Mass shootings, "Mental Illness", and Anger

My friend Paul lives in Las Vegas, he and his wife both teach psychology at the University of Nevada. In the last few years I’ve gone out there many times to guest-lecture in Paul’s classes, talking about borderline personality, trauma, homeless adolescents, and what it is to be a therapist. I was there a week before Stephen Paddock - for no identifiable reason - murdered 58 people, and shot hundreds of others. After one of these rampage killings it’s now familiar for us to hear one side calling for gun control, and the other side calling for increased “mental health services.” As a therapist, I can’t help but think of how broad and general this last term is, as an infinitesimally small proportion of people struggling with “mental health issues” become rampage killers. It would be more helpful to be more specific, and name as the issues violence and anger. Of course, not all anger is a problem. A healthy sense of outrage led to the formation of this country’s foundation, and that same sense of social justice has contributed to significant expansion of human rights. Anger grounds assertiveness, and the maintenance of healthy boundaries, so that we can be safe. And anger-driven aggression used against legitimate threats is necessary for our safety and survival. But anger, I submit, destroys lives, and is often pathological. There is no specific diagnosis for anger. Children get diagnosed with “Intermittent Explosive Disorder,” and depressed children often present as irritable. Even for adults, there’s a type of Depression called “Irritable-Reactive.” Many individuals with PTSD (and other Trauma-related diagnoses) struggle with physical stressors that often show as anger. In my experience as a therapist I’ve had success treating this kind of anger, because the anger is a symptom and not central to the individual’s way-of-being-in-the-world. It’s possible, with these individuals, to identify reasons for them to learn to decrease and regulate the anger they’re experiencing, and expressing. Once we can find motivations, we can find ways to help them see how ineffective their anger is, and the extent to which their anger is moving them away from their goals, rather than towards. But there’s another kind of anger that doesn’t come-and-go. It seems to belong to what we call “Personality Disorders,” (PD’s) named that way because the personality traits are fixed and maladaptive. A number of PD’s involve anger: “Paranoid PD” has symptoms of suspiciousness, and tendencies to bear grudges persistently; “Antisocial PD” features a lack of empathy and tendencies towards self-righteousness; “Narcissistic PD” emphasizes grandiosity and a need to be admired; “Borderline PD” features unstable moods, powerful fears of abandonment, and tendencies to be highly reactive. In my career I’ve met many individuals steeped in anger, who couldn’t or wouldn’t give their anger up. Anger felt too good, even though of course it also felt bad. For some the anger was identified with specific people and events. With others the anger had generalized onto the whole wide shitty and corrupt world. With these folks it was incredibly hard to help them find a motivation worth changing for, a motivation larger than the illusion of power anger offered. One man’s anger made him think he could predict the future. Another let his anger destroy three marriages, his idea being that in all of them, he was the aggrieved victim. There have been times I’ve seen this kind of anger and it’s felt to me like psychosis, because it so obviously divided the individual from any kind of holistic or realistic understanding of the way the world works. Anger separated the person, placed them in their own persecuted perspective, a position no one could ever possibly share with them. The fundamental aspect of this kind of anger is loneliness - separation, alienation. And it is these feelings that, I think, allow a person to act against the world. To punish it, to divorce oneself from it, to act violently against it - to destroy it within one's self, and in that (psychotic) way, become a kind of hero. In therapy, I can talk to angry people about their thoughts and feelings. I can talk to them about their behaviors. I can talk about their past, their families, the abuse and neglect they suffered through. I can even talk to them about their spiritual values - the pull of the dark side, the Satan and Vader inside. But if our meetings don’t help them find anything to care about - anything that can pierce their anger and touch their heart - then I think they stay lost. And it’s very, very sad. It's a tragedy.