Stress

At psychiatric conventions, they like to tell the story of a troubled lady who seeks help from her local analyst. Attempting to define the nature of her problem, the analyst asks her to describe a typical morning in her life. "Well, let's see," she says. "First I get out of bed, then I go to my closet and put on my robe and slippers, and then I go to the bathroom and I lean over the toilet bowl and I throw up----"

The analyst snaps awake: "You what, you throw up?"

"Doesn't everybody?" asks the lady in surprise.

More and more of us seem to be throwing up every day as part of our normal routine. Very existential, this particular phenomenon: Nothing similar occurred in the lives of our primitive ancestors. True, they had their own problems; sometimes when they finished their daily domestic cave chores, they would glance up to find a hungry mastodon zeroing in on them for lunch. When that happened, their adrenals instantly secreted substances designed to mobilize strength and energy. They sped to safety, clubbed the beast into submission or perished. But the adrenal output found release.

Now, in a time of more subtle and sinister adversaries, our glands react in those same prehistoric patterns. The intercom buzzes, the secretary announces that Mr. Griffin wishes to see you immediately concerning those lost invoices; her tone conveys anxiety, your hormones surge to help repel the enemy. Wedged behind your desk or shuffling through the office corridors, you flare within, ready for attack, but hand-to-hand combat with Mr. Griffin will not improve your corporate image and, instead, as you sit and suffer the man's abuse, you become the target of your own riotous defense mechanisms.

An advertisement that ran several years back in medical journals depicts a lonely woman seated in the corner of a school gym while her P.T.A. friends decorate the backboards for an upcoming dance.

The woman, we learn, is out to lunch, despite her master's degree in fine arts.

"Too little time to pursue a vocation," runs the text below the picture, explaining why this sad and isolated woman needs the company's product. She has been forced, we are told, to center life on home and children. "A perfect framework for her to translate the functional symptoms of psychic tension into major problems. For this kind of patient ... consider the distinctive properties of Valium."

"It's not that he's not sharp. He grasps things as quickly as ever," a young man says of his father-in-law. "But the mental letdown plays on the physical problems. Each plays on the other and that cycle makes both worse."

The young man is Edward Cox. The father-in-law suffers from phlebitis.

My suspicions are that the lady in the psychiatrist's joke is married to the man with the lost invoices, that she voted for Nixon twice and throws up every morning after reading the ad for Valium. In any case, each of these people demonstrates a wretched inability to cope, and what is true for them is fast becoming true for most of the rest of us, too.

Let's face it, optimism surrendered years ago as the transcending bond among Yankees of every caste, color and creed. Into this void leaped chronic stress--that ill-defined queasiness of the gut, that sudden stab behind the eyes, that pervasive nausea serving to help us carve out our identities as contemporary Americans. Democratic to a fault, stress inflicts itself with equal abandon on the life of the pusher in the alley, the banker at the board meeting, the poet, the housewife, the cabby, the astronaut and the cook. As a nation, we have progressed far beyond ulcers and other prosaic symptoms of maladjustment into the realm of free-floating hostility, displaced aggression, random destruction that appears senseless in origin only as long as we attempt to find the personal connection between victim and aggressor and do not look instead to those impersonal dark urges inside each of us. Life without stress is like beer without bubbles--flat, tepid, suspiciously unsatisfying. Experts inform us that disruptive change is a major cause of stress illness, that our glands are reactionary stiffs exacting a high toll in return for accommodating drastically new directions in our lives.

Alvin Toffler, for instance, defines future shock as the physical and psychological distress that arises from an overload of our adaptive systems and decision-making processes. One dismaying section of his book, Future Shock, details the research of two psychiatrists--Drs. Thomas H. Holmes and Richard Rahe--who devised a method for measuring life changes, ranking them in order of their impact and magnitude. In this well-publicized study, death of a spouse topped the list, followed by divorce.

Then, in descending order, came marital separation, jail terms, death of a close family member, personal injury or illness, marriage, being fired, marital reconciliation, retirement--all the way down through sex difficulties, foreclosure of mortgage or loan, trouble with in-laws, outstanding personal achievements, vacations and minor violations of the law.

I conclude from this list that a lousy driver on vacation with a second mortgage on his house has a better chance of maintaining good health than does an estranged husband who wins a large business bonus, reconciles with his wife and moves to a classy neighborhood. It makes one wonder.

But Holmes and Rahe, attempting to correlate change and health, compiled the life-change scores of thousands of individuals and compared these with their medical histories. Writes Toffler, in reference to this research:

It has been established that "alterations in lifestyle" that require a great deal of adjustment and coping correlate with illness--whether or not these changes are under the individual's own direct control, whether or not he sees them as undesirable. Furthermore, the higher the degree of life change, the higher the risk that subsequent illness will be severe. So strong is this evidence that it is becoming possible, by studying life-change scores, actually to predict levels of illness in various populations.

In short, my body has a simple message for me: "I have seen the future and it stinks!" But I have a message for my body: "Damn the torpedoes, full speed ahead!"

Psychosomatic disease and bouts of depression frequently result from rapid, dramatic changes in a person's life, especially when they are crowded into a short time span. The news is bad, and it gets worse: Even positive changes turn out to pickle our juices and create inner disharmony. They will often upset our biorhythms and contribute to illnesses that seem totally unrelated to the pursuits of commerce and affection. A field study by Rahe and Dr. Ransom J. Arthur, detailed in Gay Gaer Luce's excellent book, Body Time, applied the life-change scale to 3000 Navy men in an effort to predict illness within the next 12 months. Those individuals experiencing the highest number of lifestyle changes suffered twice as many ailments as the individuals whose lives had undergone few if any alterations. What comes into play is an excessive activation of the endocrine system; adaptive reaction, some people call it, while others settle for the simpler term--stress.

