Wednesday, May 19, 2010

Anger management or Power/Control

I frequently say, “Jehovah’s Witnesses have beliefs, Mormons have beliefs, Roman Catholics have beliefs and therapists have beliefs.” Unlike most of my colleagues in other specialties of medicine, there is precious little science in psychology and psychiatry. (When was the last time you read the patient-information insert that comes with a psychiatric medicine? It reads more like a theological treatise than a medical-science document. Usually it will say some variant of, “It is believed that pharmoxatine works by…” BELIEVED? In other words, they DON’T KNOW! So, I tell patients that I have a belief… and like other beliefs, it may or may not be true.)

One of my central beliefs is that all of us from birth ‘till death want to have more power & control over our environment.

Following that belief is another. Many of our emotional/psychological problems stem from an unrealistic expectation of how much power/control we actually have.

Coming to terms, consciously, with how much power we actually have, is an arduous process. When we are repeatedly confronted with circumstances that demonstrate that we do not have as much power/control as we want, or think we have. Hopefully we gradually come to accept the our power/control is limited. For some of us, this process is not only arduous but very slow. The process is slowed if we are cursed with an over abundance of money (which allows one to exercise abnormal amounts of control over others). The process is also markedly slowed if one becomes a bully, which in essence has the same effect as having too much money.

This brings me to a professional pet-peeve that I have. Perhaps in the last 20 years, the phrase, “anger-management” has come into use. It seems to me peculiar that in modern-life we need anger-management but in decades past, there apparently was no need of it. It seems to me that my profession is rampant with OCDD, obsessive-compulsive diagnosing disorder which is characterized by seeing any disagreeable situation as a psychological disorder requiring the intervention of a therapist/psychiatrist. [Warning: rant approaching.] I submit that like many other social woes, many social problems are relabeled as psychological problems by the under-funded Court system along with over crowed jails. The same thing happens when a teen is required to see a therapist for being caught with pot. This is not a psychological problem – it is a maturity problem.

Maturity naturally occurs when one experiences SIGNIFICANT consequences for one's behavior. If one does not experience SIGNIFICANT consequences, maturation is deferred. Believe me, being required to chat with a therapist a few times is not a significant consequence.

This brings me back to the matter of anger-management. In my work with patients, I am, for better or worse, known for my… unusual (others would say outrageous) illustrations. Here’s a good example of one of those illustrations. I compare anger-management problems to (are you ready?) a bowel movement and how we learn to use a toilet.

I explain that when we are quite young, we learn to identify the sensations in our belly that signal an impending bowel movement. I ask patients how they know that they should begin to search out a bathroom. For many it is so automatic that it has become an almost unconscious process, but with a bit of thought, most will eventually identify that they sense a crampy feeling and/or an abdominal pressure. Then I ask, “From the time you first sense that feeling, roughly how much time do you have before the blessed event takes place”? Many will say that they have between 15 and 30 minutes.

I then wonder aloud with great bemusement, how, at such a young and tender age, they learned to feel, identify and take preventative measures to avert a regrettable occurrence (public defecation). How were they able to do this without the assistance of a psychiatrist?

Again, I submit for your consideration that they learned to control their bowel movements because of likely significant consequences if this skill-set was not learned. They would likely be subjected to the ridicule of their peers and probably physical discomfort.

Like bowel movements, one can learn to feel and identify the sensations that herald an impending outburst of anger allowing one to deal with their anger without making a public display of it. Granted, we learn more quickly when we are toddlers but even those who have attained physical maturity CAN learn and it’s likely will learn UNLESS we are deprived of significant consequences. Again the things that might deprive us of significant consequences can be: having a lot of money (allowing one to buy evasion of circumstances), being surrounded by enabling people who help us avoid consequences (this can include enabling Court systems, school systems, etc.) or by using the ol’ diagnosis ruse, “I’m not responsible because I have a disorder”!

OK, a little self-disclosure now. Probably more than 10 years ago, I managed to accumulate four speeding tickets in one year. I am not excusing any of this but merely relating the facts. I managed to laugh-off the first two because I had a reasonable salary. The third hurt because my insurance costs increased quite a bit and receiving a letter from the DMV saying that I was officially a public menace was disturbing. The fourth ticket was very expensive and my license was taken for six months; only by pleading with the DMV did they grant a restricted license allowing me to drive to work. But here’s the big point…. I don’t speed any more! When the consequences were significant, I learned. (Yes, I know, I’m a little slow on the uptake.)

You may wonder, “What’s this have to do with anger management or power/control”? People with (so called) anger management problems have been deprived of significant consequences. Usually, people with anger management problems have an unrealistic sense of how much power/control they have in this world.

I do not have power/control over how others drive.
I do not have power/control over others behavior
I have limited power/control of what others think of me.

How much power and control do we have in our life?

This is a question I frequently ask my patients.

Often, I draw a 0 – 10 scale and explain, “Let’s accept that this represents how much power and control we have”. On the scale, 0 represents no power/control; much like the state of a newborn. A 10 would represent unlimited power and control. Almost anyone would acknowledge they do not have unlimited control. I ask my patient to estimate how much power and control do they have as represented by this scale. On average people say, “Six”.

I’ll then ask, “Do you think your estimation is reasonable?” Of course they do – otherwise they wouldn’t have said it.

Here’s the problem. Reality suggests it’s more like three.

The difference between Six and Three – that’s a problem. If you believe you have a power/control level of six; you’ll act as if your degree of power/control is a six. “Reality” however doesn’t agree with the estimation of six.

The discrepancy between your six and “Reality’s” three is the cause and measure of much frustration and anger you experience.

If we can accept a more realistic estimation of how much power/control we have in this life, we’ll be much less frustrated.

In this life, we have precious little power and control; much less than we want to believe. I have control over my personal hygiene, whether I use a seat-belt in my car and whether I choose to obey the law. I have control over whether I drive at the proper speed.

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