, relatively slow in speech and action, and generally has enough time for everyone and everything.

The Type A personality is similar to Galen’s choleric temperament, and Type B with the phlegmatic.  It is well known that men are at greater risk of CHD than women.

‘Classic’ Studies

The key pioneering study of Type A personality and CHD was the Western Collaborative Group Study (WCGS).  Over 3,000 Californian men, aged from 39 to 59, were followed up initially over a period of eight-and-a-half years, and later extending to 22 years plus. At the eight-and-a-half-year follow-up, Type As were twice as likely compared with Type Bs to suffer from subsequent CHD. 7% developed some signs of CHD and two-thirds of these were Type As. This increased risk was there even when other risk factors, such as blood pressure and cigarette smoking, were statistically controlled.

Similar results were obtained in another large-scale study in Framingham, Massachusetts.  This time the sample contained both men and women.  By the early 1980s, it was confidently asserted that Type A characteristics were as much a risk factor for heart disease as high blood pressure, high cholesterol levels and even smoking.

Failure to Replicate

Later research failed to support these early findings. When Ragland and Brand (1988) conducted a 22-year follow-up of the WCGS, using CHD mortality as the crucially important measure, they failed to find any consistent evidence of an association.

Further research continued up to the late 1980s, yielding few positive findings. Reviewing this evidence, Myrtek (2001) suggests that the modest number of positive findings that did exist were the result of over-reliance on angina as the measure of CHD. Considering studies that adopted hard criteria, including mortality, Myrtek concludes that Type A personality is not a risk factor for CHD.

Enter the Tobacco Industry

With such disappointing results, why did Type A obtain so much publicity over more than 40 years? The reason is in part connected with the involvement of the US tobacco industry.

Mark Petticrew et al. (2012) analysed material lodged at the Legacy Tobacco Documents Library. This is a vast collection of documents that the companies were obliged to make public following litigation in 1998. These documents show that, for over 40 years from the 1950s, the industry heavily funded research into links between personality, CHD and cancer. The industry was hoping to demonstrate that personality variables were associated with cigarette smoking.

Any such links would undermine the alleged causal links between smoking and disease. Thus, for example, if it could be shown that Type A personalities were both more likely to smoke than Type Bs, and more likely to develop CHD, then it could be argued that smoking might be just an innocent background variable.

The Philip Morris company funded Meyer Friedman, the originator of Type A research, for the Meyer Friedman Institute. The research aimed to show that Type A personalities could be changed by interventions, thereby presumably reducing proneness to CHD even if they continued to smoke.

Petticrew et al. show that, while most Type A–CHD studies were not funded by the tobacco industry, most of the positive results were tobacco-funded. As has been pointed out in many areas of science, positive findings invariably get a great deal more publicity than negative findings and rebuttals.

Hans J Eysenck

The late H J Eysenck was one of the most controversial psychologists who ever lived. Generations of UK psychology students had to study his books as gospel.

The German-born, British psychologist worked at the Institute of Psychiatry, University of London.  He did a PhD under Sir Cyril Burt  who was proved to have fabricated researchers and data to support his eugenic theory of intelligence.  (Kamin, 1974, The science and politics of IQ).

Eysenck used the tobacco industry as a source of funding for his research on psychological theories of personality. According to Pringle (1996), Eysenck received nearly £800,000 to support his research on personality and cancer.  Eysenck’s results were a spectacular exception to the general run of negative findings in this field.  Eysenck (1988) claimed that personality variables are much more strongly related to death from cancer than even cigarette smoking.

One of my lecturers while I was an undergraduate had worked for Eysenck as a research assistant for a year. It had seemed clear to him that data massaging was required before placing Eysenck’s studies into publication. Data manipulation or even worse, outright fraud, has surfaced in a major re-analysis of Eysenck’s work on tobacco and personality.

Ronald Grossarth-Maticek

Two of Eysenck’s papers, with Ronald Grossarth-Maticek (pictured above), based  in Crvenka, Serbia, claimed to have identified personality types that increase the risk of cancer by about 120 times and heart disease by about 25 times (Grossarth-Maticek and Eysenck, 1991; Eysenck and Grossarth-Maticek, 1991). They also claimed to have tested a new method of psychological treatment that could reduce the death rate for disease prone personalities over the next 13 years from 80% to 32%. These claims are too good to be true.

These extraordinary claims were not received favourably by others in this field. Fox (1988) dismissed earlier reports by Eysenck and Grossarth-Maticek as ‘simply unbelievable’ and the 1991 papers were subjected to devastating critiques by Pelosi and Appleby (1992, 1993) and Amelang, Schmidt-Rathjens and Matthews (1996).  The ‘cancer prone personality’ was not clearly described and seems to have been an odd amalgam of emotional distance and excessive dependence.

A Case of Fraud?

After pointing out a large number of errors, omissions, obscurities and implausible data, in a manner reminiscent of Leon Kamin’s  analysis of Burt’s twin IQ data, Pelosi and Appleby comment:

It is unfortunate that Eysenck and Grossarth-Maticek omit the most basic information that might explain why their findings are so different from all the others in this field. The methods are either not given or are described so generally that they remain obscure on even the most important points . . . Also essential details are missing from the results, and the analyses used are often inappropriate.

(Pelosi and Appleby, 1992: 1297).

They never used the word “fraud”. They didn’t need to. For an update of this story,  see this post

and this post

Update