In Man Adapting, René Dubos warns us that repeated stimulation of the endocrine glands leads to irreversible body wear and tear. Fear, anxiety, overcrowding, loud noises, simple exposure to a new situation, anticipation, hilarity--all combine to overtax our adaptive reaction.

Well, you say, what the hell, aren't those things an inescapable part of living? Yes, of course, but be advised that, as Dubos says, "There is absolutely no question that one can overshoot the stimulation of the endocrine system and that this has physiological consequences that last throughout the whole lifetime of the organs."

Terrific. With friends like endocrines, who needs enemies? Unknown to us, a quintessential love-hate relationship has evolved over the centuries between ourselves and our glands. Lacking a pituitary, hypothalamus or adrenals--the three main components of the endocrine process activated by stress events--we would perish from a stunning variety of metabolic disorders. At no great cost to our health and welfare do we take out short-term loans on the endocrines in order to cope with temporary physical and psychological crises. But these same glands (continued on page 122)Stress(continued from page 88) react to prolonged stressful situations with a lethal magic all their own, and they are very stupid. That is to say, they do not know how to distinguish between real and imaginary threats. If we carry about in our heads a constant and intense fear of death or failure, for instance, we gull our mindless hormones into everlasting strategies of defense. The ultimate cost to our internal mechanisms is incalculable.

• • •

The man has been under extraordinary pressure for more than a year. Mr. Nixon seems to keep his emotions under such control that we might have expected physical instead of emotional breakdown. ... [If physical illness strikes] it doesn't do so randomly, but at vulnerable spots unique for each of us ... and sensitized by heredity ... or neurotic strategies.... It's interesting that the phlebitis apparently didn't recur until the pardon was in the offing.

--Dr. Samuel Silverman, Time, September 30, 1974

As a brief exercise in masochism, assume for a moment that you happen to be the former President in the summer of 1974 and that you have finally been squeezed into the epiphanic moment of despair: If you do not release the final incriminating Watergate tapes, you lose your most trusted allies; if you do, you lose your job, prestige, the culmination of a life's endeavors. At this instant of agonized decision--which is only an exaggeration of stress events common to everyone--neurons inside your brain send meticulously coded instructions to your hypothalamus, where these electrical impulses convert to chemical secretions. Initially, the hypothalamus releases CRF (corticotropin) into its neighbor, the pituitary, stimulating the production of ACTH (better forget it). Then, like the second in a network of Inca couriers carrying bad news up and down the Andes, the ACTH rushes to the adrenals, where it fits snugly into molecules on the outer membrane--which has a surface shape that perfectly accepts the ACTH molecules. As a result of these lock-and-key conjunctions, steroids called glucocorticoids are synthesized and rapidly released into the blood. These glucocorticoids, known as stress hormones, might also be accompanied by another group of tricky little critters called catecholamines, which are secreted by your sympathetic nervous system when you find yourself not only uptight but also quite angry.

Taken together, the stress and anger hormones make up a defense force whose major responsibility is to protect a man's "inner environment"--first defined as such by the 19th Century physiologist Claude Bernard. Bernard had the concept, but not the technology to understand precisely how emotion affected body function. When the technology became available 100 years later, the concept had pretty much vanished from Western practical medicine, and not until recently was it re-examined as a causative factor of disease.

Those steroid hormones produced by agonized decision, rapid change and other stressful events intend us no harm. The adrenals send them out to seal off fresh wounds, to create tissue swelling around broken bones, to enhance metabolism and to convert fat and protein into usable energy. (Among these steroids is cortisone, valiant foe of inflammation.) Each organ's unique molecular structure enables it to react in a specific manner to stress hormones, so that the same glucocorticoid breaks down entirely different enzymes in the pancreas and liver--much as the same operatic aria causes women to weep and men to sleep. Released as a defensive mechanism, these steroids affect changes in the chemistry of the organs that often last beyond the immediate threat.

For 40 years, the pioneer investigator in this area, Dr. Hans Selye, now at the University of Montreal, has devoted his research to a study of hormonal stress responses. In his time, Selye has freaked out thousands of rats by injecting them, over long periods, with excessive quantities of stress hormones. Typically, the adrenals of the rats enlarge at the expense of other glands. The rats burn out in short order and develop any number of related illnesses that Selye attributes to something he calls "the general adaptive syndrome." The rats also age with astonishing speed because, says Selye, no method has yet been devised to replenish their adaptive-energy supply.

Tough luck for the rats, yes, but tough luck for us, too, since these same catastrophes can be induced in us by exposure to work and domestic situations that consistently spend our adrenal output. A pictorial study of Nixon during the last weeks of his blighted reign brings home the truth of rapid aging under stress.

I am not making this up, by the way. If I were making this up, I promise you that I would introduce into the endocrine system a very special hormone shaped like a tiny rowboat, and this rowboat would have nothing to do but float up and down our blood canals collecting excess glucocorticoids and dumping them directly into our bladders for easy removal. My brightly colored little rowboat--but never mind. In straining to communicate highly complex and mind-boggling pathological processes, I tend to wander. My palms sweat. My pulse jumps. My yin begins to yang. Could this be why Playboy put me on the case?

