A and B Personality Types 1

Lately I have been wondering about the basis for personality types, and I have been running down a few rabbit holes to try and track down the research underpinnings of "Type A" personalities. I am sure that most of us, when prompted, will remember that "Type A" people are more likely to have heart attacks, right?

Well, wrong, apparently (Benjamin, 2020; Shekelle et al., 1985). But before we look at that, let's define some terms. The "Type A/B Behavior Pattern construct [...] was first introduced by cardiologists Friedman and Rosenman" in 1959 (Benjamin, 2020, p. 383). Type A personalities had three main characteristics: those of "extreme competitiveness", "a strong sense of time urgency", and "hostility" (Benjamin, 2020, p. 383). Basically, driven, impatient and angry; or as Van Dihl phrases it, displaying "aggressivity" (1978, p. 101). Type B people are at the other end of these continua: "characterized by relative absence of drive, ambition, sense of urgency, desire to compete or be involved in deadlines" (Van Dihl, 1978, p. 101). Basically coasting, friendly, hands-off, laissez faire (Lewin et al., 1939) people.

There were a lot of papers written by Friedman and Rosenman into the apparent causality of personality type A and coronary heart disease (1959, 1960, 1974; Friedman, 1977; Rosenman et al, 1964), which turned out to be spurious (Benjamin, 2020; Shekelle et al., 1985). Even more interestingly, Friedman and Rosenman's research was extremely well-funded by the William Morris tobacco empire. Ouch. Type A personality as an alternative CHD factor, taking the heat from tobacco...?

Where it gets really interesting is that these "Type A" tendencies were apparently noted by a secretary in Friedman and Rosenman's cardiology practice. Rosenman himself was interviewed, explaining that:

"A discerning secretary in our office practice told us that in contrast to our other patients, those with coronary disease were rarely late for appointments and preferred to sit in hard-upholstered chairs rather than softer ones or sofas. These chairs also had to be reupholstered far more often than others because the front edges quickly became worn out. They looked at their watches frequently and acted impatient when they had to wait, usually sat on the edges of waiting room chairs and tended to leap up when called to be examined" (Rosch, 2004, section 4, para 3).

So... a receptionist noted that some people really were on the edge of their seats, and that led to the "Type A" classification? Well, not quite. Because this "Type A" personality type seem to have an earlier - but uncited in the research of Friedman and Rosenman - connection to some ancient Greeks, and some earlier 20th century researchers (Rosch, 2004, 2017).

Firstly, Hippocrates of Kos (c. 460 - c. 375 BCE). The credited founder of the field of modern medicine and the Koan school of Humourism. Hippocrates built on the work of an earlier Greek (Alcmaeon of Croton, c. 540–500 BCE) codifying and applying Alcmaeon's philosophy of humourism to the new field of medicine (Britannica, 2022). Humourism is most associated with the four 'humours' or the fluids needing balance for us to stay well: Flegmat/phlegm; Sanguin/blood; Coleric/yellow bile; and Melanc/black bile (Britannica, 2022; note the 'Coleric' as we will come back to this). So we have a 2500 year old theory which lasted until germ theory in the 1850s (Britannica, 2022).

Then enter Galen of Pergamon (129 – c. 216 CE). He is credited with applying Hippocrates work to the personality of patients, and interestingly being the founder of the dietetics field (Grant, 2000). Here is where the Phlegmatic, the Sanguine, the Choleric, and the Melancholic personalities, and their resulting moods, begin to translate into the "modern" personality types we know: C; B; A; and D (HireSuccess, 2022).

Alcmaeon, Hippocrates and Galen's work was used largely unchanged by a number of European physicians: Harvey in the 1600s, Corvisart in the 1700s, Von Duesch in the 1800s, and Osler into the early 1900s (Rosch, 2017). Similar to Rosenman's interview comments, Osler noted that "diagnosis of angina [could be] based on the appearance, demeanor and mannerisms of the patient in the waiting room and how he entered the consultation room" (Rosch, 2017, para 3). Rosch further outlines:

That "In the 1930s, the Menningers suggested that coronary heart patients tended to be very aggressive [..., and] Flanders Dunbar, who introduced the term “psychosomatic” into American medicine, characterized the coronary prone individual as being authoritarian with an intense drive to achieve unrealistic goals. [...] Kemple also emphasized fierce ambition and a compulsive striving to achieve power and prestige" (Rosch, 2017, para 3).

All this took place prior to Friedman and Rosenman's work. We always stand on the shoulders of giants in research (but good academic writing requires us to politely acknowledge who those giants are). 

Anyway: welcome to the "Type A" personality - the Choleric; Type B - the Sanguine; Type C - the Phlegmatic; and Type D - the Melancholic. These personality types are 2,500 year old. There is no apparent scientific grounding for the humourism theory, yet many, many personality assessments use the humourism as their basis. Exploring this further will be the subject of a future post.  

There is, interestingly, an alignment between depression, anxiety and Type D personalities (Melancholic) and heart disease (Rosch, 2017). The current thinking is that stress hormones may be a causal player for CHD and stroke.

Sam

References:

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