What You Can Change . . . And What You Can't*: The Complete Guide to Successful Self-Improvement (21 page)

Not so fast. In spite of anger being so deeply enshrined in our culture, many of its virtues are myths based on Freudian ideology or on distortions of evidence.

Anger: the unhealthy emotion
. Is it true that anger unexpressed leads to more cancer, more heart disease, and more depression?

Cancer
. The evidence that suppression of anger leads to cancer is very weak. The Type C personality, allegedly a predisposer to cancer, is made up of several characteristics confounded with one another. The Type C woman, for instance, fails to express her anger. But she is also more helpless and hopeless, has more anxiety and more depression, is more fatalistic, and has little fighting spirit. Which of these is the active ingredient? Lack of anger expression is one possibility, but hopelessness, helplessness, and depression are more likely to be the real culprits. Each of these last three has been linked to tumor growth, but anger suppression has not. Indeed, the inventors of Type C theory also found that “exploders,” people who have frequent outbursts of temper, also have more cancer than normal people.
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Examining the cancer evidence, I cannot determine if anger expression is worse, or better, or of no account in cancer.

Heart disease
. The Type A personality—heart-attack prone—is also made up of three confounded traits: hostility, time urgency, and competitiveness. Type A researchers, unlike Type C researchers, have tried to separate the components. Hostility, the overt expression of anger, is probably the real culprit. Time urgency, competitiveness, and the suppression of anger do not seem to play a role in Type As getting more heart disease. In one study, 255 medical-school students took a personality test that measured overt hostility. The angriest of them went on—twenty-five years later—to have roughly five times as much heart disease as the least angry ones. In another study, men who had the highest risk of heart attacks were the ones with especially explosive voices, more irritation when forced to wait, and more outwardly directed anger. In an exploration of the mechanism by which anger expression might damage the heart, the eighteen men in this study angrily recounted incidents that annoyed them. The pumping efficiency of their heart dropped by 5 percent on average, suggesting a drop in blood flow to the heart itself. Pumping efficiency was not changed by other stressors.
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Studies find that blood pressure stays high when anger is bottled up only among male students bottling up their anger at other male students, that is, only males of the same status. When a student bottles up his anger against a professor, blood pressure goes down, and it goes up if he decides to express his anger. And anger expression does not lower blood pressure for women; expressing hostility
raises
female blood pressure. In contrast, friendliness in reaction to trespass lowers it.
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I have a very simple theory of how emotion affects heart disease. It may well be wrong, but it is compatible with most of the facts. Your heart is a pump, and like any mechanical pump, there is a limit, or
rating
, on how many times it can beat before it wears out. So, for example, your heart might be rated at 100 million beats. Once your rating is exceeded, you are very likely to have a heart attack—if something else hasn’t killed you first. Ratings vary from person to person and from family to family, with the limit set by such factors as constitutional strength, exercise, and childhood diseases.

Some emotions, the ones that raise your heart rate and blood pressure, use up your allotted beats more quickly than others. Anger and fear are two such emotions: They mobilize the sympathetic nervous system in just this way. Relaxation and calm have the opposite effect. People who often get angry use up their allotted beats faster. Several times a day, they go into a rage; their heart races and their blood pressure soars. On a bad day, they may use up two days’ allotment. Fearful and paranoid people who see the world as a threatening place get triggered into massive sympathetic activity more often and so also use up their allotment faster. The habit of ventilating your anger—as opposed to suppressing it—uses up your allotment and so contributes to heart disease.
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The evidence is clear: Overt anger, contrary to popular belief, is bad for your heart.

Depression
. The view that depression is anger turned inward is false. Freud spun this theory out of whole cloth some eighty years ago. Unsupported as it was, his theory of depression, along with his theory of repressed sexuality, was among the main forces that legitimized our present ethic of promiscuous emotional expression.

By the 1950s, therapists were having a field day with this ethic. One of the main treatments for depression was to encourage patients to get angry. Therapists helped depressed people to shout about the times they had been victimized and to rage over how bad their lives were. When I first learned how to treat depression, in the early 1970s, this was one of the techniques I was taught. But something quite shocking occurred when we prodded depressed people into getting angry and remembering long-forgotten abuse.

Keep in mind that depressed people are often quiet, shy, and withdrawn. They are often reluctant to talk about their troubles. With our Freudian-oriented prodding, we got them to talk, and talk, and talk. They began to complain. They remembered how bad life was. They wallowed. Encouraged, they dredged up more and more tragic material. They wept. Not infrequently, they would unravel, and then we had a great deal of trouble getting them together again. What might have started as an ordinary case of mild depression sometimes escalated into a severe case—with a suicide attempt thrown in.

Put another way, there is simply no evidence that depression is anger turned inward. Getting the anger out of depressives, who are often well defended against many of the bad things that have happened to them, sometimes worsens depression. Contrary to the Freudian theory, when you measure anger during depression, hostility increases during the depression and continues after the depression is gone.
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So I conclude that venting your anger is not good for your health. It has no clear relation to cancer, it may increase—rather than decrease—your risk for coronary heart disease, and it can exacerbate depression.