Back to basics, then. Fundamental to the endocrine stress response is the hypothalamus, which initiated the hormonal output by stimulating the release of ACTH. When the level of stress hormones rises in our blood, a miraculous kind of feedback device triggers the hypothalamus to signal the pituitary to shut off further messages to the adrenals. It took Selye and other researchers about 40 years to figure that out; what they have determined is that our systems adjust the supply of stress hormones to the demands made upon them. When a crisis subsides, we are meant to lay back, light up a Thai stick and go about our business with no further need for a steroid or catecholamine supercharge. But when our endocrines are subjected to chronic stress, endless frustrations, constant feelings of insecurity and anger, strange and unlovely things occur within.

The stress hormones begin to behave like friends who stay too long and wear out the furniture. These corticoids have a nasty habit of inhibiting cell regeneration, so that holes that normally heal themselves in the lining of the stomach and intestines are no longer readily repaired with new cell growth, and peptic or duodenal ulcers form. Excessive corticoids also throw women's menstrual cycles out of phase, disturb biorhythms and cause insomnia, not to mention their encouraging attacks of colitis, asthma, diabetes and migraine. Meanwhile, they combine with catecholamines, stimulated by aggressiveness, to raise the content of cholesterol and fat in our blood and congest our arteries.

Now you are beginning to understand why you feel so lousy much of the time. I did not come here to spread cheap gossip about your glands, but the hypothalamus inside you, put there to function as an emotional thermostat, turns out to be a steroid junkie that keeps nodding off on the job. While not too accurate a description, it approximates the truth. Chances are you have little idea how much havoc your overdosed hypothalamus can wreak; in the interests of propriety, I would just as soon skip the entire issue of coronary disease and leave you to your stomach pains. But it happens that by our inability to cope with our environment, we are wasting ourselves into the grave--no small problem--and we will probably not stop committing biological suicide until we realize exactly how our bodies wither under the chronic stresses and struggles we inflict upon them.

• • •

I showed my heart to a doctor.

He said I'd just have to quit.

Then he wrote himself a prescription,

And your name was mentioned in it.

--Leonard Cohen

A massive failure of modern Western medicine has been its debilitating reluctance to accept the integral connection (continued on page 188)Stress(continued from page 122) between what we feel emotionally and what we experience physically. "The unity of body-mind has been clear for centuries," observes Luce, "but we had a religious prejudice against acknowledging it." In The Transformation, George P. Leonard remarks that Calvinism, while despising the flesh, measured each person's heavenly standing in terms of his worldly success. "Surely one of history's neatest doctrinal tricks," he comments. Four hundred years later, we are still paying off the neurotic debts of our religious and social origins. Elsewhere in his illuminating study, Leonard writes: "It is not enough to say merely that the body affects the brain or that the brain affects the body. I would like to propose, rather, that behavior affects the total organism; that every so-called mental state has its physical equivalent."

American physicians, as susceptible to the foibles of our cultural heritage as the rest of us, have traditionally concentrated their energies on mending our visceral beings; most have conceived of the mind as a ghost in the machine. But who believes in ghosts? Where do you insert the scalpel?

Happily, as things really began to snap out of control in the past few decades, medical researchers started to entertain much broader concepts of organic harmony. One dividend is biofeedback, the therapeutic treatment of "autonomous" body processes brought under the direction of conscious thought. Yet the most frequent advice a patient with a stress illness receives is to go home and relax. "I don't know how to relax," the patient replies. "If I knew how to relax, I wouldn't have these fucking pains in my side." Nodding compassionately, the doctor writes a prescription for Valium, Librium or trusty ol' Miltown. Conservative estimates indicate that $500,000,000 is spent every year in pharmacies in this country alone on tranquilizers: What they do, in essence, is to diminish our perceptual awareness of stressful events and thoughts and, as a consequence, our physiological reaction to them. Of course, they also leave us vulnerable to situations that demand a stress response and coddle us into building up a drug tolerance.

If a doctor dismisses pill popping as a remedy, he might instead recommend psychiatric treatment. But. guess what?--corporations do not like to think that the men working for them are crazy, and many stressed-out executives refuse such counseling in fear of being exposed back at the office; most, in fact, would rather admit to a seedy liaison with a transsexual yak. The irony of corporate status is that while it demands sanity as a criterion for advancement it creates pressures that generate emotional instability.

For these reasons and others, general practitioners are left with the burden of responsibility for treating stress illness. Some have augmented their staffs with "physician extenders"--a name conjuring up all sorts of bizarre prosthetic devices--who are put on the payroll as clinical psychologists and paraprofessionals dealing with behavior and trauma that lead to disease.

As a rule, however, modern medicine is so specialized, so often creased by petty rivalries and encumbered with a built-in communications gap, that basic truths constantly get lost in the shuffle of sophisticated information.

Consider that for 15 years, two cardiologists in San Francisco published more than 250 papers in every leading American medical journal concerning their research into the relationship between emotional stress and coronary disease, and just about nobody listened. Psychiatrists, they say, had no idea what they were talking about. They might have gone on indefinitely whistling down the wind except for a fortuitous accident that brought a sample of their work to the attention of a national book publisher. Type A Behavior and Your Heart resulted. In the next few years, more than 5,000,000 people probably will read it, some will even increase their life span as a consequence. If so, they might send a note of gratitude to 82-year-old Alfred Knopf, who set in motion the writing of this very accessible guide to longevity.

