One thing that's struck me about your work, Ken, is that many people with similar interests have become interested in ways of working that have taken them a long way from the research lab or the traditional medical clinic. You've chosen to stay very close to the approaches and techniques of traditional research and clinical practice. Could you comment on that?

One of the things I've been trying to do, almost insidiously, is to stay very conservative in my approach. The data is there, in the psychological research literature. You don't have to go look at far-out things. You don't have to guess; you don't have to speculate. You don't need to have far-out theories. This area is easily approached with the traditional tools.

So I've limited myself to citing from the Journal of the American Medical Association, Annals of Internal Medicine, Archives of General Psychiatry, or Science—which, by the way, has devoted an entire issue (May 26, 1978) to health maintenance and contains some of the best articles and most radical statements you will ever see on the need for a new way of looking at medical care.

I've tried to stay within the scientific medical tradition to see whether medicine really is incapable of dealing with these kinds of issues or whether there's simply a huge body of literature that has been ignored.

By and large, it comes down to the fact that the information is there in the journals, and it's been largely ignored and overlooked. This stuff is as compatible with medical practice as anything you can imagine—that's what makes me so optimistic that this is a valid direction for medicine. We're not trying to set up some wild alternative. In fact, it's probably more consistent with the roots of medicine than the biomedical fixation of the last thirty or forty years.

The most exciting thing about this work is that once you get people moving in the direction of health, they don't want to stop at just being '`normal." They keep going toward becoming much healthier than average.

What are some of the ways to break the chronic stress pattern?

I think the main ways are stress management, diet, and exercise. There seems to be a real synergistic effect among these three. If you start exercising, it breaks up both physical and mental tension. There's a slide I use that shows all the supposed effects of drugs that lower blood pressure on one side and the effect of light exercise on the other. The physiological changes produced by exercise are comparable if not greater than those brought about by the drug.

As any runner could tell you.

Right! That's the kind of thing that we, living in the Bay Area, have somehow picked up; but do you know that it's never mentioned in the literature? It's not taught in medical schools—and that's really the status of most of this information. It's there, but it's not known. There are damn few doctors that will put a newly diagnosed hypertensive on a running program.

There's a kind of conceptual shift that a person can undergo, so that afterward, things that were considered highly stressful are no longer perceived as so potentially perilous. Friedman mentions that a good proportion of post-heart-attack patients spontaneously go through such a shift after their heart attack. When he has asked them what kind of process it was, they say something like, "I just looked at all the things that used to bug me, and I said to hell with it."