Anger – What Is It REALLY a Symptom Of?

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A few days ago, I met with my prescribing psychiatrist. She was trying to convince me of the potential benefits of switching from my current, extremely mediocre antidepressant to a different drug. Among the symptoms it might reduce, she said, was my “irritability.”

“I don’t feel irritable,” I said, surprised. I’d been a bit rude with her, admittedly, when she asked me about my family earlier in the session. But I hadn’t been feeling any more irritated with her, or with the world in general, than usual.

“You’ve been pissed off and irritable every time you’ve come in here,” she said.

Well of course, I thought, you’re a psychiatrist. Being hospitalized against your will three times tends to produce that kind of outlook. The first time it happened, I was a teenager and scared to death. They had me on suicide watch, and I kept arguing with the nurse about it, saying I couldn’t sleep with someone coming into my room every 15 minutes. What if they did things to me — sexual things — while I was asleep? That was my fear. My upstairs neighbor had been accused of sexual assault by a teenage girl who was a patient at the mental health facility he worked at — the charges were dropped. I knew about it because my parents had told me to still be friendly toward him; they believed his story over hers. The nurse said I was yelling and would have to be given something to “calm down.” When I spit out the pill the nurse made me take, she called in four other people who came in with a needle, grabbed me, held me down on a table, pulled my pants down, and injected the needle into me. It felt like sexual assault. Not the kind that could be prosecuted, though. The other two times I was hospitalized, no one injected me with anything because I took whatever I was told to take, acted calm, and pretended to be as sane as humanly possible so they’d let me out.

I don’t lie quite as much to my current psychiatrist as I did to the psychiatrists in those inpatient wards. I do want her to help me, after all. To use her expertise to find me a drug that will at least allow me to function a bit better. But I don’t tell her everything. The trust level is not there, and will probably never be there, unless the laws on psychiatric hospitalization are changed.

“I’ve been pissed off and irritable practically since the day I was born,” I told her. “I’m just trying to get rid of the depression.” She continued to insist that my anger was part of the depression, even after I told her that my depression had started at age 15, while my anger problems had been present throughout my childhood.

(Saying it that way — “My depression started at age 15” — was in itself a misleading oversimplification. It made it sound like my brain just broke when I reached that age, and I started feeling sad all the time for no reason. That is not even remotely what happened, but I wasn’t interested in telling her my life story. I’d told it too many times before to various therapists and psychiatrists, none of whom seemed to find it at all relatable, and by this time I was sick of the whole enterprise. This one in particular was not the worst by any means, and was in fact considerably more caring than my last psychiatrist, but I knew from our previous conversations that, like most prescribers, she fell pretty firmly into the “your broken brain can be fixed by drugs” camp. I guess that if all you have is a prescription pad, everything starts to look like a disorder.)

I told her that I didn’t like mental health professionals very much. I was trying to make the point that she shouldn’t judge my “symptoms” by what was really more of a reaction to her than anything else. I don’t think she got it.

“You don’t have to like me for me to help you,” she said. Well, OK. But was getting rid of my anger, especially my anger toward mental health professionals, something that would help me? Or just her?

To some extent, she was right about my “pissed off” attitude being a problem. My quick temper had caused some major problems in my life, including getting me kicked out of college. But it wasn’t a symptom of depression; it was a symptom of trauma. Having recurring nightmares that your dad’s trying to rape you, to which your dad, when confronted about it, replies, “You want to think I molested you, so you can play the martyr,” tends to produce a state of overall pissed-off-ness.

I want to learn how to control my anger. But to get rid of it would be to get rid of a part of myself. It would also feel like swallowing down injustice. Such a drug probably doesn’t exist, but what if there were an antidepressant that could make me stop disliking mental health professionals? The idea felt scary to me, like some kind of mind control pill.

If I’d spoken the above paragraph to my psychiatrist, would she have written down “paranoid ideation”?

I replayed our conversation in my head the next day, trying to think of ways to make her understand:

“Imagine you were kidnapped and assaulted, and never even came close to getting justice for what was done to you. And then you saw someone, a member of the same profession as the people who hurt you and got away with it, and this person told you your anger over it was a psychiatric symptom, fixable with drugs. How would you react?”

