Tag Archives: anger

Anger, violence and mental health: a response to Deborah Orr

I’d noticed some outrage on twitter about a comment piece by Deborah Orr, published on Friday afternoon, but had avoiding reading it until this morning. The headline is incendiary enough, but it was a sentence in her final paragraph that made me really furious:

It seems to me that lack of mental health, not gender, is the defining motivation of all violence.

At its most basic level, this statement is unsupported by evidence. Women are 40% more likely than men to have mental health problems, and yet over 85% of perpetrators of violent crime are men. If there really was a causal relationship between poor mental health and violence, we would expect women to be the majority of perpetrators of violent crime.

It’s in attempting to make such simplistic causal links that Orr’s analysis falls down. Fifteen years ago, Lori Heise proposed the now widely used ecological framework for explaining violence against women. Heise’s model recognises that men’s use of violence cannot be explained by identifying a single causal factor, but that it is the interplay of personal, situational and socio-cultural factors that result in violence.

Ecological model | Image from Centers for Disease Control and Prevention, 2004. Sexual violence prevention: beginning the dialogue. Atlanta, GA: CDC.

The ecological framework doesn’t discount poor mental health as a factor, but it makes it one tiny piece of the puzzle. And like any puzzle, one piece can’t operate on its own. When a person – usually a man – makes the choice to use violence, that decision is a product of factors at the individual, relational, community and societal level. In a country where the state is sanctioned to use violence to resolve conflict through overwhelmingly male military and police forces, where perpetrators of violence against women are rarely convicted for their crimes, and where sex and relationships education isn’t mandatory on the curriculum (let alone education about consent), identifying poor mental health as the primary causal factor for men’s use of violence seems absurd.

So Orr’s argument frustrated me in its absurdity. But it made me furious because it’s personal.

I was diagnosed with Borderline Personality Disorder in 2004. The first time I’d ever heard of it was when my male psychiatrist gifted me with the label. The diagnostic criteria for BPD is changing, with the publication of the DSM-5 last month, but in the previous version (DSM-IV) there were nine criteria. One in particular stood out and made me believe the diagnosis was incorrect: “inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).” I was being told that not only was I angry, I was potentially violent. That I was a danger to others.

Earlier this year, I requested my patient file from all those years ago. It shows that we discussed the diagnosis over three sessions and although I strongly resisted the diagnosis, after three sessions the psychiatrist’s notes still recorded that I met 6 of 9 criteria for diagnosis and a letter was sent to my GP informing her of the diagnosis. The barely legible scribblings over the many following sessions contain notes like “gets angry – self harm”, “holds anger in onto self”, “showing anger by rebellion, appearance; passive aggressively; repressed.”

And this leads me back to Orr. The pathologising of my anger and being told that I was potentially dangerous to others was about the least helpful thing anyone could have done for me. While my psychiatrist interpreted my anger in his notes, I did my best to avoid addressing my anger in therapy, because I didn’t want to meet the diagnosis I’d been given. I dropped out of psychiatric treatment after 18 months and got on with my life. But I never dealt with my anger.

Nearly ten years later, I’m back in therapy again. I have another diagnosis: moderate depression – an improvement on the BPD, major depression, alcohol dependence and anorexia nervosa I was labelled with last time. Hopefully older and wiser, I’ve found a female counselling psychologist through Mind who I know doesn’t do diagnosis. And what have we been working through over the past several sessions? Finally, after all these years, my anger.

So guess what, Deborah Orr? I’ve got a mental health problem and I’m angry: but I’m not violent. I choose not to be. And that choice has nothing to do with my mental health and everything to do with hundreds of overlapping personal, situational and socio-cultural factors in my life.

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Nearly halfway.

It’s been weeks between posts and I’m now nearly halfway through my 12 counselling sessions. They’ve not been easy, and every Thursday afternoon I decide not to turn up that evening. But I haven’t missed a session yet. And I’ve been on time for every one. Moira, my counsellor, interprets this as me being strong and caring for myself. I think it’s probably got more to do with needing to be ‘good’ and not get in trouble.

I’ve had talking therapy before, and yet still I’d forgotten just how hard it is. How much I hate it. How I always feel more miserable leaving the room than I did when I stepped through the door. After my first session, I felt completely drained. After the second, full of rage. After this week, session five, I was overwhelmed. I knew I was depressed, that I’ve been feeling low for a long time. What I didn’t know is how deep those feelings go.

Moira is a good counsellor. Probably the best I’ve had. And I like her. But trusting her is another thing completely. I haven’t trusted myself enough to be honest about how I feel. Alone, with no chance of anyone hearing me, I can’t say out loud the things that are in my head. So trusting her enough to put those words in the space between us is a big project. I’ve spent five hours of my life with her. Or rather, just over four hours, since we have 50 minute session together. I’ve spent more time with acquaintances on a night out. Why should I trust her?

She’s an expert at building that trust, or ‘rapport‘ as it’s probably better described. And yes, there’s a lot more trust between us after four hours than I would have with an acquaintance on a night out. But it still takes longer than that. And sometimes, the empathy that builds rapport can also create a barrier to opening up.

Yesterday, Moira verbalised that she was feeling an overwhelming feeling of guilt and suggested that if those feelings were being transferred to her, it demonstrated the strength of my experience of that guilt. I was glad she told me, and I understood what she meant. Body-centred countertransference is a concept I know well from my own work. When she said it, it helped me acknowledge the strength of my feelings and accept that they were real. But here’s the thing about guilt: it also made me feel guilty. Guilty for transferring that to her, and scared that I had no control over that transference.

I have another six sessions with Moira. In that time, I want to work towards being able to open up to the people closest to me – and specifically my partner, P – in a healthy way. But what if meeting those needs for myself, what if that process of opening up, actually hurts someone I love? What if I pass on my guilt, my anger, my rage? And if I transferred those feelings to Moira, without me having really opened up, what will happen to her if I let it all out?

So I find myself nearly halfway through my allotted 12 sessions and I’ve barely started saying anything that’s really real. I worry that I’m setting myself up to fail. I’m opening the floodgates, and I’m going to leave myself stranded.

And the most perverse thing? I don’t want more than 12 sessions. I want it to be over as soon as possible. I hate doing it. But I believe it’s helping.

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