Posts Tagged ‘anger’

Mind and Medicine

March 19, 2018

The title of this post is identical to the title of the title of a chapter in Daniel Goleman’s book “Emotional Intelligence.” There are two extreme views regarding the mind and medicine. One view, and it is unfortunate that there are physicians who hold this view, is that there is no relationship between the mind and medicine. The other extreme is that the mind controls all and medicine is unnecessary. Actually, this extreme view is the view adopted by some religions such as Christian Scientists, that prayer and meditation, not the mind, provides the basis for treating all illnesses. As the reader will see, the truth lies somewhere in between.

The truth is that there are links between the immune system and the central nervous system, and the field that studies this, psychoneuroimmunology (PNI) is a leading-edge medical science. It’s name acknowledges the links: psycho, or mind; neuro, for the neuroendocrine system (which subsumes the nervous system and hormone systems); and immunology, for the immune system.

Some surgeons will cancel scheduled surgeries for people who are panicked by the prospect of surgery. Every surgeon knows that people who are extremely scared do terribly in surgery. They bleed too much, they have more infections and complications, and they have a harder time recovering. Patients do much better if they are calm.

A study of anger in heart patients was done at Stanford University Medical School. All the patients in the study had suffered a first heart attack, and the question was whether anger might have a significant impact of some kind on their heart function. While the patients recounted incidents that made them mad, the pumping efficiency of their hearts dropped by 5 percentage points. Some patients showed a drop in pumping efficiency of 7% or greater. This is a range that cardiologists regard as a sign of myocardial ischemia, a dangerous drop in blood to the heart itself.

Another study by Dr. Redford Williams of Duke University found that those physicians who had had the highest scores on a test of hostility while still in medical school were seven times as likely to have died by the age of fifty as were those with low hostility scores. This is a stronger predictor of dying your than were other risk factors such as smoking, high blood pressure, and high cholesterol.

Anxiety, the distress evoked by life’s pressures, is perhaps the emotion with the greatest weight of scientific evidence connecting it to the onset of sickness and course of recovery. Yale psychologist Bruce McEwen noted a broad spectrum of effects: compromising immune functions to the point that it can speed the metastasis of cancer; increasing vulnerability to viral infections; exacerbating plaque formation leading to atherosclerosis and blood clotting leading to myocardial infarction; accelerating the onset of Type 1 diabetes and the course of Type II diabetes; and worsening or triggering an asthma attack. Stress can also lead to ulceration of the gastrointestinal tract, triggering symptoms in ulcerative colitis and in inflammatory bowel disease. The brain itself is susceptible to the long-term effects of sustained stress, including damage to the hippocampus, and so to memory.

There are also medical costs of depression. In patients with chronic kidney failures who were receiving dialysis, those who were diagnosed with major depression were most likely to die within the following two years; depression was a stronger predictor of death than any medical sign.

Heart disease is also exacerbated by depression. A study of 2832 middle-aged men and women tracked for twelve years, those who felt a sense of nagging despair and hopelessness had a heightened rate of death from heart disease. For the 3% who were most severely depressed, the death rate from heart disease compared to those with no feelings of depression was four times greater.

As there are medical costs to pessimism, there are medical advantages to optimism. For example, 122 men who had their first heart attack were evaluated on their degree of optimism or pessimism. Eight years later, of the 25 most pessimistic men, 21 had died; of the 25 most optimistic, just 6 had died.

There is medical value from relationships. Two decades of research involving more than 37,000 people show that social isolation, the sense that you have nobody with whom you can share your private feelings or have close contact—doubles the chance of sickness or death. A 1987 report in “Science” concluded that isolation is as significant to mortality rates as smoking, high blood pressure, high cholesterol, obesity, and and lack of physical exercise. Goleman takes care to note that solitude is not the same as isolation; many people who live on their own or see few friends are content and healthy. Rather, it is the subjective sense of being cut of from people and having no one to turn to that is a medical risk.

