ANGER, IT’S NOT ALL THE RAGE

Maddie Blomgren, LPC, CADMS, CGP
Anger and Relationship Institute

Anger is not an issue; in fact it may not even exist according to the American Psychiatric and the National Social Work Associations. Surprisingly, anger management is neither an elective nor a required course in any Masters or Doctoral level training program in any field of psychotherapy. According to George Anderson, LCSW, Fellow, American Orthopsychiatry Psychiatric Association, "The American Psychiatric Association … maintains that anger is not a mental or nervous disorder… Since anger is not a medical condition, the APA claims that it has no position on anger or anger management. The National Association of Social Workers has not taken a position on anger or anger management either. In fact, there is a pervasive denial that anger exists as a problem. There is no research studies found on anger in any Social Work Publications. Perhaps by ignoring the issue, it may disappear."

While the Mental Health community may be ‘anger avoidant’, our American culture most assuredly is not.

· The United States has the highest homicide rate of any industrialized Western country and anger is the second leading cause of death for fifteen to twenty-four year olds.

· Every nine seconds a woman is beaten by the man she loves and four of these women die per day. Of all females murdered in the USA, 40% of them die at the hands of their husbands or intimate acquaintances. Anger has been found to be the distinguishing characteristic in domestic violence.

· Nationally it’s become the "wild, wild west" out there on our highways. Motorists involved in fender-bender collisions and silly disputes are increasingly being shot, stabbed, beaten and run over for minor or inane reasons. This makes road rage a dangerous and often fatal problem.

· Medically, coronary heart disease is the number one cause of death in the US. According to the American Heart Association, coronary heart disease, arthritis, high blood pressure, and other conditions are related to anger. Dr. S. T. Sinatra, author of Heartbreak & Heart Disease says, "A surgeon operating on a diseased heart can't tell if the patient ate a high-fat, high-cholesterol diet or if he had simmering anger. The blockage in the vessels looks just the same."

· A study found 66% of traumatized clients who were interviewed stated their therapists had become inappropriately angry and blaming towards them during therapy. Another 19% of clients interviewed stated that their therapist did not respond at all to disagreements or angry outbursts. That left only 15% of therapists who took steps to explore the reason for the client’s anger and their own role in engendering it. (Study detailed in Psychotherapy: Theory, Research, Practice, Training Winter 2004 edition.)

How then, is it possible for anger and anger disorders to be so dismissed by the governing bodies of psychotherapy? One reason is there are no medications for anger so the pharmaceutical companies do not finance research in the field. Anxiety and depression, mood disorders for which there are medications, have received the bulk of scientific attention for the last several years. No one would question the significant advancements in the assessment and treatment of anxiety and depression due to this attention, but overlooking anger has been a serious side effect.

The lack of empirical studies on prevalence of anger in both the general population and in the population undergoing mental health treatment means that no form of anger disorder has been listed in the Diagnostic and Statistical Manual (DSM-IV). Since anger is not listed in the Diagnostic and Statistical Manual, it cannot be diagnosed (and therefore is not considered to exist as a problem). If anger can’t be diagnosed, it follows that it cannot be treated. These two ‘facts’ mean that managed care often does not reimburse for anger treatment. Further, practitioners are cautioned not to treat anger and bill managed care for the depression, anxiety disorder, trauma etc. that may accompany the disorder. Until anger disorders are included in the DSM, individuals are solely responsible for paying for their treatment.

It is also surprising that there are no state or local standards, laws or ethics for the practice of anger management. Because of this, there are many non-certified and under-trained individuals teaching anger management and treating anger. With no governmental or institutional influence guiding the practice of anger therapy, anger is fast becoming the ‘loose cannon’ of psychotherapy.

Anger and the need to mange it is not going away. It is a problem worldwide and deserves the attention of Psychiatry, Psychology, Mental Health Counseling, and Clinical Social Work fields. The inclusion of anger management needs to be urged as an area of specialization in all four disciplines. Anger needs to be recognized and included in the next Diagnostic and Statistical Manual. And, it is vital to the mental health of therapy clients for graduate students in any field of therapy to receive some basic anger management training.




George Anderson, MSW, BCD, CAMF
Diplomate, American Association of Anger Management Providers
http://www.andersonservices.com/
http://www.angertrends.blogspot.com/
www.anger-management-resources.org