Tuesday, May 09, 2017

MANAGEMENT OF A REACTION - ANGER

Ladies and gentlemen, 

The psychology and physiology of a reactions like anger, depression, etc. has been studied over the centuries and the literature, both scientific and literary is quite vast. I might say that all of us here are acquainted with some cross section of this literature. 

The literature, in its novels, poetry and drama, portrays the angry man or woman, and the discerning student can come across the whole repertoire of behaviour patterns that can be subsumed under this word, anger. Sometimes, the authors portray the causes of anger, and other, the types of anger. Duryodhana of the Mahabharat can be seen displaying a whole range of the manifestations of anger at various times - the short bursts of verbal and muscular outputs, the sulky anger with verbal suppression, and the frustrated anger that has lachrymation and insomnia, all arising out of a background of sustained jealousy. 


Ravana has short moments of anger at odd times against the background of a well controlled, well disciplined and fairly generous personality. If you read Western, especially English literature, the portrayal of anger is of a more subdued somatic reactions.

The somatic expression of an anger and its perception as anger by the observer is culturally determined. The most realistic portrayal of anger can be seen on the Indian screen - specially the South Indian films. The thumping of chest, the gnashing of teeth, the rolling of eyes, the stamping of feet, the breaking of things, the tearing of hair, the hyena like bouts of laughter and torrents of words. This is most realistic if you keep your eyes and ears open to the scenes in Pondicherry. Women often, men sometimes, add crying to the scenery. The Hindi movie shows a somewhat modified form - the raised eyebrow, the heaving chest most often by the female star, the sarcastic smile, the clenching and unclenching of fists and the deliberate, slow motion breaking of things in hand.

Many educated Indians complain that the Indian films are most unrealistic and that the Indians tend to overact. The truth is perhaps, otherwise: the films are realistic. The cross cultural aspect can be best illustrated. One of my countrymen from Andhra, an educated lawyer took to acting. He was a great votary of the English drama also and did some acting in Shakespeare’s plays. He wanted to reform the Indian stage. In a drama he played the role of Duryodhana, the king in anger.

This actor, a Mr. Chary, portrayed Duryodhana as a cool, collected English gentleman in anger but dressed in Indian clothes - no shouting, no bravado, no thumping of chest or stamping of feet or brandishing the  mace. Hardly a muscle moved. He spoke his piece with deliberation. Orange peels and slippers were thrown on the stage and the hall was empty at the end of scene I.

 
Literature also portrays so-called causes and personal and social consequences.

This is a sample of reaction expression and perception.

The causes for anger have been studied by psychologists in width and depth. They are as numerous as the causes for drinking.

Neurophysiologists have located it in the amygdaloid nucleus, widened it to the rhinencephalon and I suspect they involved the whole brain, the spinal cord and the whole body. 

The animal psycho-physiologists have studied the anger in animals. Some of them have shown that a monkey whose banana has been snatched away can be quite angry, also it cannot gnash its teeth if its teeth are removed nor wave its tail if the tail is cut off. Don’t laugh. In this very institute a scientific doctor had shown a film of a monkey with spinal lesion, and the scientific doctor is shown stamping on the monkey’s tail and the monkey does not react, conclusively proving something.

The evolutionary experts have perhaps shown that earthworms can show rudiments of anger.

The anthropologists have shown how the angry savages of some place or other kill each other in anger and sometimes bite and eat others. The anthropologist merely kicks his wife and does not eat her.

At some point in this profession of learning all about anger from literature in order to treat others in overcoming it, it struck me that I myself know very little, almost nothing, as to anger in my own body and less than nothing of the processes of controlling it within myself.

When I get angry, shout at the children or at the wife or at the servant or some other, then of course, there is nothing wrong with it. After all every one knows the causes of anger, and I as a psychiatrist know all that and more. Oh, I am not really angry. Only I am reacting normally to the normal causes - children misplace important things and I am n a hurry, the wife has given away the best shirt you wanted to wear to the laundry, the servant has splashed water all over the office table - put yourself in my position. I am not mad, why should I see a psychiatrist, when I myself give lectures on it. I am perfectly normal, and I proceed to act as a statistically normal man does. I am shouting or sulking and fuming, and the breakfast which my wife prepared I spurn with contempt to teach her a lesson, scowl at the children sending them to tears, dash out of the house, banging the door and hurting the fingers, cursing fates, and then kick the car open and of course I have forgotten the keys, and after a double dose of normal anger in getting back the keys from the house, I drive off with a scowl. Simmering inside I reach the office and meet the Director and rapidly developing a smile, I wish him good morning and on his asking about my welfare and my family I say ‘in top form, sir, thank you’ and go to my room and begin advising, teaching, case demonstrating - Case - 4. The informant says that Mr. X, her husband, is getting unreasonably angry, shouts at her and the children. He says he is normal, refuses to take medicine, she wants to know if we can give something to put in his coffee without his noticing it.

My DPM and M.D. trainees express their views. With clarity and erudition. One said that it is really the wife who requires treatment - she is neurotic, fidgety and wringing her hands and crying. She must really be a nuisance at home. I entirely agree. A would be organic psychiatrist suggested irradiating the amygdaloid muscles of the case with tele-signals. He read in the Boston Journal of Neurophysiology that an angry chimpanzee at Boston was controlled in this manner from Chicago. Why not we see if there is marital maladjustment and introduce the psychiatric social worker in the network. One quoted a journal to support the case for euthanasia as a radical measure. We all agreed that the informant was a fit case for the diagnosis of anxiety-neurosis with hysterical features with a paranoid tinge. Also Dr Y requires one more case of anxiety-neurosis to complete his thesis.

