Sunday, January 28, 2007

Changing Lanes : Alcohol and Anger

I forgot about "Movie Friday".

Can it be Movie Sunday, please, this week? Let's go with the elastic is better, concept.

As the shrink in the movie Ordinary People once said, and I paraphrase,

We Therapy Docs aren't so into control.

But since today is Sunday and it's a day that a lot of people sit around and watch sports and drink beer (or commercials for next week's Superbowl game--can you believe those Bears?!) I'm going with this post.

Not an A.A. expert, I still appreciate much of the Alcoholics Anonymous program and I know a lot about it. I automatically recommend it to my patients who are problem drinkers based on the success rate in my practice. I've met dozens of people who got sober and stayed sober with A.A.

But it's better with therapy. The therapy part is key for certain issues, one being anger. In A.A. meetings people talk a lot about rage.

Therapy docs do, too. I used to want a vanity plate that said Get Therapy to speak to the road ragers. Can you understand getting angry behind the wheel of a car? Does THAT make sense? But there were too many letters in G-E-T-T-H-E-R-A-P-Y.

Which brings us to alcohol, anger, and pretty soon the movie Changing Lanes.

A.A. sponsors, the closest thing to therapists for many people, are not licensed, trained therapists of any kind. They're fabulous people, have usually survived their own sobriety, give generously of their time, and just like in the movies they can be unbelievably heroic and often step in with the proper language and interventions that makes the difference between a sponsee's decision to drink or not to drink.

But successful sobriety is all about the sponsee's (the person working the program) committment to sobriety, work on the 12 Steps, and meeting attendance. Sponsors aren't supposed to be therapists. My understanding is that they are people who can help you work the steps and they don't want to be therapists. They generally recommend therapy, as long as it isn't a psycho-pharmacologic therapy. Unless things have changed, A.A. is a little down on meds.

But a lot of people don't go to therapy because they get so much out of A.A. and similar programs. A.A. is free. (You can go, you know, to the community mental health centers or many university clinics and pay for treatment on a sliding scale and still go to A.A. if you want. Maybe should.)

The A.A. program was developed in the 1930's, well before we had a decent scientific understanding of emotions and the brain. In those early A.A. meetings people sat around and talked about their dysfunctional families, and people who had ragers in their families had the best stories to tell.

Even now, at some meetings people talk about the rage-aholic(s) in the family as if it is understood that this is a genetic disease, raging.

A rage-aholic is theoretically a person addicted to anger, consumed by it.

It is true, people may seem to be rage-aholics, unable to control their anger. It may even be true, that some people are so emotionally handicapped that they need something to calm the wild beast. For A.A. people that "something" would be community service, a relationship with a higher power, working a program. Therapy docs would recommend medication, cognitive therapy, family therapy, even psychodynamic or ANY kind of therapy along with lots of psycho-education.

Face it, sometimes incarceration is the inevitable resolution of the State for people with anger control problems.

Therapy docs look at "rage-aholics" as folks who might also be mentally ill, might suffer from bi-polar disorder, paranoid schizophrenia, a severe personality disorder or three (certainly sociopathy), eating disorders, alcoholism or other substance abuse disorders.

Or they may have been raised by individuals with these diagnoses, people who raised them with rage, in a sense communicating "permission" to be a rager.

So saying someone is a rager doesn't say very much to a therapy doc about how to treat that person. There's so much more to know.

It says (it should say) to the average Joe, Avoid that Individual.

Or get that person to a therapy doc for a diagnosis and treatment.

So recently I watched Changing Lanes again on cable. I loved it in the theater, remember not liking William Hurt and his sponsoring style--punitive, a style I've heard about more than a few times as characteristic of sponsors, along with a touch of shaming .

I've mentioned before that shaming is destructive. No good can come of it. Among other things, a person who has been shamed becomes less communicative, less emotionally available. Self-esteem goes down, self-destructive habits go up.

