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Feeling Powerless Can Be a Health Hazard Heart Problems Loom When Control Slips Away

If you're a hard-driving type, you're probably better off in the driver's seat. That's the conclusion of Duke University Medical Center researchers, who say that ambitious, control-oriented people function quite well when they're convinced they control their own destinies.

But when these people feel powerless, they may be at higher risk for stress-related heart problems. "It's not even tangibly whether you have control or not, it's whether or not you think you do," says Gary Bennett Jr., a clinical psychologist and co-author of the study.
Results were to be presented today at the Society of Behavioral Medicine meeting in Nashville.

The Duke researchers studied 74 healthy African-American men between the ages of 18 and 47 from a wide range of incomes and with educations ranging from ninth grade to medical school. The participants completed questionnaires that assessed their personalities, coping mechanisms and their perceived level of job control. Then they were asked to prepare a response to a stressful scenario, after which the researchers checked saliva samples for levels of cortisol, a stress hormone. Men who had reported that they felt little influence over their workload or whether they would be promoted released significantly more cortisol when responding vigorously to stress, the Duke team found.

In a stressful situation, the body needs cortisol to keep its energy levels high. But too much cortisol production over too long a time can increase blood pressure and weaken the immune system. Being trapped in a low-paying, dead-end job is a common image of the stressed-out worker bee. But Bennett says that even jobs with terrific earning potential can have big stress potential. Medical residents, for instance, with their rotating shifts and constant on-call status, reported a high degree of powerlessness in their jobs despite presumably bright economic futures, he says.

Bennett says he became interested in the relationship among personality, stress and disease while researching the "John Henry syndrome," the name given to a coping response associated with an elevated hypertension risk in African Americans, particularly in the rural South. "We said, 'Let's see if there's some physical response in this group,' " he says. Named after the railroad worker of legend whose heart burst when he bested a steam-powered machine in a digging contest, the "John Henry" personality is characterized by an uncompromising work ethic, stubbornness, patience and reliance on long-term goals, Bennett says. "John Henrys" contain overtones of the old "Type A" personality, a frequent player in discussions of stress-related heart disease during the 1970s and 1980s.

Unlike John Henrys, however, the defining characteristic of Type A's is hostility, Bennett says. Psychologist Mark Ketterer, of the Henry Ford Hospital in Detroit, calls the Duke study results interesting but just a beginning. It's too soon to say definitively whether hard-chargers with less control are at risk, he says. "All we can tell is that the mechanism is in place," Ketterer says. "Ideally you want to look at people ... and follow them over 10 years," he says. "That would be the test of the hypothesis." Still, he says, "it probably is an important issue: Do people feel like they're in control or not? That seems to be a strong predictor. Prospectively, there are studies that say people who have high-demand, low-control jobs are somewhat more at risk for heart attacks." What To Do It's not clear just what would be the best coping strategies for people who lack job control, Bennett says. "That's something we're thinking a lot about," he says. But for good short-term stress-relief, he suggests relaxation and meditation techniques.

 Longer-range solutions probably would involve getting high-control types to focus less on big, long-term goals, which tend to be elusive, and more on smaller, more doable short-term goals. "Certainly, I think there are ideas and remedies on the horizon," Bennett says. For more information on stress and heart disease, visit the Web site of the American Heart Association.

SOURCES: Interviews with Gary Bennett Jr., Ph.D., Duke University Medical Center, Durham, N.C.; and Mark Ketterer, Ph.D., department of behavioral health, Henry Ford Hospital, Detroit HealthSCOUT ©2000 Rx Remedy, Inc. All rights reserved.

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