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'Social isolation' may be major predictor of cardiac disease
STANFORD -- How intimately people are linked with their fellow human beings in some cases may be a better predictor of heart disease survival than diet, high cholesterol and blood pressure levels, or Type A behavior, says Carl Thoresen, director of the Stanford University School of Education's master's degree program in health psychology education.
"Type A may not be a problem by itself - rather, it's how the human drive for power and control combines with the need for intimacy," said Thoresen, a professor of education.
"In all cultures of the world, this is a basic issue that can be difficult to resolve: getting ahead versus getting along. In our culture, we're lopsided on the power end - that is, 'getting ahead' - and lightweight in our concern for sustaining intimacy and affiliation - that is, 'getting along.' Yet success in living requires a balance of the two universal needs.
"Much of life is a struggle, but when it goes on 24 hours a day, week after week, decade after decade - then it is a slow form of suicide."
Thoresen spoke June 25 to a group of counselors, educators and others in the "helping professions" at the H.B. McDaniel Conference, held annually to honor McDaniel, a Stanford professor and counselor educator who died in 1972.
Thoresen recently completed a 10-year study examining the effect of group counseling on long-term heart disease survival. With colleague Dr. Meyer Friedman of San Francisco's Mt. Zion Hospital, he is one of the leading national researchers on "Type A" behavior, which is marked by competitiveness, time urgency and hostility. Thoresen is currently writing a book on how the conflict between power and intimacy affects health and well- being.
Chronic, incessant struggle
Noting that heart disease was "still the No. 1 cause of death in this country," Thoresen said he now believes that "it may starts with an excessive and strong perceived need to control - what some call 'power motivation.' This can lead to a chronic and incessant struggle, activating a fantastic cascade of neurohormonal changes in the body, including massive changes in the cardiovascular system, as well as in the immune system."
He explained how recent research has shown that, among the various Type A characteristics, "hostility," as assessed during interviews, appears to be a strong predictor of cardiovascular disease, including mortality.
"Hostility - that is, frequent and pervasive thoughts and feelings of distrust, suspicion and hypercriticalness, often linked to easily aroused anger - is probably the lead actor in the Type A script," said Thoresen. "We play that role at a tremendous cost to ourselves and others."
Thoresen noted that a major, seven-year National Institutes of Health study of more than 12,000 men at risk for heart disease - most of them smokers with high blood pressure and serum cholesterol levels - found that those rated during interviews as more hostile suffered 50 percent more cardiac deaths than the others, especially when they were men younger than 47 years old.
Similarly, a 20-year study done at SRI International reported in 1990 that men with "high hostility," also rated from interviews, suffered 40 percent more deaths of all kinds (including 42 percent more cardiac deaths and 50 percent more cancer deaths) than those who did not.
Thoresen also noted the "provocative" results in another study, conducted in Sweden, that examined the relationship of Type A behavior and social connections in over 200 coronary patients. Those rated as "socially isolated" from a self-reported questionnaire died at much higher rates than those rated as "socially connected" - 68.9 percent versus 17.3 percent.
Studies with primates may parallel human studies to some extent, Thoresen said. He described the data on olive baboons in the Serengeti gathered by Stanford biological sciences Professor Robert Sapolsky. Sapolsky's research suggests that dominance and power may not always prove the most adaptive behaviors.
His ongoing study of a troop of male and female baboons reveals that intimate, cooperative behavior by lower-status males may pay off in many ways. When these males "hung out with females," acting in a friendly and caring way, they appeared to experience less physiological stress than other, more dominant males.
Other researchers at the University of North Carolina have found that dominant, powerful macaque monkey males show less coronary artery disease under low-stress conditions. However, when subjected to major social stress - for example, being put into a new group of unknown macaques - these dominant, power-oriented males struggling to establish status suffered considerably higher levels of coronary artery disease.
America: A self-absorbed people?
Thoresen, who returned last year from a year-long sabbatical in Europe, noted that the question he was asked most frequently about his homeland while he was abroad was, "Why are Americans so individualistic? Why are you so caught up in yourselves?"
"It's not that they weren't interested in success, either," Thoresen said.
Thoresen noted the widely read 1985 study by Robert Bellah and others, Habits of the Heart, which discussed American attitudes toward success, justice and community.
"Bellah [and his colleagues] described contemporary Americans as 'autonomous consumers,' concerned far more with personal issues than social or community-focused problems," Thoresen said.
"Alexis de Tocqueville [in Democracy in America] was concerned about how America would survive - it was so individualistic, self-centered and narcissistic. That was 1837."
If the description of Americans in Habits of the Heart is valid, Thoresen said, "that is, if we've become a nation committed to the individual right to consume and lacking any responsibility for the common good, then we may have reached in the 1990s the first real test of our democracy."
"How can we recapture a much greater sense of shared beliefs - a sense of community and a tempered concern with personal gain?" he said. How can we foster a much greater genuine mutual respect for those with divergent interests and experiences?"
Thoresen referred to his own 10-year study on heart attack survival, which "showed that group counseling actually saves lives - above and beyond surgery and medication." He reflected on his own work as a counselor working with heart attack survivors, and on what he called their "inner tyrannies of inhuman expectations."
He said that, for many of the men he has known, "the human 'being' aspect of their lives is gone - there is only a human 'doing.' No time to be present, to be here now. They are always processing the past or planning the future. They have little access to their personal feelings, to the present situation, especially how others may be feeling.
"This is not an obscure disorder, or an exotic problem - many Americans live this way," Thoresen said.
"It's an interesting experience being a group leader. Working with them for four years, once a week, I really got to experience some of their anger and mistrust. Some of the gentlemen I was working with died. That really brings home the fragility of life to group members and how important living life in the present may be."
Thoresen recalled a man in his group presenting Thoresen with a gift and telling him, "Carl, let me tell you what life is all about." He handed Thoresen a "big, fancy box from Gumps, filled with tissue paper."
"I remember digging down through the layers of tissue. Inside was a brass license-plate holder with the legend, 'He who dies with the most toys, wins!'
"Six months later, that man died from sudden cardiac arrest.
"He took his attitude to the grave with him."
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