I hope if you're a sponsor and you're reading this and disagree with what I say about A.A. or sponsors that you'll let me have it between the teeth in the comments. Make that,

I hope if you're a sponsor and you're reading this and disagree that you'll write me a Comment and assert yourself. You can be anonymous :)

But the alcoholic in the movie, Doyle Gipson, played by Samuel Jackson, is working very hard to become a stable human being, one who is not affected by the poisons of alcohol. He goes to A. A. meetings and his "new leaf" behavior is generally deliberate, the type of moral, thoughtful, considerate behavior that A.A. teaches so well.

See, one of the amazing things about this form of rehabilitation is that the language of A.A. inspires positive behavioral and personality change. The language reconnects with the best messages your parents ever taught you, the ethics you learned in school. It syncs nicely with major religious teachings, the emphasis of life being best lived with kindness, patience, and putting out good karma (what goes around, comes around).

So Doyle is doing that in the movie and we like him much more than his anti-hero nemesis, the rich, white, lawyer (played by Ben Affleck) whose fancy car collides with Doyle's beater on a highway during bad weather the very day of Doyle's Big Day in Court.

The Ben Affleck character storms off without leaving identification or insurance but forgets a most important file. Doyle is stuck with "better luck next time."

Doyle misses his hearing because of the accident and loses his wife and children who will now have court permission to move to the other end of the country. But he has that file.

The plot gets pretty good and the tension between Samual Jackson and Ben Affleck becomes palpable, the anger, the rage, the revenge fascinate. How will they resolve this and will Doyle lose his sobriety?

He has already turned into a "dry drunk" before our eyes, meaning his behavior is unpredictable, unstable, and his wife and children are afraid of him again even though he's sober.

THIS is the pattern I see so often, this "dry drunk" thing, acting drunk (irrational and emotional) while not under the influence of alcohol. Program thumpers will say that of course, if people do not work a program, that they WILL NOT CHANGE even if they get sober. They will behave the same way they did as drinkers, uninhibited and lacking in empathy for the pain they cause others. ANGRY.

There is no hard evidence to support this contention, mainly because it's hard to measure A.A.'s interventions in outcome research. It's an anonymous program.

We do know, however, that alcohol is associated with wild, uninhibited behavior because it has that disinhibiting effect upon the limbic system. Without alcohol, behavior should be and is under better conscious control for most of us.

But there other variables, like the ones I mentioned above, like mental illness (the Axis I disorders), personality (the Axis II disorders), family culture and dynamics, and the ecosystem (everything else that affects our minds and bodies).

And we know that anger per se isn't just a function of being drunk. We all get angry. Many of us are less in touch with our anger than others, especially if it was frowned upon in the family, or if only the parents were allowed to be angry. I'm certainly out of touch with mine, and I'd like to think it's from years of cultural proscription against anger and violence, a collective memory phenomenon, in the DNA.

So no, you won't be hurling insults at one another in my office. I don't need that, nor do you, so you'll have to learn another way to communicate with one another. Oh yeah, that's MY job, to teach you. Touche'.

But depending upon how we've been socialized to express aggression and our individual character traits, anger can come out as violence, either verbal or physical. Or it can be repressed. Or it can present anywhere on the continuum below.

[By the way, I see both physical and verbal violence as forms of emotional violence. The center, where I put the slash, is assertiveness, speaking dispassionately, rationally, about just the facts of a situation.]

I won't give away the ending of the movie because it's worth watching.
But if you're a person who has trouble controlling your anger, or if you live with someone who is unstable in that way, it's certainly a good idea to get therapy for it, to learn how to be assertive and when.

Left untreated, the violent expression of anger can be unforgettable, dire. We do have medications and psychotherapies to treat it, so there is really no need for the pain. Both people are hurt within an angry interaction. The aggressor loses the respect and real affection of the victim. The victim may believe he or she deserves maltreatment.

Suggestions about anger in relationships:
1. If it is you that is angry, don't talk to anyone until you're not as hot. I can't emphasize enough the importance of this time to distance and calm down BEFORE having ANY conversation with anyone.

