I want to apologize in advance for this post, which is really an esoteric debate between therapists. Yet I urge present and potential consumers of
psychotherapy to skim it, along with Dr. Diamond's cited post, to appreciate the importance of doing your own research on the ideology of any psychotherapist you might hire. Most therapists have websites that, with careful perusal, indicate whether they rely on dogma or research. You can also ask them directly whether they do objective follow-up evaluation of their work.
To escape the blind spots inherent in all our professional ideologies, therapists must be able to frame hypotheses drawn from those ideologies in empirical terms and, whenever possible, test those hypotheses with real-world data. Otherwise we merely derive assumptions from other assumptions of the ideology, which reduces it to the status of dogma, i.e., there is no way to know it is true apart from our faith in it.
A few of the fundamental scientific questions for psychotherapy are: "What are the sources of the data on which the therapist bases hypotheses, how valid and reliable are those sources, and how do you know that your ideological blind spots are not influencing your observations and interpretations of the data. These fundamental questions bring us to the major reasons why it is not the therapist's job to tell clients whether their anger is "appropriate."
First of all, the term, "appropriate" is a social construction, contextually-dependent and embedded with personal and cultural biases. More important, if the therapist does not objectively test hypotheses, he interprets data through the blurred lens of his own ideologically-biased assessments of the client. (To put it in terms Dr. Diamond prefers, how can the therapist ever really know that he is not projecting?) Still more important, the descriptions of their experience that angry clients make in the artificial environment of psychotherapy are inaccurate, as demonstrated by the empirical evidence of substantial cognitive and memory impairment that occurs during anger arousal. To the extent that their accounts even approach accuracy, they are woefully incomplete, omitting all other perspectives and mitigating information. Just as therapists can suffer confirmation bias in regard to their ideologies, angry clients suffer acute confirmation bias when it comes to their anger - because they feel like victims, they process only confirming evidence, ignoring all disconfirming evidence. Angry clients can easily sound like they are married to Norman Bates' mother - they're just minding their own business when she hacks at them with a kitchen knife. Videotapes of anger occurring in real-world interactions show that it differs greatly from the way people describe it after the fact. (More on the relevance of real-world interactions later.) In short, the therapist has no way of knowing whether the client's description of his anger in real life is contextually "appropriate."
The crucial point here is that the therapist doesn't just validate the client's anger but also the construction of reality that makes the client feel like a victim. In other words, the grandiosity of the therapist who doesn't test hypotheses validates the narcissism of the client. To be sure, everyone is narcissistic when angry. In the adrenalin rush of even low-grade anger, everyone feels entitled and more important than those who have stimulated their anger. Everyone has a false sense of confidence (if not arrogance), is motivated to manipulate, and is incapable of empathy, while angry. The therapist can hardly validate the sensations of anger without also validating (at least in the client's mind) the distorted construction of reality associated with the sensations, as well as the motivation for retaliation that go with anger arousal.
Evidence
Dr. Diamond agreed in his original response to my post that there has been a worrisome increase in anger and violence in recent decades. He attributes it to the suppression and repression of anger. He cannot support that hypothesis with mere ideological iterations; rather, he needs to present objective evidence that suppression and repression of anger are on the increase or at least that there was an outbreak of infantile suppression of anger 20 years ago. (Something in the water supply got into breast milk?") If he can establish that, he then has to explain why reasonable people should suppose that increased suppression/repression has caused the increase in anger, rather than facts like children viewing 11,000 murders on TV before the age of 14, wide-spread media glorification of anger-displays, and other potent effects of modeling demonstrated in the social psychology research literature.
If Dr. Diamond really believes that we have more anger now because we more often shame people for experiencing anger, he needs to count the number of angry displays by "heroes" highlighted in the news and entertainment media. Our heroes freely display a righteous, passionate anger, while the villains are passionless psychopaths. The all too familiar stereotype of masculinity, very much a product of cultural conditioning, proscribes only one emotion for men, and that is anger - any softer emotion is unmanly. In contrast, women are permitted to express all emotions except anger, which is oppressively deemed unfeminine. So if the hypothesis that attaching shame to anger causes pathological anger is to be supported, women would have show a lot more of it and, subsequently be acting out more pathologically than men. Of course, the empirical literature shows the opposite.
To merit credibility, Dr. Diamond's hypothesis that "narcissistic wounds" cause problem anger, like the suppression/repression hypothesis, would have to account for the observed increases in anger. Are we to believe that parents started wounding their children more two decades ago, when the steam engine theory of emotions and that infamous psychodynamic derivative - blaming parents - was well established in the vernacular? Of course, the heaviest blow to the "childhood wounds" hypothesis is the empirical finding that most abused children grow up to be fairly good parents, no angrier than anyone else.
Emotions are not Steam Engines
Dr. Diamond is correct in noting that the 19th Century steam engine view of emotions was, indeed revolutionary and widely accepted by therapists for quite a while, but it was never accepted by scientists. A revolution also occurred in medicine around the same time, yet Dr. Diamond would not expect his personal physicians to use 19th Century methods and techniques in their treatment of him. Therapy clients have the right to similar expectations of their therapists.
As I understand Dr. Diamond's rendition of the steam engine theory, "appropriate" anger should be experienced and expressed - but not acted on, as the retaliation motive of all anger would risk turning "appropriate" feelings into inappropriate behavior; in other words, it's good to feel but not do. He also seems to think that suppressed/repressed "appropriate" anger, like egg salad, eventually turns rotten when stored somewhere in the body, where it "festers" and causes inappropriate anger.
Functional MRIs show what happens when a person experiences anger - within or without conscious awareness - but, alas, do not show where or how it builds up and festers. We can measure other kinds of invisible festering by things like white blood cell counts and depleted immune system functioning. If there were such a thing as festering anger, it would show up in elevated rates of cortisol in the saliva. I know of no such empirical confirmation of the fester hypothesis.
I'm curious to learn how, apart from dogma, Dr. Diamond knows that suppressed appropriate anger festers, indeed, knows it with enough certainty to risk the iatrogenic effects of validating the anger of angry clients. Certainly the empirical literature - as opposed to those early 20th Century case studies embedded in dogma - indicates that there is no lasting therapeutic benefit of catharsis and that anger expression worsens anger problems.
