Years ago, a hulk of a man came to see me with a lump in his neck. He was as big as the lump was small, standing at least six and half feet tall with shoulders that seemed almost as broad. His lump, in contrast, was only 2 cm wide.
Wide enough, however, to warrant concern. It was firm rather than rubbery, fixed rather than mobile, and non-tender rather than painful—all hallmarks of something potentially malignant. He'd noticed it only one month prior to coming to see me, which made me think it had grown rapidly, another bad sign. He'd had no infection during that time that he could recall.
I recommended a biopsy, to which he agreed, and set up an appointment for him to see a surgeon. A week later he called me to ask some further questions. The conversation started calmly enough. He related how he'd gone to see the surgeon who'd immediately scheduled a biopsy—and then suddenly he was literally shrieking in my ear. He'd had to wait 30 minutes in the waiting room and then another 15 in the exam room before being seen! He'd expected an office procedure and instead they'd taken him to the operating room! He'd wanted general anesthesia and instead they'd used a local block! What the hell, he'd wanted to know, was wrong with these people!
I could only listen in stunned silence, not just because I was taken completely off guard and intimidated, but because he literally offered no pauses during his diatribe—which lasted a full ten minutes—to allow me to respond. By the time he'd finished, however, I'd managed to regain control of myself and suggested he come in to see me right away to discuss what had happened.
He arrived later that afternoon, his bulk hardly fitting through my office door, and sat down in a much calmer state than he'd been in on the phone. He even laughed derisively as he related how someone had called the police after he'd gotten off the phone with me. Apparently, he'd been standing in a bookstore during his angry rant and his yelling had frightened someone enough to lead them to call for help in case he became violent. He had no insight into why someone would have done that, found it a completely overblown response to his "blowing off steam," and apologized for "being a little harsh" with me.
There's no shortage of theories about why people get angry. My own view is that it happens for four main reasons:
Though anger is often considered a negative emotion that we should do our best to eliminate, the validity of this has always seemed to me to depend on why the anger arises in the first place and what's done with it. For example, anger has always seemed to me an appropriate response to injustice, one that does little harm to oneself psychologically and very well may even be beneficial in that it motivates action to rights wrongs. The goal, it seems to me, isn't to eliminate anger but to control it; not to suppress it but to create value with it. How, then, can anger be properly managed?
Not by ignoring or suppressing it. Experience and science have shown repeatedly how poorly those strategies work. Once anger rises past a certain point, it seems to require satisfactory expression to be diffused. That is, it must be expelled in a way that feels good—in a way that is literally emptying. The goal then would be to expel it in a way that does as little damage as possible. How one does this depends on why the anger one feels is rising in the first place.
Of course, anger may arise for more than one of these reasons at one time. Anger at an injustice committed against you (as opposed to someone else) may intermingle with anger aimed at achieving control (as an expression of a wish for control that could have prevented the injustice from being committed in the first place). Anger aimed at yourself for being powerless in a given situation may intermingle with anger at someone else as a way to achieve the very power you lack.
The goal here is two-fold, your ability to carry out the second being dependent on your ability to carry out the first:
Though buried deeply, fear was the obvious cause of my patient's anger, an emotion with which I could far more easily sympathize. As he'd already calmed down by the time he came to see me (he'd satisfactorily discharged a lot of his anger already over the phone), I spent most of my time validating his anger and attempting to address its underlying cause. He never would acknowledge he was afraid, however, which made me worry there would be similar future outbursts (there were), but having fully apprehended its cause, his anger never again intimidated me. He was ultimately diagnosed with lymphoma, endured several cycles of chemotherapy, and was eventually cured. Of his lymphoma, that is.
Dr. Lickerman's book, The Undefeated Mind: On the Science of Constructing an Indestructible Self, is available now. Please read the sample chapter and visit Amazon or Barnes & Noble to order your copy today.