2. If you do talk to someone while you are angry, make sure that person is someone who will be unconditionally supportive and will let you vent. Be sure there's no way you will become violent under any circumstances in any way (emotionally/physically/verbally).

3. When you are direct with the person you're angry at, don't be accusatory or blaming, stay assertive. (Read other posts)

And if someone else is angry?

4. Wait until that person is NOT angry to talk to him/her. And even then, be careful and have an exit strategy in place if that person has been violent in the past.

Is that so hard to do? Yeah, actually it is. So therapy, Al Anon (the program for family members of individuals with alcohol addictions), ANY outside support that strives to eliminate domestic violence is pretty key.

5. The best advice? Don't handle a partner's or your own raging alone. Get help on this one before someone gets hurt.

Copyright 2007, TherapyDoc

23 comments:

J said...

So what if they continue to verbally attack you even if you do not engage, and there's really no place to exit to (ie in the car, a small apt, etc)? And other than walking on eggshells, is there any way to stop explosive people from exploding if they refuse to see that there's problem and get help?

Hmmm, sorry if this is more detailed than you intended to get on this forum.

TherapyDoc said...

I wish there were some laser or lightsaber that we could use that would just SHUT THEM UP, but so far I don't believe these things are available for public use.

The AVOID these people thing is best to begin with, but once you're in a relationship you still DO NOT ENGAGE if someone's beating on you. If you can get away, great. If you're trapped, you're trapped. Fantasize about being somewhere else. This is, you many not realize, the beginning of a dissociative disorder, that kind of fantacizing while being abused.

Most people, however, are amenable at some other point to discussing feelings. It is finding that other point that is key, and then saying,

You: Uh, can we talk?

Him/her: Sure.

You: I really hate it when you call me names, why do you think you do that?

People are often quite unaware a) that they're being verbally abusive, b) that they learned it at home, c) that it hurts the other person.

If this is a sociopath, quite aware of what he/she is doing, then you have to get out of that relationship. Eventually. The sooner the better.

Verbal abuse chips and hammers away at self-esteem.

That wasn't too detailed. It's exactly the feedback I look for.

Chana said...

I could have done without knowing that next Sunday is the Super Bowl, LOL...

TherapyDoc said...

Chana, if you lived in Chicago you'd hear it on the morning, the afternoon, the evening and the nightly news and everything everything inbetween. It's pretty boring, makes the orange alert seem, well, like some kind of make-up thing.

Anonymous said...

Couldn't help but be reminded me of this song [not a single]. Fortunately I can't relate to the physical part, but the rest feels vaguely familiar. http://www.atlyrics.com/a/alanis/page19.html

TherapyDoc said...

I got the lyrics, thanks. It's traumatic reading. (TD warning)

Sympathetic Character

I was afraid you'd hit me if I'd spoken up.
I was afraid of your physical strength.
I was afraid you'd hit below the belt.
I was afraid of your sucker punch.
I was afraid of your reducing me,
I was afraid of your alcohol breath.
I was afraid of your complete disregard for me.
I was afraid of your temper,
I was afraid of handles being flown off.
I was afraid of holes being punched into walls.
I was afraid of your testosterone.

I have as much rage as you have.
I have as much pain as you do.
I've lived as much hell as you have.
And I've kept mine bubbling under for you.

You were my best friend
You were my lover.
You were my mentor.
You were my brother.
You were my partner.
You were my teacher.
You were my very own sympathetic character.

I was afraid of verbal daggers.
I was afraid of the calm before the storm.
I was afraid of for my own bones.
I was afraid of your seduction.
I was afraid of your coercion.
I was afraid of your rejection.
I was afraid of your intimidation.
I was afraid of your punishment.
I was afraid of your icy silences.
I was afraid of your volume.
I was afraid of your manipulation.
I was afraid of your explosions.

I have as much rage as you have.
I have as much pain as you do.
I've lived as much hell as you have.
And I've kept mine bubbling under for you.

(chorus - chorus)
You were my keeper.
You were my anchor.
You were my family.
You were my savior.
And therein lay the issue.
And therein lay the problem.

healthybpm said...