Type A behavior may be defined as an action-emotion complex that can be observed in any man or woman "who is aggressively involved in a chronic, incessant struggle to achieve more and more in less and less time, and if required to do so, against the opposing efforts of other things or other persons." The above italics, as well as the concept, belong to co-authors Drs. Meyer Friedman and Ray H. Rosenman. In their book, they inform us that those who exhibit excessively competitive behavior, constantly hurried activity, free-floating hostility, an urge to interrupt others' speech and a tendency to do or try to think of two or more things simultaneously--those of us, in brief, who are striving to prosper on this planet at the expense of inner peace--are the very same persons who can look forward to an early visit from the Grim Reaper, especially if that striving consumes almost all of their emotional and physical energies.

By contrast, the Type B person relaxes without guilt, works without agitation and feels little need to discuss or display his "achievements or accomplishments. He is far more aware of his capabilities than concerned about what peers and superiors may think of his actions." Finally, his self-confidence develops from his realistic appraisal of his attributes and deficiencies.

So much for theory. Cardiovascular diseases affected 28,000,000 Americans in 1972, according to the American Heart Association's most recent figures. They accounted for 53 percent of all deaths. 35 percent of which were caused by heart attacks. In 1971, more than 1,000,000 people died of heart-related diseases, one fourth of them under 65. The numbers keep piling up year by year. It costs us 19.7 billion dollars annually in medical and research expenses to treat cardiovascular problems. The Heart Association is finally beginning to consider stress as a probable cause. Officially, the A.H.A. does not wish to be asked what to do about it: "Only the individual himself can alter his lifestyle and control his emotional reaction to daily events." That's the policy statement. Somehow it evokes the attitude of Victorians toward sexual disorders: Only the individual himself can alter his disgusting habit of masturbation and prevent hair from growing on his palms by controlling his despicable urge to stick his Sir Thomas in every Lady Jane that flutters by.

Drs. Friedman and Rosenman have another notion. They devote one third of Type A Behavior to practical guidelines and suggestions for lifestyle change. They include drills and exercises: Remind yourself daily that things worth being are more important than things worth having; learn to hold opinions loosely; become intimate (spiritually) with your friends; stop and look around and open your senses to the wonders of the universe; slow down stop talking and start listening.

Sound familiar? Maybe even a little sophomoric and platitudinous? Well, you've no doubt come across most of this material before in those self-improvement guides written by men who swear to have earned $12,000,000 in their spare time and who offer their secrets to you for $7.98 on a 80-day no-risk basis. Indeed, it must be said that Friedman and Rosenman seem a little out of their depth when they plumb the mysteries of self-realization. No matter, they are onto something massively important to our collective health, and it may ultimately be for humanists and behaviorists to step in and lend them a hand with more refined and persuasive coping methods. Many valid attempts in this area--ranging from Esalen and other self-fulfillment groups--often scare away Type A individuals: too mystical, they think, too damn prying, maybe even a little fruity, and besides, who has time for such nonsense?

It appears that more and more of us will begin to make time as our awareness increases: Fear of dying does that to us, makes us amenable to strategies for living outside our normal spheres of interest.

But most of us don't listen until it's too late--even if our bodies have been haranguing us for years to lay back and look around. Once again, our glands precipitate the damage, but in this instance they convert stress into mortality by a slightly different process. The relaxed reader will recall that when last we visited the hypothalamus, it was so stoned on steroids that it neglected to send a cease-fire signal to the pituitary. Not content merely to screw up our endocrines, it was also elevating the level of cholesterol in our blood, a direct cause of coronary disease.

Several years ago, Friedman and Rosenman induced Type A behavior into laboratory rats by purposely damaging their hypothalami. The damaged rats left docile ones alone but viciously attacked competitive rats. Their cholesterol levels shot up. Way up.

"The hypothalamus is a very interesting son of a gun," says Friedman. "We discovered that under chronic struggle it overdrives the sympathetic nervous system, releases hormones that discharge cholesterol, increases clotting elements in the blood, even a prediabetic state. Amazingly, cardiologists have been barely aware that it existed."

We are seated in Friedman's small uncluttered office in the Harold Brunn Institute for Cardiovascular Research at Mount Zion Hospital and Medical Center in San Francisco. He says he considers himself a Type A personality who works as much Type B behavior into his life as possible. "For instance," he says, "once I would have scheduled this interview for an hour sharp; now I've given myself all morning, so we can take as much time as necessary."

I am especially happy to learn this, for I found myself, minutes before, exhibiting heavy Type A behavior as I interrupted his pleasant ramblings to stick in some pertinent questions. He has already identified me as a Type A by virtue of my speech patterns--bunching words together, punching out certain phrases for emphasis. I am, to say the least, chagrined. How can he deny me my wonderful inner tranquillity? Doesn't he know how many joints I had to smoke in my life to become so cosmically serene, at what cost to my jellified brain I hope never to comprehend? I have been yogafied, acidized, Cannabisized and mescalinated into near catatonia, and yet this foolish fellow insists on classifying me with the hard-nose pushy bastards who run the world.

Hmmm.

"A Type A motorizes his anxiety into his struggle," the doctor is explaining. "By that I mean he fuels his competitiveness with worry and doubt. Type A's are very insecure, so they constantly feel a need to prove their worth by acquiring more and more. They begin to think in numbers, always in numbers. A while back, we ran a study of thirty-five hundred local corporate men; over the ten years we kept records on them, the ones we originally classified as Type A's turned out to be three times more likely to get coronary heart disease than Type B's. It made us suspicious."

