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.