Thursday, December 22, 2016

How to Recognize When Anger Is Killing the Angry Person

(Cut from the Link Log due to length.)

I spent way too much time commenting on this one. (What happened to focus on the rest of the e-mail?)

Reason: I see it as a clear case of a medical problem that's becoming more serious for more of my generation every year, from which people are being distracted by the woman's "ugly rant" happening to involve hot-button words. The article explains what happens: A young woman brushes past other shoppers waiting in line to rejoin a friend, closer to the front of the line, with one more purchase. The young woman is fat. So is an old woman waiting in line behind the younger ones. Possibly their mutual obesity forces them to make actual physical contact as the young woman brushes past. So the old woman starts yelling that the young one is cutting in line. The young woman softly says "I say 'sorry'" with a foreign accent, and the old woman really loses it and accuses the young women of being illegal aliens and welfare cheats. (I was always told that there's a precise legal term for that kind of ungrounded factual accusation of a crime--slander--and it can incur substantial financial penalties if prosecuted.) So there's a lot of hysteria about how all people who oppose illegal immigration blah blah...

I don't see that as even being the problem...because I've known people like the old fat angry woman. More of them are male than female; if female they're past middle age, and are described as "unattractive" or just plain "mannish." Once in a while the triggers of these outbursts are things about which these people really do feel angry, sometimes understandably angry. More often they're things whose insignificance embarrasses these people after their anger attacks subside. These people get into a towering red-faced rage, literally "every so often," at predictable intervals, whether they have any real provocation or not.

I am not saying this in order to encourage a social tendency to shush women who complain about things that need to be complained about. Saying "Go to the back of the line!" is reasonable, even if a woman says it, and even if she (shudder, quake) says it in an authoritative "angry tone" without any fake smile or self-sabotaging apologies. And if the person were in fact violating the rule for waiting in line, and replied to the woman in an offensive, confrontational way, then for the woman to escalate more anger would be...more typical of men than of women, but not unreasonable or unjustified. In that situation I'd say the woman deserved support from other people for her complaint.

But that's not what Dave Urbanski is reporting, at all. The younger women are not violating a social rule, nor are they hostile or confrontational. They just want to smooth over the incident and go home. The older woman just wants to spew anger all over the whole store.

Some of my close relatives had tendencies in this direction, early in middle age, and succeeded in getting them under control after doctors taught them about cardiovascular disease. Anger attacks are part of cardiovascular disease for the vast majority of people who have them. Some people get angrier and uglier (and usually fatter) every year until they collapse from a stroke, a heart attack, or sugar shock; sometimes these collapses are crippling or even fatal.

That fifth grade math teacher I've called "Old Miss Mean" was a classic case. My class remembered her as having the meanest mouth on Earth. My brother's class, just a few years later, remembered her as losing control to the extent that she grabbed kids' hair or shirts (sometimes forgetting that the kid in question was taller and stronger than she was). She avoided diagnosis or treatment until she collapsed...her death was reported almost ten years before it happened, because she really had come close.

People for whom I've worked, people for whom friends worked...could be scary. Once you learn to recognize the pattern, seeing an old, fat, sick person challenge a strong, fit person to a fight stops being funny and starts being seriously scary.

If you see this happening to someone you don't know well, here are some indicators that it's not an ongoing social or emotional problem the person has, but a physical disease:

1. Anger is totally out of proportion to the provocation. A wrong-number call, even to a phone line for which the number includes multiple repeating digits so sticky keys on phones always generate wrong-number calls, "causes" someone to yell, swear, pound on the desk, or throw the phone across the room. A customer with an attractive, exotic accent starts screaming and fist-waving and threatening to sue for discrimination the first time a store employee says "What did you say?" A customer complaining about a silly company policy requiring a bus to spend a certain amount of time in a certain station, when the bus is late and likely to miss a connection, triggers a bus driver not just to snap "I know the policy's stupid but I can't change it!" but to scream, "Get out of this station! I don't have to haul your *** and I'm not going to! Get away from my bus!" Also, no matter how inoffensive the other person was or how much the other person apologizes, the anger escalates--the angry person may actually feel justified in dumping more and more anger on someone who apologizes, backs off, and acts deferential. (This is the pattern often observed in abusive family relationships where others try to be loving and submissive, and the abusive person merely becomes more irrational.)

