Heart disease and the cultural construction of time: the type A behaviour pattern as a Western culture-bound syndrome.
For over 20 years, the image of the coronary-prone 'type A' individual, ambitious, competitive, hostile, and time-obsessed has been a familiar feature of cardiology literature, and of popular discourse on health. A closer examination of the moral content of this model, suggests that it is based on a binary classification of social values type A (bad) and type B (good). But the type A individual is also a figure of moral ambiguity, embodying many of the inherent contradictions of Western industrial society. In particular, his anti-social behaviour is rewarded in money, or status by that same society. The paper proposes a model of symbolic inversion, whereby these social contradictions are resolved for both victim, and society by his development of coronary heart disease. The type A behaviour pattern can be regarded as a 'culture-bound syndrome', particularly of middle-aged, middle-class men, and one which condenses key concerns and behavioural norms of the society. As a diagnostic category, it can only be understood in the social context of the industrialized world and against the background of the unique social and symbolic characteristics of Western time.
Department of Primary Health Care, University College & Middlesex Medical School, Whittington Hospital, London, England.
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Helman
D003327:Coronary Disease / Q000523:psychology*; D003469:Culture; D005260:Female; D006801:Humans; D007221:Industry; D008297:Male; D009014:Morals; D013577:Syndrome; D013995:Time; D014434:Type A Personality