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),

and

~ 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?