C H A P T E R
6
Personality Type and Stress

The Self
Relationships
Work
Emotions
Self-Control
Real World

The Angry Heart
New research suggests that rage kills. Here s how to use optimism and patience to stay healthy.

You've had a rough day and you're sick of listening to your toddler wail. Before you can stop yourself, you haul off and slap him hard enough to make his little head spin. Or you see your boyfriend flirting with another sister at a party, and in a heartbeat you march up to them and go off. Or when a less experienced white man receives a promotion before you, you hold in the humiliation and rage until you're nearly blinded by a headache.

       Incidents like these happen all too often. Whether it's a screeching child, trouble in a relationship or discrimination at work, these kinds of occurrences generate feelings of anger and frustration. The cumulative effect of hostile responses or the compounding, silent, internal rage may be health problems as minor as a constant headache or as serious as a deadly heart attack. "Microaggressions happen to us on a daily basis," says Dr. Michelle 0. Clark, assistant clinical professor of psychiatry at the University of California at San Francisco. "It may seem like a small thing when it occurs, but these small things add up, day after day, month after month, year after year. They wear you down and you may begin to manifest physical symptoms."

       Whether we express or suppress it, anger can be deadly. More and more experts are discovering that when we allow anger and hostility to get the better of us, we expose ourselves to serious and often life-threatening health problems.

       But we don't have to allow stress to kill us. We must learn to control ourselves by letting go of anger and reacting differently to stressful, unpleasant situations when they occur. While hostility and anger can be dangerous, replacing them with optimism and controlled, positive, thoughtful responses can heal and protect us.

What the research says
The fact that anger and aggression can lead to sickness first came into the limelight in the 1950's. Experts discovered a connection between driven, harried, irritable, competitive Type A behavior and increased risk of heart disease. Recent studies, however, suggest that it may actually be suspicion, anger, mistrust, cynicism, low self-esteem and hostility-reactions to stress-that make you sick.

       Some of the latest research also questions another popular notion: That only repressed rage makes the blood boil. It seems that screaming, hollering and cursing have proven to be just as damaging as simmering, stewing and brooding. "Expression or repression is not the issue," says Dr. Willard Gaylin, author of the book Rage Within: Anger in Modern Life . "The real problem lies with the emotion."

       Drs. Ernest H. Johnson and Clifford L. Broman explored how both anger and stress affected the physical health of more than 2,000 Black men and women coast to coast. They found that subjects who directed their anger outwardly had more marital difficulties, higher unemployment and fewer friendships and committed crimes more often than people who were able to think situations through and respond without anger. The subjects who faced stress with external anger were also more prone to engage in negative health behavior-smoking, alcoholism, overeating. Both the negative life experiences and the bad habits often led to heart disease and other chronic ailments. More tellingly, anger alone was linked to all kinds of illness.

       "We found that angry subjects-people who either express their anger outright or suppress it-have more diabetes, kidney problems, strokes, cancer, hypertension and circulatory difficulties," says Dr. Johnson, associate professor of clinical psychology at the University] of Houston.

How anger leads to illness
The link between anger and illness can be traced to a basic animal response. When an animal-and that includes the human animal-feels threatened or endangered, the central nervous system responds and the fight-or-flight survival mechanism kicks in. "Rage and fear are emergency emotions," says Dr. Gaylin. "The pupils are dilated or constricted. Palms become sweaty. The heart rate and respiration are altered. Adrenaline is pumped into the blood and the blood is then redirected from one part of the body to another." But repeatedly activating this defense system overtime may lead to long-term problems. "When we are angry or enraged, the stress hormones that are released cause the heart to pound, cholesterol to increase and blood pressure to go up," explains Dr. Johnson, who is coauthor of the forthcoming book The Deadly Emotions . "Happening time after time, this can lead to cardiovascular disease, stroke and other problems related to hypertension. The stress hormones also cause an increased metabolism of so-called dirty lipids, or 'bad' cholesterol," adds Johnson. "When this cholesterol begins to collect, it can damage the veins, heart, liver, kidneys and even the brain."

