What You Can Change _. And What You Can't - Martin E. Seligman [61]
Heart disease. The Type A personality—heart-attack prone—is also made up of three confounded traits: hostility, time urgency, and competitiveness. Type A researchers, unlike Type C researchers, have tried to separate the components. Hostility, the overt expression of anger, is probably the real culprit. Time urgency, competitiveness, and the suppression of anger do not seem to play a role in Type As getting more heart disease. In one study, 255 medical-school students took a personality test that measured overt hostility. The angriest of them went on—twenty-five years later—to have roughly five times as much heart disease as the least angry ones. In another study, men who had the highest risk of heart attacks were the ones with especially explosive voices, more irritation when forced to wait, and more outwardly directed anger. In an exploration of the mechanism by which anger expression might damage the heart, the eighteen men in this study angrily recounted incidents that annoyed them. The pumping efficiency of their heart dropped by 5 percent on average, suggesting a drop in blood flow to the heart itself. Pumping efficiency was not changed by other stressors.7
Studies find that blood pressure stays high when anger is bottled up only among male students bottling up their anger at other male students, that is, only males of the same status. When a student bottles up his anger against a professor, blood pressure goes down, and it goes up if he decides to express his anger. And anger expression does not lower blood pressure for women; expressing hostility raises female blood pressure. In contrast, friendliness in reaction to trespass lowers it.8
I have a very simple theory of how emotion affects heart disease. It may well be wrong, but it is compatible with most of the facts. Your heart is a pump, and like any mechanical pump, there is a limit, or rating, on how many times it can beat before it wears out. So, for example, your heart might be rated at 100 million beats. Once your rating is exceeded, you are very likely to have a heart attack—if something else hasn’t killed you first. Ratings vary from person to person and from family to family, with the limit set by such factors as constitutional strength, exercise, and childhood diseases.
Some emotions, the ones that raise your heart rate and blood pressure, use up your allotted beats more quickly than others. Anger and fear are two such emotions: They mobilize the sympathetic nervous system in just this way. Relaxation and calm have the opposite effect. People who often get angry use up their allotted beats faster. Several times a day, they go into a rage; their heart races and their blood pressure soars. On a bad day, they may use up two days’ allotment. Fearful and paranoid people who see the world as a threatening place get triggered into massive sympathetic activity more often and so also use up their allotment faster. The habit of ventilating your anger—as opposed to suppressing it—uses up your allotment and so contributes to heart disease.9
The evidence is clear: Overt anger, contrary to popular belief, is bad for your heart.
Depression. The view that depression is anger turned inward is false. Freud spun this theory out of whole cloth some eighty years ago. Unsupported as it was, his theory of depression, along with his theory of repressed sexuality, was among the main forces that legitimized our present ethic of promiscuous emotional expression.
By the 1950s, therapists were having a field day with this ethic. One of the main treatments for depression was to encourage patients to get angry. Therapists helped depressed people to shout about the times they had been victimized and to rage over how bad their lives were. When I first learned how to treat depression, in the early 1970s, this was one of the techniques I was taught. But something quite shocking occurred when we prodded depressed people into getting angry and remembering long-forgotten abuse.
Keep in mind that depressed people are