Anger Managed Pt.2

In a previous blog, I explained how anger can be viewed as a secondary emotion—that it serves as a signal to inform us that we are emotionally upset and that we ought to look deeper for an underlying emotion. I suggested that the most common underlying primary emotions are hurt, fear and frustration. If we look under our anger, we will usually find one of these.

Let’s consider the following example. You’re driving your car on a busy freeway at 110km/h. A driver in the adjacent lane fails to see you and cuts in front of your car, narrowly avoiding a collision. I’m sure we can all recall a similar incident. Our immediate reaction is most likely to be cursing and swearing at the driver for their recklessness, “You stupid ass, watch where you’re going!”. Notice here how the default reaction appears to be one of anger, but taking a moment to look beneath the anger, we can see that the primary emotional response is fear. In an instant you were fearing a collision. The threat detection centre in your brain stimulated a fear response. 

On a recent occasion I had this very experience, startled by a driver cutting in front of me. I was able to arrest my alarm centre, and rather than shouting abuse, I calmly said out loud, “you gave me such a fright”. I deferred the secondary response of anger by going straight to the primary feeling and communicating from the fear.

The following stories have been included to demonstrate further, how with expanded awareness and emotional intelligence we can better manage our relationship with anger.

One afternoon I was working a busy shift in the Emergency Room at UCLA hospital in Los Angeles. The department was full of patients waiting to be seen and we were falling behind with our care. Suddenly an enraged man began shouting with anger. He was a big and threatening individual with tattoos suggesting his gang affiliations. A nurse colleague went to press the duress alarm before I intervened and asked her to hold off for a moment. The duress alarm would have summoned four big security staff and the situation may have escalated out of control. I approached the gang member in a non-threatening manner and calmly said, “you’re really pissed off about something, aren’t you?”, to which he replied, “I’m fucking ropable”. Needing more information, I enquired, “what’s going on?”, to which he softened a little and said, “that’s my mum over there and she has chest pain, and no one has seen her”. At this point, I recognised that he was afraid for his mother’s wellbeing, and that this fear was driving his anger. “I can see you’re very concerned about your mother, please come with me and I will assess her immediately”. At this point, with his anger and fear heard and validated, he calmed down and became non-threatening and cooperative. His mother turned out to be okay too.

Fast forward twenty or so years, and I’m back in Australia working a night shift at a mental health ward on the Gold Coast. I arrive for work at 9pm and as I enter the ward, I notice it's tense and chaotic. The patients and staff are all agitated and moving about frantically—the place is in disarray. There are 6 security staff standing over and intimidating a young male patient in a wheelchair. I quickly realised this patient was the source of all the mayhem. I said to myself under my breath, “no, I will not allow my shift tonight to be chaotic”. My next move went against all the security and safety training I’d ever received. I politely asked the security staff to leave and told them I’d call them if they were needed. I then asked the young man in the wheelchair to direct me to his room, where I entered  alone with him and closed the door behind us.

I could see the visible rage in him and I could also see that he seemed to lack fear. He had the demeanour of someone who had seen far too much to be afraid of anything. I noticed that he was in a wheelchair because his left leg was bright red and very swollen. He had a serious case of cellulitis which if untreated can lead to sepsis and death. He had been seen in emergency, but because he refused treatment he was sent for psychiatric evaluation against his will. I said the following to him, “I’m on your side, what is it that you want more than anything right now?”, to which he replied, “to get out of this shithole”. I told him I was his best chance at that and sensed he could tell I was genuine and truly concerned for his wellbeing. Being in his quiet room with someone who cared to ask him what he wanted was certainly an improvement to the debacle he was facing moments earlier.

I asked about his leg and how it got infected. He went on to tell me a long story about how he was homeless and living on the streets, about how he had been raised by bikies, how he had witnessed people being murdered and that his whole life had been about surviving the constant violence he’d been exposed to since he was a little boy. He also made a point to tell me how he wasn’t threatened by the security staff and how he could’ve taken them all down. He lamented that his life has always been chaotic and that he was proud of his fierceness in the face of malevolence. I listened intently to his story and noticed an alliance forming between us. I sensed I’d gained his trust by remaining calm throughout our entire interaction. When he stopped to take a breath, I reminded him of his desire to get out of the hospital as soon as possible. I explained how under mental health law he could be detained against his will for a minimum of three days. I looked him in the eye and told him the quickest way out was for him to consent to being admitted to the medical ward overnight for intravenous antibiotics and that if he cooperated, he could probably be discharged after 24 hours of treatment. He was satisfied with the plan. I made a few calls and then took him to the medical ward where he agreed to being admitted and treated.

I returned to the mental health ward around 10pm. As I opened the door you could hear a pin drop. All the patients had gone to bed and the staff were sitting at their desks writing their notes and having cups of tea. Peace and quiet had been restored. My shift was not going to be chaotic after all. I’d learned once more that when confronted by anger, it’s often best to face it and validate it first. Only then should we seek to reconcile the underlying emotional driver.