Friday, June 26, 2009

When the Heart Pays the Price of Anger - Robert Allan -

Not long ago, a cardiac patient in a cardiac support group I was leading told of his response to a recent incident: He and a female friend were on the plaza at Lincoln Center after seeing a performance of Verdi's opera "Il Trovatore" when a car nearly hit the woman. She ran after the vehicle, which was slowly moving away, and slammed the trunk with her rolled up program. The driver emerged from the car hurling expletives in her direction. The patient then hit the driver with his cane. The driver shoved the patient into a fender, at which point, the patient insisted, he had no choice … It was no ordinary cane he was carrying, but a beautiful 19th-century model with a sleek, sharp sword concealed within. He then insisted that the driver "apologize at swordpoint" in front of a small crowd that had gathered. The characters in "Il Trovatore," he added, proudly brandished swords.

The patient shared this story at his first — and only — session of the support group. (He terminated treatment, insisting that the others needed my help with their anger far more than he did.) Even after deliberating for several weeks, the patient felt justified and vindicated, totally satisfied by his actions.

Many of us harbor the "make my day" fantasy, emblazoned into the American psyche by Clint Eastwood's Dirty Harry. Americans get mad — and get even. However, whenever one pursues such satisfaction they run the risk of triggering someone else's thirst for revenge, and so begins a recurring, sometimes escalating cycle. Soon, one always has to look behind his or her back in fear that a former adversary will find an opportunity for the proverbial knifing.

Not many people on earth can claim regular, deep, long-lasting satisfaction. Satisfaction is fleeting, and often whittled away by recorded telephone menus, rude waiters and any number of other indignities of contemporary society. And of course, this has particular currency today. Many of us are justifiably angry at our former employers for loss of jobs or at the financial service industry's inability to protect our life savings.

Challenging times certainly increase the tendency for negative moods and aggressive behavior (this dynamic was described in the "frustration-aggression hypothesis" first put forth in the 1940s.[1] However, giving way to an angry impulse makes nearly any situation worse.

The aforementioned patient's life, in spite of considerable intelligence, advanced degrees, and a personable demeanor, was one of mere survival in a cramped studio apartment. When we met, he was selling some of his few remaining valuables to make the next month's rent. This patient's career was marked with disappointments – in others who disappointed him. Moreover, he was a cardiac patient with a bad family history and suffered a heart attack at a young age. The swordsman was keenly aware of the link between chronic anger and heart disease. Indeed, a recent meta-analysis of 44 prospective studies in the Journal of the American College of Cardiology[2] confirms a strong relationship between anger and both the onset and outcome from coronary heart disease; moreover, approximately 1.5 percent of heart attacks are "triggered" by intense anger.

While it is not possible to make a definitive causal connection between the swordsman's actions and unfortunate life circumstances, the experience of a 35-year practice as a clinical psychologist and abundant literature on the subject all inform me that the sort of satisfaction of which he was so fond ultimately did him in, both in health and life. Expressing his anger didn't benefit him at all.

People often challenge this view with the idea that unexpressed anger "builds up," leading to resentment, high blood pressure, a heart attack or stroke. Many of us conceive of anger just as we fill a balloon with (hot) air. We get angry, the balloon expands. An injustice befalls us, we get angrier — the balloon gets larger. Something else "bad" happens and the balloon gets so big that it … bursts! The comedian Jonathan Katz described a moment like this in a joke about having dinner with his father: "I meant to say, 'Can you pass me the salt, please?' But it comes out, You creep, you ruined my childhood!"

Jokes aside, anger is not a measurable substance. There is no organ, gland, or other repository in our bodies for anger. Yet, we have myriad terms that make reference to anger as an accumulating substance. Anger "builds up," "leaks out," and is sometimes transformed into "explosive rage." The idea that anger accumulates is a myth that can sometimes lead to the sort of "satisfaction" achieved by my patient. His didn't "bottle-up" his anger; he "released" it ("it," in his thinking, transformed into a substance). My patient obtained "real satisfaction" by drawing his sword — but ultimately slashed his existence to a sliver of what he might have become.

When faced with frustrating disappointments, we may all secretly wish to advise our money managers, as well those with whom we are close, about their expanding waistline, receding hairline, or the pimple that has suddenly sprung up in the middle of their forehead. But such "satisfaction" inevitably comes back to haunt us as others are even more likely to remember our insult than we are to relish getting the best of them. To quote another patient, "life is very lonely when you are always right."