Wednesday, June 07, 2006
I.E.D.
Improvised Explosive Device? No, not this time, but close. Today we're talking about Intermittent Explosive Disorder, which is apparently being tapped as the root of so-called "road rage".
Road rage, temper outbursts that involve throwing or breaking objects and even spousal abuse can sometimes be attributed to the disorder, though not everyone who does those things is afflicted.
By definition, intermittent explosive disorder involves multiple outbursts that are way out of proportion to the situation. These angry outbursts often include threats or aggressive actions and property damage. The disorder typically first appears in adolescence; in the study, the average age of onset was 14.
The article goes on to discuss how underdiagnosed the problem appears to be, with a little alarmism, brow-furrowing and hand-wringing thrown in for good measure:
"It is news to a lot of people even who are specialists in mental health services that such a large proportion of the population has these clinically significant anger attacks," [health care policy professor at Harvard Ronald] Kessler said.
And then we get to the meat of the matter:
...the disorder involves inadequate production or functioning of serotonin, a mood-regulating and behavior-inhibiting brain chemical. Treatment with antidepressants, including those that target serotonin receptors in the brain, is often helpful, along with behavior therapy akin to anger management...
Frankly, I find all of this very disturbing, but probably not for the reason the article wants me to. As near as I can tell, from this article and others printed since the study was released, I'm a pretty good candidate for having the problem.
I remember a very early incident from my childhood. I know where we were living, so I was between 2nd and 6th grade, or about age 8 to 11. My brother, who is a year younger, had discovered and picked the absolute largest dandelion we had ever seen. I thought it was kind of cool, but then something happened, I don't remember what, and I wound up sitting on the sidewalk in a bit of a funk. Maybe Dad yelled at me or something, I don't know. Anyway, my brother was sitting next to me, poking the flower at me, trying to get me to smell it. I think he was trying to cheer me up. Suddenly something just boiled up inside me and I grabbed the flower and broke it.
I can still see his sad little face as he went bawling to Mom, and hear him telling her that I broke his flower. I can hear my parents demanding an explanation for my actions, which to this day I'm unable to give. I've replayed that scene countless times in my head, and I still don't understand what it was that made me do it. I've been tortured by it for years now, and on several occasions have almost blurted out an apology while talking to him on the phone. But I've always held back because it feels foolish to bring something up 25 years or so after the fact. I've convinced myself that he doesn't even remember it. And yet, there are times when I wake up in the middle of the night and all I can think of is that sweet little kid trying to cheer up his big brother, and having his heart broken for his troubles. I want so badly to be able to go back and undo that moment.
In the years since, there have been other moments like it. Everything will be just fine, and something small will happen that irritates me in just the wrong way. The anger rises like a wild beast, a roaring plume of red-hot lava flowing up from somewhere deep in my guts. Many times it's all I can do to just express it in a way that minimizes damage to my surroundings. All I can know or feel is the burning rage, the absolute need to destroy something with my bare hands if at all possible. I don't know if that is somehow expressed chemically in my brain or not. Maybe there's a sudden shortage of one chemical or overabundance of another. Maybe all it would take is a pill of some kind to make it all go away. That would be so nice.
It's also something I will fight to never do. No pill is ever going to tame me, if I have anything to say about it. I proceed from an absolute conviction that I -- meaning the Mind that is me -- am ultimately responsible for my every action. I cannot and will not accept that I am a victim of some random chemical process. Subjectively, it feels as though I'm being run over by a freight train when the red hot lava beast awakes. But my entire worldview depends on the unwavering belief in the fact that I have a choice. I can choose to stand in the path of that freight train and try to stop it. I can choose not to blow up. I can choose to remain calm. And if I do not choose to do any of these things, then I have chosen my subsequent actions.
I. Am. Responsible.
I will not allow some chemical to dictate my moods and behaviors. Brain is a wonderful thing, but I remain convinced that Mind is more powerful. If it does boil down to chemicals and hormones, then the interface is two-way. If chemical A makes you think one way, then thinking another way will produce chemical B. If you've seen A Beautiful Mind, you've seen a man with a different problem, but the same solution. John Nash is my hero in this regard. Nobody has forced me to do the things I've done. I own it all. And in claiming responsibility for my screwups, I gain a measure of freedom that drugs would deny me.
It's been a long hard road. Some times are easier than others. I've fought compulsive behavior that arises out of this problem or some common root. Some of those behaviors I've defeated. Some I'm still working on. It's easier to shut down the beast nowadays. As it says in James 1:20, the wrath of man does not produce the righteousness of God. Sometimes all I need to do is remember that verse, and I'm OK. So I say screw the pills.
And Jim, if you're reading this, I'm sorry I broke your dandelion.
Road rage, temper outbursts that involve throwing or breaking objects and even spousal abuse can sometimes be attributed to the disorder, though not everyone who does those things is afflicted.