It’s probably just as well I never told her that. It could’ve taken the conversation in a direction that would’ve led to me getting locked up a fourth time. Like I said, I never even came close to getting justice.

My point in writing all this is not just to share my story, but to make any mental health professionals reading this take a look at their own practice. Whether you’re a psychiatrist, a social worker, or anyone else working in this field, you probably have at least one client who “displays irritability.” The easy thing to do when someone like that is snapping at you, is to dismiss it as “just their symptoms.” It preserves your own sense of calm detachment and prevents you from losing your temper back. But it’s also a form of disrespect toward the people you’re supposed to be trying to help. It denies the legitimacy of their emotions, as if there could never be any reason for them to feel upset about anything. It papers over the very real reasons behind people’s rage, such as sexual trauma, abandonment trauma, poverty, sexism, racism, classism…and it creates a new form of anger in your client: anger at not being taken seriously.

Imagine that the person in front of you were not “mentally ill” in any way. If you thought about them that way, you’d be curious about how they got hurt, and about what could cause them to react the way they’re reacting. You’d try to understand the “why” before rushing to the “fix-it.” And once you understood the “why,” you’d see their behaviors as relatable — not “patient displays symptoms of X disorder,” but “there but for the grace of God go I.” And the person in front of you, having been heard and recognized as a human being, will be more able to recognize your own humanity.

It has become a meaningless cliché for therapists to announce that they’re “client-centered.” But at the core of client-centered therapy is an idea no one in the “helping professions” should ever lose sight of: what your client wants comes first. If they’re not sure what they want, you can try to help them figure it out, but you should never be imposing your own preconceptions, because who knows if they’ll fit? Maybe the angry person in front of you wants to learn how to turn their anger into useful action, but not to get rid of it — and that’s OK. Maybe the “schizophrenic” in front of you wants to get rid of the negative voices in their head, but not the positive ones — and that’s OK. Maybe the person in front of you feels like not cooperating with the mental health system, even to the point of self-destructiveness, is the only way they have of asserting control over their life — and that’s an attitude that may have some very solid reasoning behind it. Your job is not to change the person you’re working with into someone more accommodating to your needs. Your job is to help them get to where they want to be.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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27 COMMENTS

  1. As a psychotherapist, I completely agree and always use a trauma-informed and attachment-informed approach to people I work with. I have a framed saying facing me in my office: Those who need the most love often act in very unlovable ways. In fact, I have developed Self-Acceptance Psychology a paradigm for understanding human behavior that is based on the idea that complex trauma and attachment trauma, along with our natural human need for love and acceptance, often lead to poor shame tolerance. “Anger is shame’s bodyguard” is another saying that I use to reframe irritability with others — often because one is irritable at the self and self-rejecting. Lashing out at others in self-protection may feel safe and helpful, but does harm relationships. More on shame intolerance and the solution — self-acceptance — at http://www.HarperWest.co

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  2. What you say seems so clear and obvious to me. It’s baffling that so many “mental health professionals” don’t see it this way. If someone’s angry, you can bet they’re angry at something or someone. Why not find out who or what is involved instead of snuffing out the anger to make yourself feel more comfortable?

    Thanks for sharing this – I am sure many readers will relate.

    — Steve

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    • Agreed. A well-trained psychotherapist addresses the emotions in the room in the moment, rather than dismissing or avoiding or confronting them with judgment. I am EFT trained (Emotionally Focused Therapy) and privilege emotions as a predictor and driver of behavior. And there are usually primary emotions (shame is the most powerful one) and attachment fears/needs (rejection/belonging) that must be accessed and understood by the client to address anger.

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    • I had outbursts for years, until I realized I had to give up caffeine completely. None of the various professionals I intermittently saw over the years were aware of this, and some of my worst times were when I avoided caffeine when I was feeling strange, but not otherwise. Now, if I’m asked about something related to someone else’s outbursts, I inquire about background information from their lives, to make sure something like this isn’t happening to them without their knowledge.

