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Consider anger in society and psychiatry

May 30, 2017
by H. Steven Moffic
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“Fear is the path to the dark side. Fear leads to anger. Anger leads to hate. Hate leads to suffering.”

—Yoda, from “Star Wars”

 

Grabbing the political headlines recently was the race in Montana for its lone House of Representatives seat. The Republican candidate, Greg Gianforte, was charged with assaulting a reporter on the eve of the election, apparently body-slamming him to the floor. His anger was heard on the audio tapes.

Yoda might think that Gianforte was fearful of the reporter’s persistent questions on healthcare—so important to our own work and patients—and that his answers would cost him the election. He won, nevertheless, and it is not clear whether his anger and consequent aggression helped or hindered the results of the voting.

Certainly, this was not the first such example since the recent presidential campaign was in full gear. At some of the rallies, anger at opponents spilled out one way or another, leaving some of us to wonder if something in the country is changing as far as the prevalence and expression of this emotion.

Anger as a normal emotion

It seems self-evident that we see the precursors of anger in infants. Their strident cries convey needs that need to be fulfilled. If parents respond to these needs appropriately, most children gradually learn to express their needs in other personally effective and socially appropriate ways.

As we age, societal authority figures like teachers, bosses, religious leaders and presidents are not only responsible for fulfilling some of the needs of others, but model how anger should be handled. The psychologist Abraham Maslow developed the commonly accepted hierarchy of needs pyramid, going up from physical, to safety, to belongingness and esteem needs, arriving at the top of the pyramid at self-actualization. 

Healthy anger is proportional and responsive to a real and persistent need. It can be a powerful component of human survival and adaptation. Normal anger can be sublimated into socially acceptable outlets such as sports and political blogging.

On occasion, normal anger can be expressed too intensely. That calls for an apology and better control in the future.

Clinical anger

There is no such diagnosis as an “anger disorder” that would be like a depressive or anxiety disorder in DSM-5. Probably the closest is intermittent explosive disorder, characterized by the periodic eruption of anger and rage which are quite disproportionate to the circumstances. Nevertheless, as a symptom, it can be a major manifestation of many other disorders, including oppositional defiant, mood dysregulation, bipolar and attention deficit disorders. Freud thought that depression could be caused by anger turned inward, but that is now a controversial theory.

Anger is common is substance use disorder, either directly or from withdrawal effects. It is also common in personality disorders, such as borderline and narcissistic. Some medical disorders need to be considered as the cause at times, including being in a delirious or demented state.

Treatment of the anger needs to be appropriate to the underlying condition. Modalities include anger management therapy, behavioral modification, cognitive behavioral therapy and medication like beta blockers.

Anger in leadership

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H. Steven Moffic

H. Steven Moffic

H. Steven Moffic, M.D. retired from the clinical practice of psychiatry and his tenured...

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