Years ago, a hulk of a man came to see me with a lump in his neck. He was as big as the lump was small, standing at least six and half feet tall with shoulders that seemed almost as broad. His lump, in contrast, was only 2 cm wide.
Wide enough, however, to warrant concern. It was firm rather than rubbery, fixed rather than mobile, and non-tender rather than painful—all hallmarks of something potentially malignant. He’d noticed it only one month prior to coming to see me, which made me think it had grown rapidly, another bad sign. He’d had no infection during that time that he could recall.
I recommended a biopsy, to which he agreed, and set up an appointment for him to see a surgeon. A week later he called me to ask some further questions. The conversation started calmly enough. He related how he’d gone to see the surgeon who’d immediately scheduled a biopsy—and then suddenly he was literally shrieking in my ear. He’d had to wait 30 minutes in the waiting room and then another 15 in the exam room before being seen! He’d expected an office procedure and instead they’d taken him to the operating room! He’d wanted general anesthesia and instead they’d used a local block! What the fuck, he’d wanted to know, was wrong with these people!
I could only listen in stunned silence, not just because I was taken completely off guard and intimidated, but because he literally offered no pauses during his diatribe—which lasted a full ten minutes—to allow me to respond. By the time he’d finished, however, I’d managed to regain control of myself and suggested he come in to see me right away to discuss what had happened.
He arrived later that afternoon, his bulk hardly fitting through my office door, and sat down in a much calmer state than he’d been in on the phone. He even laughed derisively as he related how someone had called the police after he’d gotten off the phone with me. Apparently, he’d been standing in a bookstore during his angry rant and his yelling had frightened someone enough to lead them to call for help in case he became violent. He had no insight into why someone would have done that, found it a completely overblown response to his “blowing off steam,” and apologized for “being a little harsh” with me.
WHY PEOPLE GET ANGRY
There’s no shortage of theories about why people get angry. My own view is that it happens for four main reasons:
- To harm oneself. Being depressed often results in anger directed at oneself for feeling and being powerless, and represents a wish for self-destruction.
- To achieve control. Whether arising from paralyzing fear or merely irritation that things are going differently than we want, anger is often used to intimidate in order to manipulate.
- To feel powerful. If we feel small, getting others to feel smaller makes us feel in comparison big.
- To fight injustice. Righteous indignation coming from a person’s moral center, outrage at an inequity being committed against oneself or others.
Though anger is often considered a negative emotion that we should do our best to eliminate, the validity of this has always seemed to me to depend on why the anger arises in the first place and what’s done with it. For example, anger has always seemed to me an appropriate response to injustice, one that does little harm to oneself psychologically and very well may even be beneficial in that it motivates action to rights wrongs. The goal, it seems to me, isn’t to eliminate anger but to control it; not to suppress it but to create value with it. How, then, can anger be properly managed?
HOW TO DEAL WITH ANGER IN YOURSELF
Not by ignoring or suppressing it. Experience and science have shown repeatedly how poorly those strategies work. Once anger rises past a certain point, it seems to require satisfactory expression to be diffused. That is, it must be expelled in a way that feels good—in a way that is literally emptying. The goal then would be to expel it in a way that does as little damage as possible. How one does this depends on why the anger one feels is rising in the first place.
- Anger aimed at harming oneself. Depression is almost certainly the cause and should be identified and treated.
- Anger aimed at achieving control. Ask yourself why you feel out of control. Fear is a common reason. Actually lacking control is another. Anger is, fortunately or unfortunately, often a good strategy to regain control in the short-term, and easier to feel than many of the emotions that trigger it. But as it ultimately remains an expression of our unfulfilled need to control (if we actually had control, we wouldn’t get angry), far better to identify a means to actually provide us real control rather than the illusion of it. When such control isn’t possible, a next best option is to fully recognize what feelings being out of control leads to first, before anger: fear and uncertainty. If we can identify these feelings each time they arise, we at least have a chance to deal more constructively with them—or at least more consciously.
- Anger aimed to make us feel powerful. Control isn’t exactly the issue here. It’s more that we feel small and insecure and have stumbled upon anger as an effective means to feel bigger than those around us. Recognizing this is what’s going on empowers us again to interrupt the generation of anger and instead to deal with the feelings of insecurity. Anger that arises from insecurity is particularly efficient at destroying intimate relationships.
- Anger at injustice. How best to discharge this anger? Take action to correct the injustice, whether committed against yourself or someone else.
Of course, anger may arise for more than one of these reasons at one time. Anger at an injustice committed against you (as opposed to someone else) may intermingle with anger aimed at achieving control (as an expression of a wish for control that could have prevented the injustice from being committed in the first place). Anger aimed at yourself for being powerless in a given situation may intermingle with anger at someone else as a way to achieve the very power you lack.
HOW TO DIFFUSE ANGER IN OTHERS
The goal here is two-fold, your ability to carry out the second being dependent on your ability to carry out the first:
- Remain in control of yourself. When you find yourself on the receiving end of someone’s anger, they’re either trying to control you in some way or make you feel small so they can feel big. Or you’ve done them some kind of wrong. You should seek to understand which of the three it is. You must tell yourself that anger is their strategy and has nothing to do with you at all, unless of course you really have committed an injustice against them, in which case you should make amends.
- Help them discharge their anger in a way that feels satisfying without causing harm. Responding to anger with anger rarely accomplishes anything positive. If you remain in control of yourself so that another’s anger neither manipulates you nor makes you feel small, you have a chance to help them deal with the real issue that triggered their anger in the first place. What tactics work to accomplish this?
- Validate their anger. Resisting a person’s anger, getting angry back at them, denying that their anger is justified all do nothing more than inflame it. Even if their anger isn’t justified in your mind, what would convincing them of that accomplish? It likely wouldn’t give them control over it. Feelings require no justification to be felt.
- Apologize. I told my patient how sorry I was he had such an unpleasant experience. It wasn’t my fault, but in commiserating with him, I was able to validate his anger.
- Help turn their anger into language. Get them to express in words, rather than in harmful action, just how angry they are. This is often an effective way to help them discharge their anger in a way that feels satisfying.
- Get angry with them. Get even angrier than they are. Transform yourself from the object of their anger into their partner in feeling the same anger as they.
Though buried deeply, fear was the obvious cause of my patient’s anger, an emotion with which I could far more easily sympathize. As he’d already calmed down by the time he came to see me (he’d satisfactorily discharged a lot of his anger already over the phone), I spent most of my time validating his anger and attempting to address its underlying cause. He never would acknowledge he was afraid, however, which made me worry there would be similar future outbursts (there were), but having fully apprehended its cause, his anger never again intimidated me. He was ultimately diagnosed with lymphoma, endured several cycles of chemotherapy, and was eventually cured. Of his lymphoma, that is.
Next week: Tribute To A Patient