Mental Health

The Hurt Underneath

Something happened to trigger the client's rage just before group was to begin, and the client came into the group in a fury. He had enormous difficulty reporting the incident. But once the details emerged, it became clear that his angry response was out of proportion to the actual event: loudly explosive, with an energy that signaled an imminent loss of control, mere steps from actual violence. Over the years, I’ve had a lot of experience with helping angry clients, but I felt a bit anxious in the presence of such volatility, concerned about being able to insure safety while helping the client and the group manage and work through it. Nonetheless, the group helped the client regain enough control so that he was able to recognize what had happened. He spoke of feeling that “my brain is like scrambled eggs right now”—a vivid image that illustrated the level of his activation as well as his confusion and his experience of being out of control. He described his rage as “like being suddenly trapped in a space that gets smaller and smaller. I’m determined to get out and will do whatever it takes to get myself out of it.” Another client commented that “When I get angry I hurt people. I know how to hurt people; getting mad and getting violent is how I survive. I hurt them so they wouldn't hurt me, or so that they would stop hurting me. I don’t want to hurt people, but it’s what I do when I’m in that space." Yet another client said "I don’t get angry; I go right to rage. And when I’m in that place, I lose sight of all the consequences that can occur. When I think about it, it really scares me because I realize that I’m capable of anything. And then when the anger is over, I regret what I did.”

These men have all experienced rage; they have all experienced the consequences of out-of-control anger. They are slowly, painfully learning about their anger’s triggers, patterns, and nuances; and they are learning specific techniques for better managing it, without violence or negative consequences. They are learning about and trying to change their own thinking. Indeed, the group’s members are encouraged to look at their beliefs about anger while also developing new skills for managing it. And they are admitting that they are actually frightened of their anger.

But the most challenging aspect of the work centers on perceiving the connections between anger and the pain that anger can mask. The hurt underneath the anger is acute, and getting at that hurt is a slow, delicate process. The hurt underneath is a vulnerability. For most of us, acknowledging the pain, fear and vulnerability that arises in tandem with anger/rage is very difficult.

It’s all too easy to see only the anger. It’s dramatic and gets attention. The trouble is, anger is an effective means for hiding pain. Anger can be defensive. It can push people away, preventing anyone from touching what is most painful. Quite frankly, anger and rage can be scary. (The men I've quoted know just how scary they can be; they know just how frightening they appear to others, and they know how close they can come to outright violence—and most of them are afraid of themselves when they feel themselves veering toward rage; they are afraid because they often feel powerless to control their anger.) Paradoxically, what many people—the men in the group included—really want is to feel connected with others so that they can safely connect with and heal their pain. However, it’s hard to be around angry people, and most of us keep angry people at arm’s length whenever we can. And so the deeper pain remains raw and unhealed.

Anger that is out-of-proportion to its immediate cause almost always has roots in deeper conflict and pain. So too with displaced anger. Psychotherapy—both individual and group therapies--reaches for that pain and tries to help each person understand it; psychotherapy helps clients understand how pain manifests as anger, and learn how to manage anger and pain’s impact in the present. The pain can be rooted in traumatic events, unresolved conflicts, profound losses, abandonment. Identifying the hurt beneath the anger is an important step toward healing and being able to manage anger in a healthy manner. Many of the men in the group have difficulty acknowledging, much less being in touch with, the pain underneath and instead have learned to enact it—usually with terrible consequences to themselves and others. But until the hurt beneath the anger is identified and worked through, explosive, destructive anger will continue to manifest.

The group helped the client understand that the anger he was expressing was largely rooted in his past, and that the immediate trigger merely tapped into all that repressed anger. The group helped him separate the past from the present and helped him develop strategies for managing the here-and-now anger, and encouraged him to work through the older anger in individual psychotherapy. At the group’s end, he thanked his peers for helping him and expressed hope that he could continue the work that would help him “be a better man.” The group had done its job.

*Note: In order to respect and protect the confidentiality of the clients, I've omitted identifying information. I've drawn upon and condensed material that had developed over a long period of several group processes. I received permission to quote the men. As one of them said, "if my experience helps someone else, it's important to share it."

Looking for that magic pill

“Isn’t there a pill that I can take to make these feelings go away?” It’s a plaint I frequently hear. The client, faced with powerful feelings, feels overwhelmed and is looking for a means—any means—of altering the feelings, making them go away. And I understand that impulse: who enjoys the experience of acute anxiety, or depression, or grief, or rage? The urge to change uncomfortable feelings is, I think, a very human one. However, I also think that strong feelings, when carefully managed, offer opportunities for insight, for creative solutions, for growth. I think that medications are not, in and of themselves, the sole means for dealing with powerful feelings. Rather, they may be part of a strategy—but usually only a part.

The search for a magic pill for managing difficult feelings has become more pronounced in the age of Prozac—one that appears to have become more urgent in recent years. While feelings of all kinds can be powerful and even seem overwhelming--especially uncomfortable feelings like anxiety, sadness, anger, and depression--they are less and less tolerated; we want to make them go away as soon as possible. Quite frankly, there are times when medications are necessary and effective. Medications provide relief when carefully prescribed and monitored. But there are other times when medications are mis-used. Sometimes the line between elevating mood and eradicating feelings is difficult to discern.

These days, though, there seems to be an increasing movement to medicate away any feeling of discomfort. Pharmaceuticals would seem to offer unlimited panaceas to all our ills, allowing us to live in worlds where there are easy solutions to life’s challenges.

It’s not that easy.

Most of us have developed beliefs about our feelings. That we label feelings as “good” or “bad” reflects some of our beliefs, as does the assessment that some feelings are more “appropriate” or “acceptable” than others. The impulse to make feelings “go away” also reflects beliefs about our relationships to our feelings (that they are alien to us and must be erased). Reaching for alcohol or a pill to alter our feelings reflects our dis-ease with some of our feelings as well as beliefs about our ability to cope with strong feelings. (And the impulse to self-medicate is an especially strong one in a culture where the chemical means to alter mood is so readily available. It’s also a tricky impulse: self-medication is a common path to addiction.)

Feelings just are. They are neither “good” nor “bad”. They rise and fall throughout the course of a day, an hour, even a minute. We don’t have much control over their existence, but we do have control over our responses to them. The trouble is, too many people respond to their feelings by trying to eradicate them instead of working through them, letting them teach us about ourselves, letting them lead us to insights and even change.

Mental health involves the ability to manage feelings. Sometimes managing feelings may require medical help. There are psychiatric conditions that are effectively managed with medications. Certain depressions, anxieties, and thought disorders respond very well to medical intervention. However, even these are usually treated most effectively with both medication and psychotherapy.

Let me be clear: there is a time and place for medications. Psychotropic medications have value and can be an enormously effective means for helping alleviate anxieties, depressions and other mental ills. Medications can be useful for helping people develop cognitive clarity, thereby supporting problem-solving efforts. However, medications by themselves do not usually lead to optimal mental health. For that, some combination of medication and psychotherapy is most effective.

In any event, I think that the question to ask yourself when reaching for a chemical solution to a difficult feeling is this: what is my intent? To erase a feeling? To develop greater clarity in my thinking? To support my growth? Talking about this with a professional might be a first step toward discerning an answer and working through to a solution.