The position thus far can be summarised: 

  1. Anger has many causes; things sent to laundry, not sent to laundry.
  2. Apparent causes become justifications which prevent a real perception of anger itself and its processes.
  3. Whatever be the cause its effects are an increasing disturbance of perception and consequent behaviour - these consequences further accentuating the anger by positive feedback. 
  4. This nucleus of infection rapidly spreads around the family, the work and so on.
  5. Anger is not something uncontrollable - scowl at the wife's neglect regarding the laundry can be replaced by smile at the Director who has been repeatedly neglecting to sign requests for promotion. 
  6. The subject of anger is not only unaware that he is suffering from any mental disease with deep widespread epidemic properties and wider consequences but he actually carries it around with him as a certificate of merit, as a peculiarity worth cherishing. “You don't know me but when I get angry nothing stops me. Also, I never get angry easily or without reason”. 
  7. These subtle certificates of so-called normal disabilities which become almost qualifications are quite an obstacle in rectification.
  8. If the subject is happily unaware of the gross effect of anger you can see how much more unaware he is of the ruin he is causing to his subtle cardiac and other mechanisms and the chaos he is inducing in his witnesses.

This basic anosognosia, the non-recognition that any serious damage is occurring to himself or others is quite deep seated.

At some point I realised that what we actually mean by normal causes of anger are really a rephrased justification for anger. A subtle screen is put between me who is angry and the body which expresses the anger - by every available means increasingly sophisticated - pills, biofeedbacks, psychotherapy and whatnot.

Popular moral religious preaching puts in value judgement - anger is bad, controlling anger is beneficial to mankind and so on. And in this too the preaching is done by men who like the doctors have successfully camouflaged their own anger. Always it is the other man’s anger that is bad. 

That man is a highly complex dynamic organisation in evolution, and not a test tube nor a chimpanzee, capable of learning to express anger and therefore of expressing tolerance and love is forgotten. This sterile, endless task of trying to express and understand man in ever subordinate terms yields data but not true interactional experience. What is qualitatively new is the starting point from which any other data may be evaluated. Any summation of subordinate data cannot reveal the interactional truth of the new. It is the new that has to appraise the data.

By now, for you ladies and gentlemen, the properties and parameters of any reaction must be well known. However, they can be summarised. The stimulus, its strength, rate of ascent to threshold and the duration of application; the reaction itself - its rate of build up, maximum height, the duration of maintenance of the peak, the rate of decline. To complete the realistic picture we have to include the other persons in the situation - because the powerful factor of mutually reinforcing reflections between any two nervous systems is often insufficiently appreciated by using a terminology that does not permit adequate appreciation.

Much of behavioral therapy rests on consideration of these factors: The recognition that each reaction is the result of a series of subordinate circuits, a sort of chain reaction, in which the operation of one switch activates another and yet another before the final explosion. An accurate appreciation of these various factors helps the behavioral therapist - to enable him or his apparatus to break or annul the reaction by attacking the most accessible or vulnerable circuit in the chain.

This procedure is good to the extent it can activate the I -My Body relationship, the I being the final witness and arbiter of all that goes on in the body. The procedure is ineffectual to the extent it reinforces the idea that the polygraphic dashboard or the gadget is the factor in any improvement. It is only the other side of the coin - X made me angry, doctor gave me pills, that gadget made me better. The control is placed outside the body.

In fact such improvement as it occurs in a patient is often due to the painstaking inquiry of the therapist who by a series of questions directed to elicit the links in the chain indirectly helps to awaken the witness function of the ‘I’ in the patient. This witness function is the first level of the ‘I’ as touched in the Gita.

My friends, I have already told you that I am a worker in the field and I bring to you empirical findings and experience. There is something very important to convey and I have not yet found any adequate method of doing it.

First, there must be a person who not only says ‘I’ am angry ‘it is bad’. Next this person must not only say this but actually perceive it to be harmful to himself, his own body. The whole mechanism of destructive deception occurs at this second level. This deception is mutually sustained by the Society and the individual and every subterfuge is used to maintain this subtle loss of autonomy wherein everyone learns to say and feel that somebody else is responsible for one's behaviour. This disturbance of volition attributed to catatonic posturing is merely an accentuation of the respectable postures we adopt without any real volition. 

Secondly I have observed that once this autonomy is reawakened I have seen the remarkable qualitative changes that occur in the person and his reactions. Sometimes these reactions remain, sometimes even accentuate but often the secondary or overflow or after reactions get eliminated and most importantly the effects on the others becomes markedly different. 

Thirdly there seems to be created a different field of influence around the person quite unrelated to the actions being done which may not differ in any essentials from what others are doing. 

Fourthly after numerous observations I have found that the awakening and sharpening of the witness function with regard to any reaction is the beginning and end and it pursues its course on its own and elaborate rituals and sadhanas are unnecessary or only of subordinate interest. 

Fifthly, the only adequate method of awakening this ‘I’ sense in another is for the person wanting to do this to be himself involved in this affair. 

In this awakening of  the self to its inherent autonomy, any reaction can be used and any method whatsoever. The results are dependent on the degree to which the operator of these methods: rajayoga, behavioral therapy - himself has this sense of autonomy: The operator must be able to say that I know for myself on myself what the consequences are of doing what I'm doing.

There can be no free society without free men. No man is free who does not learn the steering of his own machine. It is not equivalent of saying, ‘Oh I pretty much do what I want’. It is exactly like saying ‘Oh I pretty much do what I want with my car’ without having learnt the ABC of driving. Negative reactions like anger are most helpful to awaken in a person the desire to learn better ways of driving. So far I have found no adequate means of conveying this, verbal method of being the least effective. Maybe I will learn it yet, from some of you.
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