Anger management?

[Guest guest]

Anger management?

By GABOR MATÉ

From Saturday's Globe and Mail

When it comes to anger, human beings find themselves between a rock and a

hard place: Too much anger can make us ill, but so can too little.''It was

blind rage, I was sure, that had gotten me into this fix with my heart, as

well as genetics,'' American journalist Lance Morrow wrote in his memoir of

his nearly fatal heart attack.

Mr. Morrow was right. The connection between anger and cardiovascular

disease is well established.

In a multicentre U.S. study, patients carried heart monitors strapped to

their bodies while they kept diaries of their physical and emotional

experiences as they went about their daily lives.

Intense anger was found to be powerfully related to the heart muscle being

deprived of its oxygen supply. The relative risk of a heart attack has been

shown to increase more than two-fold in the two hours after an episode of

anger.

In a recent Israeli study, episodes of anger and hostility were linked to an

increased risk of strokes -- something long recognized by folk wisdom, which

has employed the word " apoplectic " as a synonym for enraged. Apoplexy is an

archaic word for stroke.

At the other extreme are people who hardly ever experience or express anger.

They are at increased risk for a wide range of illnesses from migraine

headaches to cancer, irritable bowel syndrome, Crohn's disease and many of

the rheumatic conditions.

Not infrequently we read about such people as having died before their time.

It may be no coincidence that Neilson, the gifted and much-loved

hockey personality who died of cancer in 2003, was described as perhaps the

only coach in the National Hockey League who never swore or lost his temper.

In many international studies, the inhibition of anger has been associated

with markedly heightened risks for cancer. It has also been linked to the

presence of rheumatoid factor, an antibody directed by a person's own immune

system against the self in rheumatoid arthritis.

How would the extreme outpouring of anger or its direct opposite, anger

repression, increase the risk for illness? Because mind and body are an

absolute unity, and emotions are physiological events with a wide range of

effects, including the release of stress hormones, nervous system discharges

and blood flow changes.

Eruptions of anger can contribute to heart disease or strokes by many

mechanisms, among them elevated blood pressure, sudden spasms of blood

vessels and increased clotting of the blood.

In 2003, Korean researchers reported that anger plays " an important role " in

the calcification, or hardening, of the coronary arteries.

Conversely, the suppression of the normal aggressive impulses associated

with anger can inactivate or confuse the immune system, enabling the

development of cancer or autoimmune disease.

An important class of immune cells called natural killer cells is more

active with the healthy expression of aggression -- as, for example, in

people who do martial arts. The activity of these NK cells is depressed in

people whose anger is inhibited.

How, then, to escape this human dilemma? Is there healthy anger and, if so,

how do we find our way to feeling it and expressing it?

" The key is to experience anger without anxiety, " says Kalpin, a

Toronto general practitioner/psychotherapist who has studied anger and works

with patients who have anger problems of all kinds. " What many people think

of as signs of anger are actually manifestations of anxiety. "

My brother, Maté, a Vancouver businessman, concurs. A few months ago,

he began anger-management counselling after, in a fit of rage, he kicked in

a door in his house.

has diabetes, a stress-related disorder and a risk factor for heart

disease.

He says he has learned that " the anger you think just sneaks up on you

doesn't just sneak up on you. It's not volcano-like. There is buildup

inside, with certain physiological signs: tightness in stomach, tension in

my body and my mouth will go dry. "

Such signs denote anxiety, as do the shallow breathing and tightness of

throat and vocal cords that also accompany anger in many people. They do not

occur with healthy anger, which is described by Dr. Kalpin as " a surge of

calm energy, an empowered and energized feeling without tension or anxiety. "

And it is anxiety, not anger as such, that triggers the nervous discharges,

the abnormal outpouring of hormones and the other harmful physiological

consequences.

People discharge their anger outwardly because they fear fully experiencing

it internally. Both the unbridled expression of anger and its automatic

suppression arise from an anxiety we first feel in early childhood. It is

inherently anxiety-producing for a small child to be angry with those he is

dependent on, Dr. Kalpin points out.

Especially in families where normal expressions of anger were discouraged, a

child will learn automatically to repress aggressive impulses, even when

appropriate. A child may also become frightened of anger if his parents are

given to displays of rage.

There are two keys to the healthy experience of anger. First is to permit

ourselves to feel calmly, without anxiety, the surge of aggressive energy

that arises with anger. The second is not to allow the emotion to dictate

our behaviour.

" Anger does not have to be acted out, " Dr. Kalpin says. " We can allow

ourselves to experience anger without venting, without losing control. "

Ultimately, it's a question of who is in charge: the person or the emotion.

When anger seizes hold of us, or when we are so frightened of anger that we

habitually suppress it, we are at risk for disease.

Vancouver physician Gabor Maté is the author of When The Body Says No: The

Cost of Hidden Stress.

Mad maxims

Don't be afraid of your anger: Allow yourself to feel the surge of

aggressive energy that arises with it.

Don't let the emotion control your behaviour: Talk about your anger, rather

than act it out.

Note the signs of anxiety that precede anger outbreaks (such as dry mouth,

tight stomach).

If you never experience anger or are given to rages, seek counselling.

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