The baby-faced kid is crushed against the chain-link octagon, swallowing punches from a fighter twice his size. His skin glows under the lights, until something gives way, and soon he's covered in blood. He's done--pinned, but too proud to tap out--yet the crowd jeers when the ref stops the fight. Even his father protests. Somehow, this Cleveland cage fight has become Caesar's coliseum.
Why so angry? That's the question I'm mulling ringside. And I'm not talking about the grapplers. As combatants in the unofficial minor leagues of the Ultimate Fighting Championship, one of the fastest-growing sports in America, their anger is subsidized. I'm talking about the fans. According to a 2006 Harvard study, 10 million adult men in the United States are so angry, they're sick. In fact, their disease has a name: intermittent explosive disorder, or IED.
The condition has been on the books since 1980, but the Harvard study claims it's far more common than anyone believed. Few people see psychiatrists because they can't control their tempers. And those who do, say the researchers, are often misdiagnosed with other mental problems. Previous estimates put the number of IED sufferers in America at less than 0.5 percent of the population. But if the Harvard researchers are correct, almost 1 in 10 adult men routinely display wildly disproportionate aggression, and are so angry that they're likely to damage property, or threaten or injure others. (The researchers estimate that only half as many women suffer from IED.)
“We never thought we'd find something this big,” says Ronald Kessler, Ph.D., the lead study author. “People think their anger isn't a big problem. But there are very serious ripple effects. IED sufferers are also more likely to be divorced, they have worse jobs than others with the same education, and they have fewer friends.”
Considered alone, the symptoms of the disorder are easy to dismiss: a commuter flipping off a fellow driver in a traffic jam, a basketball player charging the stands during an NBA game, the guy I saw a few rows back screaming at the hot-dog vendor because he had no mustard left. But there's more behind an IED diagnosis than a few isolated acts of rage. “If you're blowing up a couple of times a week, you probably have the disorder,” says Emil Coccaro, M.D., a leading anger researcher at the University of Chicago. “The average person shouldn't be having arguments and temper tantrums.”
A couple of times a week? That's my Monday-morning commute. Have the Harvard researchers defined IED too broadly? Many experts think so.
“Everyone has bad days,” says William Narrow, M.D., the associate director of the division of research at the American Psychiatric Association (APA). “It's difficult for me to believe that 9.3 percent of the male population in America would destroy property or physically assault another person because of their anger.”
As the debate over IED continues, our understanding of the health consequences of anger, in all its forms, grows. “Anger is like cigarette smoking,” says Howard Kassinove, Ph.D., an anger researcher at Hofstra University. “In the short run, you feel good. In the long run, you're more likely to die of heart disease or stroke. People think it's macho to be angry. It's more macho to be alive.”
Not all anger outbursts are created equal. Regularly grumbling about the long lines at the dry cleaner doesn't necessarily mean you suffer from IED. Along with how often a person blows his lid--and the intensity of his outbursts--the other hallmark of IED is how disproportionate the rage is to the insult. Think Michael Douglas taking a baseball bat through a Korean grocery over the price of a Coke, in the film Falling Down.
Michael Overstreet used to think his fuse was simply short. When the 46-year-old Minnesota engineer was 15, he chased his sister to her bedroom and booted away at the door until it splintered and he could see inside. Years later, he'd turn from loving husband to drill sergeant in a snap, leaving his 3-year-old son to referee between screaming father and sobbing mother. He tried anger management; it didn't work. Finally, his wife had enough and ended the marriage.
After his divorce, Overstreet found another love, but he quickly fell into old habits. One night, when his new fiancée took a wrong turn on the way home, he lost control. “You can almost make a machine-gun-intense argument, when you don't give someone a chance to respond,” Overstreet says. “It's a verbal assault under the guise of some logical, reasoned argument. You're watching it happen, you know it's happening, but you can't stop it.”
Only after Overstreet was finished reaming out the love of his life did he remember that her roommate, a meek foreign-exchange student, was riding in the backseat. When Overstreet turned around, he saw her cowering, like a witness to murder.
That outburst left him desperate for an explanation. He stumbled across an IED news report online, saw a psychologist, and was diagnosed. But even after starting medication--Overstreet takes Depakote, an anticonvulsant thought to raise the threshold for anger outbursts--he still has problems controlling his temper.
“An alcoholic might still say he's recovering after 20 years,” says Overstreet. “When I haven't had an episode in 10 years, then maybe I'll know I have it under control.”
Most anger is productive. In Anger: Taming the Beast, therapist Reneau Peurifoy proposes a three-part test to decide whether your anger is helpful, rather than hurtful: (1) A real threat existed. (2) The level of your anger was proportionate to the threat. (3) Your actions effectively reduced the threat with the least amount of harm to yourself and others.
