PubMed · 8990997
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S Chapman. Wrath.. https://doi.org/10.1136/bmj.313.7072.1593
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Research on the nature of anger and how it differs from other emotions is reviewed. Dimensions that differentiate disturbed from normal anger are also discussed. Based on the research and results of several reviews of anger treatment, an ideal treatment package for the treatment of anger is presented. The components include: (i) addressing motivation; (ii) cultivating the therapeutic alliance; (iii) managing physiological arousal; (iv) fostering cognitive change; (v) implementing behavior change; (vi) providing environmental supports for change; (vii) teaching relapse-prevention skills; and (viii) initiating restitution and reintegration. Also, the articles describing experiential, self psychology, cognitive-behavioral, Buddhist, and systems approaches to anger are compared and contrasted. Each of these treatment approaches is compared with the ideal treatment components.
The recognition that the onset of cardiovascular events follows a circadian periodicity and is frequently triggered by physical or mental stresses has created new possibilities for disease prevention. Morning peaks in occurrence are now well-documented for acute myocardial infarction, sudden cardiac death, transient myocardial ischemia, and ischemic stroke. The morning increase in events begins after subjects assume an upright posture and start the day's activities, during a time of sympathetic nervous system activation. Additional triggers of onset include heavy physical exertion, sexual activity, and anger, the risks of which have been quantified in the Determinants of Myocardial Infarction Onset Study. A general hypothesis of the triggering of coronary thrombosis has been proposed. The process begins with the development of a vulnerable atherosclerotic plaque, which may become disrupted by internal forces or by external hemodynamic or vasoconstrictive changes. Once disrupted, the plaque becomes a thrombogenic focus. An occlusive thrombus is more likely to form if other factors come into play to increase coagulability and vasoconstriction. From a clinical standpoint these findings provide theoretical support for the use of long-acting agents to provide adequate anti-ischemic protection during the higher risk morning hours in patients already taking anti-ischemic medications. From a research standpoint this new information on triggering provides clues to a mechanism of onset that might lead to more effective preventive therapy. Because most deaths from coronary artery disease occur before any type of acute therapy can be given, further efforts to explore this new field are warranted.
This article argues that it may be illuminating to look at breast cancer also from a cultural point of view. It is built around a hypothesis which proposes that, on a certain level, breast cancer can be seen as an attempt by women to rid themselves of the breast as a symbol of some of the essential aspects of their femininity, as feminine qualities are seen as of little import in today's industrialized Western world. The argumentation begins by showing that there is a certain type of personality which is prone to cancer: One of the main characteristics of this personality is either the repression or the inability to express or feel anger. Furthermore, studies on sex-roles and defence mechanisms have shown that persons with feminine sex-role orientations use more repressive, self-blaming defence mechanisms. The author finally goes on to discuss the psychic mechanisms thought to lie behind somatization and cancer as a psychosomatic disease.