Smiling affably, Friedman withdraws a cassette recorder from his desk. For the next half hour, we listen to interviews with various subjects. By listening to quite unsubtle cues in their speech patterns as the doctor points them out to me, I am quickly able to distinguish A from B. Though most of us are a mix of the two, one type will predominate. But there seem to be gradations of each. Yes, replies Friedman, there are different levels of both. A-l people are in the most danger. "I think," he says, "it would be good for you to hear a hot A."

Into the recorder goes a tape of a manufacturing engineer at Lockheed. At the end of his responses, the man frequently sighs--"A sure sign!" Friedman exclaims--and the man's staccato rhythms betray an unmistakable hostility.

"He died of a heart attack two months after that interview," Friedman reveals. "He was forty-eight."

"He sounded pretty healthy to me, doc. Uptight but healthy."

"He's dead."

Friedman inserts another tape. On it, a bank president speaks glowingly of increased revenues, snaps out a few words, bites off syllables, interrupts the interviewer to complete her sentences for her.

"Died a year after that was made," says Friedman. "Fifty-one."

And so it goes. Strong, vigorous business executives punch out answers in clipped professional tones, pound the desk for emphasis and are pronounced dead when the recording ends.

All this, I must admit, chills me, and I am not even a businessman. In fact, I sit by myself in a small room much of the time, pushing oval type keys and getting off on obscure words. I am ecstatic to discover, for instance, that a xyster is a small instrument used in surgery. Immediately, I deduce that a lawyer handling lawsuits involving this instrument must be a xyster shyster, and my day is made. Still, I apparently exhibit more Type A behavior than I anticipated, and with no difficulty my sympathies reach out to embrace departed bank presidents and late ballbearing tycoons.

We do not have to be reminded that we are all under enormous pressures, nor is it necessary for us to bone up on the grisly capitalistic vices that contaminate our glands, squeeze off our capillaries and clog our arteries with greasy plaque. What does seem worth learning is the dynamics of self-damage; having considered them, we stand at least a chance of re-engineering our lives to eliminate as much emotional flack as possible. This is just about all that professional healers like Friedman and Rosenman keep trying to impress upon us.

No great surprise, the easy division of Type A and Type B has provided palaver for many parlor games over the past year. Well, we made bisexuality a pop commodity, so why not coronary disease?

In a moment of plaintive reflection, Friedman reveals a small sadness: "I feel we've written a book on how to read and write for a bunch of illiterates." Type A's, he says, have lost the patience to read. They think they don't have time, and they're innately resistant to any philosophy that seems designed to diminish their competitive drive. "But we're telling them," Friedman continues, "that nobody ever failed in business because he managed to do a job too well too slowly."

Type B executives typically plan well ahead, space their conversations and thoughts over a longer period, feel little need to thrust their opinions into the middle of a colleague's remarks. Usually they survive their Type A counterparts, but perhaps equally as important, they seem to enjoy life much more along the way. "A's have no respect for B's," observes Friedman. "But the smart B uses an A. The great salesmen are A's. The corporate presidents are usually B's."

What happens when the boss is an unrelenting Type A? Well, consider what happened to Richard Nixon--the head of the world's biggest conglomerate. Errors in judgment are endemic to Type A's. "The mistakes these people make are incredible!" Friedman exclaims. "They get locked into thought patterns, they get harried, they literally don't have time to think straight. Nixon keeping those tapes around--a perfect illustration of A behavior. Now, if he had surrounded himself with a few B's, he might have been rescued. A combination of A's and B's at the highest level of decision leads to magnificent creative irritation. But a Type A at the very top, if he can't stand criticism, if he's constantly combative...." The thought upsets Friedman and he drops it to reclaim another area of diagnosis. "Habits are scabs on the personality," he says. "They can be changed, no matter how long a person has been behaving in only one way."

Many experts in the field of cardiovascular research disagree with the Type A hypothesis; they argue that Friedman and Rosenman slough off obvious risk factors--smoking, for example, and high-saturated-fat diets. Among the skeptics is Dr. Henry Blackburn of the University of Minnesota. He suggests that if the Type A behavior theory deserves serious consideration, it should be able to transcend cultures. The urban Japanese, says Blackburn, live in an overcrowded, often frantic environment--ideally suited by Friedman and Rosenman's standards to produce coronary disease. But the heart-attack rate in Japan has always been exceedingly low. The Finns, on the other hand, live stolid outdoor lives free from stress and strain, yet they exhibit the highest rate of coronary disease known to man, most probably as a consequence of their diet.

"The Type A behavior idea remains an inadequately tested and possibly even an untestable hypothesis," Blackburn adds. He worries about glib assumptions of cause and effect. "There is no statistical relationship yet, as there is between cigarette smoking and lung cancer." He feels that Friedman and Rosenman may also be misinterpreting their own data, mistaking one of a set of multiple influences on coronary disease as its major cause.

"The point," Blackburn continues, "is that Type A behavior may be bad, but it isn't essential to the coronary-risk question. We all have a gut feeling that goalless and aggressive behavior may be stupid and unhealthy and should be a major concern. But the tragedy of the Friedman-Rosenman book is its tendency to make baseless, fanatical statements."

Blackburn and others pillory the authors for dealing superficially with profound cultural issues. Matthew Dumont in his New York Times review asks rhetorically: "What should we have expected? After 10,000 years of philosophy, should cardiologists be the ones to do a new accounting of the human condition?"

