You At Your Best

By suzANNe rHoDes NWA DeMoCrAt-gAzette Do men have a harder time controlling their anger than women? At Northwest Arkansas Psychiatry, a MANA Clinic in Springdale, Drs. Randall Staley and Lance Foster believe cultural norms play a significant role in anger management. As Foster explained, "Men feel they need to be perceived as strong and not having weaknesses. 'That I have a problem' is a weakness." "Men are more often noted to have anger management issues," Staley added. "They tend to be more boisterous and physical and to seem scarier than what a female would be, and so they're recognized as having anger management problems more than females. Women tend to internalize. But I don't know that I'd actually say men are more prone to anger issues than women." Both psychiatrists agreed that the emotion of anger, usually a reaction to a stressful and unpredictable situation, is neither good nor bad. It's when a person's anger harms their family or other relationships, or causes repeated job losses or creates legal issues, "that's when anger goes from healthy to unhealthy," Staley said, like the patient who admits, "I've been punching holes in walls, I've been threatening my wife, I've been fired from three jobs." Family members can assist in influencing their angry loved one to get help, "but it's important to underline that there's safety in numbers," Foster said. "Many times, particularly with anger management, people feel unsafe in confronting the behavior or confronting them without help. So sometimes it needs to be more than one person or be done through intermediaries, like talking to the PCP [primary care physician] about it, talking to clergy, being able to start the conversation in a safer way." Both doctors find that in their practice, anger issues are frequently triggered by substance use, whether alcohol, steroids, marijuana or other drugs. "You've got to treat the underlying issue," Staley said. "I've got individuals that the cause of their anger is from childhood trauma. Growing up with domestic violence, being personally, physically or sexually abused — that will sometimes come out as an externalizing of those emotions we identify as anger." He mentioned that veterans traumatized by war are often haunted by threats "real or perceived to their physical integrity. Some were in situations where their life was at risk 24/7. Now that they're back in a situation where that's not the case, even small things can make them feel their physical integrity is threatened, and they end up lashing out as a protective factor for themselves." Physiology is a factor, too. "There are differences between male and female and how they respond to things," Foster noted, adding that cultural norms come into play – "men going to war, women not going to war for a big chunk of our history, men being the head of the household, women not being. Perceived male domination can come out in physical ways as well as emotional and mental ways." Both doctors agreed that these norms are beginning to shift and that over time social expectations toward men will change positively. Treatment at the clinic for individuals with anger issues is comprehensive. "The type of work we do as psychiatrists is more evaluation, medication treatment and therapy that goes along with that. Specific therapies for anger management are usually done either through education practices, like classroom settings, or through therapy work," Foster said. The most successful outcomes are seen in the patient's willingness to accept the recommendations. "I've had patients who've come in and said they weren't going to do anything different, they didn't have a problem, they were only here because the court told them they had to be or their job told them they had to come. And then there are individuals who voluntarily realized, 'Oh, my goodness, I'm harming my family – I'm going to do something different,' and those have really good outcomes that are lasting." As Foster observed, "The therapeutic, educational and group work is key, and that requires someone to be invested." Investment means "continuing on in the work for a longer period of time [than treatment] or life even, and investing in those principles and ideas as part of the changed life." Those principles include communication – being in tune with your feelings, "being able to step outside yourself and look at the issues going on – insight. Community is key. Good health habits. It gets worse in isolation." Staley recommends "using healthy coping mechanisms whenever you get angry. Being able to communicate and say, 'I'm getting upset, I'm getting angry. Can you give me five minutes to cool off?'" Finding an outlet for anger, like a hobby, activity or other beneficial things is good "to have in your toolbox to deal with your anger." anger management means investing in healthy lifelong principles randall staley, M.D. lance Foster, M.D. Treatment goes beyond medication and therapy at NWA Psychiatric Clinic 8 | YOU AT YOUR BEST | nwAdg.cOm/YOUATYOURBEST AUgUST - mEn'S HEAlTH | SATURdAY, JUlY 27, 2019

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