Hypertension also stalks a lesser-known personality type, one driven by what Sherman A. James, an epidemiologist at the University of Michigan, calls John Henryism. The name refers to the American folk hero who, hammering a six-foot-long steel drill, tried to outrace a steam drill tunneling through a mountain. John Henry beat the machine, only to fall dead from the superhuman effort. As James defines it, John Henryism involves the belief that any and all demands can be vanquished, so long as you work hard enough. On questionnaires, John Henry individuals strongly agree with statements such as “When things don’t go the way I want them, it just makes me work even harder,” or “Once I make up my mind to do something, I stay with it until the job is completely done.” This is the epitome of individuals with, to use some psychological jargon, an internal locus of control—they believe that, with enough effort and determination, they can regulate all outcomes.
What’s so wrong with that? Nothing, if you have the good fortune to live in the privileged, meritocratic world in which one’s efforts truly do have something to do with the rewards one gets, and in a comfortable, middle-class world, an internal locus of control does wonders. However, in a world of people born into poverty with limited educational or occupational opportunities facing prejudice and racism, it can be a disaster to be a John Henry, to decide that those insurmountable odds could have been surmounted, if only you could have worked even harder. Stress physiologists have long known the dangers of trying to control the uncontrollable, a classic case of mismatched coping. Strikingly, James’s pioneering work has shown the cardiovascular disease dangers of John Henryism to occur predominately among the very people who most resemble the mythic John Henry himself, working-class African-Americans.
These links between personality type and overactive stress responses have been known for years. Yet some recent studies reveal an additional, unlikely personality type that has this sort of physiologic problem.
These are not people who are dealing with their stressors too passively, too persistently, too vigilantly, or with too much hostility. They don’t appear to have all that many stressors. They claim they’re not depressed or anxious, and the psychological tests they are given show they’re right. In fact, they describe themselves as pretty happy, successful, and accomplished (and, according to personality tests conducted by psychologist Dirk H. Hellhammer and colleagues at Trier University in Germany, they really are all the above). Yet these people (comprising approximately 5 percent of the population) have chronically activated stress responses. What’s their problem?
Their problem, I think, is one that offers insight into an unexpected vulnerability of our human psyche. The individuals in question are said to have “repressive” personalities, and we all have met someone like them. In fact, we usually regard these folks with a twinge of envy—“I wish I had their discipline; everything seems to come so easily to them. How do they do it?”
These are the archetypal people who cross all their T’s and dot all their I’s. They describe themselves as planners who don’t like surprises, who live structured, rule-bound lives—walking to work the same way each day, always wearing the same style of clothes; the sort of people who can tell you what they’re having for lunch two weeks from Wednesday. Not surprisingly, they don’t like ambiguity and strive to set up their world in black and white, filled with good or bad people, behaviors that are permitted or strictly forbidden. And they keep a tight lid on their emotions. Stoic, regimented, hardworking, productive, solid folks who never stand out in a crowd (unless you begin to wonder at the unconventional nature of their extreme conventionality).
Some personality tests, pioneered by the psychologist Richard J. Davidson and colleagues at the University of Wisconsin, identify repressive individuals. For starters, as noted, the personality tests show that these people aren’t depressed or anxious. Instead, the tests reveal their need for social conformity, their dread of social disapproval, and their discomfort with ambiguity, as shown by the extremely high rates at which they agree with statements framed as absolutes, statements filled with the words “never” and “always.” No gray tones here.
Intertwined with those characteristics is a peculiar lack of emotional expression. The tests reveal how repressive people “inhibit negative affect”—no expressing of those messy, complicated emotions for them. This was shown with particular subtlety in a study where repressive and nonrepressive individuals were asked to recall an experience associated with a specific, strong emotion. Both groups reported that particular emotion with equal intensity. However, when asked what else they were feeling, nonrepressors would typically report an array of additional, nondominant feelings: “Well, it mostly made me angry, but also a little sad, and a little disgusted too. . . .” Repressors steadfastly reported no secondary emotions. Black and white feelings, with little tolerance for subtle blends. As another example of that, repressors are less likely to report observing a blend of dominant and nondominant emotions in the facial expressions of other people.