My own feeling is that rhetorical questions like the one above are a major cause of coronary disease. As an uninformed citizen, my sympathies lie with Friedman and Rosenman; even so, it seems to me they propose that the meek shall inherit the earth at the expense of the rest of us. The schleppers, the ham-and-eggers, they appear to argue, will ultimately prevail. I don't mind leaving my meager estate to the paper plucker in the park if I have to go before he does, but it would at least comfort me to know that he won't pass his extra hours dribbling soup all over my collected manuscripts.

• • •

Man should not try to avoid stress any more than he would shun food, love or exercise.

--Hans Selye, Newsweek, March 31,1958

If Nixon and Ivan the Terrible, among others, have given chronic stress a bad name, it should be remarked that some forms of stress, like some forms of abstinence, assert a therapeutic value on our lives.

Currently, one of the most vocal and respected proponents of beneficial stress is the very same chap who first revealed to the world what a miserable mess it was making of its bodily functions: Dr. Hans Selye. On the dust jacket of his recent book, Stress Without Distress, he can be seen fondling a large white rat. Selye peers studiously above bifocals while the rat gazes off into space with a look of infinite resignation, knowing in its genes that there are better places to be for a large white rat than in the clutches of this small adventurous researcher.

Luckily for the rodent, Selye in the past few years has drifted away from experimental investigation into biochemical philosophizing--to wit, an attempt to fashion a universal code of behavior for mankind out of his cellular discoveries.

For much of his life, Selye, 68, has engorged animals' adrenals with stress hormones and otherwise upset their homeostasis; but of late, he has confined himself to squinting into his microscope past the minute particles on his slides, beyond the illuminating mirror and out into the cosmos, where the heady questions of meaning and purpose wait to be pondered. Dissecting a leaf to understand the concept of a tree--others before him have made the attempt and some, like Don Juan, the Yaqui sorcerer, have succeeded.

"What I have discovered," Selye confides, "is that the body uses clearly identifiable chemical instructions to raise its resistance and to adapt. The laws of self-preservation that operate here are inherent in the subcellular structure of all living organisms and furnish natural guidelines for behavior in daily life."

Oh?

In the past 12 hours, I have traveled 3000 miles to visit this celebrated man at his Institute of Experimental Research in Montreal; have slept with cockroaches and Canuck dopers and hookers in the only available room in town, bathroom down the hall and don't sit on the toilet; have labored through his book under a naked 20-watt light bulb in search of truth; have been misunderstood in French, English and several languages in between; and have developed blisters from walking the cobblestones of Old Montreal in new shoes.

Am I ready for a few answers? Mais oui. Does Selye have them? Qui sait? What I do know is that he resides in the world's most wonderful office--plush red leather, deeply buffed, with mighty tomes rising celestially to the ceiling like pillars of pure intellect, handsome walnut everywhere and the faintly musty smell of scholarship. Selye himself reminds me much of Sam Jaffe doing his archetypal Kindly Physician. Compact, alert, unruffled. An elfin smile for every situation.

Any flaw will do, then, any human frailty to match mine.

But no, Dr. Hans Selye made most of his mistakes long before I was born. Not that he seems smug or self-righteous; it is simply that as the afternoon wears on, he speaks to me of the central problems of the universe in such hackneyed phrases that I yearn for a few hard-won insights and smelly truths.

"Earn thy neighbor's love," he says. "Practice altruistic egotism." And "Adapt and collaborate." The laws of biology, he says, are ruthless and inevitable; we must structure codes of behavior that are compatible with them. Cells cannot thrive without symbiosis; therefore, be selfish but not at the expense of other humans. Earn their gratitude or love. Evolution depends on cellular harmony, but a cancer cares only for itself and feeds on other parts of its own host and thus commits biological suicide.

Knowing all this, Selye continues, we should structure our lives to create as much personal harmony as possible. Engender good will; you will reduce external threats, securing your place in society.

"Frankly, you did well to come here to see me," the doctor observes. "I can tell you things you could not hope to learn anywhere else."

Things about stress?

"Exactly."

Beneficial stress?

"Yes. I call it 'eustress' to distinguish it from distress. Eu- as in euphoria."

What about it?

" 'Fame and tranquillity can never be bedfellows,' " he says, quoting Montaigne. I think it's a terrific quote, but I have no idea how it relates to the issue at hand. The doctor leans forward to explain. "The lash of a whip or a passionate kiss is equally stressful." Then he smiles.

Somehow we have skipped from cancer to fame to kisses in a matter of seconds. I falter. Seeking refuge in silence, I search for missing links. But, like the oracle of the I Ching, Selye leaves space for interpretation. Much space. He next shows me a steel molecular model of a stress hormone; it reminds me of mistakes I made with my erector set as a child.

"To go from this model to how to behave with a drunk is a great jump," Selye says. At that I nod.

Pressing on, I learn from him that good stress involves marshaling just enough defense mechanisms to meet a specific demand; bad stress is overreaction. Bad stress, by analogy, is the entire Canadian border patrol charging into Vermont to beat back one man armed with a BB rifle. Bad stress is too many good hormones doing too many good things all at the wrong time.

Heredity and other internal conditioning factors give each of us a particular and unique stress-resistance threshold. While some need to burn off energy, others are more tuned to passivity. Stress, as Selye now defines it, is a very broad concept, indeed; it is the nonspecific response of the body to any demand made upon it. Myself, I prefer to think of stress as a response to pressures, responsibilities and real or imagined threats.

