On Healing 7/10/2006: Treat the whole life, not the symptoms

Road rage is not really road rage. Of course, anyone who has seen that frightening and dangerous behavior might argue with that.

But according to a recent study in the archives of General Psychiatry, it’s something called Intermittent Explosive Disorder, and it affects nearly 16 million Americans, more than schizophrenia and bipolar disorder combined.

This was an impressive study involving nearly 10,000 interviews. Intermittent Explosive Disorder is defined as multiple angry outbursts that seem inappropriate to the situation. The behavior typically begins around puberty, and the average number of lifetime episodes is 43.

According to lead author Ronald Kessler, the incidence was much higher than previously thought. They go on to suggest that the disorder is partially a result of inadequate serotonin – the mood regulating brain chemical. So medication and therapies such as anger management can be helpful.

Make sense? Not to me. Much of my continuing education comes from my patients. Granted, I am not examining a sample of 5,000, but I get to learn about people while they are learning about their symptoms.

I recently treated a fellow I will call Joe. A married man with no children, Joe was a kind soul. But often when he felt stressed, he could feel rage building up inside. Although he has never harmed anyone, he has often raged at other drivers.

On occasion, he has become so furious at home that he has thrown dishes and put his fist through a wall. His wife said she used to be terrified; now she just feels sad and helpless.

After the rage, he feels great shame, so he drinks to cope with his feelings. And because he is drinking, he feels even worse. So his fury turns inward and he continues to drink. Eventually, he climbs back on the wagon and returns to his baseline state of kindness.

Charlotte was 14 when I first met her. Like Joe, she was a loving person who would become enraged at what seemed to be the slightest provocation.

Her rages began shortly after puberty. She confided that when this happened, she hated herself and now she is beginning to hate herself all the time. Like Joe, she felt ashamed.

Both Charlotte and Joe had family members who were prone to bouts of anger, so much of their reactivity may have been genetic. And I am sure both were low on serotonin since both were depressed.

I recommended Charlotte see a gynecologist to have her hormones evaluated before we went further. Both saw their doctors and were prescribed medication. Both showed modest improvement. And I am sure if they had received short-term anger management therapy, they would have shown even more improvement.

But there are 16 million people out there with the same problem. Maybe we need to ask bigger questions than which pill or technique to employ.

Here’s the problem. Like so many, Joe was living a life that was terribly stressful. He worked too hard at a job he didn’t enjoy, slept too little, and deprived himself of joy. And we are learning that continued exposure to the stress hormone cortisol can actually cause depression. So here was Joe, living a life that was unhealthy, and because of his genetics, his unhappiness turned to rage.

Charlotte felt different from the other kids. She felt as though there was something wrong with her. But at school, she pretended she was OK for fear the other kids would make fun of her. This also caused sustained stress, which worsened her depression and made her feel more different. Nobody noticed that Charlotte was suffering; they just noticed her rage.

Do 16 million people have a disorder? I don’t think so. But 16 million people may have symptoms that demand attention. When we become enraged more frequently than we would like, it could be our genetics, an undiagnosed depression, or both. But it could also be that we are living lives of not-so-quiet desperation. Please don’t ignore your symptoms, but don’t simply try to fix them, either. They might be an invitation to take a look at our lives.

The more we treat people’s serotonin and ignore their humanity, the more they will suffer. We all will.

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