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William P. Wilson, M. D.
Professor Emeritus of Psychiatry
Duke University Medical Center
Durham, N. C. 

Director, Institute of Christian Growth
Box 2357 Burlington, N. C.

No emotion is more destructive to human relationships than anger. It is small wonder that Jesus made teaching about its control an important part of his ministry. He made the points that anyone who is angry at his brother is subject to judgment (Matt. 5:22), and that if people were angry with us we should be reconciled with them immediately (vs. 23). We are to love our enemies (vs. 24) because they are persons with whom we are angry. We should not carry anger in our hearts. To love them we have to forgive them using the means by which we get rid of our anger. Paul made many references to the management of anger. In the fourth chapter of Ephesians (vs. 26-32) he gave us practical rules for dealing with anger. Most of us experience anger, but we do not know much about it. Let us look at anger as another emotion that we all experience, and how, using the power the Holy Spirit gives us, we can mange it.

If one searches the index of a standard textbook of psychiatry or the database of the National Library of Medicine, one finds few references to the subject of anger. This state of affairs is probably due to our neglect of the function of emotion in our study of the workings of the mind. It is an interesting fact that as we peruse the psychiatric literature even books that primarily address the subject of emotion contain little on its phenomenology. In a like manner, there is no consensus on a theory of emotion, and the evidence available to document the verity of the various theories of emotion, on careful examination seems to be unconvincing. It is important, then, that when one speaks to a group about a specific emotion, it is necessary to define emotion and present a concept of the phenomenology of emotion. This provides not only mental health professionals, but also any other audience with an understanding of the conceptual framework that is being used

Many years ago, William James wrote an article entitled, "What Is An Emotion?" The question that he asked is still a cogent one today. Unfortunately, many of the definitions that we have are so complicated that they are not understandable. I will, therefore, choose to define emotions simply as mental events that move a person. James believed they were reflexes. Cannon on the other hand thought they were reflex release phenomena of a tonic force that arises in the midbrain. The Papez-McLean theory expanded on the Cannon-Bard theory by involving the limbic system as a mediator of emotion. Gellhorn, whose work has largely been ignored, saw an emotion as the response to stimulation of either an excitatory or inhibitory system in the brain. Even though we may not as yet have formulated and provided evidence to support an adequate theory of emotion, it is a truism that the pathways for specific emotions are determined by the structure of the brain. We can emote at birth, but after birth we must attach cognitions (perceptions) of the stimuli that are appropriate for the various emotions.

Emotions are not simple reflexes for they have four components. These are autonomic, motor, sensory and cognitive. They are stimulated by events occurring both in the internal and/or external environment. Like all reflexes they have two major dimensions, these are intensity and duration. The intensity of the response is determined by the meaning and significance of the stimulus. The duration is determined by both the significance of the stimulus and the effect of the behavioral components of the emotion. When emotions move us, they either move us toward or away from the stimulus. Some inhibit our movement.

Most persons who have studied emotion have divided the specific emotions into two groups, the pleasant and the unpleasant. The pleasant emotions are love, joy and awe. The unpleasant emotions are sorrow, fear, anger, jealousy, shame, confusion, pain, disgust (nausea), and emptiness. Other names used to describe emotions modify the basic emotion by adding some idea about intensity, duration or both. Thus rage is anger of great intensity, hate is anger of great intensity and long duration, and resentment is mild anger of long duration. All are easily stimulated by an internal or external stimulus. Hostility is the expression or anger in a controlled way.

William James further observed that emotions are not immutable, one can find mixtures of emotion both in their normal expression and in disease. In the normal person, the expression of anger is inhibited by fear of retaliation if the anger felt is expressed. In disease, emotions are commonly mixed. For instance, in patients with emotional disorders one commonly finds sorrow mixed with fear (anxiety), with anger (irritability), with shame (guilt) or with confusion. Joy may be mixed with love, or with awe.

Emotions can also be inhibited. Inhibition is learned usually through both operant and aversive conditioning. All parents teach their children to inhibit emotions as soon as they are able to understand that inhibition is possible and desirable. In some instances, parents will force the child to inhibit all emotion causing them to grow up as emotional isolates incapable of expressing any emotion. One frequently observes this in children who have been abused or have grown up in cold unexpressive environments. Some persons have learned to inhibit one or several emotions, but can express others quite normally. Two of the most commonly completely inhibited emotions are the emotions of love and anger.