What if people with alcohol rage refuse to change and live with people who support them through all the rages?....it doesn't make sense to me. I can't deal with these rage attacks and so I just stay away unless I have no choice.

TherapyDoc said...

Dear Healthy,
For sure stay away when someone's raging if you can. But if you can't, and that person hurts you, you can call 9-1-1 for help.
Battering is illegal in this country.

Michael said...

The 12 Steps Down To Hell

I imagine 12 Step recovery programs are a slow slide into the jaws of Satan. I was involved with this evil “satanic cult” [AA] for over 30 years but was saved through the power of Jesus Christ. He directed me to a therapist who was into “real” recovery, not the mind destroying, soul destroying, cult, which is AA. I have met two Steppers recently & I imagine they are completely devoid of any emotion or insight. I feel pain because both these men are decent human beings but AA has destroyed their individuality & they have no idea how to relate apart from expounding AA propaganda. I imagine Hell to be a continuous flow of AA meetings without any light at the end of the tunnel because one never recovers'. I beg you people who are in 12 Step programs, to get out before it is too late.

How does one recover when one is handing one’s power over to AA. The 12 Steps were written out of Wilson’s head, he certainly didn’t get his guidance from the Bible. I imagine he was an agent of Satan & he & Smith’s “cult religion” has filled millions of Steppers with their anti - Christ propaganda.


Step Three of AA is "Made a decision to turn our will and our lives over to the care of God as we understood him." While many in the Oxford Group placed their faith in Jesus Christ as Lord and Saviour, there was much leeway given. Shoemaker, a leader of the Oxford Group, says, "The true meaning of faith is self-surrender to God." He further explains:
Surrender to whatever you know about Him, or believe must be the truth about Him. Surrender to Him, if necessary, in total ignorance of Him. Far more important that you touch Him than that you understand Him at first. Put yourself in His hands. Whatever He is, as William James said, He is more ideal than we are. Make the leap. Give yourself to Him.
Aside from capitalizing the "H," which Christians do to refer to the God of the Bible, "Him" could refer to any god of one’s own making [bedpan].

Can you see what is happening to you? Ask Jesus to take control of your lives, read the Bible & instead of 12 Step groups, go to Church. Burn your Big Book or use it as toilet paper. Can you see the difference: With The 12 Steps, you never recover but with John 3:16 you are guaranteed Eternal Salvation. The “ball is in your court”

PS: I am a recovered alcoholic with over 21 years of sobriety

TherapyDoc said...

Fantastic.

MICHAEL said...

"HEY BOB"

BILL:]
Hey, hey BOB, I had a SPIRITUAL AWAKENING
Hey, hey BOB, my higher power, will always do
I've waited so long for BOOZE to be through
BOB, I can't wait to meet you
My love, my love

[BOB:]
Hey BILL, I've had a BRAINSTORM too
Hey, hey, hey BILL, I want to meet you too
If your PROGRAM is true, if you love AA, BILL!!
The BIG BOOK will always be real
My love, my love

[BILL&BOB:]
AA means planning a life for two
Being together the whole day through
True SOBRIETY means waiting and hoping that soon
The 12 STEPS will come true
My love, my love

Peace Be With You
Micky

Anonymous said...
This comment has been removed by a blog administrator.
therapydoc said...

Thanks so much, Anon. Sorry about the thump. I hope you continue this program. Seems to be working wonders. I've never seen anyone who worked a program not grow.

mona said...

Hi guys,
I think that its really interesting article on changes lanes, where everyone needs THERAPY.
Thanks for such great Suggestions about anger in relationships.
=================================
caroline16

http://www.alcoholtreatment.info

depanshu said...

Rehabilitation centers in country offers different types of effective alcoholism therapy to treat alcohol addicts. Detoxification program of centers is most famous to treat alcohol users. The staff members of center provide personal attention on each patient of center.

http://www.edrugrehabs.com/

Anonymous said...

I was with you, until you started preaching about god. That just shows how weak minded you are in the first place.

therapydoc said...

