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Depression anger outbursts


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How do depression and anger interact?

Anger arises from a sense of threat to our emotional or physical well-being. It is also a reaction to, and often a distraction from, other negative emotions and the associated physical stress. Anger makes us direct our attention outward. Thus, it can be seen as a buffer against depression and the feelings and thoughts associated with it.

Symptoms of depression

Clinical depression is defined as a depressed mood accompanied by symptoms such as:

- Insomnia or persistent sleep;

- Feelings of worthlessness or inappropriate guilt;

- Significant unintentional weight loss or gain;

- Excitement or retardation of psychomotor development;

- Fatigue or loss of energy;

- Poor concentration or indecision;

- Recurring thoughts about death.

Anger is not listed as a symptom in the official guidelines for diagnosing depression. However, in recent years there has been an increase in research on the relationship between anger and depression. In particular, some studies have shown that anger can be a mask for depression.

Depression as inward anger

Psychoanalytically, depression has much to do with inward anger. This is an accurate estimate for many people. Heightened self-criticism, a deep sense of shame, and the accompanying feelings of hopelessness and helplessness associated with depression can be seen as the consequences of intense and constant self-esteem, a flurry of self-directed anger over dissatisfaction with oneself. They are combined with the discomfort and even fears associated with directing anger towards its true sources.

Inward-turned anger is often the result of childhood neglect, physical or emotional abuse. Feeling like a helpless child, a person can be confused and overwhelmed by the emotions of strong experiences. Subsequently, he may blame himself for such treatment, since all his well-being depends on his parents. This contributes to a predisposition to not feeling “good enough.”

Of course, other experiences both in adulthood and in adulthood can trigger depression. This can be significant loss and injury. However, the intensity of their impact can also be reduced by the degree to which previous experiences have contributed to emotional and mental stability.

Anger as a result of depression

Anger can be a result of depression, the result of frustration, hopelessness and irritability associated with depression. This trend is not mutually exclusive in that underlying depression may reflect inward anger.

The relationship between depression and anger is complex. The more accurately we can identify the details of this association, the more accurately we can diagnose and treat both anger and depression.

Research on the association between depression and anger

Research is increasingly looking at defining a specific association between depression and anger. In one study, 293 outpatients diagnosed with depression were assessed over a period of time to determine the extent to which irritability predicted temper tantrums. Although they may occur with or without aggression, this study looked at only those tantrums that were aggressive in nature. Questionnaires conducted showed that those who scored high in irritability had significantly more temper tantrums.

Another study attempted to better define the factors that contributed to the association between anger and depression. A group of 88 patients with major depressive disorder was assessed using the Beck Depression Inventory (BDI), the Multivariate Anger Inventory (MAI), the Cognitive Emotion Regulation Inventory (CERQ), and the Anger Scale (ARS). The researchers concluded that problems with emotional regulation and thinking about anger are key to the association of anger with depression.

Anger is not considered a mental disorder. However, it has been found to be present in a variety of psychological disorders, including emotional, anxiety, and depressive disorders. One review of this association highlights that, in general, anger is increased in these emotional disorders. However, more importantly for treatment, the study concludes that when anger is present, it is associated with greater symptom severity and worse response to treatment.

Much of our emotional suffering comes from judging our feelings. We may experience anger or sadness due to feelings of depression, anxiety due to anger, or depression and anger due to the presence of shame, and so on. These emotional responses to our emotions are often referred to as meta-emotions. In fact, much of the clinical work is focused on helping people become more self-compassionate, which includes developing the ability to recognize and accept the full range of emotions that are part of being human.

One study assessed the presence of anger and irritability in 536 people diagnosed with a major unipolar depressive episode. Frank irritability and anger were present in 292 participants. In addition, overt irritability and anger were associated with a significant increase in the severity of the depressive state, longer duration of the depressive episode, poorer impulse control, more chronic and severe long-term course of the disease, higher rates of lifetime comorbid substance abuse and anxiety disorder, more antisocial personality disorder, greater psychological impairment, decreased life satisfaction, and higher rates of bipolar disorder among relatives.

Conclusion

Research and clinical observations have confirmed the relationship between depression and anger. So, whether a person is self-medicating or seeking professional services for depression or anger, getting the details of that connection right is critical to improving well-being.