Goleman argues that for medicine to enlarge its vision to embrace the impact of emotions, two large implications of the scientific findings must be taken to heart:

HELPING PEOPLE BETTER MANAGE THEIR UPSETTING FEELINGS—ANGER, ANXIETY, DEPRESSION, PESSIMISM, AND LONELINESS IS A FORM OF DISEASE PREVENTION. The data show that the toxicity of these emotions, when chronic, is on a par with smoking cigarettes, helping people handle them better could potentially have a medical payoff as great as getting heavy smokers to quit. One way to do this that could have broad public-health effects would be to impart most basic emotional intelligence skills to children, so that they become lifelong habits. Another high-payoff preventive strategy would be to teach emotion management to people reaching retirement age, since emotional well-being is one factor that determines whether an older person declines rapidly or thrives. A third target group might be so-called at-risk populations—the very poor, single working mothers, residents of high-crime neighborhoods, and the like—who live under extraordinary pressure day in and day out, and so might do better medically with help in handing the emotional toll of these stresses.
MANY PATIENTS CAN BENEFIT MEASURABLY WHEN THEIR PSYCHOLOGICAL NEEDS ARE ATTENDED TO ALONG WITH THEIR PURELY MEDICAL ONES. While it is a step toward more humane care when a physician or nurse offers a distressed patient comfort and consolation, more can be done. But emotional care is an opportunity too often out of the way medicine is practiced today; it is a blind spot for medicine. Despite mounting data on the medical usefulness of attending to emotional needs, as well as supporting evidence for connecting between the brain’s emotional center and the immune system, many physicians remain skeptical that their patients’ emotions matter clinically, dismissing the evidence of this as trivial and anecdotal, as “fringe, or worse as the exaggerations of a self-promoting few.

Passion’s Slaves

March 13, 2018

Passion’s Slaves is the title of a chapter in Daniel Goleman’s book “Emotional Intelligence.” Since the time of Plato a sense of self-mastery, of being able to withstand the emotional storms that the buffeting of Fortune brings rather than being “passion’s slave,” has been praised as a virtue. The ancient Greek word for it was “sophrosyne.” Page DuBois, a Greek scholar translates it as “care and intelligence in conducting one’s life; a tempered balance and wisdom.” The Romans and the early Christian church called it “temperantia”, temperance, the restraining of emotional excess. The goal is balance, not emotional suppression. Aristotle observed, what is wanted is appropriate emotion, feeling proportionate to circumstance. The passions discussed in this post are anger and rage, worry and anxiety, and depression and melancholy.

Anger and Rage

The design of the brain means that we very often have little or no control over when we are swept by emotion, nor over what emotion it will be. However, we can have some say on how long an emotion will last. Consider the anatomy of rage. Say you are cut off in traffic by a driver. You think, “He could have hit me! That bastard—I can’t let him get away with that!” Your knuckles whiten as you tighten your hold on the steering wheel, which you regard as a surrogate for strangling his throat. You body mobilizes to fight not run—leaving you trembling, beads of sweat on your forehead, your heart pounding, the muscles in your face locked in a scowl.”

Compare that sequence of building rage with a more charitable line of thought toward the driver who cut you off. “Maybe he didn’t see me, or maybe he had some good reason for driving so carelessly, such as a medical emergency.” Such thoughts tempers anger with mercy or at least an open mind, short-circuiting the buildup of rage. Aristotle’s challenge is to have only appropriate anger reminds us, is that more often than not, our anger surges out of control. Benjamin Franklin put it well: “Anger is never without a reason, but seldom a good one.” There are different kinds of anger. The amygdala is a main source of the sudden spark of rage we feel at the driver whose carelessness endangers us. On the other end of emotional circuitry, the neocortex, most likely foments more calculated angers, such as cool-headed revenge or outrange at unfairness or injustice.

Rage seems to be the most intransigent of al the moods. Researcher Diana Tice found that anger is the mood people are worst at controlling. Anger is the most seductive of the negative emotions; the self-righteous inner monologue that propels it along fills the mind with the most convincing arguments for venting range. Unlike sadness, anger is energizing, even exhilarating. Anger’s persuasive power might explain why some views about it are so common: that anger is uncontrollable, or that it should not be controlled, and venting anger in “catharsis” is to the good. A contrasting view holds that anger can be prevented entirely. However, a careful reading of research findings suggests that all these common attitudes toward anger are misguided if not outright myths.