Emotions kept firmly under control, “never” and “always” to sort out those ambiguous curveballs that life throws at you now and then, and things keep flowing without a ripple.
Are these people for real? Maybe not. Maybe beneath their tranquil exteriors, they’re actually anxious messes who won’t admit to their frailties. Careful study indicates that some repressors are indeed mostly concerned about keeping up appearances. (One clue is that they tend to give less “repressed” answers on personality questionnaires when they can be anonymous.) And so their physiologic symptoms of stress are easy to explain: cross those folks off the list.
What about the rest? Could they be deceiving themselves—roiling with anxiety, but not even aware of it? Even careful questionnaires cannot detect that sort of self-deception; to ferret it out, psychologists traditionally rely on less structured, more open-ended tests (of the “What do you see in this picture?” variety). Those tests show that, yes, some repressors are far more anxious than they realize; their physiological stress is also readily explained.
Yet even after you cross the anxious self-deceivers off the list, there remains a group of people with tight, constrained personalities who are truly just fine; mentally healthy, happy, productive, socially interactive. But they have overactive stress responses. A 1996 paper by psychologists Laurel L. Brown, Andrew J. Tomarken, and colleagues at Vanderbilt University shows that repressives have levels of glucocorticoids in their bloodstream that are as elevated as those of highly anxious individuals. Earlier work by Davidson showed that the fight-or-flight component of the nervous system (the source of adrenaline) is also overactive. When exposed to a cognitive challenge, repressors show unusually large increases in heart rate, blood pressure, sweating, and muscle tension. And these overaroused stress responses may exact a price. For example, coronary disease patients who have repressive personalities are more vulnerable to cardiac complications than are nonrepressors.
Overactive, endangering stress responses—yet the people harboring them are not stressed, depressed, or anxious. Back to our envious thought—“I wish I had their discipline. How do they do it?” The way they do it, I suspect, is by working like maniacs to generate their structured, repressed worlds with no ambiguity or surprises. And this comes with a physiological bill.
Nothing brings home the material nature of our minds like a certain type of study utilizing a PET scanner, an instrument that measures the consumption of glucose or oxygen in different parts of the brain. Give a person a mathematical task, and the PET scan indicates that metabolic demand increases in certain areas of the brain. Have them recall a happy memory, and a different anatomic pattern lights up. Provoke anxiety, and there’s a different pattern. It takes energy to think. And, apparently, it takes a whole lot of energy to think and plan and avoid and deny all the time like a repressor. Tomarken and Davidson have used electroencephalographic (EEG) techniques to show unusually enhanced activity in a portion of the frontal cortex of repressors. This is a
region of the brain involved in inhibiting impulsive emotion and cognition, the nearest neuroanatomical equivalent we have to a superego.
A similar theme emerges from the work of James J. Gross at Stanford University. Show people film clips that evoke strong emotions (such as graphic footage of an amputation) and you trigger some pretty strong arousal of the fight-or-flight response. Show people the same film but now instruct them to try to hide their emotions, and the neural response is even stronger, just like for a repressor. It begins to seem plausible that there is a physiological cost to going through life with all these psychic sphincter muscles holding on for dear life.
This is a newly emerging area of research, and much remains unknown. For example, how readily can a repressive individual become less so with therapy? When they change, do their hormone profiles change as well? Will it ever be possible to discern a repressive individual just by recognizing a distinctive hormonal profile? Regardless of the eventual answers to these questions, the physiologic correlates of repressive personality teach us some pretty interesting and unexpected things right now.
It can be a frightening world out there, and the body may well reflect the effort of threading our way through those dark, menacing forests. How much better it would be to be able to sit, relaxed, on the sun-drenched porch of a villa, far, far away from the wild things baying. Yet what looks like relaxation could well be exhaustion—exhaustion from the labor of having built a wall around that villa, the effort of keeping out that unsettling, challenging, vibrant world. A lesson of repressive personality types and their invisible burdens is that, sometimes, it can be enormously stressful to construct a world without stressors.
