June 22, 2006

Is He Sick, or Just a Jerk?

I've seen a few articles lately claiming that 'road rage' is a diagnosable disorder.

Ronald Kessler
, professor of health care policy at Harvard Medical School, is getting quite a bit of press time lately due to his enthusiasm regarding this particular theory. Dr. Kessler - citing a study funded by the National Institute of Mental Health, the findings of which appeared in the June issue of the Archives of General Psychiatry - wants us to know that lots of people have this 'disorder', perhaps more than 7% of the population.

That's a pretty impressive claim, given that less than 1% suffer from schizophrenia, only 2.6% suffer from bipolar disorder,
all the 'personality disorders' put together only account for 7.9%, and the most generous statistic for depression - the most common disorder of all - is 25% over a lifetime (including situational depression, the sort you'd have when your spouse or child or parent dies... personally, I'd think you had a disorder if you didn't get depressed in such a situation).

Of course, Kessler headed up the study... he could be suspected of having a vested interest in the matter.

According to the DSM-IV (the diagnostic handbook of psychiatry), people with "Intermittent Explosive Disorder" overreact to certain situations with uncontrollable rage, experience a sense of relief during the angry outburst, and then feel remorse about their actions.

People who work in the areas of Domestic Violence and law enforcement are pretty familiar with that particular emotional/behavioral process... and so are school teachers, and parents of young children.

Parents and teachers, of course, generally don't see this behavior as pathological. They see it as being a normal stage of emotional maturity (or lack thereof), and deal with it affectively in most cases... by teaching three skills that are *also* taught in Anger Management classes for adults with Domestic Violence issues. Those three skills are:

1. Self Assessment. This involves learning how to figure out what feelings precipitated the action, what triggered those feelings, and what alternatives are available for dealing with those emotions.

2. Empathy. This involves learning how to figure out what the other person experienced, working out how they might have felt about it by imagining oneself in their place. Taking this to the next step often involves figuring out how the other person's feelings and reactions impact one's own life... enlightened self-interest is a more stable motivator than feelings of affection, which can fluctuate pretty radically.

3. Self Control. This third skill basically boils down to recognizing the beginning of a build-up towards rage and applying the first two skills prior to taking action.

In other words, most cases of IED-type behavior are not due to a chemical or neurological disorder... they are due to a lack of emotional skills and maturity that even small children can learn fairly easily if they are willing to do so.

Are there people who truly can't learn those skills, no matter how willing they are and no matter how skillful the teacher? Sure, I imagine there are a rare few. But I suspect that this would be easily found to be due to serious brain injury or a major disorder that has already been on the DSM for a long time, where the ability to empathize or to assess cause and effect are seriously compromised. In which case the resultant behavior is not a disorder so much as it's a symptom.

Here is where I take issue with Dr. Kessler, and with the DSM-IV. The psychiatric profession is adding clinical 'disorders' to the DSM at a rather profligate rate, and it bothers me. Whatever their reasoning may be in terms of treatment, I don't think the practical effects are good for us as a society or as individuals, for two reasons:

~ it tends to relieve us of responsibility for indulging in a particular set of behaviors - and excuses us for not putting forth adequate efforts to change them (or instill them in our children),


~ it tends to unnecessarily encourage the already overly aggressive pharmaceuticalization of America (and as America goes...) In other words, given the excuse that it's an illness rather than a lack of skills or maturity, people will often take the easy out of dosing themselves (or worse, their children) with brain-altering chemicals rather than taking the time and effort to acquire and apply perfectly learnable skills.

Great for the psychiatrists, who get permanent patients, and great for the pharmaceutical industries, who get rich... but what does it do to us?


Anonymous Anonymous said...

Some very good points!
And outside of the fact that I agree with you, I'd like to point out that the trend in behavior theory has been towards the evolutionary/deterministic/hardwiring explanations. Nature over nurture. The more we find out about the influence of genetics and brain structure and hormone mixes and whatnot, the more the academicians and people who write the stuff that the students have to study (and we lay people swallow as gospel) theorize that x behavior can be attributed to y physical trait and therefore a physical (read: pharmaceutical or surgical) solution is called for. Explosive disorder has been traced to malformation of or damage to the temporal lobe, I think? It may be more complex than the Nancy Reaganesque "just say no/count to ten and take a deep breath"...but efforts to do the latter might cut down on episodes.
I suspect that the cranked-up crack-like pace of modern life might be contributing, as well...
all in all, everyone seems to have a darned excuse these days and the guys in the ivory tower aren't helping matters any.

1:04 PM  
Blogger mE said...

The study in this case didn't examine the brains of the persons involved, simply asked whether people had experienced inappropriately rageful behavior in either themselves or in someone else during their lifetimes and during the past year, and whether and how they had been treated subsequent to the event(s).

The study interviews also covered supposed co-morbid conditions, concluding there was a connection but NOT assessing causal relationships... again, leaving little evidence as to whether the behavior was actually a disorder or simply a symptom of some other set of circumstances.