The train of angry thoughts that stokes anger is also potentially the key to one of the most powerful ways to defuse anger: undermining the convictions that are fueling the anger in the first case. The longer we ruminate about what has made us angry, the more “good reasons” and self-justification for being angry we can event. Brooding just fuels anger’s flames. Seeing things differently douses those flames. Tice found that reframing a situation more positively was one of the most potent ways to put anger to rest. Timing matters. The earlier in the anger cycle, the more effective. Anger can be completely short-circuited if the mitigating information comes before the anger is acted on.

The second way of de-escalating anger is cooling off physiologically by waiting out the adrenal surge in a setting where there are not likely to be further triggers for rage. This is a common way of dealing with anger according to Tice’s research. One such fairly effective strategy is going off to be alone while cooling down. People go for a drive or a walk. Of these two, the second is preferable. Exercise also works. Relaxation methods such as deep breathing and muscle relaxation, perhaps because they change the body’s physiology from the high arousal of anger to a low-arousal state, and perhaps too because they distract from whatever triggered the anger. [enter “Relaxation Response” into the search block of the healthy memory blog to find relevant posts].

However, a cooling-down period will not work if that time is used to pursue the train of anger-inducing thought, since each such though will trigger more cascades of anger.

Distractions like TV, movies, reading and the like work, but not shopping or eating.

Ventilation does not work. In fact there is a ventilation fallacy. Ventilation may feel satisfying, but it is counterproductive. Tice found that ventilating anger is one of the worst ways to cool down: outbursts of rage typically pump up the emotional brain’s arousal, leaving people feeling more angry not less.

Worry and Anxiety

Worrying is at the heart of all anxiety. The reaction that underlies worry is the vigilance for potential for potential danger that has, no doubt been essential for survival over the course of evolution. When fear triggers the emotional brain, part of the resulting anxiety fixates attention on the threat at hand, thus forcing the mind to obsess about how to handle it and ignore anything else. Worry is a rehearsal of what might go wrong and how to deal with it. The purpose of worrying is to come up with positive solutions for life’s perils by anticipating dangers before they arise.

Worrying becomes a problem with chronic repetitive worries that go on and on never getting nearer to a positive solution. Goleman writes that a “close analysis of chronic worry suggests that it has all the attributes of a low-grade emotional hijacking. Worries that seem to come from nowhere and are uncontrollable generate a study hum of anxiety, are impervious to reason and lock the worrier into a single, inflexible view of the topic of worry. When this cycle of worry intensifies and persists, it crosses over the line into a full-blown neural hijacking, the anxiety disorders: phobias, obsessions and compulsions, panic attacks.

For each disorder worry fixates in a distinct fashion: phobic anxieties rivet on the feared situation; obsessive disorders fixate on preventing some feared calamity; panic attacks can focus on fear of dying or on the prospect of having the anxiety attack itself.

Researchers have observed that anxiety comes in two forms: cognitive, or worrisome thoughts, and somatic, the physiological symptoms of anxiety, like sweating, a racing heart, or muscle tension. Insomniacs are suffering from anxiety attacks. Their main problem preventing them from sleeping were intrusive thoughts. No matter how sleepy they were, they could not stop worrying. The one technique that worked in helping them get to sleep was getting their minds off their worries, focusing instead on the sensations produced by a relaxation method. In summary, the worries could be stopped by shifting attention away.

Unfortunately, most worriers seem unable to do this. These worriers get a partial payoff from worrying that reinforces the habit. It seems that there is something positive in worries: worries are ways to deal with potential threats. When the work of worrying succeeds, it is to rehearse what those dangers are, and to reflect on ways to deal with them. But Goleman writes that worry doesn’t work that well. “New solutions and fresh ways of seeing a problem do not typically come from worrying, especially chronic worry. Instead of coming up with solutions to these potential problems, worriers typically simply ruminate on the danger itself, immersing themselves in a low-key way in the dread associated with it while staying in the same run of thought. Chronic worriers worry about a wide range of things, most of which have almost no chance of happening; they read dangers into life’s journey that others never notice.”

Still chronic worriers report that worrying helps them, and that their worries are self-perpetuating. So why should worry become what seems to amount to a mental addiction? Borkovec notes that the worry habit is reinforcing in the same sense that superstitions are. Since people worry about many things that have a very low probability of actually occurring, to the primitive limbic brain there appears to be something magical about it. “Like an amulet that wards off some anticipated evil, the worry psychologically gets the credit for preventing the danger it obsesses about.”