       Along with physical wear and tear, anger can also cause people to indulge in bad habits that lead to a mountain of negative health consequences. "Angry people do angry things to themselves," sums up Dr. Johnson. "They smoke, they drink, they do drugs: they slowly do things to destroy themselves."

What you can do 
Many of the stressors in our lives are beyond our immediate control. But we do have control over ourselves, and we don't have to allow anger and hostility to take hold. We can plan our reactions to the things we cannot alter. "You are the only thing you have control oŁ" says Dr. Billie Jean Pace, an Orlando, Florida gynecologist who counsels her peers and patients about stress. "But we have relinquished that control by reacting to the responses of others. We have to be focused enough to feel that anger and then let it go. Too often we hold on to it and let it build into an explosive situation."

      What's more, we must learn more positive ways to respond to stress, especially in the heat of an unpleasant incident. This requires a change in attitude, discipline and self-control. The first step is to control the urge to respond automatically with angry words and actions unless the situation is truly life-threatening.

       Here' s a familiar example of an anger-producing situation and the appropriate response: you're in a meeting at work and a co-worker brings up an idea in front of your superiors. You realize that the person stole your idea without giving you credit. You feel like screaming at the co-worker or walking out of the meeting and slamming the door. But remember: The deed is done. You can't make it go away and you can't control the co-worker or your superiors. You only have control over yourself

       Dr. John T. Chissell, chief consultant of the Positive Perceptions group, a Baltimore health-education organization, suggests a productive response: "Take a deep breath and then ask yourself, How can I turn this situation around in my favor?  Say in front of your supervisor, 'That's a good idea; in fact, when I brought it up to so-and-so earlier, I thought. . .' Add on to the idea, letting both your colleague and the supervisor know you're on top of things. Afterward, take your co-worker aside and broach the subject directly, rationally and without hostility. Calmly explain to him or I her the need for the employees to work together. By taking this approach, you control the situation; you don't allow the situation to control you."

       Take Dr. Clissell s advice to respond productively when unpleasant situations crop up—as they often do. Once we learn how to let go of our suppressed anger and monitor our responses to unpleasant incidents, we will be able to view the world through a prism of optimism. With this newfound power, our bodies will be able to heal and strengthen themselves, and our minds willbe free to soar.

To Beat Stress, Don't Relax: Get Tough
         by Laurence Miller

Ok, so you've tried every stress-busting technique in the book. You believe, along with many psychologists, that equanimity of mind and body somehow amounts to good health. You've learned to relax. You've had yourself hypnotized and bio feed backed. Yet you still find yourself undone by life' s slings and arrows. Well buddy, forget that mushy mellow scene. If you want to stay mentally fit, it' s time to get tough.

       As defined by health psychologist Richard Dienstbier of the University of Nebraska at Lincoln, toughness means a distinct reaction pattern to stress-mental, emotional and psychological-that characterizes animals and humans who cope effectively. To understand the toughness response, it's necessary to look at the two main psychological systems that mediate it:

The Toughness Systems
       The first involves a pathway from a deep-brain structure called the hypothalamus to the sympathetic branch of the autonomic nervous system, and from there to the adrenal medulla. The sympathetic nervous system, or SNS, is responsible for the heart-pounding, sweaty-palmed "fight or flight" response that mobilizes body and mind to deal with challenging situations. As part of this response, the adrenal gland releases its main hormone, adrenaline.

       The second system involved in the toughness response also begins with the hypothalamus, but acts through the pituitary gland, which in turn stimulates the adrenal cortex to release cortisol-the chief "stress hormone" in vloved in Hans Selye's now-famous stress model. Together, the pattern of SNS-adrenal-medulla and pituitary-adrenal-cortex responses to stressful challenges defines the nature of the toughness trait.

        Dienstbier muscles up an impressive array of research to show that the bodily response of his tough individuals differs dramatically from that of their less mentally fit colleagues. In toughies, the normal, everyday level of activity in the two systems is nice and low; tough people are at relative ease under most ordinary circumstances, and their psychological responses reflect their ease.