To conclude our brief discussion of the phenomenology of emotion, we would like to observe that pleasant emotions tend to occlude unpleasant emotions and vice versa. It is more difficult for a person who is basically a loving person to become angry. In a like manner it is just as difficult for a person who is angry much of the time to be loving. The fundamental emotional mind set of a person provides the tonus for the expression of similar emotions or the inhibition of opposing emotions. This tonus is determined by our past experiences. J. Marias (a Spanish philosopher) has said that we live in the present through the past in anticipation of the future. This is certainly true for our emotional life.

There are many angry people in the world who do not have other significant psychopathology. Nearly all of them have learned to be angry in their childhood. Most often their angry parents taught them by example. Some were angered because they were physically, verbally, or sexually abused. Some by all of these. Some are angry because they were neglected and/or rejected. This forced them to be responsible long before they were mature enough to assume the responsibility forced on them. In contrast, there are many who were dominated and controlled so rigidly in an unloving environment that they are filled with resentment and hate. Finally, there are those who because they were never disciplined, have not learned to control any emotion, especially anger. The bulk of this latter group do know how to control anger in the world outside of their homes, for society does not tolerate unbridled anger, but in their homes they are frequently out of control. These are the people who are likely to abuse their own loved ones. Most "normal" persons who have problems with anger have had little unconditional love and affirmation of their worth.

Mental disease often has a symptom of anger. There four personality disorders that have anger or one of its variants as a major symptom. These are: intermittent explosive, narcissistic, antisocial and borderline personality disorders. All of them are characterized by explosive outbursts of anger, rage or aggression.

Only two of the disorders that we consider to be psychologically determined are said to be associated with irritability, anger, hostility or aggression. These are: dysthymic disorder and post traumatic stress disorder.

The major affective disorders are predictably associated with anger as a symptom. DSM IV states that in both manic and depressive states anger can be seen either transiently or as a pervasive disturbance of affect. In our own experience, it is almost universally seen in both manic and depressive states, but profound anger is more common in mania than in depression. After World War II, we saw a large number of manics who were constantly angry. They were quite assaultive and combative. In a series of 400 major affective disorders studied by us, we found only fourteen patients with a primary affect of anger. Thirteen were excited and four were depressed. A much larger group of patients had anger occurring as secondary affects.

In schizophrenic patients, anger occurs as a recognizable affect primarily in persons who are paranoid. Many paranoids have a tonic affective state of anger. They appear angry and respond to any verbal interaction with replies that are unmistakably angry and hostile. Others may respond inappropriately to stimuli with anger. Others may display anger in response to their hallucinations. Paranoid schizophrenics are often unpredictable in their anger and suddenly become assaultive and combative without provocation. Like paranoid schizophrenics, patients with paranoid disorders may display anger, hostility and violence.

A number of syndromes occurring with medical disease of the brain have disturbances of affect that are characterized by anger. The one most commonly found to have anger, hostility or violence associated with it is the organic personality syndrome. These patients’ affective life is characterized by affective ability, explosiveness, and temper outbursts. Trauma is the most common cause of such a syndrome. It is said that these same symptoms are frequently associated with temporal lobe epilepsy, but our clinical experience of thirty years involving hundreds of temporal lobe epileptics does not document such an assertion.

Patients with Huntington’s Chorea often have irritability, anger and uncontrolled outbursts of rage. These can be so violent that they may serious injure the objects of their anger.

Anger, hostility and aggressiveness are commonly found in patients with organic syndromes due to alcohol and drugs. Patients with idiosyncratic reactions to alcohol may become belligerent and assaultive with minimal amounts of alcohol. Amphetamine psychoses are characterized by paranoia and anger. Cocaine occasionally produces anger, belligerence and fighting. Phencyclidine and amphetamines have much greater proclivity to produce these symptoms. It is small wonder that violent crimes are associated with alcohol and drug induced anger.