But I can live with his definition, if only he will fill in some of those yawning gaps. He speaks of the need for commitment in life, the need for recognizing one's limitations. And the necessity of choosing one's own goals, regardless of what others urge. Shades of Bishop Fulton Sheen and Norman Vincent Peale. I am not quite ready to dismiss the man as a philosophical featherweight, but he does seem cushioned from the bleak realities of making do.

How do you apply your behavior code to a blue-collar worker with three kids, debts, a lousy job, a nagging wife and psoriasis? I ask.

"I have my hands full making that translation," he confesses.

Well, then, how do you apply it to your own life?

"I don't know if you noticed," Selye replies, "but I have no hips."

For a second, I am certain the secretary laced my tea with a double dose of acid. Reeling, I follow him to the library shelf. On it rests a clear-plastic cube encasing a hip joint the size of a baseball.

Yours? I inquire.

Selye nods. "I have two artificial hips. It doesn't bother me in the least. I know I must accept the limitations this imposes, and so I never worry about what I can't do. I take pride in what I can do with two artificial hips. I bicycle to work every morning at five A.M." A twinkle flickers across his eyes; again the leprechaun grin.

At 68, this fellow bicycles to his office at dawn and works daily until eight in the evening. He is loved at home, respected on the job. His library alone contains 97,000 articles and books on the physiology of stress, and they all owe some debt to his original endocrine research. He must rank as one of the most secure people on earth. No wonder that he finds it difficult to empathize with misery and fear. I feel impertinent to have considered him remote. Having listened closely, having seen his hip, I begin to understand. Here is a happy man.

• • •

Back in San Francisco's North Beach, on the corner of Grant and Columbus, I come across Patrolman MacGillvray, a 20-year veteran who laughs and tweaks his nose like somebody's favorite uncle. Murders, rapes, muggings, they pass through his life as regularly as seasonal winds. Still he laughs. He must know something. "In this occupation," he says, "you gotta keep your smile."

A smile, the instant stress tonic! I will take you, MacGillvray, and I will broadcast you coast to coast ... but wait, what's this? The laughing policeman is hoisting up his thick blue shirt right in broad daylight, exposing before my eyes one terrible-looking scar shaped like a roof, rising up from both sides of his rib cage to meet below the heart.

"They just about killed me," he says.

Who? How?

"Ulcers," says MacGillvray, "they cost me my stomach."

When?

"Worked radio dispatch for ten years, screening calls--who to take serious, who to hang up on, tough to decide."

I see, MacGillvray, you were one of us in those days, hypertense, taut, but after the stomach thing, you learned to laugh, and now----

"Discorrect," he interrupts. "I was born a wiseass joker, only way to keep your e-queer-librium." Ha-ha-ha. Another chuckle.

Then tell me, MacGillvray, if you were always so loose and easy, how come the ulcers? I've done a fair amount of research and----

"Mustard," he replies. "Too much mustard on the pastrami."

Goddamn! Here, right before my eyes, is the Krishnamurti of the street beat, and the best I can get from him is mustard.

"Don't spend any wooden nickels," he says, strolling away with a merry whistle.

End of dialog.

Patrolman MacGillvray's ulcers pose a direct threat to my speculations on stress, no doubt about it. Best to move on quickly, then, hoping to find aid and comfort elsewhere.

The next man who speaks about on-the-job stress turns out to have spent the past six years of his life figuring out what to do about it, and since he happens to be a pro quarterback, recently retired, he can be considered an authority on nervous indigestion. Eight years ago, when 49er quarterback, John Brodie was struggling to maintain his starting berth, he succumbed during one practice session to a fit of exasperation. "Get off my ass!" he shouted at coach Y. A. Tittle, unloading a left hook in the direction of Tittle's nose. In time, Tittle and Brodie grew to be close friends, and along the way, Brodie developed a personal philosophy designed to help him withstand the pressures of his craft.

"Mental anguish from outside is part of what you come to expect," he says. "Every quarterback up there can throw a football and hit a target nineteen times out of twenty, all things being equal. But primarily what counts is the size of the guy who's playing; I mean, how able is he to handle all those outside factors, one of them being stress? To take a look at that, you've got to take a look at what is stress. Well, once you get to the point where you realize any situation is only as important as the importance you place on it, and that importance can only affect your play derogatorily, to the degree you allow it to distract your attention from the performance itself, then the whole bag becomes to let other people do the worrying. If you're in a decision-making position, you've got to learn not to be affected by outside pressures. If you're the type who is, you don't belong in that capacity.

"Most good quarterbacks are like that. They see in a way, they say, 'What is all this shit, is it something we can touch? No, it's only as big a deal as I make it.' So, in my case, the less attention I paid to what the fans thought or what my wife thought, the more I could approach being as able as I really was potentially."

Which was more able than most. Over a career that spanned 16 years, Brodie, while reflective, was not remote from the abrasive humor of locker rooms. In fact, he thrived on it, and he says that sense of camaraderie sustained him through injuries and the yearly floods that turned Kezar Stadium into an uninhabitable 100-yard marsh.

"Pressure," he continues, "has a crazy way of creating itself in you when you get into agreement with what other people think you ought to be doing. Pressure is agreement with inferior viewpoints. The whole game of life is one of understanding, and that's exactly where my involvement with Scientology comes in."

