I post comments on an email grouping of some 350 psychiatrists around the world. What I plan to do now, is trim these, and post them up here, on Substack. They are addressed to an audience of doctors, but are couched in terms everyone should be able to follow. This one turns on anger, and how it can poison things.

At the end of the last one, I posted my endnote, which I’d added at the close of my latest book, which has just received its publication date – 4 July 2023.

Endnote

When you're a toddler, being angry at your parent is murder – but if this befogging emotion doesn’t vanish when you're an adult (which it needs to), it will underpin all strifes, all crimes, all wars, and far too many mental diseases. Buried anger is toxic, as my next book (now completed) explains.

I start by thanking those on the list who responded.

Thanks all, for picking up this hot potato – emotions are so slippery and subtle, they can bite you quite savagely, if you try and pick them up in them the wrong way. Of all the medical challenges, this is perhaps the most hazardous.

I like nothing better than a seminar on the philosophy of emotion – so here goes. You see, what goads me is that I claim to have found a silver thread running through, which avoids so many of the pitfalls, the verbal tank traps, and allows a calming, healing clarity to prevail. Of course, many can conclude that this is cutting through the jugular, instead of letting in fresh air and light, to mix a few metaphors.

FIRST OFF, CONSIDER PAIN. All the verbal mantraps which afflict anger, sink pain. Now pain is much less controversial than emotions. No one doubts that pain exists, or that it is important. Indeed one definition of what the medical (and nursing) profession is for, is to reduce it, wherever it can. Many religions struggle, and then lose the battle to cope with it, especially in the orient.

So pain exists. No one pooh-poohs it, or minimises its vital significance. All I’ve done, is apply the same verbal tools that work for pain, to anger, and indeed for those still awake, to delight.

The silver thread which links all these troublesome entities together, is as follows.

(1) There will never be an objective, scientific, universal definition, let alone a precise repeatable measurement, of pain. It’s what you feel yourself. It doesn’t occur if you're not conscious. It requires an awake mind. And indeed it varies from moment to moment, and can easily disappear entirely from time to time, if that mind is distracted by something else. More, one theory as to how morphine works is by diverting the attention. The same applies to anger.

(2) Pain serves a vital purpose. If you pretend it doesn’t exist, or think it is too awful to be taken seriously, then you miss out. Cancer is notoriously pain-free, such that it often only makes its presence felt too late for effective remedy. A broken leg gives enough pain to stop you walking on it longer, thereby stopping you making it worse.

These two factors make a mayhem of philosophy. Here’s something intrinsically personal and subjective, strictly available only by introspection – yet we need to talk about it, to share it verbally with others. Tricky. How can you be sure that the pain described is not fictitious? How can something inherently ‘painful’ ever be of any use, of value?

The only “proof” that pain exists is that someone else tells you it does. There’s no ‘pain-meter’, nor ever will be – you’ve only got someone else’s word for it. You can empathise, you can sympathise, but the pain belongs exclusively to the sufferer from it. You cannot get inside another’s consciousness – though it is often tempting to try.

This doesn’t stop the need to cope better with it. Pain is unpleasant, and severe pain can be agony – do something, for Heaven’s sake. Which is where the ‘bedside manner’, or the ‘therapeutic relationship’ win. If you haven’t established a trustworthy, realistic channel of communication between you and the patient, then you're dealing in fictions, in half-truths.

NEXT, all pains are eased by a sympathetic understanding ear. Talk to me. That’s the start. Then help me work out where this pain is coming from, so we can review remedies, even cures. Yes, cures for some pains do exist – but realism, or accuracy of diagnosis is crucial.

It’s the same with anger. It’s invaluable in some circumstances, gives accurate warning of worse to come. But it’s impossible to measure, define or objectify. It needs careful, trustworthy assessment, and even then it can mock or even destroy you. It’s precisely this unmeasurability which makes Dr Bessel van der Kolk’s brainscans so exceptional, so unique. Something as amorphous as emotion – in this case Terror – can be shown, objectively, scientifically, to impact where we can all see -- on frontal lobes and speech centres – giving us that universal psychiatric lesion – Speechless-Terror. No need for introspection here, remarkably.

So anger, like pain, has a purpose. It gives a warning of damage about to come, or already happening. This is healthy anger, as useful and valid as healthy pain. BUT, and here’s the rub, pain from say arthritis has lost its warning benefit – we all know that the joint surfaces are shot, we don’t need reminding of this every time we move. And so it is with anger – once the initial provocation is over, then anger ceases to help – it hinders, and Boy, can it hinder really bad.

And here is where the full impact of the first four words of my endnote impact. As ‘Dr M’ notes, being angry as an infant, is murder.

All I’ve done is follow this up in real life. Every one of the 50 murderers I worked with in Parkhurst Prison, UK, suffered from bottled up (infant) anger. By talking this out, where I could elicit enough consent, it evaporated, it vanished, taking all violence, all psychiatric morbidity with it, leaving golden opportunities for delight. The endnote asserts that out-of-date anger needs identifying as such. Only then can its poison be pulled, and the person become anger-free, in the same way a healed leg, is pain-free. OK, as a result of this seminar, I’ve added ‘buried’ anger – psychosomatics wouldn't be the same without it

Clarity cures.

I don’t expect everyone to roll over and wave their legs in the air. But I hope I’ve described enough to show why I hoot with delight. And, yes, the book I mentioned is really going to be published, not by me, not by a vanity publisher – but by Waterside Press, UK, – now due out on 4 July 2023, following close on the heels of my wife, Sue’s, graphic account of what looking at angry people feels like.

Rock on

Bob

refs
Dr Bessel van der Kolk on YouTube – see minute 19 – 20.
“The Prison Psychiatrist’s Wife” by Sue Johnson. https://www.watersidepress.co.uk/books/the-prison-psychiatrists-wife/

Dr Bob Johnson’s simple science of sanity

Buried anger is toxic