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  3. Many “therapists” are more coercion-centered than anything else. Particularly the one’s who work for community centers.

    One of the reasons I fired mine before leaving the psych system altogether is we were getting nowhere. M. believed since I was supposedly SMI it was useless to encourage me to do anything but take my pills and not kill myself.

    I got tired of hearing her preach about how magical the “meds” were; I had read too much and knew it was crap even if M. herself believed it. (I WAS still compliant, but I’d been questioning why no one ever got better.)

    Then she would cheerfully give me 202 reasons why I would never succeed. Also told me I should only date “bipolars” since no one else can understand us. We’re all alike you know! 😛

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  5. I was severely mistreated by a staff member because of my diagnosis of Borderline Personality Disorder. I nearly died and she ended up being convicted of abuse of a vulnerable adult.
    After that I was understandably angry and was frequently criticized for my unreasonable hostility and paranoia by professionals who didn’t know my background.
    This happened more than 20 years ago. I have a master’s degree and work in behavioral health. I was rediagnosed long ago. I never had BPD. I I mention to other professionals that people can be abused because of being diagnosed BPD, they say it never happens. They don’t know about my story. I can’t afford for them to know, even though I wish I could openly tell my story and advocate for them. My therapist knows my story and we are working to resolve the PTSD that was a result of what happened.
    If you work in mental health, don’t ever assume you know people’s real stories. They may be hiding something from you for a good reason.

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    • Once, I had a Master’s-level “clinician”, working with the local CMHC, (Community Mental Health Center) “diagnose” me with so-called “NPD”, – Narcissistic Personality Disorder.
      I also worked long-term with 3 PhD-level Licensed Clinical Psychologists, not connected with that CMHC, who all agreed that I do NOT have “NPD”. Guess who the local “mental health court” listened to? The lone Master’s level clinician, because of the exclusive contract the CMHC and Court had….
      Psychiatry is a pseudoscience, a drug racket, and a means of social control. It’s 21swt Century Phrenology, with potent neuro-toxins. And the DSM-5 is nothing more than a catalog of billing codes.

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  6. I couldn’t agree with this article more. I have known certain religious people, well-meaning, I must say, to make claim that anger is bad, that’s right, MORALLY bad. And then there are others that take “Turn the other cheek” to mean you are never to express nor even feel anger.

    I agree that anger is amazingly useful. My anger at the MH profession saved my life. My anger got me away from them. My anger helped me realize just how wrong they all were. My anger showed me the diagnoses were fraudulent. My anger fuels my writing and fuels these words I am writing now.

    Just as Sarah says here, I, too, was called paranoid just for expressing anger. That’s so insane, insanity on the part of people who have the audacity to call themselves “professional.” I was called violent, too. I have some choice words for that I cannot even say here.

    Julie

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  7. “Imagine you were kidnapped and assaulted, and never even came close to getting justice for what was done to you. And then you saw someone, a member of the same profession as the people who hurt you and got away with it, and this person told you your anger over it was a psychiatric symptom, fixable with drugs. How would you react?”

    Yup…exactly what happened to me, and yes, if you express anything but gratitude for being kidnapped and drugged, and losing everything you have worked a lifetime to build, then, yes, according to them, you are ANGRY and in need of further imprisonment and drugging.

    Psychiatrists are absolutely unreal, but like others here, I too have used my anger to escape my torturers rather than working on “gratitude lists” for the “help” I have received (whether I wanted it or not) from them. I had never been totally comfortable with anger, but now it is my companion. It lets me know when I have been violated or treated badly. It warns me that I am being taken advantage of or my experience is being discounted. My absolute rage reminds me of the severity of psychiatry’s abusiveness and my own powerlessness to stop it or to gain any recognition of the damage it has done to my life. That anger, that rage, has a cause and it has a purpose.

    And that is not to harm others, it is to provide us with the wherewithal to free ourselves from our oppressors and reclaim our integrity.

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  8. One of the words I share with clients is “Indignation” — Anger due to injustice or inequity. I encourage them to use that idea, because “anger” can take on a meaning of impulsive, irrational acting out that is loaded with judgment. Indignation is self-protective and completely appropriate when mistreated or abused. I also like that the root word is from “dignity,” which means a lot to me Maybe I’m just a word geek!