MANAGEMENT OF ANGER

It should be quite obvious that the treatment of patients with biologically determined symptoms of anger, hostility or the behavioral concomitants of anger, is the treatment of the disease causing the symptom. But what about the anger that occurs as part of personality disorders, and in those persons who we would consider normal variants. It is our belief that their problems with anger, hostility, resentment or whatever terms are used to describe this negative emotional state are learned, cannot be effectively treated with pharmacological agents or other somatic therapies. These patients have to be treated psychotherapeutically.

It is unfortunate that psychiatry’s deterministic view of man’s behavioral aberrations makes it theoretically impossible for us to treat these dynamically (learned) determined problems. This view has been summarized by D. J. O’Connor as follows:

Every event has a cause.

Every human action is an event.

Therefore: Every human action is caused.

Any event that is caused could not have happened otherwise than it did.

Therefore: No human action could have happened other than it did.

With such a view, man is not responsible for his behavior. He is propelled through life by his biological drives and his previous experiences. If we hold such a view, then it is only possible to deal with anger, hate, resentment, or rage by using somatic treatments. Fortunately we have not, as yet, found drugs or other treatments that will control normal or neurotic anger and its derivatives. Let us hope that this never takes place or if we do find one, real mind control and complete social control will be possible.

Since anger, resentment and hate give rise to the greatest amount of conflict in the world, we must examine our basic assumptions about their origins and what we can do about them.

F. W. Furlong has examined all the theoretical positions of modern psychiatry to determine how they have been influenced by determinism. After doing so, he made the following statement. "Absolute determinism is a concept so deeply ingrained in the theories (of the nature of man) that it is difficult to recognize the hidden assumption for what it is. As much as any individual may feel himself capable of some choice (as to how he will behave), there seems to be no basis for taking this (ability to make choices) seriously with twentieth century scientific assumptions." With such a theoretical basis for treatment, we can see why psychiatry finds it impossible to treat persons who have problems with the expression of anger. Since we know that repression is deleterious, all we can do is to accommodate it, and encourage its expression as the norm. This then forces us to exonerate the person of any responsibility for the trauma that he inflicts on himself and others, even though the offended persons hold him responsible.

There is, however, a different view of the nature of man. It postulates that he/she is a responsible being who, although not outside of the natural order, may make certain choices and bring about events as a prime cause actively intervening in the world. Such a view is posited by the existentialists and by Judeo-Christian theologians who believe that man is responsible for the choices that he makes. Laws have evolved out of his history to help him make the right choices.

If it is true that we are responsible, then we have to be responsible to someone. The someone(s) to whom we are responsible is ourselves, the significant others in our lives, society and, if we believe that He exists, to God. But what happens when we are not responsible? We most certainly will infringe on the rights of others. We will cause them emotional or bodily harm. Such acts will elicit anger and a desire for retaliation on the part of the offended persons. Society knows that there must be a way to deal with anger. Since retaliation is likely to be uncontrolled, it is necessary that we have some way of punishing the offender and making restitution to the offended. This has been done by the establishment of the rule of law. Society from the dawn of history has assumed the responsibility of dealing with anger judicially. Unfortunately, most of the anger that arises in everyday life does not come under the rule of law. This anger if not resolved gives rise to resentment and hate. Hate may give rise to actions that will require adjudication by the law. We do, therefore, have to have some means by which we can control its expression so that retaliation is not likely to occur. Stafford has observed that this can be done by: (1) An acceptance of the fact that we are angry. (2) Examining our anger and its cause and our intention about its use. (3) We must next find appropriate ways to direct the anger that we feel. (4) Confess the anger that we feel toward the behavior that has disrupted a relationship. When we do so the anger fulfills the objectives of love. Assertiveness training can accomplish these objectives. After we have done these things, there is one final act that is necessary. This is to decathect (detach) the anger from the memory of the event. This last and most important act can only be done by forgiving the person.

A deterministic view of the nature of man does not require forgiveness. Because we can make no choices, there is no responsibility, therefore there is no wrongdoing, and forgiveness is unnecessary. But we do not subscribe to a deterministic world view. There is wrongdoing in our world and there is free will. The possession of free will makes us responsible for dealing with our anger if we are not to harbor resentment or hate, both of which are destructive to relationships. We must then give up our desire to punish the person who has hurt us by pardoning them, i.e we must release them from the responsibility for their acts. In so doing, we adjudicate them not guilty. If they are repentant (sorry), it is easier to forgive them than if they are not repentant.