When we're threatened, the sensory regions of our brains trigger the autonomic nervous system's fight-or-flight response. We puff out our chests and bare our fangs, and the aggressor slinks away (or we fight, and someone wins). But today we rarely face hungry predators. Now most threats are abstract or indirect: e-mails, snide remarks, construction zones
Some people--Overstreet, coach Bob Knight, Ron Artest--just aren't that good at assessing these threats. Dr. Coccaro's lab, the aggression clinic at the University of Chicago, has conducted facial-recognition tests, for example, that show people with IED are likely to mistake a neutral expression for hostility, meaning they feel under attack even if they're not. Another study shows men are extra-sensitive to angry expressions in a crowd, thanks to our evolutionary advantage of quickly detecting an aggressor. Put the two findings together and you'll see why someone like Overstreet thinks the world is against him.
“People pick up cues through emotions, facial expressions, body language, and vocal intonation,” says Kurt Noblett, Ph.D., one of the clinic's researchers. “People with anger disorders, it's thought, don't accurately pick up on all those cues. They focus on hostility.”
Perceiving anger is only part of the equation, though. How we react to a threat is the other. While most of us are able to rein in that primitive part of the brain that wants to beat somebody to death with a tree branch, people like Overstreet cannot. Dr. Coccaro and others believe they have narrowed the search for the cause of IED to the neurotransmitter serotonin. Low serotonin levels lead to disengaged frontal lobes, the top-down analytical parts of the brain that match a threat with a well-reasoned response
“People with this problem have an insufficient 'stop' response,” says neuropsychologist Royce Lee, M.D., adding that the clinic is now testing whether serotonin receptors and transporters are to blame
Other researchers have linked this serotonin deficiency to a pair of genes that regulate neurotransmitter levels. The more expressive these genes are, the better you're able to deal with anger. That means there's likely a genetic component to IED
Is it any surprise, then, that Overstreet's grandfather used to lash out when his mashed potatoes had too much gravy?
“Abandon. Loneliness. Hate. Suicide.”
As I sit strapped to a chair in Dr. Coccaro's lab, these words flash on the computer screen in front of me. This experiment, I'm told, will measure how angry I am. I'm assured by a cheerful research assistant that future versions of the test will feature vivid photos of cross burnings, battered women, and other horrific scenes. Thank goodness for beta testing
Lest I become too comfortable, a loud burst of static erupts in my ear every few seconds at random intervals. The noise is designed to elicit what psychologists call “the startle-blink response,” or what the rest of us call flinching. A computer will track the intensity of my startle-blinks
“Someone with a pronounced startle-blink is more aroused and more likely to have an emotional response,” says Noblett. “He feels the stimulus as more magnified, so the reaction is greater.” People with IED, Noblett says, are more sensitive to hostility, and more likely to respond with aggression, creating a vicious circle--or in this case, a circle of viciousness
The sharp peaks and valleys of my startle-blinks, Noblett tells me after I complete the test, may be a sign of IED. Or maybe I'm just jet-lagged. Only a thorough interview would tell, and even then, diagnosing the disorder is a judgment call
Dr. Coccaro proposes an easier test to determine whether you should seek help: “Ask yourself: Does it get me into trouble?” he says. “It really is that simple. If people tell you that you have to calm down, or that you have an anger problem, you probably have one.”
Not everyone agrees. When the Diagnostic Statistical Manual--the bible of the mental-health field--officially recognized IED as a disorder in 1980, a fair number of psychologists were outraged. They argued that anger is simply a basic human emotion, and that Dr. Coccaro and his colleagues were providing a convenient psychiatric excuse for bad behavior
The APA, in fact, is currently reexamining the criteria for an IED diagnosis. “We have to defend ourselves against accusations that we're turning everything into a disorder,” says Dr. Narrow. “What if someone says, 'I'm bad at golf.' Does that mean he has golf disorder?”
The debate over whether IED is real--or as common as the Harvard researchers claim--is almost beside the point. We all blow our lids now and then, right? So the question remains: Why so angry?
Our culture may be as much to blame as our biology. Kessler is now studying IED rates around the world to find out whether significant differences exist that would suggest environmental causes. “Anger may be one of those crosses that comes with success in the material world,” he says
Statistics seem to support his theory. U.S. population density has almost quadrupled over the past 100 years. Today we squeeze 80 people into each square mile, on average. (In New York City, 23,700 people now live in each square mile.) The closer people live, the more likely they are to rub one another the wrong way, according to researchers at Cornell. They demonstrated that higher population density increases levels of the stress hormone cortisol in our blood--it's cortisol that readies us mentally to fight or flee
As urban centers have become more crowded and suburbia has taken over the country, our commuting times have increased from 15 minutes to 26 minutes over the past 20 years. Cornell researchers have found that cortisol increases as a person's commute time lengthens. And they were studying rail passengers, not people trapped in rush-hour bottlenecks on I-10.
“People talk about the domino effect,” says Jean Johnson, coauthor of Aggravating Circumstances: A Status Report on Rudeness in America. “You leave your house, someone cuts you off, then you go into a store and no one will help you. Eventually, all that stuff adds up.”