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  11. “Imagine the person in front you is not mentally ill, you’d be curious about how they got hurt” and I would add “or what is going on in their life to make them angry”. Sarah, that sums it up so well.

    The beliefs we have shape our understanding (the evidence we entertain) and the questions we ask. Psychiatrists have been taught to organize ‘symptomatic’ behaviors in particulars ways and use the tool they have – the prescription pad you mention. This is their (professional) belief system limiting care – though I doubt they see it as limiting.

    We can change our expectation of what we get from them – I think you’d get a better outcome for the scenario you paint from chatting to a psychologist, most of whom are trained to help us work through our feelings, often without the need for a diagnostic label. Ordinarily that’s a choice we can make.

    The problem lies in how the system has given psychiatry (the profession, not the individuals) all the power… in defining what mental illness is, in defining who “suffers from” a particular group of behaviors that are “out of range”, in shaping the care plan… and the insurance money mostly flows from that. This power is at it’s worst when psychiatrists are able to force care on people… based on this skewed professional (therefore supported) “understanding”.

    Anger is usually a response to EXTERNAL stimuli/situations in which the person feels helpless or unable to act to achieve a desirable outcome. Our drive system has an outcome in sight, but is frustrated in achieving it. Anger happens when the situation ‘makes no sense’, is ‘outside my control/influence’, is bigger than me… or when something happens against my preferences/will, when I have a right for my preference to be considered, especially if this happens repeatedly. It is a product of something getting in the way of our ability to act and gets worse when we are unable to vent our frustration/anger at the source/cause of it…

    I hear voices – one of which is just an irritating pain in the a&&, an irritation that escalates to anger over a period of about a week or so, by which time I just want to yell and swear at her. So I do. I go outside, find somewhere that I can yell without disturbing others… and pace and yell for a minute… come back inside and get on with my day as if nothing had happened. In time. it has almost become amusing – I laugh at myself having to do this, but it works.

    Anger produces chemicals that require activity (fight or flight) to disperse them. Find a safe space to yell. Recognize that you are doing it only to vent for a minute… the source doesn’t go away (it usually doesn’t, that’s the point), but at least I can acknowledge my emotion and disperse the chemistry that goes with it.

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  12. I have been deposing some so-called mental healthcare practitioners in my lawsuit against them for false imprisonment (among other things). They have seemed oblivious to the fact that State law does not empower them to detain a nonviolent individual simply for being irritable and angry about his or her circumstances. Who trains these people??!! Irritability in and of itself is not a sign of mental illness.

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    • Lauren, don’t you know “mental illnesses” are subjective and arbitrary? If they can find 6 or 7 behaviors they don’t like and fit them into a “diagnosis” from the DSM 5–out of say 9–the label is real and valid enough for all practical (legal) purposes.

      I wonder how many articles you read here. The only “symptom” I have for “bipolar 2” is that I was diagnosed with it long ago. Yet, because they have predetermined that recovery is impossible, they’re trying to ruin my life. And my psychotic mania was created by a reaction to Anafranil.

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  14. Both psychiatry in particular, and the “mental health” system in general, ask and answer the question, “What’s wrong with you?”, by slapping some stigma, and a DSM-5 label on you. And then usually drugging you with potent prescription neuro-toxins. That’s how the scam works.
    What they need to ask, but don’t, is: “What happened to you?”…..
    I’ll be MORE surprised, Sarah, if you continue to return to your slave-masters and oppressors, who are really only GAS LIGHTING you. Can’t you see that?
    Psychiatry is a pseudoscience, a drug racket, and a means of social control. It’s 21st Century Phrenology, with potent neuro-toxins. The DSM-5 is nothing more than a catalog of billing codes. So-called “”mental illnesses” are exactly as “real” as presents from Santa Claus, but NOT more “real”.
    Your experiences, and your pain, &etc., ARE REAL, however…. But that doesn’t mean the DSM-5 can, or should, “label” them as so-called “mental illnesses”. Unless YOU consent….
    Best Wishes!

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