       But when faced with a stressful challenge or threat, the SNS-adrenal-medulla system springs into action quickly and efficiently, while the pituitary-adrenal-cortex system remains relatively stable. As soon as the emergency is over, the adrenaline response returns quickly to normal, while the Cortisol response stays low.

       The smoothness and efficiency of the psychological arousal pattern is what characterizes the toughness response- a response that has important aftereffects in the brain. Such a restrained reaction, Dienstbier finds, prevents depletion of catecholamines, important brain neurotransmitters that affect mood and motivation.

        Not so for the untough. Their psychological reactions tend to be far more overblown and longer lasting, even in the face of everyday hassles. The result is a greater, more disorganizing arousal, less effective coping and faster depletion of brain catecholmines, which can lead to helplessness and depression. With each tribulation, major and minor, those lacking toughness over-respond, unable to do much about the current situation and having little confidence in their future ability to cope.

Using the Toughness Response
     That's where the real psychological significance of toughness comes in. Dienstbier points out that the psychological toughness response-or its absence-interacts with a person' spsycholgical appraisal of his or her own ability to cope with challenge. This in turn contributes to the person's self-image as an effective master of adversity or a helpless schlemiel-a self-assessment that influences later psychological reactions to stress.

       The most effective place to intervene is at the psychological level. Learning effective coping skills, says Dienstbier, can make the psychological reaction of the two systems to threat or challenge less intense and more automatic. Instead of being immobilized by gut-wrenching panic, for example, your nervous system's appraisal of threat becomes a goad to seek out alternative solutions. It's as if your stress system is learning the skill of coping, much as you once learned, and wired into your brain, how to ride a bike.

      And like bike riding, once you get used to coping effectively, you never forget the skill, except perhaps in the face of the most dire catastrophe. As you build confidence in your ability to cope with a wider and wider range of situations, your two psychological response systems waste less effort in the face of each new threat or challenge. In this positive spiral, more-efficient psychological stress responses lead to better coping, which in turn makes for an even smoother mind-body response pattern. You end up truly tough.

        Toughness-coping easily and effectively with stress-has important implications for everything from the common cold to cancer because of its effect on the immune system. We know that high levels of Cortisol dampen immune function, while ample supplies of brain cathecholamines enhance the activity of blood cells that fight infection. So the inefficient response of the untough to stress-producing more Cortisol and depleting catecholamine- may increase vulnerability to disease.

Type As? They're Not So Tough
Is toughness, then, the equivalent of the now-legendary Type A personality, the hard-driving, competitively hostile, workaholic behavior pattern that's been linked with early death from heart disease? Aren't Type As, who aggressively seek out new worlds to conquer, automati-callytough?

       No way. The recent literature on Type A suggests that it isn't the challenge-seeking aspect of Type A behavior that causes problems, but rather its frequent hostility, frustration and depression. These result from a behavior pattern that relies on trying indiscriminately to butt one's way through social interactions. Workaholism, in itself, need not be hazardous to your health, as long as you're good at the work, cope well with the tasks involved and, best of all, enjoy yourself in the process.

       Research shows that the SNS-adrenal-medulla systems of Type As recover more slowly than those of Type Bs and that when Type As are challenged, both their adrenaline and Cortisol systems react more strongly. Type As with a family history of cardiova scular disease also have higher Cortisol levels than other Type As. So, despite his blustery, I kick-ass facade, the hostile, illness-prone Type A usually comes in dead I last in the true toughness marathon.

     Dienstbier's model of toughness raises questions for psychotherapists who use low-arousal approaches such as relaxation, hypnosis and meditation for stress management: Are patients who never learn to face and deal with stressful situations doomed to repeat them? If they don't stand eyeball to eyeball with adversity and periodically flex the coping skills needed to make it in the world, they may never fully develop a sense of mastery. Without this, their psychological stress response systems may remain disorganized, untough and unprepared for future challenges.