“And even if the traffic jam fades from memory after you park at your desk, your elevated levels of adrenaline and cortisol wreak havoc on your system all day. “Blood-pressure surges damage the lining of the coronary arteries and other arteries,” says Redford Williams, M.D., the director of the behavioral research center at Duke University. “It's like a rushing stream. Over time, it erodes the banks.”
In fact, more than 30,000 heart attacks each year are triggered by momentary anger, according to a 2004 Harvard study. “People who have a lot of anger invest a lot of energy in trying to control it, and that kind of friction is likely to increase the probability of a heart attack,” says Charles Spielberger, Ph.D., a University of South Florida psychologist who developed the most widely used test to measure anger. “The more intense the anger, the more likely the heart attack.”
Other studies have shown that angry men are three times more likely to develop premature cardiovascular disease, six times more likely to have an early heart attack, and three times more likely to have a stroke
In other words, chill or die. But how?
For much of the 20th century, the most popular method for beating anger was catharsis therapy. Analyze This, the gangster parody, even committed this method to film. About halfway through the movie, Billy Crystal, playing the psychologist to Robert De Niro's tough guy, tries to treat his patient's outbursts
“You know what I do when I'm angry? I hit a pillow,” says Crystal. “Just hit the pillow. See how you feel.” De Niro whips out a pistol and pumps the pillow full of lead
“Feel better?” Crystal asks
“Yeah,” De Niro says. “I do.”
That's catharsis theory, in a nutshell. Sigmund Freud and his brethren seized on the instant-release model in the early 1900s, but it wasn't until the 1990s that psychologists thought to actually test it. Their discovery: Catharsis may, in reality, make anger worse.
The most famous study required 700 undergrads to write essays about the hot-button issue of abortion. The students then had their papers returned, graded by someone posing as a fellow student and laced with vitriolic feedback: “This is one of the worst essays I have ever read,” for example. Some students were told to distract themselves after the feedback by reading a short story or playing solitaire; others were allowed to work out their aggressions by pounding on a heavy bag. When volunteers were given the chance to confront the grader, the students most likely to shatter eardrums were the ones who'd been throwing leather, not the ones shuffling cards
“When angry people hit something, they'll tell you they feel good afterward,” says study author Brad Bushman, Ph.D., a University of Michigan psychologist. “But that's the worst possible thing you can do, because it just heightens your arousal.”
So what to do with all your anger? Let it go, man. In meditation therapy, patients are typically asked to imagine themselves in a calming place--at the beach or nestled in front of a warm fire. They take deep breaths and progressively relax various muscle groups. “My grandma told me to count to 10, and that's great advice, because as you delay, your arousal decreases,” says Bushman. “People who are aroused make really bad choices. They behave impulsively.”
Another effective method: distraction. When you're having an anger episode, try detaching yourself. One way to do this is to have a running narration in your head--sort of like that annoying voice-over on Desperate Housewives, only talking about your life. Hmmm, that man just cut me off is a much healthier response than leaning on the horn
Avoidance works, too, naturally. “It sounds simple, but some people aren't aware of their triggers,” says Jon Grant, M.D., an associate psychiatry professor at the University of Minnesota. “If driving home every night sets you off, then maybe you have to drive home an hour later. Keep a journal of what's triggering your anger and look for patterns.”
“The last-resort treatment, of course, is medication. “Certain drugs will increase the threshold at which someone will explode,” says Dr. Coccaro. “In an IED patient, the frontal part of the brain doesn't inhibit the primal, knee-jerk parts of the brain.” Serotonin reuptake inhibitors (Prozac and other SSRI meds) can ensure more of the neurotransmitter stays in circulation, allowing the top-down crimping of the anger responses
And anticonvulsant medications like the ones Overstreet takes can have a similar effect. Researchers actually don't know exactly why they work, just that they do . . . most of the time
Last fall, Michael Overstreet felt like he had his anger licked when he took his fiancée to Breezy Point, Minnesota, for a friend's wedding. That night, they returned to the condo they were sharing with other couples, only to find the front door locked.
“Suddenly, I began pounding on the door, and my friend's wife came out and confronted me,” Overstreet recalls. “I was screaming at her and calling her a bitch, saying, 'Why the f--- am I locked out?' Some of the guys got protective and stepped in. It was an unsettling event for everyone.”
“The blowup was textbook IED: A simple argument rapidly escalated. Overstreet was forced to sleep in a separate condo, and, afterward, he wrote personal letters of apology to all his friends and their wives who had witnessed his outburst. The rush of guilt is another telltale sign of IED
Soon after, his fiancée returned the engagement ring. But he's had no major blowups since then, and now the engagement is back on. He says that maybe, just maybe, he finally has his temper under control. His only regret is that he didn't seek help sooner. His message to men: Don't let anger destroy your life
“We need to open the conversation about IED, so people know it's not just them,” he says. “There's help for people like us.”
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