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From depression to aggression | Nauka i Zhizn

We will designate this problem with a dotted line - the questions of psychiatry as a science, as an aid in the treatment of mental illness in our country are very complex and will not fit into one article. But a crisis is brewing - the lawyer who killed five young people clearly did not receive psychiatric help at the right time. Fights of motorists, "madness" of fans, dog hunters - aggression is growing in society, especially among young people. In recent years, Russia has been among the countries leading in the number of suicides, and ranks first in teenage suicides. The total death toll over the past 20 years is huge - 800,000 people. Very often, teenagers during puberty (the age of puberty) become uncontrollable, drop out of school, find dangerous companies. How to distinguish where are the transient age-related deviations, and where is the disease?

"Deviant behavior" is not a rare psychopathological phenomenon. It seems that not only in humans. Photo by Vasily Klimov.

Doctor of Medical Sciences Yu. B. Mozhginsky. Photo by Igor Konstantinov.

Vincent van Gogh. Burning old man. 1890

M. C. Escher. Bifurcation. At a point or line of bifurcation, a mental process can change its course, and there are many options for its development.

M. C. Escher. Puddles and other worlds.

Milton Erickson - American hypnologist and psychotherapist (1901-1980).

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Doctor of Medical Sciences Yury Mozhginsky, psychiatrist, specialist in mental disorders in young people, answers questions about the causes and structure of mental disorders, about the connection between psychopathology, physics and philosophy. The interview is conducted by Elena Kudryavtseva.

— Yury Borisovich, how do the material (physiological) and spiritual components of the psyche interact and change?

- In the Middle Ages, it was believed that the mentally ill were possessed by "demons." In the 20th century, the materialistic paradigm prevailed, according to which mental phenomena are associated with the processes of excitation and inhibition in brain cells and with the movements between them of "messengers" - chemical mediators. But in this way we can explain a very small circle of mental deviations. The subtleties of human relations, actions, "overflows" of emotions still remain outside the scope of purely materialistic theories. The famous Swedish director Ingmar Bergman lamented and ironically about how doctors are trying to change his mood with “pills”, which means changing his self-awareness, his view of the world.

— What do you think, are "languages", paradigms (thinking models) of other sciences applicable to such subtle matter as mental illness?

- Not only applicable, but also give new knowledge. In different areas of science, there are points of intersection and common provisions. Even Vladimir Ivanovich Vernadsky spoke about fundamental methodological issues, basic, general phenomena in the sciences. Any specialist has to deal with them, in whatever area he works. Albert Einstein dreamed of creating a theory for "all events occurring in nature" that would describe the ever-changing picture of the world. He expressed the conviction that "the train of thought developed in one branch of science can often be applied to the description of phenomena that appear to be completely different."

— Are there "markers" in the human body that can detect mental disorders and show the development of a mental illness, help diagnose and suggest ways of treatment?

- Psychopathology is located, relatively speaking, between the "exact" science of physics and the "abstract" - philosophy. Of course, there are no direct analogies between the "events" that become the subject of study in these three disciplines. It is possible, probably, to speak only about the degree of conformity of general regularities in the processes under study.

Today, the results of fine biochemical studies of the brain, measurements of the concentration of neurotransmitters - "signal carriers", "messengers" involved in the processes of excitation and inhibition in the central nervous system, are described in detail. But the conclusions about their role are the opposite. For example, according to numerous studies, the level of the mediator serotonin in different parts of the brain in patients with depression is either elevated or reduced. And the mechanism of action of antidepressants is sometimes directly opposite: some drugs increase the concentration of serotonin, while others, on the contrary, reduce it. Nevertheless, both types of antidepressants help. I have repeatedly heard this opinion of biochemists: now there is a fashion for serotonin, but time will pass, and another fashion will appear, for some other chemical compound. We are doomed to constantly clarify the role of mediators in the development of depression until a new paradigm emerges in which the role of chemical "vehicles" is not the main one.

- Depression manifests itself in a depressed state, fears, apathy, longing. What are the forms of this disease and when should one seek medical help?

