Monday, August 2, 2010

Anger as viewed by a nurse

Welcome back to "As viewed by a nurse". Currently my role in nursing is Psychiatric Mental Health Nurse Practitioner. I will always be a nurse and these stories are what that means to me.

Men often express distress through anger or rage. This will cause adverse attention from their wives, bosses, and the police. They will be told 'get help or get out' 'get help or get fired'. Or the judge will tell them, 'get help or go to jail'. Then they come see me, "To do something about my anger."

I then ask them series of questions which measures their temper. I ask them, Do they raise their voice when they become angry? Do they become irritable or sarcastic? Do they throw things? Punch walls? Have they ever broken anything? What is the most expensive thing they ever broke?

This provides a gauge and give us goals to work on. If they don't raise their voice or become sarcastic, anger is not an issue. If they have smashed their flat screen T.V, put gaping holes in the drywall or busted out the windshield of their truck, anger is an issue. I see many scrapped up knuckles and forearm scars at my job. This is anger released onto objects.

Then I move onto the other area of anger-anger released onto others. Have they raised their voice at others? What about shoving? What about kicking, slapping or punching? Do they get into bar fights a lot? Then I ask about their significant others. Have they hurt their wives, girlfriends or partners? What about their kids? Have they ever put anyone into the hospital?

Then comes the clincher questions. How do they feel about the yelling? How do they feel about the fact that they busted a bat over someones back? Does it bother them that they smashed their flat screen? Do they feel bad about it?

One guy said yes, the flat screen was tough to take. The other guy, that busted out the windshield of his truck with his fists- yes, these were regrettable moments. Only because they still had payments on the T.V and the windshield repair cost 450 dollars.

That is the decisive factor. If they do not see a problem or feel justified with busting up others and objects up with words or deeds-then they are sociopaths. That particular brand of psychopathology is not treated with medication. In fact, there is no treatment at all. Except jail.

Sometimes, with some patients, the anger is not apparent through answers or tales of misdeeds. Like with my patient Adam (not his real name of course), he was about twenty years old. Young. Very young. He was quiet and gave one or two word answers. During his intake appointment, my mouth went dry and I felt myself shaking. I did not feel threatened, and make no mistake, I have felt threatened before. I was just completely knocked sideways by his anger. It was unbelievable.

He would show up month after month, not saying anything about his anger. I would point it out though, the clenched fist, jaw, and the muscle spasms in his neck and biceps. I would point out his short, forceful bully breath. 'That isn't anger' he said, 'It's just piss poor sleep.' This was his reason for seeing me. It was no surprise the medications we tried did nothing. Sleep was never the real issue.

Each time I would see him, I would do my yoga breathing to slow down my shaking. I would sip water to help with my dry mouth. I would not challenge him, I would just let his unspoken rage fill the room. It could have filled the whole building. It went on like this for almost a year. He just kept coming.

Finally, he started hinting that things were not so well. He had to drop out of school because threatened to rip a guys arm off. This was the first time he saw something what was glaringly apparent all along. He looked scared.

Then, for the first time, he made eye contact and said a whole sentence. He said he didn't want to be like this anymore. I was so excited I could have stood up and cheered. I could have shouted to the rootops. Finally I thought, finally we're getting somewhere! I didn't though, I just quietly acknowledged the truth that he had found.

It took six more months to convince him to go to counseling and anger management class. He did go though. And maybe just maybe, given enough time and effort, he won't be so angry anymore.

7 Left a message at the beep:

Brown said...

I thought that only the Incredible Hulk could smash through a windshield with his fist. I mean really?

I rarely get angry enough for it to manifest physically. Besides, who could be angry for long with such beautiful glowing caramel skin? If it does, I use words. I'm sarcastic and uncaring. Just my way of letting people know I'm not in the mood. Those who know me though, know that there's no bite behind that bark. Unless, of course, I'm really angry. In which case even the Hulk stays out of my way.

timothy grant said...

Is it possible for a sociopath to go his/her entire life without committing a crime? Or are they so absolutely unhinged from any rules that it is only a matter of time?

This stuff fascinates me...

Big Pissy said...


I know of a situation that I'd like your opinion has to do with a person who I consider to be a sociopath.

I'd like your opinion.

I'll email you. :)

Mrs. Hall said...

Brown: such lovely caramel skin indeed! you can just take your frustrations out while massaging people! really working those muscles and tendons!! knots be gone!

and yes, WITH HIS FISTS! a bit excessive really.

TrG: it's something that starts in childhood. every kid steps over the line- kits hit, bite, steal and lies. then they learn that that's wrong. They learn via a combo of feeling it's wrong (empathy) and being punished because they did something wrong (by loving parent(s))

but sometimes, one or both of these things are absent in a kids life and they learn they can get what they want just by taking and stealing and lying. and there are no consequences. thus begins the path of a sociopath.

it's not a matter of unhinging, it is a matter of operating-learned behavior and interacting, ingrained by reward. people and objects become one and the same. means to an end to get what they want.

then they get to my office and talk about the guy they put in the hospital and how that guy had it coming to him.

or that they smacked their wife and she was asking for it. she knows when she pisses him off. it was her fault.

or they stole money from the company because they don't pay him enough and it's their right to take what's theirs.

no remorse, no insight that they perpetuate actions that hurt others, and no personal responsibility or remorse is felt.

again, this begins in childhood when sociopaths are called "kids with conduct disorder".

That's why I ask if they feel bad about what they did in their fits of anger. If they don't I can't help them. If they DO and DON'T WANT TO BE THAT WAY!!! DING DING DING!! I have fodder to work with.

WHEW!!! don't get me started TrG!!!

I could go on and on !!!

Pissy: butcher (dot) hollow (at) gmail

Mrs. Hall said...

dermatology is on the third floor Mr. Dumass.

Bruce Johnson said...

The scary part, is that I sort of feel like I am becoming more and more like this guy, and not less and less like this guy. I really need to find another job.

Mrs. Hall said...


see now, you need to listen to that voice that is saying "this job is making me into a person that resembles a mental patient"

LISTEN TO THAT VOICE AND EITHER A) GET A DIFFERENT JOB-or B) see someone about this, because even in hell people can cope and be healthy.

seriously, don't make me come over there and start smack with you!

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