That's not how we act around here, Anonymous.

Invoice Factoring said...

I wanna share a poem about alcoholism. :D I don't own it.


I drink all day and half the night.
I drink to drown out the pain from last nights smash.
I drink in hopes of falling into a coma.
Maybe I could find prince charming.
Not some punk with a tin hat.
I drink and laugh, I find it funny.
My friends are so hammered that they can't see my attempts.
I like this way. This way of total end.
I like the darkness, I welcome it as my best friend.
I wish that yelling would stop, it ruins my salute to the world.
My peace out to a spinning bomb.
Why is an earthquake happening while I die?
Should I get up and help my friends before I go?
Opening my eyes, I see bright lights.
On the right is my dad, crying in his hands.
My poor mom screaming my name.
My best friend shaking me while the doctors pull her away.
Maybe one last fight, maybe I can stay awake.
I wonder why I'm bleeding.
I wonder why I'm crying.
The I.V in my arm hurts like a bitch.
And for a moment, I'm in complete bliss
Maybe one last fight, maybe one last chance
Can keep my sane for my poor life.


Invoice Factoring

Anonymous said...

Doc....I've struggled with AA for several years...about 10...been sober 6-8 months several times I always end up getting frustrated with the people in the program constantly pounding me with AA sayings,slogans etc. I've lost my job...company closed down....not alcohol related and have no health insurance..I want to try therapy..I feel I have a shot to be sober with some one on one therapy...please help me I feel like I'm going to lose it
DUB

therapydoc said...

DUB, in my experience, people do better in therapy with (1) a good therapist, (2) a good psychiatrist for medication (yes, drugs are good!) and (3) working a program with others, a group therapy like AA is nice because you can find your people. The magic bullet is you. That's what gets you there, to working with all three. Best of luck.

Anonymous said...

A A is better than no help at all. Therapy can be helpful for those that are willing to utilize it. It unfortunately has been my experience that most alcoholics are not willing to quit and the associated personality traits are rather permanent and the alcoholic believes them self to be normal while everyone else is damaged or messed up. The rage involved seems to be a manifestation of brain damage caused by repeated assaults on the brain from drinking or substance abusing. If this correct based on a brain damage theory, then wouldn't it b reasonable to approach the treatment of alcoholism from a more of a behavioral modality than from the cognitive. Similar to the treatment for mental retardation or other organic brain damage. It is my belief that the personal choices people make to drink or not is dependent on how far and how destructive someone is willing to go to manipulate others. All this being said, as non alcoholic partners, friends, etc. It makes sense to question the mental health of those choosing a continued association with that are harmful to them. Personally, if i care about the alcoholic / rageahaholic i will simply state the facts about it and not allow access to my personal space nor allow myself to be manipulated by such behaviors. The alcoholic personality is one of the most damaging and harmful personalities to be around, and even more so for the person that has developed it. Always be alert and cautious when dealing with this individual just as you would a rabid animal. In a sense they are very similar.

therapydoc said...

Thanks, Anon.

And on that note, suggested reading by Augusten Burrows (a really good writeer), DRY.

Anonymous said...

I am a recovering alcoholic and drug addict, sober/clean for 30 years now. I was married to and lived with a serious abuser, physical, mental, emotional, financial, sexual. I came to within an "inch" of being killed by him. Not being dramatic, as the police came, put him in jail (I have a protective order out on him) and then I found out that he had killed his first wife by throwing her off a balcony! I was devastated for so long...I'm still not over it all 10 years later..he also abused my daughter...not physically but it was serious abuse and she has problems with alcohol and drugs now too. Abusers are not really angry. They are controlling and want to control people. They grow up with an abuser in the family, and learn to be abusers. They are made, not born. And there's very little treatment for someone like this, the statistics are very low that they ever will stop their abusive behavior. Coupled with alcohol and or drugs, it only becomes worst, but it will always be there. For my ex, he will never be anything different, as he is a sociopath, and has committed crimes again since I finally got rid of him. Getting away from the abuser however possible, is key.