- Reactive depression is provoked by conflicts in the family, problems at work. The dream is upset, the person is fixed on the difficulties that have arisen. Usually, the emotional reaction to a strong experience fades over time. But ordinary stress can develop into a qualitatively different, more severe condition, accompanied by biochemical changes in the metabolism in brain cells at the molecular level. This is how endogenous depression appears with physical, “material” symptoms (fluctuations in blood pressure, weight loss, disorders of the gastrointestinal tract). To use physical definitions, this transformation of an ordinary experience into clear depressive symptoms is like the transformation of a "field" into a "substance".

Let me give you an example from a newspaper article. A young man went home from work. In the yard he went into his garage and hung himself there. When he was going home, his colleagues did not notice any change in his mood. Subsequently, it turned out that the day before he had experienced an objectively minor mental trauma. And yet, a minor problem led to suicide. There is a transition, "quantization" of everyday, ordinary stress exposure into symptoms of depression with thoughts of suicide. The energy of the "field", "psychic energy", according to Freud-Jung, passes into the "matter" of depression.

It is clear that a sad mood, loss of interest in life, fear and anxiety can be observed in any person. The American neuropsychiatrist Gustav Weibrecht, back in 1970, spoke in this regard about "the wide boundaries of the average norm with its smooth transition to psychopathic variants." In other words, there is a continuity of depressive experiences from mild reactions to severe melancholy with lethargy or anxiety, suicidal attempts, when medical help is indispensable.

The state, which at first looked like a normal reaction to stress, gradually acquires a pathological color, transforms into a self-regulating internal process. At the same time, there is no linear (progressive, uniform) increase in pathology. Unfortunately, we cannot give an accurate prediction of the course of depression. Its depth does not depend on the simple accumulation of prerequisites (stressors, personality traits, heredity, etc.). This circumstance is also reflected in the treatment: a simple increase in the doses of an antidepressant does not increase their effectiveness.

— It has always been difficult to manage with teenagers: it is sometimes impossible to reach an agreement, to get through to them. But it seems that today the gap between "fathers and sons" is getting even deeper, and aggression from the youth is growing.

- The transitional age is a life span from 12 to 18-25 years. Behavioral disorders are exacerbated mainly in 14-16 years. Teachers and parents apply “logical” approaches to the child: they teach the rules of “good manners”, the observance of the “senior-younger” hierarchy, appeal to moral laws, etc., but often to no avail.

So-called deviant behavior is the most common psychopathological phenomenon observed in adolescence. It falls “like snow on the head” of unsuspecting and unprepared parents and teachers. Children become naughty, irritable, rude, show unmotivated aggression, do not come home on time, use intoxicants, refuse to go to school. A common feature of such disorders is the uncontrollability of children, the inability to "correct" their behavior. All attempts to reason with the child are in vain. He doesn't seem to understand what they want from him. The growing conflict of "fathers and children" (in modern society with its disintegrating ties, it would be more correct to speak of the conflict of "mothers and children") leads to physical aggression.

That's when parents find themselves in a dilemma: admit the fact of a mental illness and turn to a psychiatrist or hope that "everything will pass", that there is no illness and you just have to "wait".

— But why do the educational measures taken by parents not work in most cases?

Let's remember the different coordinate systems in the theory of relativity. For example, a moving object is a train and the station it "flies" past. The transitional age can be considered as a “movement” or “train”, and the mature age as a static formation, a “station”. If we talk about mistakes and miscalculations in the behavior of adults, then this is “frozen evil”. Compared to adults, a teenager is more flexible, more “potential”, he has more vital energy, more unknown. Childhood is “when everything is still possible”. One way or another, the speed of events in a teenager and an adult is different. In general, adult norms of behavior, moral rules are some kind of “frozen structures”, while in children they are plastic, multivariate, and changeable. And it is precisely this fact that causes misunderstanding and, accordingly, rejection by “frozen structures” that recognize only their own values ​​and rights. In these systems, any event is evaluated differently. "Force", gravitational fields, described in the theory of relativity, in a sense, resemble the mechanisms of crisis behavior of adolescents. As you know, large physical bodies change the forces of gravity around them. For a teenager, a group of peers becomes such a “body” with powerful gravitational energy. It forms a "force field" into which young people fall. Their mental reactions and behavior are distorted, and independence is sharply reduced. Actions become incomprehensible, frightening, immoral. It is difficult, sometimes impossible, to stop a child from committing rash actions and return, as they say, to the true path.

