SECTION E – ANGER

E1. THE NATURE OF ANGER

Anger is a defensive response (reaction) to pain. If there is no response to pain (physical or emotional), pain becomes cumulative and devastating. Anger is inherently an action against or towards the source of pain.  If managed constructively, anger can be the tool which allows the caregiver to continue to give, despite the pain and suffering inherent in the task at hand.

Ironically, anger is the emotion most caregivers try to conceal and suppress, as it is perceived to be 'bad'. This perception is largely based upon confusion between 'anger' and 'violence', and the implied destructiveness that is 'automatically' associated with anger. This 'automatic' association between anger and destruction is a myth. However, in order to prove this, it is important to recognize the following facts:

1. People have a deep-seated fear of rejection. As a result, they suspect that expressing anger towards another person will result in the destruction of that relationship, which is essentially a self-created rejection by the other person. Few people want that to occur.

2. Few people have been taught how to express their anger in a way that harms no-one - including themselves. In the light of the fear of rejection described in point 1, and the absence of skills in safely expressing anger, the natural outcome is that caregivers feel pain, but bottle up their anger inside of themselves.  The pain is not responded to, and the internalised anger builds.  Within a short period of time, the caregiver's survival mechanisms kick in, causing them to detach from further pain and anger. Numbness and depression set in, and the caregiver often ceases to give care. Furthermore, the existing pain and anger seeps out into their world, typically poisoning relationships. Some would regard this process as the heart of BURN-OUT. Therefore, dealing with anger - in a constructive and healthy manner - is crucial to being a Caregiver, as pain and anger is part and parcel of the caregiving territory.

E2. MANAGING MISMANAGED ANGER

STEP 1 - RECOGNIZE THE VALIDITY OF ANGER

• Recognize that anger is a justifiable emotion - a healthy response to pain.
• Recognize that anger is a valid emotion.
• Recognize that anger is an activity - a response. Without expression, it becomes destructive.
• Recognize that anger is not violence - although misdirected anger can be destructive.

In caring for those who have serious illnesses, the caregiver deals with a wide range of confronting and anger-provoking situations, with the client or the client's family or friends, or even society. The final stages of life provoke emotional reactions and behaviors from people that often appear irrational, and which often run counter to general expectations of how people 'should' behave.

These confronting situations are often experienced as emotionally painful, and as forms of invalidation of the value and efforts of the caregiver, or the value of the client's dignity. As previously described, anger is a reaction to this emotional pain. Anger, in such situations, is clearly a constructive survival-based reaction to the situation.

STEP 2 - RECOGNIZE THE DANGER OF FAILING TO DEAL WITH YOUR ANGER

Research clearly and unambiguously shows that the suppression of this anger affects the caregiver directly or indirectly in the forms of more frequent illness, fatigue, depression, and emotional exhaustion - burn-out.

It is important to also recognize the effects on the client: People who are ill are highly aware and sensitive to the insincerity of those around them. The caregiver's suppressed anger may be incorrectly perceived by the client as being a reaction to the client's own processes, expressions, and behaviors.  Although this may indeed be true, it may also not be the case. Failure to deal honestly and constructively with the caregiver's anger can lead to client behaviors which may appear to be unreasonable and difficult to understand.

The following are typical forms of mismanaged caregiver anger, and some ways of dealing with them:

1. Bottling - being fearful to express your emotions (Not allowing your anger to be expressed).

Stop pretending the situation makes you angry as it will create an emotional distance between you and them.

2. Displacing - Directing anger at someone who did not cause the pain.

Direct your anger at the person you are angry at, not at some innocent victim.

Identify who you are angry at and then speak to them, not someone else.

3. Dumping - Unloading all your anger on one person.

This is dangerous as bombarding someone with your anger may make you feel better in the short term, it will create remorse in the long term.

STEP 3 - FIND HEALTHY WAYS OF DEALING WITH YOUR ANGER

Expressing anger is good only if it is done in a safe way. You need to express this anger as it is a signal that something is hurting or wrong. Pay attention to the signal and make it a point to understand the source of this anger. Doing this will enable and empower you to use this energy in a productive way  - seeking solutions to the situation.

1. Clarify who and what is causing your anger. Are you masking other feelings like fear, hopelessness, sadness or helplessness?

2. Write an ANGRY letter to the person you are angry at. You need not mail it, but it can help you identify the basis of your anger. It will also help get the feelings out of your head and heart.  Say exactly what you would like to say - be as irrational and rude as you like - pretend that you are saying it to them. When you have nothing more to add, throw the letter away or burn it.  Get the anger outside of your head and body!

3. Get support. Find supportive friends or colleagues with whom you can share your feelings and this too will serve as a method to understanding your anger.

4. Confront the person you are/were angry at, only once you have identified exactly why you are angry at them - perhaps write a letter to them first (refer point 2) to 'get the edge off'. Tell them why you are/were angry. Be specific, to the point, and do not attack them. Attacking leads to defensive responses, which simply makes things worse. Use words like "I feel..." and "I think..." .  Avoid "you make me feel ..." words and attacks. Set limits and boundaries, such as "I just want you to listen for a minute without interrupting me.  Then you can respond, and I will listen without interrupting you. Do you agree?".... once this has occurred ... "I have nothing more to add/ Do you have anything more to add ?" ... "THANK YOU FOR YOUR TIME". 

Good Example:      

          "I feel angry and upset when you do ... and say ..., because I think that you mean ...."

Bad Example:

          " You make me so angry when you do ... and say ...."

5. Anger is worse when you are not taking care of yourself. The situation is seems much larger and more out of control when you are tired, hungry, and rushed.  Watch your stress level. Nurture yourself properly. Take a break, get some rest, have something to eat, find some activity to distract you pleasantly for a while.

E3.  PERSONAL EVALUATION

1. List some of the caregiving situations in which you have found yourself feeling angry. Then mark those situations where you felt that it would have been inappropriate to express your anger.

List Anger-provoking Situations	Appropriate to express Anger?
a.
b.
c.
d.
e.
f.
g.