Following my blog, Dealing with Unresolved Anger, one reviewer challenged my thesis that unresolved anger could be at the root of anxiety disorders, particularly Post-traumatic Stress Disorder (PTSD).  This reviewer may be correct, insofar as PTSD affects the military.  As far as I know, in spite of all the millions of dollars spent on innovative ways to treat these cases, nothing has proven effective.

If unresolved anger were at the root of PTSD in the military, the client could have overwhelming anger, if not blinding rage, at the military commanders for having subjected him or her, and befriended comrades, to endless and winless warfare. Yet, those who serve in the military largely have the mind-set of defaulting to embedded authority or outside authority to make decisions for them. This would create an irresolvable intrapersonal conflict which may help explain why PTSD is so difficult to treat in the military. 

The PTSD with which I am familiar is the home-grown type, where intrapersonal conflict, if uncovered, is resolvable. To illustrate this home-grown type of PTSD, let me tell you about Heather, a 34-year-old librarian.

Heather was referred by her husband for her incessant anxiety and concern about her aging mother, who lived in the Midwest. Heather telephoned her mother every night to hear how she was doing, and her mother invariably complained of various symptoms—a cold, a remote ache, shortness of breath, and loneliness, leaving Heather with excessive feelings of guilt. And now, against her husband’s protestations, Heather had asked her mother to come live with them. 

At our first session, I asked Heather what she did for fun.  She said she and her husband enjoyed opera and classical music. I asked if she did any singing herself. She nodded, saying she formerly sang soprano in a church choir, but now couldn’t get above contralto. I then asked Heather about her mother. Heather said she was deeply indebted to her mother. When Heather was about five years old, her mother, upon short notice, took minimum wage at a local clinic to support the family, following her husband’s sudden death from an auto accident. Heather’s mother was left with a house, Heather, Heather’s baby brother, and Heather’s pregnant dog, Nellie.        

Several months later, because of her mother’s meager income, Heather was sent out of state to live with an aunt and uncle, whom she detested for being so rigid and rule minded. Heather was forbidden to telephone her mother, about whose safety Heather had become increasingly concerned, for what reason she couldn’t explain.

I asked Heather if she could remember any major events, besides her father’s death, and being sent to live with her aunt and uncle, that may have enraged her as a child?  After some searching, Heather recalled awakening early one morning upon hearing a noise, excitedly rushing downstairs to the basement, and seeing her mother holding a chloroformed towel over a basket containing Nellie’s new-born pups. Her mother explained that they simply could not afford to provide for the pups and that killing them was better than giving them away to be abused. 

“Wow, that must have been pretty traumatic for you,” I said.  Heather began to cry, saying, “I loved Nellie. She was a member of our family. How could my mother do such a horrible thing to Nellie’s pups?”  I suggested that Heather might have covered-up her anger at the time as the result of a misplaced fear, that her mother might chloroform her for the same reason. Heather sat back and looked at me in shock, as though she had a flash awakening.

I continued, “As an adult, you can now accept your childhood fury toward you mother, which could help explain your over-bearing concern about her well-being.”

At our next session, Heather reported that for the first time since she ran downstairs to see her mother with Nellie’s puppies, she felt liberated. Her irrational fear and anxiety had completely vanished. She no longer had to displace her shadowy feelings toward her mother (which in reality were anger and a wish to harm her) onto some mysterious forces that threatened her mother’s life.  She agreed with her husband to place her mother in a retirement community.  And, she exclaimed, “I can now sing, hitting all the high notes, with complete freedom!”

A distinguishing feature that is common to unresolved anger, I believe, is the fear of expressing it.  In this case, Heather, with a child’s mind, bottled up rage at her mother out of fear of being chloroformed for the same reason as Nellie’s pups.  This unresolved anger and fear of expressing it, led to her inexplicable anxiety as an adult.

I have been questioned, which comes first, the anger or the fear.  Fear is about a happening in the future, whereas anger is about an event in the past. Although the two are often intertwined, I believe that anxiety is based upon a past event.

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