Anger: honest? just? effective?
We deem it honest to tell the object of our anger just what we think. This is, after all, the truth, and we should tell the truth. But there is a difference between honesty and truth. Anger, specifically, and emotion, generally, color evidence. This may be one of emotion’s reasons for existing. By biasing the evidence, emotion readies us to act in certain ways that may be highly adaptive when we are in the right niche. Emotion places colored lenses on the spectacles through which we usually view the world. Anxiety makes the world look more frightening than it is; fear lowers our threshold for seeing danger, and makes us more apt to flee. When we are watching a horror movie on the VCR, a real cat leaping from behind a desk momentarily terrifies us.

Depression colors the world, too, and so gets us to give up, turn inward, and sit in our cave conserving our energy until happier times materialize. To a depressed person, the world often seems bleaker than it actually is (one of the most objectionable aspects of the latest best-selling suicide manual is that it fails to recognize that wanting to kill yourself may be based on a temporary distortion of the evidence, not on rational evaluation). Anger readies us to attack—innocent actions seen through its lens appear to be trespass. Our perceptual threshold for affront lowers. When a clumsy fifth-grader accidentally drops his lunch tray on a bully, the bully interprets the action as aggressive and intentional. This “hostile-attribution bias” characterizes the way aggressive boys think all the time, and the way normal people think when they are angry.
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So while it may be honest to be angry, it is not truthful. The judgments we make when we are angry are often far off the mark, coloring evidence in a hostile and threatening manner.

The same can be said for justice. Anger moves us toward justice—
as we see it
. Anger is not an emotion that helps us see things from our attacker’s point of view. Rather, it imposes a protective, self-interested lens of trespass on the world. Sometimes it is correct, and it punishes the trespasser most fittingly. Other times it wreaks revenge on innocent people or demands overly severe punishment for minor transgressions. When in the heat of anger you make the mistake of punishing a small child severely, you may create excessive damage. An accurate description of the moral tone of red-hot anger is “self-righteous” rather than “righteous.”

Finally, the effectiveness of anger is not all it is cracked up to be. Certainly, in a desperate, back-against-the-wall, physical fight on our own territory, anger gives us the strength of many. But we are almost never in that situation. A rival insults us. A co-worker slights our efforts. Our spouse flirts with another man. Our two-year-old disobeys us. A voyeur peeks at us. How effective is an outburst of temper in these situations?

Anger galvanizes some people into clever repartee and resourceful argument—they become masters of the “last word.” For most of the rest of us, anger is a very disorganizing emotion. We fume and we sputter. We forget our most important points. We are reduced to shouting epithets. We regret what we said when the argument is over. We wish we hadn’t gotten angry.

The Cons of Anger

If you are patient in one moment of anger, you will escape a hundred days of sorrow.

Chinese proverb

First and foremost, anger is the emotion that fuels violence. A society like ours, which urges the expression of anger, sanctions it, and makes movies about its virtues, is a violent society. It should be sobering to “ventilationists” that America has five times the rate of violent crime as Japan, an anti-ventilationist society. Murder, assault, and violent rape occur in unprecedented numbers in America. Child abuse and spouse battering are rampant. Strangely, though there are disorders of anxiety and depression, the nosologists have seen fit to designate no certified disorders of anger. The outmoded category “explosive-personality disorder” and the rare category “paranoid disorder (without schizophrenia)” are as close as the taxonomy of mental problems now comes. But out-of-hand anger ruins many lives. More, I believe, than schizophrenia, more than alcohol, more than AIDS. Maybe even more than depression.

A second impact of anger is subtler, but almost as shattering: Serious turmoil between parents is the most depressing ordinary event that children witness. We have followed the lives of some 400 children for the last five years, focusing on children whose parents fight (20 percent) and those whose parents divorce or separate (15 percent).
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We watched these 140 children carefully and contrasted them to the rest of the children. What we saw has important implications for our society at large and for how married couples should deal with anger.

The children of fighting families look the same—that is, just as bad—as the children of divorce: These children are more depressed than the children from intact families whose parents don’t fight. We had hoped the difference would diminish over time, but it didn’t. Three years later, these children were still more depressed than the rest of the children.

Once their parents start fighting, these children become unbridled pessimists. They see bad events as permanent and pervasive, and they see themselves as responsible. Years later this pessimism persists, even after they tell us their parents are no longer fighting. Their worldview has changed from the rosy optimism of childhood to the grim pessimism of a depressed adult. I believe that many children react to their parents’ fighting by developing a loss of security so shattering that it marks the beginning of a lifetime of dysphoria.

It is important to realize that these are averaged results. Some of the children do not become depressed, some of the children do not become pessimists, and some of the children recover over time. Divorce or fighting does not doom a child to years of unhappiness; it only makes it much more likely.

Many more bad life events occur to children whose parents divorce or fight. This continued disruption could be what keeps depression so high among such children. Among these bad events are

• Classmates act less friendly
  

• Parent hospitalized
  

• Child fails a course at school
  

• Parent loses job
  

• Child himself hospitalized
  

• A friend dies
  

This adds up to a nasty picture for the children of parental turmoil.

Parents’ fighting may hurt children in such a lasting way for one of two reasons.

The first possibility is that parents who are unhappy with each other fight and separate. The fighting and separation directly disturb the child, causing long-term depression and pessimism.

The second possibility is the traditional wisdom: Fighting and separation themselves have little direct effect on the child, but awareness of parents’ unhappiness is the culprit—so disturbing as to produce long-term depression.