Escaping the red mist

You may have heard the expression ‘mad with rage’ that is used to describe a person who is extremely angry, and is acting out of control. The term ‘mad’ in this context refers to losing touch with reality while rage is a state of intense anger or fury. The term ‘rage’ originates from the word ‘ragen’ — meaning full of rage — and can be traced back to many texts including that of Shakespeare.

While we all may have felt intense anger and rage as an emotion, lately, we have been seeing more people acting out in rage. Rage is an emotion but, in its outcome, can come in the form of myriad responses. Rage is an intense and uncontrolled anger which reflects an increased stage of hostile response to a perceived egregious injury or injustice.

Neurobiology of rage

No one chooses to be full of rage. It’s all about a neurobiochemical phenomenon. Various parts of the brain and chemical systems that fire up when someone is boiling with anger are: amygdala, hypothalamus, and the PFC (prefrontal cortex). The amygdala may perceive the ‘fight or flight’ response, leading to activation of the sympathetic nervous system which, in turn, can result in an increase in heart rate, blood pressure and muscular tension. The hypothalamus begins to adjust the response to stress and is connected to the ANS (autonomic nervous system); and release of cortisol occurs, which further contributes to anger. It is our PFC that helps regulate emotions and inhibits the impulse to indulge in inappropriate behaviors, which can get disrupted during rage, hence allowing the impulsiveness to surface. In fact, in traumatic brain injury to this area, extreme uncontrollable rage has been reported.

The chemicals that fire during rage are in the serotonergic, dopaminergic, glutamatergic and noradrenergic systems. The excess of dopamine and noradrenaline, alongside low serotonin levels, can spiral out impulsivity and aggression.

Rage is complex and has environmental, social, psychological and neurochemical reasons. Some of the most common causes of rage can be pinned down to an interplay of:

Underlying causes

* Mood disorders: Rage and anger can be the tip-of-the-ice-berg expressions of underlying depression and dysphoric manic episodes. Extremely anxious folks can also come across as angry at times;

* Perceived injustice: When people believe that they or others are being mistreated, they perceive injustice;

* Low frustration tolerance: Some individuals can get more easily unsettled at a lower threshold for tolerating frustration than compared to others;

* IEED: Intermittent explosive disorder involves repeated, sudden episodes of impulsive, aggressive, violent behaviour, or angry verbal outbursts in which one reacts grossly out of proportion to the situation;

* Trauma: PTSD can show in the form of rage, acts of rage during wakefulness and even during sleep, as there is intense hyperarousal and nightmares;

* Stress: Higher stress can lead to difficulty in managing emotions;

* Substance abuse: Drug abuse can cause lack of inhibition;

* Medical conditions: Traumatic brain injury, strokes and infection of the nervous system can present with rage;

* Personality traits: Certain personalities are more prone to expressing anger outwards. This cluster of traits is often referred to as Cluster B personality;

* Perceived failure or threat: As a mechanism to defend ourselves, we can sometimes attack others, even without enough provocation;

* Feeling trapped: Feeling stuck or trapped can cause one to resort to rage;

* Displacement: Displaying anger of one person on to the other is called displacement. At times, a person may not be able to express anger towards the real source and, instead, finds a softer target to direct the rage.

Rage can have a variety of expressions like verbal rage or using offensive language, high-pitch screaming, rude tone and even physical rage — meaning actual acts of violence and display of aggression that can physically harm another person. Rage can cause stress, destroy mental peace, physical grievances, relationship issues, loss to property and legal issues.

Varied facets of rage

* Pregnancy rage: This is an intense form of rage that pregnant women may endure during various trimesters of their pregnancy; it occurs due to hormonal changes;

Climate change rage: Lately, a few climate change activists have been showing their rage by resorting to attempts to damage famous pieces of art;

* Road rage: Most individuals may have faced this at some time while being in the driver’s seat. This is an uncontrolled anger of a motorist that is usually provoked by another motorist’s irritating act, breaking of rules etc., and may lead to expression of violence. This occurs due to perceived threat to the vehicle and ego;

* Air rage: Recent reports of air rage are growing, sometimes as bizarre as a man urinating on a female passenger. Air rage is the aggressive or violent behavior exhibited by the passengers or screw while onboard an aircraft. It can be due to many factors like alcohol consumption, feeling powerless and being confined in a closed space;

* Rage against doctors: Cases of doctors being at the receiving end of displaced anger are increasingly reported, where the family members are upset with the treatment outcome. Some reports say that nearly 75 per cent of doctors may have dealt with one or the other form of violence during their practice in India;

* Cyber rage: The Internet is an entire world of its own. Rage is often expressed in cyber spaces such as social media with the use of verbal display and acts of trolling.

* Sleep rage: REM sleep behavior disorder (RSBD) is a sleep disorder in which a person may physically act out vivid, often unpleasant dreams with vocal sounds and sudden, violent arm and leg movements during REM sleep. It is also called dream-enacting behavior.

How does one manage rage?

* Acceptance and acknowledgement;

* Ownership and zeal to try to change;

* Psychotherapy;

* Anger management: This is a specific kind of therapy that aids in understanding the source of anger, learning to manage it, and expressing anger in a healthier way. It can be done individually or in a group;

* Relaxation therapy: Learning to calm down the nervous system is an imperative step. Techniques like progressive muscular relaxation, yoga, deep breathing and meditation have all been proven to be useful;

* Medications: Certain medications are helpful in reducing the frequency and intensity of anger. These may be certain antidepressants, mood stabilisers and antipsychotics. Treating the underlying medical cause of anger is imperative;

* Sublimation: Learning to channelise the anger through a healthier outlet is advocated. This can be in the form of physical exercise or even an artistic expression;

* Lifestyle changes: Reducing stress and substance abuse, and sleeping better can help tremendously;

* Community support: Creating a safe space to help those suffering, and validating their feelings is important.

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