Thursday, March 21, 2013

Anger and Abandonment

It has been blustery in Chicago, the reputation as the Windy City well deserved. So blustery that at the end of March, when the weather is supposed to be mild (March comes in like a lion, out like a lamb, every second grader knows this) that we tell frail little people like mother, "Don't go out for lunch. You'll be grabbing onto your walker as the wind carries the both of you away." She goes to lunch anyway.

FD tells the story. He's in a parking lot at Home Depot, returning the cart. A bundled-up middle-aged man with a white beard is holding on tightly to a cart. If we don't hold them tightly, carts will take charge, fly off and hit parked cars. Chicagoans know this.

The man begins to curse as his hat flies off his head and hits the ground. FD, retrieving it, is rightly impressed by the long string of expletives, ef__, es___, d__, ef'in___b, b___, ef___, ef'n___, es-ef___, spewing from the man's mouth. Listening to this, he doesn't say it, but is thinking, Save your expletives for when you break a leg, or lose a house, maybe. Why waste them here?

A few years ago, two men with romantic accents came to see me in one week for anger management. It sometimes happens that two or even three new patients with similar problems come to therapy in the same week. It is as if there is something in the air or the stars are aligned in some special way. This affords the therapist the opportunity to experiment, to do her own little research study, assign homework and see what works and why, and see what doesn't and why not, because there is something of a control, having that second patient with comparable symptoms, comparable objectives.

It gets better. Both tell their narratives fluently, and both are from that continent hailing the new pope, South America. Both are reflecting upon a childhood living with extended family, not their moms or dads. Their parents left southern climes to establish themselves in this country, the United States, a land of opportunity, and called the sons to join them years later.

Years. Later. A long time to miss a parent. Without means, long distance phone service was prohibitive back then, and letter writing, well, there wasn't money for computers and email, and who had time for it anyway?

The child left behind, defenseless, odd-man out among the cousins, abused by drunk uncles and bullied at school, learned to be a very tough human being, so tough that peers eventually realized that to mess with him meant a fist fight that he relished. To beat another human being with his fists felt fantastic. This is where the phrases  sees red, has a hair-pin trigger, and Intermittent Explosive Disorder can meet as one.

Left behind.

Therapists hear about domestic violence, but usually not from the perpetrator, but the victim. The spouse or child tells the story. Here the patient is both victim and perpetrator. As an angry man, however, he doesn't hit his children or his partner, and has learned, as an adult, not to beat other adults, either, unless the circumstances clearly warrant physical violence. To him, they occasionally do, certainly if he hasn't stopped drinking yet.

We don't need advanced degrees to see where it comes from, the anger, and why the expletives become something that will need work, and surely the physical pounding, the rage, the immediate need to redistribute justice and turn things around, has to be channeled productively. One of the interventions I love, one that started with those two-in-a-week, works as follows.

The patient is told that he has to deliberately lose every argument. Every disagreement, every difference of opinion, my bad. He is to tell his partner, dispassionately, "Fine, I'm driving poorly?  I'll work on it." That kind of thing.

"Two weeks, you're an idiot for two weeks. She's the smart one. It's okay. You're really not an idiot. In your heart, in your head, you know that. You do know that, right?!" The therapist asks this in all sincerity. "Keep that in mind at all times. Nobody left because of you. Nothing to prove. Nobody thinks less of you if you are wrong. Your partner will value you more for being human."

It helps to have a partner or spouse in the therapy to reinforce the intervention, someone to look into his eyes, to tell him, "You're the smartest guy I've ever known. I love you. Love me."

And if he can't, there is that possibility, she might leave. Been there, done that.



Grace-WorkinProgress said...

Sad the prisons we make for ourselves self abuse self hatred. We carry this around and randomly spew it out on other people especially people we know and suppose to love.

Getting over being left by who we think defines us or accepts us leaves a large hole that takes years to fill if it gets filled at all.

Unknown said...

Thanks for sharing this information. I have been seeing the online family counseling and it works very well. Keep up the great work.

Syd said...

I wonder whether some ragers may not have a condition like ADD. And ADD seems to go hand in hand with substance abuse which adds a whole other dimension to raging.

therapydoc said...

Of course there are many mental and behavioral disorders that underlie raging. What we look at is whether or not a disorder becomes so so frustrating that a person begins to rage, or did life get so frustrating that a person became "disordered". Not always an easy call.

Lorri M. said...

"or did life get so frustrating that a person became "disordered". Not always an easy call." I had not thought of it that one food for thought.

So many senior citizens that I see during my errand running, etc., seem to be "disordered" in frustrating efforts trying to act as if they are "normal". I am not sure they always know what is spewing from their mouths, in their difficult moments.

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Brian said...
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Ron said...

I really like this perspective. Society views therapy as a treatment for a problem, but this viewpoint is much healthier. Well written, thank you for sharing.

David said...

There are surely a lot of different factors that contribute to a person's rage. Therapy is really good in this problem especially if you have a great support system.

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