Does anger kill?

For thousands of years the cultural answer was yes. Rage provokes killing—and often leads to the death of the enraged. But what happens in modern life?

Therein's a tale involving personality, tobacco, and the changing mores of research.

What’s New Now?

A large meta-analysis in the European Heart Journal, put together by Elizabeth Mostofsky and others. Picking through what they consider to be reasonable and not-so-hot data, the group comes up with these numbers: a five-fold increase in heart attack in the two hours following an angry outburst, a three-fold increase in stroke.

Are These Numbers Believable?

Pretty much. The group has done plenty of studies themselves. The numbers of different studies run pretty close.

How Bad is the Problem?

Depends on how angry you are—and the risk profile of your heart. For people with “low risk” delivering an angry outburst once a month might increase risk of an MI by just 1 in 10,000 people. But if you are really angry—five outbursts or more a month—the numbers are much higher. 

How Much of this is Due to Personality?

That's the story of A and B.

Do you consider yourself "Type A"—driven, controlled by the clock, striving, productivity oriented, impelled by a series of self-declared rules? Or are you the “opposite”—the very laidback "Type B"?”

After Meyer Friedman and Ray Rosenman developed the concept in the 1950s, the idea really took off. The “leaders” of the nation frequently declared themselves type A. But there was a price for them—more heart disease.

Study after study by Friedman and Rosenman showed greater heart disease and death to the hard charging Type As leading America toward greater productivity and economic supremacy. A large business developed in “calming” Type As so they would not rush to the cemeteries.

Other epidemiologists could not reproduce their results. One prominent member of the heart epidemiology community once told me, “it turned out that what determined who was Type A and who Type B was an interview with Ray Rosenman.” When operational criteria—reliably consistent stuff—was developed by Jenkins and others, Type Bs appeared to die quicker than Type As.

But what was Rosenman picking up?

Redford Williams, who wrote Anger Kills, eventually found that the subgroup of Type As who died more quickly suffered from hostility and anger. It wasn't being Type A that was "bad"—it was being an angry Type A. Williams argued that suppressed hostility was perhaps worse than the directed kind. Now the emphasis has shifted.

Anger itself appears bad for the heart.

Still, Rosenman and Friedman fought back. And it turned out their backers in many cases—with real research bucks—were the tobacco companies. One of Big Tobacco's programs was entitled "Associates for Research in the Science of Enjoyment."

Big tobacco recognized that “muddying the waters” would help them in the courts. Were cigarettes killing people—or were smokers just disproportionately Type A? When it comes to paying legal fines and giant class action suits, doubt is a very handy thing to have.

So What Do You Do With Anger?

Humans possess many emotions. Many of them may appear—or erupt—simultaneously.

Yet expressions of anger appear to create more anger—especially when someone else is around. Arguments get out of control. Drugs interdict inhibition.

An angry alcoholic may be more than a cardiac danger to herself—driving a car or wielding a gun may prove highly dangerous to family members and friends—or passersby. Plus there are many others increased risks: suicide; the collateral damage on families; the economic costs of thwarted dreams and disrupted lives; the cultural damage inflicted on a more angry population. In many ways, anger kills.

The main individual treatments remain behavioral. They are as varied as the thousands of rest and relaxation techniques civilizations continually create. They include simple acts like walking and hiking in nature; meditating and performing yoga. Just breathing. The number of behavioral treatments for anger is a very long list.

Yet medications also have a place. Freud taught that depression was “anger turned inward.” Clinical studies describe something opposite. Perhaps half of depressed people are angry—often very angry. People suffering from bipolar illness often complain of intermittent explosions of fury that were provoked by “practically nothing.”

Moodiness and anger are linked.

As anger is linked to death. Controlling it has many benefits—for individuals and populations.

And for both their literal and metaphorical hearts.

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