When we looked at the postwar mortality risk for those men who were sent overseas and faced combat as compared to those who were sent overseas but did not face the stress of direct combat, a consistent picture began to emerge. The combat veterans were less likely to go on to live long lives. In a fascinating finding, each stress posed a distinct risk—serving overseas, serving in the Pacific, and facing combat. The more alien and disturbing the situation, the worse the later health.
Personality and Battle Roles: The Surprising Selection
As often happens in our Terman studies, an unanticipated twist appeared as we pored over the statistical analyses—a finding with ramifications even for those who will never put on a uniform. We had seen before that the lives and paths of the participants were much less random than they first appeared. Could this be true even for wartime experiences, which are so heavily shaped by the demands of the military? We knew that conscientiousness measured in childhood was highly relevant to a whole host of later-life health trajectories. Could it even be relevant to war?
Even we were surprised to discover that the more conscientious subjects, such as John, were less likely to be sent to the Pacific theater. That is, the more careless, vain, and impulsive a man had been as a child (like Philip), the more likely he was to wind up fighting the Japanese in very dangerous and stressful Pacific operations.
As a child, Philip was impetuous and full of energy. He had plenty of friends despite his bouts of moodiness and his attention-seeking behaviors. Throughout his life he seemed to have more health problems than the average Terman participant. Although none of these illnesses was particularly severe, every report mentioned physical ailments ranging from tonsillitis in childhood to an ulcer, fungus infection, and sinus problems in adulthood. Over the course of his adult life Philip’s financial status fluctuated; on more than one occasion he reported to Dr. Terman that he had money worries.
Although sometimes a meteorlike strike would come out of nowhere and smack down a Terman participant, it was more often the case that an accumulation of small decisions and reactions would lead to large and significant consequences. While we have no direct information about why the less conscientious, like Philip, were more likely to end up serving in the Pacific, this fascinating discovery, taken in context with our other findings, leads to interesting conjectures about paths to long life: those traveling dangerous byways often crashed, and it repeatedly goes well beyond bad luck.
Most people who face serious trauma do not go on to face long-term problems or to be classified as suffering from post-traumatic stress disorder (PTSD). Sure, they may turn anxious in certain evocative situations or they may be more aware of the fragility of life, but most do not struggle with chronic nightmares, ongoing irritability, and disrupted social relations. But many do face PTSD, perhaps up to a third of trauma victims. As we revealed, such serious stress is a major threat to health.
Why Is Traumatic Stress Harmful?
Scientists know a lot about what happens inside a human body under stress, as the brain struggles to preserve the health of the body. Hormones are released as the body revs up to be able to fight an enemy, flee a threat, battle a germ invader, repair a wound, or cope with a loss. So in many ways, stress is a good thing. The problem arises when the body cannot settle back down and instead keeps revving—what is usually called chronic stress. It is almost as if the brakes have failed and the vehicle is in constant danger of careening out of control.
Nevertheless, we scientists have been much less successful at thinking about stress across the long term. One cannot and should not “stop stressing” as one might “stop smoking.” In fact, the stress response is essential to staying healthy.
The lifelong Terman study allows us to look not only inside the body at disease, longevity, and cause of death, but also outside the body. That is, the lifetimes of remarkable data permit a look at how stress at one point causes a host of problems at later points.
The journeys of the Terman participants down different life pathways revealed a simple but powerful way to think about stress: health problems arise when you veer off a healthy pathway and cannot steer back to safety. For example, when Patricia’s parents divorced and her world turned upside down, she needed to react and adapt. She didn’t choose Donna’s path, which included smoking and drinking. Instead, she stayed in school, kept her conscientious friends, and later established a good marriage and career for herself. She lived a long life. But for those like Donna, chronic stress can feed on itself, leading to more and more destructive patterns. In particular, those on long life paths paired their individual strengths with their good social relations to get back on a road to healthier patterns.
The same is true of more severe, traumatic stress. The Terman war veterans who encountered traumatic stress and died young drove off the road. Alcohol was one of the key later problems for those who had faced wartime combat. Consistent with other research, we found that these Terman men were more likely to develop drinking problems, which in turn raised their postwar risk of dying. Many, but not all, were also less likely to go back and conscientiously complete the advanced education toward which they were headed prior to leaving for war. Sadly, they were not only especially likely to die from diseases commonly associated with stress—heart disease and injuries or accidents. The stress-filled paths often took a toll throughout their bodies.
Depression and Heart Disease
A close companion of chronic stress—and a bad sign—is depression. This was the case with Philip, who suffered regular bouts of depression, never severe, but enough to be a concern. As a good deal of research now documents, the fact that he was chronically stressed and a catastrophizer made it likely that he would get depressed. And the fact that he was depressed made it much more likely that he would die of heart disease, and at a relatively young age. Depression is a risk factor for many illnesses but is an especially well-established risk factor for heart disease.
What is unclear in Philip’s case—and for the many millions of others who battle depression—is whether or not the depression per se was the problem. This matter is one of the most important in all of health and health care, yet it is one in which we think there’s a terrible degree of misunderstanding.
When the stress of war or trauma leads to severe depression and then to suicide, it is clear that depression has played a key causal role in the early death. An obvious intervention along the way would be to treat the depression. Of course this often works—individuals who come out of their depressed state have their risk of suicide fall dramatically.
The case of stress, depression, and heart disease is much more complicated, however. Back a number of years ago, one of us (Howard) and his student Stephanie Booth-Kewley did several quantitative reviews—meta-analyses—of relevant studies involving depression and disease. Surprisingly similar patterns appeared between a variety of psychological predictors like depression and multiple diseases. This contradicted the then-prevailing notions of a distinct type A “coronary-prone personality,” a distinct “ulcer-prone personality,” and so on.
This broader pattern—having a disease-prone personality—suggested that negative traits such as depression, and its complements—hostility and aggressiveness—are markers of increased risk for both cardiovascular disease and a host of other illnesses.92 This conclusion has since been confirmed by others. No narrow coronary-prone personality was found—suggesting that perhaps some underlying variables were affecting both the likelihood of depression and the likelihood of heart disease. If that were true, then treating depression would not necessarily affect the risk of heart disease.
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For discussions of the disease-prone personality, see H. S. Friedman and S. Booth-Kewley, “The ‘Disease-Prone Personality’: A Meta-Analytic View of the Construct,”