Borkovic discovered simple steps the can help even the most chronic worrier control the habit.

The first step is self-awareness, catching the worrisome episodes as near their beginning as possible. Borkovec trains people in this approach by first teaching them to monitor cues for anxiety, especially learning to identify situations that trigger worry, or the fleeting thoughts and images that initiate the worry, as well as the accompanying sensation of anxiety in the body. With practice people can identify the worries at an earlier and earlier point in the anxiety spiral. People also learn relaxation methods that they can apply at the moment they recognize the worry beginning, and practice the relaxation method daily so they will be able to use it on the spot. [Much has been written about relaxation in the healthy memory blog. Enter ‘relaxation’ into search block of the healthy memory blog.]

Goleman offers the following precaution: “for people with worries so severe they have flowered into phobia, obsessive-compulsive disorder, or paid disorder, it may be prudent—indeed a sign of self-awareness—to turn to medication to interrupt the cycle A retraining of the emotional circuitry through therapy is still called for, however, in order to lessen the likelihood that anxiety disorders will recur when medication is stopped.

Melancholy and Depression

The single mood people put most effort into shaking is sadness: Tice found that people are most inventive when it comes to trying to escape the blues. Melancholy like every other mood has its benefits. The sadness that a loss brings has certain effects: it closes down our interest in divisions and pleasures, focuses attention on what’s been lost, and saps our energy for starting new endeavors, hopefully for the time being. It causes a reflective retreat from life’s pursuits, and leaves us in a state to mourn the loss, mull over its meaning, and make the psychological adjustments and new plans to continue with out lives.

Although bereavement is useful, a full-blown depression is not. In a major depression, love is paralyzed: no new beginnings emerge. The very symptoms of severe depression place a life on hold. For most people psychotherapy can help as can medication.

The far more common sadness that at its upper limits becomes a “subclinical depression” is sometimes referred to as melancholy. This is a range of despondency that people can handle on their own, if they have the internal resources. Unfortunately, some of the strategies most often resorted to can backfire, leaving people feeling worse than before. One such strategy is staying alone. However, more often than not this only adds a sense of loneliness and isolation to the sadness.

Tice found the most popular tactic for battling depression is socializing. Going out to eat, to a ball game or movie. Doing something with friends or family. This works well if the effect is to get the person’s mind off his sadness.

One of the main determinants of whether a depressed mood will persist or lift is the degree to which people ruminate. Worrying about what’s depressing us seems to make the depression all the more intense and prolonged. In depression, worry takes several forms, all focusing on some aspect of the depression itself, such as how tired we feel, how little energy or motivation we have, or how little work we’re getting done. Typically this reflection is not accompanied by any concrete course of action that might alleviate the problem.

Cognitive therapy aimed at changing these thought patterns has been found in some studies to be on a pair with medication for treating mild clinical depression, and superior to medication in preventing the return of mild depression. Two strategies are particularly effective. One is to learn to challenge the thoughts at the center of rumination. The other is to purposely schedule pleasant, distracting events.

Tice found that aerobic exercise is one of the more effective tactics for lifting mild depression, as well as other bad moods. A caveat here is that the mood-lifting benefits of exercise work best for the lazy, those who don’t work out very much. For those with a daily exercise routine there is a reverse effect on mood: they start to feel bad on those days when they skip their workout. Exercise seems to work well because it changes the physiological state the mood evolves: depression is a low-arousal state, and aerobics pitches the body into high arousal. Relaxation techniques, which put the body into a low-arousal state work for anxiety, a high-arousal state, but not so well for depression.

Tice reports that a more constructive approach to mood-lifting is engineering a small triumph or easy success: tackling some long-delayed chore around the house of getting to some other duty they’ve been wanting to clear up. Lifts to self-image were also cheering, even if only in the form of getting dressed up or putting makeup.

One of the most potent antidotes is cognitive reframing. For example, stepping back and thinking about the ways a relationship wasn’t so great, and ways you and your partner were mismatched, seeing the loss in a more positive light is an antidote to sadness.

This post offers some tips for dealing with emotional problems. Should problems persist and become chronic, please see professional help. Should you ever fear that you are a danger to yourself or others, SEEK PROFESSIONAL HELP IMMEDIATELY. If necessary, go to an emergency room.