It is not our nature to be forgiving, for with each memory that we store we also store its emotional significance. In this museum of emotions, we store anger along with the memories of offenses. This is the stuff out of which resentment and hate is made. To easily detach this anger so that it may be disposed of, we want to know that the person is sorry (repentant) and wishes to make restitution if possible, or we must know that there will be an adjudication of his offense and that he will ultimately be punished. The Judeo-Christian understanding of forgiveness requires us to forgive if a person is repentant, and assures us that there will be ultimate punishment by God if they are not repentant. This understanding provides the mechanism to get rid of anger both in the present and that accumulated in our memory stores. The anger cathected to our record of wrongs is canceled by forgiveness and we are set free to relate without being prejudiced by our load of anger from the past. It is unfortunate that we have not learned to use this intervention. Even worse is that we frequently refuse to use it.

Our Lord knew that his kingdom of love could not be established if anger could not be controlled. It is interesting that the Christian faith really is predominantly about emotion. The greatest commandment is to love God, but how can you love God if you are angry with him. The second greatest commandment is to love your neighbor, but again how can you love him if you are angry with him. Jesus knew that it is impossible for Christians to love one another if they are angry. Knowing all this, our Lord took steps to make it possible for us to overcome our human nature and live a life of love.

First, He gave us the Holy Spirit. The Holy Spirit is the Spirit of God. Since God is love and his Spirit lives in us, he installs love in us when he comes to dwell within us at the time of our salvation. A number of scientific observers have noted that the predominant moods after salvation are love and joy. The old gospel song "Give me that Old Time Religion" boldly asserts that "it makes you love everybody." Everybody is God, our spouses and children, our friends and one another.

The next gift we receive with our salvation us the power to forgive. In John 20:22,23 our Lord is quoted as saying, "Receive the Holy Spirit. If you forgive anyone his sins, they are forgiven; if you do not forgive them, they are not forgiven." This means we can forgive transgressors for their sins against us, God or other people. They should be repentant for us to do this or Jesus made it one of the conditions to offer forgiveness (Luke 17:4). There are times though when we have to forgive even though the sinner does not believe they have sinned against us, refuses to admit their sin, does not know they have sinned, or has died. We want to forgive them so that we can be released from a hate bondage that has allowed them to control us. They will still be responsible before God. He will award them the punishment they deserve for their wrong behavior. At the judgment seat described in Matthew (25:31-36) we will all be rewarded or punished for our right or wrong behavior. We do not have to believe those who offended us will escape their punishment if we forgive them. We are the beneficiaries of our forgiveness. Set free from the anger that has dwelt in our souls, our love will no longer be muted. We can truly pray for our enemies even when they despitefully use us.

Anger is a major problem in the church. Why do church members have to indulge in hatred, discord, fits of rage, dissensions and divide into factions? Why can they not love one another? The answer is that they are living in the flesh, and not in the Spirit. If they were obedient to Christ’s commandments they would not experience the fruits of their human nature (Gal. 5:19-21). All to often the dissensions that occur are the result of anger that is brought in from events and actions that occur outside the church. These may be political, educational, relational, or as a result of a struggle for power in the community.

When dissensions occur as a result of problems within the church, they arise most often as a result of control issues in the church. All too often there is a power structure in the church that will fight to maintain control when their position is threatened. This position has often been secured with money, family dominance in the community, hard work, or aggressiveness. Not infrequently the music ministry of the church is a great source of dissension. They often feel that they alone can order the worship. Any attempt to change it by the pastor or worship committee creates great anger.

From the forgoing I think you can see that good anger management is a must for a victorious Christian life. Expressing anger is not the way we mange it. When we express it we empathetically elicit anger in those with whom we are angry. Confession is the only way to get it out and convey our feeling to others. Forgiveness defuses anger and effects reconciliation. This allows us to love those who might have despitefully used us (Matt. 6:44).