This post is in response to Bitterness: The Next Mental Disorder? by Christopher Lane

imageTo fellow PT blogger, literary professor Christopher Lane--and the American Psychiatric Association's DSM-V Task Force-- I say, yes, you bet, as to whether bitterness can become problematical enough in some cases to warrant being deemed a mental disorder. Emphatically yes.

Bitterness, which I define as a chronic and pervasive state of smoldering resentment, is one of the most destructive and toxic of human emotions. Bitterness is a kind of morbid characterological hostility toward someone, something or toward life itself, resulting from the consistent repression of anger, rage or resentment regarding how one really has or perceives to have been treated. Bitterness is a prolonged, resentful feeling of disempowered and devalued victimization. Embitterment, like resentment and hostility, results from the long-term mismanagement of annoyance, irritation, frustration, anger or rage. Philosopher Friedrich Nietzsche noted that "nothing consumes a man more quickly than the emotion of resentment."

Most mental disorders stem either directly from--or secondarily generate--anger, rage, resentment, hostility or bitterness. This is why I personally applaud the American Psychiatric Association's possible long overdue recognition of the debilitating and deleterious aspects of Post-Traumatic Embitterment Disorder (see my previous post on "The Trauma of Evil"). There is no question that, if left to fester unconsciously, anger, rage and resentment about having been traumatized become bitterness and hostility, which in turn give rise to self-defeating, sometimes passive-aggressive, destructive, vengeful or even violent behavior. Pathological embitterment is a dangerous state of mind that can and does motivate evil deeds. This attempt to include what I would categorize as another "anger disorder" (see Part One) ) in the forthcoming DSM-V is a good beginning, a step in the right direction. But it is just the tip of the proverbial iceberg. Given the rising tide of violence (see my previous postings) it is paramount today for both the American Psychiatric Association and American Psychological Association to formally recognize the pre-eminent role anger, rage, resentment, hostility and bitterness play in the etiology and perpetuation of so many different mental disorders, and in human suffering and destructiveness in general.

At the same time, it is crucial that psychiatrists and psychologists take great care not to hyperpathologize or overbiologize what professor Lane correctly calls "justifiable" anger, rage, resentment or bitterness. Normal, existential, ontological or healthy degrees of anger, rage or resentment must be distinguished from pathological embitterment. But embitterment, which, like irritability, is often associated with clinical depression, must, like depression itself, be understood as a primarily psychological or emotional rather than biologically determined phenomenon. At one time or another, we are all prone to such emotions, some of which seem to be an archetypal or universal part of the human condition. Psychiatrist Carl Jung (1967), for instance, recognized that " a deep resentment seems to dwell in man's breast against the brutal law that once separated him from instinctive surrender to his desires and from the beautiful harmony of animal nature." Similarly, psychologist Otto Rank (1929) suggested in his theory of the "birth trauma" that the experience of birth is a traumatic tearing away of the child from the idyllic womb into a strange, hostile environment, and that the child naturally feels great anxiety and resentment toward the mother for this precipitous expulsion from Paradise.

Frustration is yet another existential root of resentment and bitterness, as is one's confrontation with fate: those aspects of life we don't choose and can't control. Chronic frustration of what Viktor Frankl (1969) called our "will to meaning"--existential frustration-- may engender a deep-rooted rage, that, when repressed, gradually turns into a hard-to-shake, hostile, bitter resentment toward the world. Toxic embitterment typically underlies the life-negating rejection of meaning, purpose and values existential psychotherapists refer to as nihilism. Such pathological embitterment is closely related to Sigmund Freud's theory of Thanatos, the "death instinct," which drives one to destroy life, as well as to Goethe's satanic "spirit of negation." When and how does "justifiable" anger, rage, resentment or bitterness cross the line and become pathological? When we speak of someone as being a "negative" or "self-destructive" individual, we may well be observing the morbid, pathological consequences of chronic, unresolved bitterness. Perhaps the authors currently revising the DSM-IV-TR should also consider including a diagnosis for Hostile Personality Disorder, which, even more clearly than Conduct Disorder or Antisocial Personality Disorder, would designate an enduring, pervasive, somewhat more behaviorally subtle pattern of bitterness, resentment, negativity and hostility since adolescence or early adulthood. And one for Rage Disorder, which would describe what John Bradshaw refers to as "rageaholics" or those prone to involuntary pathological rage attacks. Another possible diagnostic term worth considering for such patients might be Anger Possession Syndrome.

Officially including such anger disorders in the APA's diagnostic system would serve to bring desperately needed attention to the pervasive problem of repressed anger and rage in our culture and in so many psychiatric and psychotherapy patients. But, as with the majority of mental disorders, the determining criteria differentiating them from normal, non-pathological behaviors or experiences require the presence of "clinically significant impairment in social, academic, or occupational functioning" (DSM-IV-TR). So, when anger, rage, resentment or bitterness becomes a problem unto itself, negatively impacting the quality of our life and/or of those around us, it has taken on pathological proportions. (For a cinematic example of PTED, see Part Three.) And this typically occurs when the normal anger or rage have been chronically denied. Now, the key question, of course, is how to treat pathological anger, resentment or embitterment. Should it be further suppressed psychopharmacologically? Or ought the focus of treatment be to try to convince the patient that there is no valid, rational reason or right to feel bitter about the cards life unfairly dealt them? Or perhaps to shift attention from the bitterness itself to that which is believed to underlie it, for example, feelings of grief, fear, pain, shame, or distorted and irrational cognitive schemata? While each of these therapeutic interventions can sometimes be useful, they are, even when combined, insufficient to the task of treating pathological anger, resentment or embitterment. The only truly efficacious way to resolve pathological bitterness is by confronting and consciously acknowledging  the repressed and often justified anger or rage burning beneath, of which embitterment is but a manifest symptom.

Parts of this posting are derived from Dr. Diamond's book Anger, Madness, and the Daimonic: The Psychological Genesis of Violence, Evil, and Creativity (1996, SUNY Press).

Be sure to read the following responses to this post by our bloggers:

A Slippery Slope: Pathologizing Bitterness is a reply by Christopher Lane Ph.D.

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