— And how, in your opinion, does the development of mental pathology occur: does it accumulate gradually, or can any events, influences cause a sharp deterioration in the state?

- Mental illness develops non-linearly. A simple accumulation of pathological elements and a smooth achievement of some pathological result is not observed. A qualitatively different level of mental disorder manifests itself not as a result of the “growth” of previous symptoms, but as a result of some kind of “accidental” step. Depression can develop into aggression. There is a “point, or line, bifurcation”, suggesting that after passing it, the system has several different paths for further development, further life. Which one will she choose? Nobel laureate, Russian-born American physicist and chemist Ilya Prigogine argued that the set of these possible paths is limited. There are a number of signs that indicate the most likely course of the disease, but its exact development is still impossible to predict. Even if we collect many features in one row, there will always be an element of uncertainty before the “bifurcation point”. In this regard, the fate of suicidology, the study of suicide, is indicative. There are two directions in it: some scientists believe that suicide is a consequence of depression, others admit the possibility of committing suicide attempts by healthy, non-depressed people who find themselves in a hopeless situation. But if the first construct is correct, then prescribing antidepressants should reduce suicide rates. However, in reality, a different picture is observed. Studies show no significant differences in the frequency of suicide attempts in patients taking antidepressants and patients receiving placebo (that is, an indifferent chemical compound).

Not always visible depression threatens suicide. On the contrary, suicides are often committed by active, sociable people. Yes, they may have stress, everyday problems, but ordinary ones, "like everyone else." Of course, what has been said should not be understood as a call to refuse treatment in the hospital and prescribe psychotropic drugs to depressed patients. We are talking about a probabilistic approach to predicting the course of the disease.

— But it's impossible to force all of us to behave equally correctly under the influence of total control over each person, as in Yevgeny Zamyatin's novel "We", written almost 100 years ago?

“Of course not. Ilya Prigozhin critically assesses the idea of ​​optimizing certain aspects of behavior that dominates biology and sociology, when a “comforting picture of nature as an omnipotent and rational calculator ...” is drawn, when they talk about “universal rigorous progress.” In fact, there is a "fundamental uncertainty" of historical and biological processes, and hence in human behavior. The system may be in a "strongly non-equilibrium region", and at this moment it has the property of increased adaptation to external conditions. This means that the system itself contains such opportunities, such functional resources, which vividly respond to external flows, even of weak strength. We find many similar cases in history, in the "dynamics" of the masses and states: some unpleasant incident suddenly turns out to be the "last straw" for the outbreak of revolt.

The stage-by-stage combination of necessity and chance constitutes the “history of the system”, one might say, in relation to psychopathology, the “history of the disease”.

The same psychopathological symptoms entail different variants of the development of the disease. For example, two teenagers have a puberty crisis. One of them demonstrates his hatred for loved ones, threatens to kill his parents, shows sadism, ties helpless old people to a chair. In another teenager, aggression manifests itself weaker - only in verbal abuse. It is interesting that in the first one the aggressiveness is smoothed out over time, while in the second there is an increase in hatred, which becomes delusional.

It turns out that in the first case, all these symptoms were temporary. After the "bifurcation point", the system "left" the period of instability along one of the possible lines - towards the correct formation of the personality, socialization, recovery. In the second case, the system "chooses" a different path of development - illness, degradation of the individual. This choice was made contrary to the initial symptoms.

The first teenager, for example, had gross disorders of ethics, that is, ideas about morality, good and evil; showed emotional dullness. One could assume the worst, say, schizophrenia would begin, but the opposite happened. In the second case, the prognosis at first seemed more favorable, since there were no gross symptoms of personality damage, sophisticated sadism. It could only be a neurosis, but a schizophrenic process developed. So in both cases, predictions based on a "critical", positivist approach, taking into account only the sum of symptoms, did not materialize.

Depression can lead to delirium, obsessive thoughts - to schizophrenia, neurosis. Aggression can pass almost without a trace, or it can become a stage, for example, of schizophrenia. Prigogine speaks of the "arrow of time", irreversibility, closely associated with the appearance of random deviations. Probably, this is close to what Anna Akhmatova wrote about: “horror”, which is called “the passage of time”.