It's not that I doubt that there is a problem with the behavior itself, or that I doubt that the behavior is more prevalent than we'd think or prefer... it's that I think that the study was poorly constructed, the conclusions and/or interpretation of the results is dubious, and that I have serious doubts about the legitimacy of IED as a disorder in and of itself, rather than it being a symptom/result of other core issues. Some of those core issues might be neurological in nature... but I suspect that a large percentage of those reported incidents were caused not by brain chemicals or brain construction, but instead by lack of learned skills and/or just plain self-centeredness (note the high incidence of this behavior among overly-indulged athletes, for instance, where there is a high reinforcement ratio for aggressive behavior 'on the field' and a low consequence ratio for aggressive behavior in the 'real world'... also note that in the case of Domestic Violence, for instance, this supposedly 'uncontrollable behavior' almost NEVER happens when there are witnesses)

3:11 PM  
Anonymous Anonymous said...

Athletes may have some sort of natural aggression that they sublimate into sports, but I agree that their narcissism is in part responsible for their belief that they can behave as they please off the field. Your point that abusive partners abuse when there are no witnesses is very well taken. Remember too that sometimes they will hit/pinch etc. in places that won't "show". It could also be that the behaviors that "trigger" such violence take place when there are no witnesses, either (insults/challenges, etc.). But children DO often witness this stuff, and repeat the pattern. Sometimes, too, the dynamics underlying the abuse are complex and the aggression is just a surface manifestation of some other things going on in the "system", societal or familial.

3:31 PM  
Anonymous Anonymous said...


in which the author Linwood Barclay cites more disorders:
Refrigerative Emptiness Disorder

Persistent Flickeration Irritation

Hydrophobic Illumination Disorder

Entertainment Liberation Frustration Syndrome

Telephonic Humanoid Non-Realization Disorder (my personal fave and the most likely to trigger an explosion in ME)

Evacuation Maintenance Panic Attack

we could come up with more than a few of our own... :D

3:48 PM  
Anonymous Anonymous said...

among which.
I would like to add
the Alimentation Freshness Deprivation Syndrome in which a person flies off the handle in a volcanic reaction to days/weeks/years of other people failing to seal breakfast cereal boxes back up and re-close bread bags, etc., thus leading to a large volume of stale food no one enjoys eating - after only one day of having something open. Drives me, well, Explosive. :D

3:56 PM  
Anonymous Anonymous said...

Derision-motivated aggression reaction.
That's the phenom observed mostly in harried parents who fly off the handle at smirking from snotty older children or gormless dependents with an Entitlement Syndrome ... :D

4:05 PM  
Blogger mE said...

Ummm... you are right. About everything. Here, have a nice cup of chamomile tea to soothe your nerves...

8:09 PM  
Anonymous Anonymous said...

tsk. oh, you're no FUN. :D
And didn't you KNOW? I have Placation Intolerance Disorder.
[throwing china at blog]

11:02 PM  
Blogger Tink said...

I totally agree! In fact this statement:

"it tends to relieve us of responsibility for indulging in a particular set of behaviors - and excuses us for not putting forth adequate efforts to change them (or instill them in our children)"

pretty much sums up my feelings on the subject. Very interesting post girl. I love it when you speak your mind. :)

9:05 AM  
Blogger Carrie K said...

Great post, as I agree with it too. So much immature behavior being excused away. And I love the fact that on one hand it's "just say no to drugs" and the other is handing out pills to mold behavior.

"I suspect that the cranked-up crack-like pace of modern life might be contributing, as well..." by anonymous

- now this is just something that drives me crazy. Even a hundred years ago so much of life was taken up in physically demanding labor to do the meanest of chores. Now that we have all this leisure time, what do we do? Fill it up with "the crack paced" lifestyle and use it as an excuse to behave badly.

12:08 PM  
Anonymous Anonymous said...

Yep, it's insane, isn't it.
I think that the things we used to fill our time with were basic and simple survival things, and there were only a few of them. So we were busy, but it was the chop wood/carry water type of tedious time-filling. There's so much automatic frantic bling now and so many more CHOICES than a caveman would have had! It's really bad in the States but getting bad other places, too. Read "American Mania" for how our hunter/gatherer primate wiring has been overstimulated but also trapped by an acquisition- and stimulation-oriented lifestyle we ourselves have been driven to create, by our own wiring. It is really interesting. You could argue with some of the guy's hypotheses. But when I read it, I smelled "sumpin in there", he is getting his finger on some kind of important pulse, maybe not exactly but somewhere near one.

Ah, I owe, I owe, off the work. ;P
"the sis entity"

8:02 PM  
Anonymous Anonymous said...

ah freudian slip.
off TO work, I meant. ;D
I'd like to off it.
Top it.
But alllll in good time.
Said the Wicked Witch.

8:03 PM  
Anonymous Anonymous said...

I'd also like to mention that this may be a false dichotomy.
One can be BOTH sick AND a jerk. :D

8:04 PM  

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