If Emotion is so Central to Human Nature, Why Can it Be Harmful?

March 7, 2018

The answer is the same as why some of us tend to be overweight. In earlier stages of human development when starvation was commonplace, it was advantageous to eat foods that would load the body with fat. That time has passed and there is no longer a need to load the body with fat.

So in spite of social constraints, passions overwhelm time and time again. This is due to the basic architecture of mental life. The basic neural circuitry of emotion that we are born with is what worked best for the last 50,000 human generations not the last 500 generations. Goleman writes in his book “Emotional Intelligence,” “The slow deliberate forces of evolution that have shaped our emotions have done their work over the course of a million years; the last 10,000 years—despite having witnessed the rapid rise of human civilization and the explosion of the human population from five million to five billion—have left little imprint on our biological template for emotional life.” Given this explosive increase in population, the need for emotional intelligence has greatly increased. Unfortunately, our appraisal of every personal encounter and our responses to it are shaped not just by our rational judgments or our personal history, but also by our distant ancestral past. “In short, we too often confront postmodern dilemmas with an emotional repertoire tailored to the urgencies of the Pleistocene.”

Goleman continues, “All emotions are, in essence, impulses to act, the instant plans for handling life that evolution has instilled in us. The very root of the word emotion is “motere”, the Latin verb “to move,” plus the prefix “e-“ to connote “move away,” suggesting that a tendency to act is implicit in every emotion. That emotions lead to actions is most obvious in watching animals or children; it is only in “civilized” adults that we often find the great anomaly in the animal kingdom, emotions—root impulses to act—divorced from obvious action.”

Emotions have distinctive biological signatures:

*Anger— blood flows to the hands. This makes it easier to grasp a weapon or strike at a foe. Heart rate increases and crush of hormones such as adrenaline generates a pulse of energy strong enough for vigorous action.

*Fear—Blood goes to the large skeletal muscles, like the legs, making it easier to flee. This makes the face blanch as blood is shunted away from it (creating the feeling that blood “runs cold”). Simultaneously, the body freezes, if only for a moment, perhaps allowing time to gauge whether hiding might be a better reaction. Circuits in the brain’s emotional center trigger a flood of hormones that put the body on general alert. This makes it edgy and ready for action. Attention fixates on the threat at hand to better evaluate what response to make.

*Happiness—Here the main biological change is an increased activity in a brain center that inhibits negative feelings and fosters an increase in available energy, and a quieting of those that generate worrisome thoughts. There is no particular shift in physiology but a quiescence, which makes the body recover more quickly from the biological arousal of upsetting emotions. This configuration offers the body a general rest, as well as readiness and enthusiasm for whatever task is at hand and for striving toward a great variety of goals.

*Love—Tender feelings and sexual satisfaction entail parasympathetic arousal, which is the physiological opposite of the “fight or flight” mobilization shared by fear and anger. The parasympathetic pattern dubbed the “relaxation response,” is a bodywide set of reactions that generates a general state of calm and contentment, facilitating cooperation. [Entering “relaxation response” into the search block for the healthy memory blog will produce many posts on the relaxation response, to include how to induce the relaxation response, and the many benefits of the relaxation response]

*Surprise—The lifting of eyebrows in surprise allows the taking in of a larger visual sweep and also permits more light to strike the retina, allowing more information about the unexpected event, making it easier to figure out what is going on and concoct the best plan for action.

*Disgust—An expression of disgust looks the same around the world and sends the identical message: something is offensive in taste or smell, or metaphorically so. The facial expression of disgust—the upper lip curled to the side as the nose wrinkles slightly—suggests a primordial attempt, as Darwin observed, to close the nostril against a noxious odor to to spit out a poisonous food.

*Sadness—A main function of sadness is to help adjust to a significant loss, such as the death of someone close or a major disappointment . It brings a drop in energy and enthusiasm for life’s activities, particularly diversions and pleasures, and, as it portends an approaching depression, slows the body’s metabolism. This withdrawal creates the opportunity to mourn a loss or frustrated hope, grasp its consequences for one’s life, and, as energy returns, plan new beginnings. This loss of energy might have been kept saddened and vulnerable early humans close to home, where they were safer.