— And what is depersonalization and how does it manifest itself in adolescents?

- This condition includes, in its extreme variants, a "feeling of loss of feelings", painful insensibility. A teenager realizes that he has lost the ability to empathize, and is tormented by this. There are less pronounced forms of depersonalization, for example, a vague feeling of change in one's feelings, one's "I", a change in one's outlook on life, the fading of the colors of the outside world, and the loss of the brightness of impressions. But this is a transitional state that contains the potential of other mental symptoms: fear, anxiety, delirium, aggression.

The behavior of such a person is devoid of logic, integral motivation, divorced from the realities of life. A patient in this state can talk about a strange feeling of his own duality, as if there is a kind of “second self” inside him. He becomes irritable, aggressive, mocks loved ones. These symptoms are incomplete, unstable. Subsequently, they can transform into schizophrenia, into pathological aggression. But they can also disappear, and then there will be an acquisition of personality. It is also possible "cementing" of pathological character traits (psychopathy).

By the way, another important transitional syndrome should be considered depression. A person who has been in a depressed state for a long time, especially mild and moderate, is prone to drunkenness, drug use. Depression in some cases precedes the development of obsessive phenomena. Similar transformations can be observed, in particular, on the example of "transformed aggression" in a teenager. It happens that his mood decreases for a long time, he is gloomy, gloomy. Statements about the futility, uselessness of one's own existence, about the loss of the meaning of life "break through". He says to his mother: “Why am I so unhappy?”, “Why did you give birth to me?” In such experiences, the motive for suicide sometimes does not sound so clear, the depressive ideas themselves are also not structured. They are, as it were, in the embryo, in potency, but they have their own inner, hidden dynamics.

At a certain stage in the development of such a state, the next, “ordinary” conflict quite unexpectedly grows to incredible proportions. The child has physical aggression, uncontrollable behavior, “complete insanity”. A teenager commits seemingly unmotivated acts: runs away from home, threatens with a knife, etc. Parents are forced to resort to the help of neighbors, call the police, call the psychiatrist on duty. This explosion of aggression speaks of the transformation of mental pathology into a qualitatively new state.

— What can precede such an explosion? Can it be foreseen?

— It should be noted that the transformation is always preceded by a hidden dynamic. It is manifested by a number of external symptoms: gloominess, thinking out loud about the hopelessness, worthlessness of life, and so on. This state of inner emptiness is similar to the so-called latent depression (the term of the Spanish psychiatrist Juan-Jose Lopez-Ybor). It appears, as it were, from “nothing”, but in it, in this “nothing”, a destructive energy of enormous power is hidden. The "emptiness" develops into a kind of "possibility". If there is a possibility, then there is also a "bifurcation": the event must have alternative development.

Ilya Prigogine complained that the laws of physics are used in biology and sociology in a straightforward manner, in a simplified positivist paradigm. According to this approach, evolution, a process in a certain biological or social system, goes up all the time, towards progress. In fact, everything is more complicated, in a sense more fatal. Any system has, conditionally speaking, two trajectories: deterministic (definite) and unstable, fluctuating. If in relation to the first it is possible to apply development formulas and predict the future, then the second is unpredictable.

The disease algorithm is not visible, but it has already been “written”. It exists in potency and waits for "the slightest fluctuations of the environment" for its incarnation at the "bifurcation point".

- But in addition to the drug effect in psychiatry, another brainchild of the twentieth century is also used - psychoanalysis. How does it relate to clinical psychopathology?

- Of course, the successes of "materialistic" psychiatry are indisputable: we can, relying on the theory of mediators, treat psychoses, epileptic seizures. But no matter how hard scientists strive to improve the “chemical” approach, psychotropic drugs help only 50% of cases. Not to mention the side effects of drug therapy, sometimes leveling its positive effects. This is why psychotherapy is so important.

Clinical psychopathology balances at the intersection of everyday reality and the changeable, subtle, relative, transcendent (according to Immanuel Kant) world. This circumstance probably determined the emergence of the psychoanalysis of Sigmund Freud, the analytical psychology of Carl Gustav Jung. Later, they were supplemented by the psychosynthesis of the Italian psychiatrist Roberto Assagioli, the theory of perinatal matrices by the Czech psychotherapist Stanislav Grof, the ontopsychology of the Italian psychologist Antoni Meneghetti, and others.