FURTHER READING
The relationship between depression and an overactive stress response is reviewed in R. Sapolsky and P. Plotsky, “Hypercortisolism and Its Possible Neural Bases,” Biological Psychiatry 27 (1990): 937. Depression as a disorder of inappropriate coping is reviewed in the classic M. Seligman, Helplessness: On Development, Depression and Death (New York: W. H. Freeman, 1975). The current thinking about Type A is reviewed in R. Williams, The Trusting Heart: Great News about Type A Behavior (New York: Random House, 1989). A review of John Henryism can be found in S. James, “John Henryism and the Health of African-Americans,” Culture, Medicine and Psychiatry 18 (1994): 163.
The studies concerning repressive personality and its physiologic correlates can be found in:
J. Brandtstadter, B. Baltes-Gotz, C. Kirschbaum, and D. Hellhammer, “Developmental and Personality Correlates of Adrenocortical Activity as Indexed by Salivary Cortisol: Observations in the Age Range of 35 to 65 Years,” Journal of Psychosomatic Research 35 (1991): 173. This is the study of Hellhammer and colleagues.
L. Brown, A. Tomarken, D. Orth, P. Loosen, N. Kalin, and R. Davidson, “Individual Differences in Repressive-Defensiveness Predict Basal Salivary Cortisol Levels,” Journal of Personality and Social Psychology 70 (1996): 362.
R. Shaw, F. Cohen, R. Fishman-Rosen, M. Murphy, S. Stertzer, D. Clark, and K. Myler, “Psychologic Predictors of Psychosocial and Medical Outcomes in Patients Undergoing Coronary Angioplasty,” Psychosomatic Medicine 48 (1986): 582.
R. Shaw, F. Cohen, B. Doyle, and J. Palesky, “The Impact of Denial and Repressive Style on Information Gain and Rehabilitation Outcomes in Myocardial Infarction Patients,” Psychosomatic Medicine 47 (1985): 262.
A. Tomarken and R. Davidson, “Frontal Brain Activation in Repressors and Nonrepressors,” journal of Abnormal Psychology 103 (1994): 339.
D. Weinberger, G. Schwartz, and R. Davidson, “Low-Anxious, High-Anxious, and Repressive Coping Styles: Psychometric Patterns and Behavioral and Physiological Responses to Stress,” Journal of Abnormal Psychology 88 (1979): 369.
The studies of James Gross concerning the intentional inhibition of emotional expression can be found in J. Gross and R. Levenson, “Emotional Suppression: Physiology, Self-Report, and Expressive Behavior,” Journal of Personality and Social Psychology 64 (1993): 870. See also: J. Gross and R. Levenson, “Hiding Feelings: The Acute Effects of Inhibiting Negative and Positive Emotion,” Journal of Abnormal Psychology (in press).
The Trouble with Testosterone
WILL BOYS JUST BE BOYS?
Max Ernst, Health Through Sports, c. 1920; The Menil Collection, Houston
Face it, we all do it. We all believe in certain stereotypes about certain minorities. The stereotypes are typically pejorative and usually false. But every now and then, they are true. I write apologetically as a member of a minority about which the stereotypes are indeed true. I am male. We males account for less than 50 percent of the population, yet we generate an incredibly disproportionate percentage of the violence. Whether it is something as primal as having an ax fight in an Amazonian clearing or as detached as using computer-guided aircraft to strafe a village, something as condemned as assaulting a cripple or as glorified as killing someone wearing the wrong uniform, if it is violent, males excel at it.
Why should that be? We all think we know the answer. A dozen millennia ago or so, an adventurous soul managed to lop off a surly bull’s testicles and thus invented behavioral endocrinology. It is unclear from the historical records whether this individual received either a grant or tenure as a result of this experiment, but it certainly generated an influential finding—something or other comes out of the testes that helps to make males such aggressive pains in the ass.
