Stress: Can We Cope?

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less damaging. University of Wisconsin researchers exposed monkeys to loud, irritating noise but allowed half of them to interrupt the sound by pulling on a chain. Though both groups of monkeys were exposed to the same noise, those with access to the chain showed lower levels of stress-related hormones in their blood. Being in control seemed to make the difference.

The same appears to be true of workers. Robert Karasek, an industrial-engineering professor at Columbia University, has found that people who have little control over their jobs, such as cooks, garment stitchers and assembly-line workers, have higher rates of heart disease than people who can dictate the pace and style of their work. Telephone operators, waiters, cashiers and others whose work makes substantial psychological demands but offers little opportunity for independent decision making are the worst off. This combination of high demands and low control, concludes Karasek, appears to raise one's risk of heart disease by "about the same order of magnitude as smoking or having a high cholesterol level."

In recent years doctors have come to recognize another psychological factor that drastically increases an individual's susceptibility to heart attacks and other stress-related illnesses: Type A behavior. First identified by San Francisco Cardiologists Meyer Friedman and Ray Rosenman, Type A has two main components, both of which can be recognized by giving standardized personality tests or conducting careful interviews with the patients. Says Friedman: "First, there is the tendency to try to accomplish too many things in too little time. Second, there is free-floating hostility. These people are irritated by trivial things; they exhibit signs of struggle against time and other people."

Type A has been accepted as a bona fide risk factor for heart disease by the American Heart Association and the National Heart, Lung and Blood Institute. Studies have shown that Type A's respond differently to stress than do calmer people classified as Type B's. When Dr. Redford Williams at Duke University asked a group of male undergraduates to perform a mental arithmetic task (serial subtraction of 13 from 7,683), the Type A students produced 40 times as much cortisol and four times as much epinephrine as their Type B classmates. The flow of blood to their muscles was three times as great, though there was no difference in their level of performance. "The Type A man is responding as though he were in an emergency or threatening situation," says Williams. The jolt of cortisol and epinephrine, he speculates, "could be causing more fat to be released into the blood, which may later be deposited around the heart."

Mort Ciment, 59, was what Friedman would call a typical Type A. Excitable to begin with, he worked as a Los Angeles commodities trader, a job he likens to "being in a mad cage." When the market was really moving, he says, "there was terrible tension. You'd leave to go to the bathroom, come back and find the position horribly changed." When he got home, he admits, "my nerves were singing, and I'd take it out on the nearest person."

All that ended three years ago when Ciment had a heart attack. A quadruple bypass saved his life, and a chastened Ciment resolved to slow down. He quit his job to become a