2. Most, though not all, cardiovascular patients are obese.

3. Many, but not all, cardiovascular patients' faces flush red (yes, even if they have dark skin, you can see it under bright light). Blood vessels may visibly expand and protrude through the skin, distorting the shape of the face. You might see one or more large blood vessels throbbing at a fast pace, or even vibrating as the heart fibrillates. If the person's normal complexion is ruddy, it may darken to an alarming beet color.

4. If you can see the patient's ankles, and they don't taper between the calf muscles and the heel, you're looking at a cardiovascular patient.

5. Some cardiovascular patients' necks may seem to swell, bulge, or strain above the line of the collar during a hypertensive episode.

6. Not all cardiovascular patients have anger attacks. The overwhelming majority of those who do are male. Females almost never develop anger attacks as a symptom of cardiovascular disease before age 55. However, when women do develop this symptom, they are in as much danger as men--maybe more, if their doctors don't tell them about cardiovascular disease.

7. Many people who have anger attacks as a symptom don't become violent, or at least don't lose control enough to hit or threaten other people. However, Newton Hightower learned a great deal about anger attacks as a symptom by studying male domestic violence offenders. Some women who have anger attacks abuse children. While some patients form abusive relationships with weaker people, many people who have anger attacks show "insane rage" in which they threaten or even attack people who are much bigger or stronger than themselves. In my home town's yucky supermarket, a cruel person could have some sadistic fun provoking those two big fat employees who look like a caricature of a lesbian couple...I have seen one of them raise her hand to threaten a man who was bigger than she was, not that many people, male or female, are bigger than she. Many nurses have had the experience of being hit or kicked by a patient who collapsed in the midst of his or her violent outburst.

If you know the person slightly, as a customer, co-worker, or employee, here's a 99% certain indicator that it's classic cardiovascular disease:

8. Anger attacks occur at regular intervals. You can chart this on a calendar. Although some men (like my husband) start to notice the pattern while their anger attacks coincide with some phase of their wives' hormone cycles, anger attacks can begin on a longer cycle (every six or seven weeks instead of every month), and the cycle may shorten over time.

Female sex hormones make it almost impossible for young women to have cardiovascular disease (which means the grumpy moods and irregularity some PMS patients get are a different, usually less life-threatening problem). Older women who have less of these hormones can have the same symptoms men have.

Many people who have cardiovascular disease can get their blood pressure and "bad temper" under control in just a few months. Many don't even need medication. However, indulging in "anger attacks" is one of the habits that literally cripple and kill cardiovascular patients.

Why I feel a need to post at length about this situation is that once in a while, I don't know how rarely, it's not classic cardiovascular disease. Classic cardiovascular disease is very common; a majority of North Americans develop it to some degree, if we don't conscientiously prevent it. Multiple myeloma is very rare. But if someone has anger attacks on a cycle that's as regular as clockwork, but otherwise seems to have any cardiovascular condition they ever developed fully under control, the way my husband did...the population of multiple myeloma patients is so tiny that it's hard for observations to be more than anecdotal, but "stubborn" blood pressure highs and lows, with anger attacks, can be an early indicator of multiple myeloma.

Even in Washington's diplomatic community my husband was more than ordinarily "diplomatic," tactful, patient, gentle, and reasonable...most of the time. During the first few episodes when he, among other things, was the person with the slight foreign accent screaming about discrimination and being a U.S. citizen by *** and speaking English better than you *** , and so on, at the employee who hadn't understood him the first time, I wondered whether it was some sort of Freudian need to release suppressed angry energy...Short answer: it was not. It was his blood pressure. I wasn't the target of his rage attacks for several years, but then I was the target of some of them; by then I'd learned not to be intimidated, to know that the rages ended with a blood pressure drop during which he felt faint and sick and that he'd always be ready to make peace and act like himself before bedtime. He tried working the Anger Busters program, which is always rewarding for the wife at least, and usually also helps the husband. I was willing to forgive him and work the program with him. I had no idea, nor had he, that when Anger Busting didn't work when he sincerely tried it, that meant that he was in more immediate danger than a person with classic cardiovascular disease. (Like many people with multiple myeloma, he heard the disease named three months before it killed him.)

One reason why multiple myeloma is so deadly is that it's almost impossible to spot before the last year of the patient's life. Awareness that anger attacks are a symptom, first of all, and awareness that when they don't respond to ordinary "Anger Busting" treatment they may indicate multiple myeloma, just might be the key to overcoming this rare but deadly disease...if there ever is one.