The Myth of Normal 85

respond intelligently and effectively to illness—or preferably, to mitigate the risks in the first place. This is as true for individuals as for society. There is nothing radical about the idea that certain personality traits can pose risks for illness; in fact, it is a restatement in modern scientific terms of insights that date far back. The physiological pathways connecting an irascible temper and heart disease, for instance, have long been well understood: they include increased blood pressure and heart rate, intensified clotting, and tightening of blood vessels, among others.[4], [5], [6] Already in ancient times Hippocrates spoke of the “choleric” temperament, believed to result from an excess of choler (yellow bile). In English we still speak of people who are habitually grumpy as “bilious.” And in traditional Chinese medicine, the liver—the source of bile—is associated with anger, bitterness, and resentment. In 1896, the renowned internist and medical teacher Sir William Osler, often called the father of modern medicine, asserted to graduate students at Baltimore’s Johns Hopkins Hospital that “it is not the delicate, neurotic person who is prone to angina [a cardinal symptom of coronary artery disease], but the robust, the vigorous in mind and body, the keen and ambitious man . . . whose engine is always at full speed ahead.” He was foreshadowing the modern concept of the driven, compulsively preoccupied, impatient, readily upset, and heart-disease-prone type A personality—a biopsychosocial dynamic, which, both scientifically and “anecdotally,” is easy to grasp. In 1987 the psychologist Dr. Lydia Temoshok[] proposed what became known as the “type C personality,” referring to traits strongly associated with the onset of malignancy.[] These couldn’t have been further from the type A traits on the temperamental spectrum; they included being “cooperative and appeasing, unassertive, patient, unexpressive of negative emotions (particularly anger) and compliant with external authorities.” She had interviewed 150 people with melanoma and found these patients to be “excessively nice, pleasant to a fault, uncomplaining and unassertive.” They were identified “pleasers”: while anxious about their disease progression, their worries were focused in a specifically outward direction, away from themselves and toward the effect that their illness was having on the