That something or other is testosterone.7 The hormone binds to specialized receptors in muscles and causes those cells to enlarge. It binds to similar receptors in laryngeal cells and gives rise to operatic basses. It causes other secondary sexual characteristics, makes for relatively unhealthy blood vessels, alters biochemical events in the liver too dizzying to even contemplate, has a profound impact, no doubt, on the workings of cells in big toes. And it seeps into the brain, where it binds to those same “androgen” receptors and influences behavior in a way highly relevant to understanding aggression.
What evidence links testosterone with aggression? Some pretty obvious stuff. Males tend to have higher testosterone levels in their circulation than do females (one wild exception to that will be discussed later) and to be more aggressive. Times of life when males are swimming in testosterone (for example, after reaching puberty) correspond to when aggression peaks. Among numerous species, testes are mothballed most of the year, kicking into action and pouring out testosterone only during a very circumscribed mating season—precisely the time when male-male aggression soars.
Impressive, but these are only correlative data, testosterone repeatedly being on the scene with no alibi when some aggression has occurred. The proof comes with the knife, the performance of what is euphemistically known as a “subtraction” experiment. Remove the source of testosterone in species after species and levels of aggression typically plummet. Reinstate normal testosterone levels afterward with injections of synthetic testosterone, and aggression returns.
To an endocrinologist, the subtraction and replacement paradigm represents pretty damning proof: this hormone is involved. “Normal testosterone levels appear to be a prerequisite for normative levels of aggressive behavior” is the sort of catchy, hummable phrase that the textbooks would use. That probably explains why you shouldn’t mess with a bull moose during rutting season. But that’s not why a lot of people want to understand this sliver of science. Does the action of this hormone tell us anything about individual differences in levels of aggression, anything about why some males, some human males, are exceptionally violent? Among an array of males—human or otherwise—are the highest testosterone levels found in the most aggressive individuals?
Generate some extreme differences and that is precisely what you see. Castrate some of the well-paid study subjects, inject others with enough testosterone to quadruple the normal human levels, and the high-testosterone males are overwhelmingly likely to be the more aggressive ones. However, that doesn’t tell us much about the real world. Now do something more subtle
by studying the normative variability in testosterone—in other words, don’t manipulate anything, just see what everyone’s natural levels are like—and high levels of testosterone and high levels of aggression still tend to go together. This would seem to seal the case—interindividual differences in levels of aggression among normal individuals are probably driven by differences in levels of testosterone. But this turns out to be wrong.
Okay, suppose you note a correlation between levels of aggression and levels of testosterone among these normal males. This could be because (a) testosterone elevates aggression; (b) aggression elevates testosterone secretion; (c) neither causes the other. There’s a huge bias to assume option a, while b is the answer. Study after study has shown that when you examine testosterone levels when males are first placed together in the social group, testosterone levels predict nothing about who is going to be aggressive. The subsequent behavioral differences drive the hormonal changes, rather than the other way around.
Because of a strong bias among certain scientists, it has taken forever to convince them of this point. Behavioral endocrinologists study what behavior and hormones have to do with each other. How do you study behavior? You get yourself a notebook and a stopwatch and a pair of binoculars. How do you measure the hormones? You need a gazillion-dollar machine, you muck around with radiation and chemicals, wear a lab coat, maybe even goggles—the whole nine yards. Which toys would you rather get for Christmas? Which facet of science are you going to believe in more? Because the endocrine aspects of the business are more high-tech, more reductive, there is the bias to think that it is somehow more scientific, more powerful. This is a classic case of what is often called physics envy, the disease among scientists where the behavioral biologists fear their discipline lacks the rigor of physiology, the physiologists wish for the techniques of the biochemists, the biochemists covet the clarity of the answers revealed by the molecular biologists, all the way down until you get to the physicists, who confer only with God.8 Hormones seem to many to be more real, more substantive, than the ephemera of behavior, so when a correlation occurs, it must be because hormones regulate behavior, not the other way around.
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