R. Murali Krishna, M.D. President

By R. Murali Krishna, M.D.

What makes you angry? Is it a difficult co-worker or client? It it knowing that you'll work all day and then be responsible for most everything at home, too, without the help you'd like from your spouse? Is it being caught in a slow line of traffic on the highway or a slow checkout line at the grocery store?

Everyone faces aggravations and challenges, and occasional outburts of anger are understandable. But if your anger is frequent and unusually intense, it's a matter of concern. When anger is beyond your ability to govern – if it manages you rather than you managing it – then you're in a situation that is potentially destructive to your mental and physical health. How so?

There's a great deal of research showing that heart disease, the nation's leading killer of men and women, is significantly influenced by anger. A study published in the American Heart Association Journal, Circulation, in October 1995 showed that the risk of heart attack increased by 2.3 times in the two hours following an episode of anger. A 1996 Harvard School of Public Health study showed that men with the highest levels of anger were three times more likely to develop heart disease than men with the lowest levels of anger. At Loyola College of Maryland, a study determined that of 41 patients who had angioplasty to unclog arteries, those who scored highest in hostility were 2.5 times more likely to need another angioplasty within a year.

The risks don't stop at your heart. A study reported earlier this year in the Journal of the American Medical Association says that men who experience outbursts of anger have twice the risk of stroke as men who manage their tempers. A 1993 study found that "anger attacks" were found in more than 40 percent of people with major depression. There are relationships between chronic pain syndromes and anger. The pain and inflammation of arthritis can be worsened by anger. Anger weakens the immune system and delays healing. The truth is, there's not a part of the body that isn't influenced by anger.

How can you manage the anger you feel?

First, you have to recognize it. Rage is plainly evident, of course. But will you see anger in early stages, before it builds? Will you be able to see resentment, irritation and frustration? Do you know how to tune into early warning signs of anger, perhaps tenseness, increased heart rate or a flushed feeling?

Second, you have to determine what is causing your anger. Anger occurs when you feel powerless or when you feel a sense of injustice. For example, you may feel powerless – and angry – when you find your schedule controlled by the decisions of judges or the machinations of judicial process. But take it a step further. Was the problem that your schedule was changed, or was it your reaction to the change of schedule? This is the time to identify any mistaken attitudes and convictions that cause you to be excessively angry.

Third, pause before your anger grows too strong. Count to 10 (or 20, or 30, or however high you need to go), breathe deeply, call a friend, go for a walk, listen to music, meditate, pray or do whatever else will calm your mind.

With your mind calm, the fourth step to take is to look for solutions. Hopefully you've identified what's causing the anger. Now, you must modify either the situation or your feelings. Replace negative thoughts with positive ones. Reconsider your expectations. If changing your thought patterns doesn't help, or if you aren't able to change them, then you may have to decide to get yourself completely out of situations that trigger anger.

At this point, be aware that suppressing anger is not a solution. When you suppress your anger, you're not dealing with the causes. You're keeping your anger on a tight leash, so tight that it is bound to break at some point.

Fifth, look for chances to channel your anger in a positive way. An emotional outburst may make you feel better at some level, but real relief comes when you use anger to motivate you to change situations or thoughts that are causing problems. If your anger comes from a sense of powerlessness, you may at a deeper level be feeling self-doubt and self-contempt. If so, you'd want to trade destructive self talk for constructive self talk, feelings of worthlessness for feelings of worth. It's up to you to decide how you'll react to a given situation, so you might as well decide to react in a way that is emotionally healthy rather that emotionally injurious.

Finally, have balance in life. A rich life with balanced attention toward family, work, exercise, laughter, socializing and spirituality helps you cope with daily ups and downs.

Will managing your anger really help you be healthier? Research so far indicates that may be the case. A study conducted at Mount Zion Medical Center in San Francisco indicated that heart patients who underwent 14 months of counseling to reduce their hostility (and time urgency) suffered 60 percent fewer heart problems. A similar study at Stanford found that men and women who survived heart attacks and then were counseled on controlling their aggressive, hostile and hurried behavior reduced the number of recurrent heart attacks by half.

What, then, should be your goal? Anger is a normal human emotion, so it's not something you can shut out of your life. What you want is a sense of equanimity, a capacity to feel calm and stay calm in spite of challenges. Getting to this point in life puts you in a wonderful place from which to live. You aren't blown whichever way the wind is blowing, and you have healthy control over your emotions and reactions. It's from this perspective that you get the tranquility and peace of mind that enriches your life and enriches those around you.

R. Murali Krishna, M.D., is president and COO of INTEGRIS Mental Health Inc., one of the state's largest providers of mental health services. He is also president of the James L. Hall Jr. Center for Mind, Body and Spirit. He has maintained a private psychiatry practice for more than 25 years and is a clinical professor of psychiatry at University of Oklahoma Health Sciences Center.