"There is more anger in America today than at any time I can remember."-- Democratic Senator Arlen Specter commenting on public reaction to President Obama's proposed health care reform legislation.
Change can be scary, stressful, and sometimes, traumatic. Americans are currently confronted with changes every bit as fundamental as those that shook this country to its very foundations during the turbulent 1960's. First, there was 9-11. Then the protracted and unpopular war in Iraq. Followed by the worst economic crisis since the Great Depression. The stock market and real estate crash. Next, the election of our first black President as part of a backlash against Republican policies. And now, radical healthcare reform. Should we really be surprised by the outrage, anger and embitterment of many concerned and nervous citizens regarding the controversial issue of universal healthcare coverage?
Americans are very angry. Just look at some of the rowdy recent town hall meetings regarding healthcare reform. This anger has been festering for decades now, but appears to be reaching a boiling point, as seen in the explosive epidemic of violent mass killings (see my prior posts), rampant incivility, and a pervasive embitterment rooted in a barely suppressed, smoldering rage. The anger, resentment and hostility I refer to here is also raising its ugly head in the form of racial hatred. Congressman David Scott, a supporter of the President's healthcare legislation and who happens to also be an African-American, found a swastika spray-painted outside his Atlanta office last week. He expressed concerns about the "racial hatred bubbling up" right now, and the "hatred out there for President Obama."
Hatred is a feeling closely correlated with chronic embitterment, and frequently, evil deeds of various sorts. This widespread bitterness has become so prevalent and problematic that the American Psychiatric Association is now debating whether to include a new diagnosis to describe it: Posttraumatic Embitterment Disorder (see my prior post). In my view, there is very good reason to do so. Change can be traumatic. And how we deal with the trauma of change can be maladaptive, leading to mental disorders of varying kinds, including depression, anxiety, substance abuse, and sometimes even psychosis.
Posttraumatic Embitterment Disorder (PTED) was first proposed by German psychiatrist Dr. Michael Linden in 2003, based on his clinical work with troubled immigrants from East Germany following the fall of the Berlin Wall. That profound cultural change proved to be quite traumatic for some of those whose lives were directly affected by it, and the disturbing repercussions of this life-changing event--seen almost universally by the rest of the world as a positive development--were felt for years. We in this country are going through some significant social changes of our own. As Linden (2003) observes, some of the debilitating emotional symptoms of those patients meeting his proposed diagnostic criteria for PTED include chronic feelings of injustice, victimhood, helplessness, hopelessness, powerlessness, self-recrimination, aggression, anger, rage, resentment and, of course, embitterment. Such individuals feel they have lost control of their lives and their destiny. The values and structure that once provided a stable sense of self, meaning, purpose and personal or professional identity have been lost or eroded. The old life has been altered irrevocably. The new life has not yet been established, leaving the person in a state of existential limbo.
Viennese psychiatrist Viktor Frankl referred to such limbo states as living in an "existential vacuum." This is a classic existential crisis, not unlike what typically occurs to some extent or another to us all during mid-life. But the crucial difference is that these patients--like those in the throes of a protracted major mid-life crisis-- have been unsuccessful in navigating this treacherous transition from the old existence to the new. They have been unable to let go of their anger and grief about losing the status quo or feeling unfairly treated by life. They remain stuck and become bitter rather than accepting change and bravely moving forward in life. In a sense, they bitterly choose to live in the past: At least dwelling in the past and dreaming of retribution provides some sense of meaning and purpose that the present and future appear to lack. But, existentially speaking, this refusal to relinquish one's past and embrace the present and future can be understood as a fundamental failure of courage. Life requires courage precisely because of its inherent insecurity and transitory nature.
So America is in crisis again. Change is the cause of that crisis. Psychotherapists know all too well how difficult it is for people to change themselves and to accept change in their lives, even when they know that change is inevitable. (See my previous post on change vs. acceptance.) There is great anxiety and resistance accompanying change. The anxiety and fear of moving from the familiar to the unfamiliar. The known to the unknown. We humans have a primal fear of the unknown, which is one reason we tend to fear the unconscious. And most people will do almost anything to avoid the anxiety of change, including choosing to persist in a lifestyle which no longer really works for them, and, in some cases, clearly causes them harm. This is the decision, the existential choice with which Americans are currently confronted: To courageously move forward. Whatever its legitimate pros and cons, no one likes to be forced into confronting such a choice before being psychologically ready to do so. No one wants to confront the anxiety of change unless they absolutely must. And this is part of why so many Americans are reacting to these proposed sweeping changes so negatively and with such vocal hostility. It is a primal defensive response, a form of "fight or flight." It is also an example of the classic "frustration-aggression hypothesis": Frustration in certain segments of the citizenry is leading to anger, rage, aggression, and conceivably at some point, violence. (See my prior post.)
What is the therapeutic treatment for this pandemic embitterment? As with treating any anger disorder, the anger must be acknowledged, heard, accepted and understood, even validated at times. And the therapist must help the patient to channel that anger constructively, to help them move through their fears, insecurities and anxiety about change. Life is change. Americans need to be encouraged to confront the unknown, and to recognize that existential anxiety can be a kind of excitement about the future and its new possibilities. We all must embrace change, and the normal anxiety that inescapably comes with it. The angry refusal to do so is an oppositional, negativistic, cowardly choice to become embittered rather than empowered, to stagnate rather than grow and develop, to remain vengeful, passive victims of fate rather than willing participants in our own collective destiny.