When tendonitis hindered Brodie's passing ability in the late Sixties, he sought help from doctors, who prescribed a variety of painkillers. He soon found himself more dependent on pills than he wanted to be. Casting about for other remedies, he stumbled upon Scientology, a "brain game," as he puts it, that connects pathways of communication. Hocus-pocus to some, but for Brodie this venture into emotional clarity provided a real and permanent cure.

"It turned out the stress I was bringing in had affected my arm, only I didn't know that at the time, of course. My secretary happened to be a Scientologist, and while I was trying to denounce what she was doing, she kept looking better and better and I kept looking worse; so finally she introduced me to this fellow who was an auditor, and I went in for a session. It was exposed to me during those four hours of auditing how the arm problem had arisen through my agreement with it--or, in other words, my head. Now, that's fine, to know it's there, but my contention was, OK, now I know, but it's still there, right? Except that after those four hours, the arm tendonitis disappeared. I came out with no pain. I figured, if it can do that for my arm, what can it do for me?"

Has Scientology held up for him over the years?

"It never ceases to get better," says Brodie, who at 39 looks to be as healthy and content as a Marine drill sergeant on his way home from a Zen monastery. Some of that equanimity may be attributable to a $75,000-a-year retirement stipend, his long-term reward for manipulating the old A.F.L. against the N.F.L. when the two warring leagues decided to make peace and only Brodie's threat of a lawsuit stood in the way.

But enough economics. "There are so many cult games totally unlike Scientology. You get to feeling real good and you're away from the environment you live in, but then you go back into life and you find yourself in the same bag you were in before. The idea is to be in any space, no matter what's going on, and not bring it in on you. It doesn't mean don't be involved, it means be very involved, but without getting hung up on irrelevant problems, things you don't have any control over. Handle what you can do something about.

"It's a question, I think, of always knowing what your purpose is. If your purpose in playing football is to make money, as a team you're going to fail, that purpose is not sufficient to carry you to a championship. The same thing happens to a guy who gets started in a business right out of college; he gets moving and grooving and he's having a ball, all right, and six months later the world caves in. Well, somehow his purpose has changed, it's been altered by the people around him who keep saying, 'This is all a bunch of shit anyway, just put in your time and make money.' Now, that totally balls up his purpose, which was to do a real good service to the community, to be somebody who's respected."

The more honest you are with yourself and others, Brodie feels, the less likely you are to invite distrust and inner conflict.

"Look at the Oakland Athletics. The only way they can make it as a team is to all be aboveboard. Right out. They don't let anything go unconfronted. Because if they allowed what could happen to them in that organization to happen from the top, they'd be overwhelmed, rocking off the walls. I'm sure they've discussed how to handle the stress, and they decided the best way was to let it all hang out."

The trick, for sure, is to deflect stress and anxiety by applying clarity of vision to yourself in difficult times. Toward the end of the 1973 season, Brodie re-examined his quarterbacking abilities. "When you read a blitz but you can't do anything about it, you don't belong in the game," he concluded. A day later, he announced his retirement.

"I was no longer as effective a player as it was necessary for me to be by my own standards. My other involvements and interests obviously ate into this; in order to play that simple game, you gotta get all the complex shit out of your system and keep it out. Some of the importance of playing had diminished for me; I wasn't performing like I wanted to, so I just quit. That's all. I have no regrets."

Which leaves Brodie alive and well and pretty much on top of his case. But what about the rest of us?

Well, for most people who cherish the rub and tug of testing our capacities against high odds, it makes sense that release from work pressures logically includes a heavy dose of exertion. Exercises that do us the most good are those that involve an element of injury risk, says Dr. Sol Ray Rosenthal, who has been studying the subject for years.

He has determined that when we ride horses, ski, scuba dive or mountain climb, for instance, our endocrines release hormones that give us a feeling of intense exhilaration. The euphoria is pure, unencumbered by any feelings of doubt or fear. "Calculated risks," he argues, "are essential for our daily well-being."

The more efficient we become, the greater the challenges we should undertake. Although the possibility of sustaining injury is essential to the exhilaration that comes with accomplishment, Rosenthal warns against reckless endeavors. They do nothing good to our systems, he says. Mostly what they do is break our bones and tear our ligaments. Rosenthal's belief in risk exercise stems from a lifetime of fox hunting; his considerable research gives substance to the theory, but it still remains for scientists to isolate a particular steroid responsible for the ecstasy of agony.

Touch football and other competitive sports perform the same biochemical functions to a lesser degree; what we risk is the possibility of losing, and for some that emotional drain negates the beneficial aspects of exertion. Competition, says Rosenthal, provides a good release only for those who can leave their frustrations on the playing field.

Jogging, swimming and other sports that demand little risk and no competition are valuable in toning the nervous system and enhancing endurance. If there is no exhilarating rush, there is often a sense of subdued release attached to them.

Ironically, the two most highly recommended methods of coping with stress appear to demand contravening disciplines: total relaxation in the case of meditation, total exertion in the quest for risk. Yet each approach requires an element of unremitting concentration on the present moment. It is as if the elusive and enigmatic answer to shedding the tensions of daily life locates itself in the epicenter of our psyches. Orbiting about, we throw off random waves of energy that are quite capable of destroying us, if unchanneled. But when we concentrate that energy within and trust it to transport us beyond the limits of reason, a miraculous act of rejuvenation takes place. In our complex and disjointed time, this simple achievement of inner harmony may be the most difficult task of all.