Appeal to the subconscious is the main thing in the methods of the famous American psychotherapist Milton Erickson. For example, he says to the patient: "I don't know how and when your behavior will change." There is a statement in this phrase ("will change"), which is colored by non-directiveness ("I don't know"). This disarms the patient, who is prepared to resist the "violence" of the therapist.

- Tell me, is it possible to help teenagers using the Erickson method? In his practice, a lot of cases of cure are known.

- I'll start from afar. Aggression in adolescents is a manifestation of vital will, an attempt to remove obstacles in its path. This is society, rules of conduct, parents with their "mossy" moral attitudes. The influence of the "street", the company of peers acts as a trigger. Manipulation, development of motives and goals of behavior take place here.

Philosopher Mikhail Epstein believes that it is precisely unrealized opportunities that have a special emotionality. Even before realization, the possibility of this or that action is strongest. Remember the anticipation of the holiday, which is stronger than the holiday itself. The state of uncertainty is able to activate the energy of the subconscious, stimulating the true work of the individual, including overcoming chronic neurotic, depressive complexes. The subconscious mind chooses the most correct and effective ways. In Erickson's psychotherapy, his stimulation of the subconscious leads the patient to solve his real problems, to fight his "cockroaches". At the same time, fruitless defensive reactions that only deplete the energy of healing are significantly reduced or completely disappear.

— Please remember those cases from your practice when such methods helped.

Let's say there was such a case. The first conversation with one patient, I still do not know her complaints. I suggest that the girl herself choose where it would be more convenient for her to sit during the session. She sat down next to the wall. She said that at school she always sat against the wall. She had few school friends. It became clear that the girl was unsociable, shy. She herself remembered how she went to study at the university, where her grandmother taught. They didn’t like her there, they thought that she was “thieves”. From this point on in our conversation, the patient was driven by her memory. Her mother died when she was one and a half years old. Her father is overprotective of her. At his insistence, the girl entered the Faculty of Mathematics.

She continued to tell, although I didn’t even ask what her problem was, that is, a properly started conversation activated the subconscious, and memories “poured” from there. They lined up in the right chronology. The patient herself told everything, almost without my questions.

She can't live with her dad. When they went to rest together “on the water” in the summer, she suffered, could not bear the presence of her father. She remembered that she had a dream in which she was with her dad "like a husband." Here is the answer! Her father took great care of her, transferring his love for his dead wife to her, to his daughter. This weighed on the patient. And she herself said: “We need to divorce dad.” She became firm in this intention. It only remains for me to recommend to her what she herself, her subconscious, has developed. The girl stopped fighting with her father, made some concessions: she began to answer his calls, come earlier, warn about her plans. But she firmly decided to move out of the apartment after a certain time. Finally, I recognized all her complaints: insomnia, depression, seizures, exacerbations of gastritis. But within a few days, her condition improved. She stopped taking sleeping pills. The truisms recommended by Erickson also played their part. An example is the words: “It is dangerous to take off, if we don’t take off, we will die. Hence the conclusion: we will take off.

I emphasize that it is very important that the patient herself remembered everything, she herself outlined the problem and naturally accepted the ways to get rid of it. Here you can see the mechanism of activation of the subconscious. The forces dozing in "nothingness", which were waiting for a signal to activate, turned on. The signal is genuine, non-directive.

When treating and communicating with young people, it seems to me very important not to dictate, but to lead them to the right decisions themselves. And do not miss the time when the activation of one's own spiritual forces is still able to help in curing the disease. Of course, it is easier to expect a miracle, to think that the problem will resolve itself somehow. Non-recognition by relatives of the painful nature of inappropriate behavior, fear of turning to psychiatrists was once called in the USA the syndrome of the 50s: “it’s a shame if there is a mentally ill person in the family.” We have this syndrome for many reasons exists today. Postponing the intervention of a psychiatrist where it is needed can lead to increased neurosis, depression and serious crises, and in some cases, disaster in your child's life.

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