By definition, intermittent explosive disorder involves multiple outbursts that are way out of proportion to the situation. These angry outbursts often include threats or aggressive actions and property damage. The disorder typically first appears in adolescence; in the study, the average age of onset was 14.
The article goes on to discuss how underdiagnosed the problem appears to be, with a little alarmism, brow-furrowing and hand-wringing thrown in for good measure:
"It is news to a lot of people even who are specialists in mental health services that such a large proportion of the population has these clinically significant anger attacks," [health care policy professor at Harvard Ronald] Kessler said.
And then we get to the meat of the matter:
...the disorder involves inadequate production or functioning of serotonin, a mood-regulating and behavior-inhibiting brain chemical. Treatment with antidepressants, including those that target serotonin receptors in the brain, is often helpful, along with behavior therapy akin to anger management...
Frankly, I find all of this very disturbing, but probably not for the reason the article wants me to. As near as I can tell, from this article and others printed since the study was released, I'm a pretty good candidate for having the problem.
I remember a very early incident from my childhood. I know where we were living, so I was between 2nd and 6th grade, or about age 8 to 11. My brother, who is a year younger, had discovered and picked the absolute largest dandelion we had ever seen. I thought it was kind of cool, but then something happened, I don't remember what, and I wound up sitting on the sidewalk in a bit of a funk. Maybe Dad yelled at me or something, I don't know. Anyway, my brother was sitting next to me, poking the flower at me, trying to get me to smell it. I think he was trying to cheer me up. Suddenly something just boiled up inside me and I grabbed the flower and broke it.
I can still see his sad little face as he went bawling to Mom, and hear him telling her that I broke his flower. I can hear my parents demanding an explanation for my actions, which to this day I'm unable to give. I've replayed that scene countless times in my head, and I still don't understand what it was that made me do it. I've been tortured by it for years now, and on several occasions have almost blurted out an apology while talking to him on the phone. But I've always held back because it feels foolish to bring something up 25 years or so after the fact. I've convinced myself that he doesn't even remember it. And yet, there are times when I wake up in the middle of the night and all I can think of is that sweet little kid trying to cheer up his big brother, and having his heart broken for his troubles. I want so badly to be able to go back and undo that moment.
In the years since, there have been other moments like it. Everything will be just fine, and something small will happen that irritates me in just the wrong way. The anger rises like a wild beast, a roaring plume of red-hot lava flowing up from somewhere deep in my guts. Many times it's all I can do to just express it in a way that minimizes damage to my surroundings. All I can know or feel is the burning rage, the absolute need to destroy something with my bare hands if at all possible. I don't know if that is somehow expressed chemically in my brain or not. Maybe there's a sudden shortage of one chemical or overabundance of another. Maybe all it would take is a pill of some kind to make it all go away. That would be so nice.
It's also something I will fight to never do. No pill is ever going to tame me, if I have anything to say about it. I proceed from an absolute conviction that I -- meaning the Mind that is me -- am ultimately responsible for my every action. I cannot and will not accept that I am a victim of some random chemical process. Subjectively, it feels as though I'm being run over by a freight train when the red hot lava beast awakes. But my entire worldview depends on the unwavering belief in the fact that I have a choice. I can choose to stand in the path of that freight train and try to stop it. I can choose not to blow up. I can choose to remain calm. And if I do not choose to do any of these things, then I have chosen my subsequent actions.
I. Am. Responsible.
I will not allow some chemical to dictate my moods and behaviors. Brain is a wonderful thing, but I remain convinced that Mind is more powerful. If it does boil down to chemicals and hormones, then the interface is two-way. If chemical A makes you think one way, then thinking another way will produce chemical B. If you've seen A Beautiful Mind, you've seen a man with a different problem, but the same solution. John Nash is my hero in this regard. Nobody has forced me to do the things I've done. I own it all. And in claiming responsibility for my screwups, I gain a measure of freedom that drugs would deny me.
It's been a long hard road. Some times are easier than others. I've fought compulsive behavior that arises out of this problem or some common root. Some of those behaviors I've defeated. Some I'm still working on. It's easier to shut down the beast nowadays. As it says in James 1:20, the wrath of man does not produce the righteousness of God. Sometimes all I need to do is remember that verse, and I'm OK. So I say screw the pills.
And Jim, if you're reading this, I'm sorry I broke your dandelion.
Posted by Tom @ 7:48 PM 
Comments:
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Ah, here comes an old debate in psychiatry. Does diagnosis with a disorder mean that you have a disease process? What I mean is, if I have intermittent explosive disorder, am I "suffering" from an "illness" that needs "treatment"? Or am I just an asshole? That is to say, I have been rewarded in some way in the past for acting out in an angry and explosive manner, which increases the chances that I will behave in the same way in the future?
More cynical yet, drug company ABC markets drug XYZ and does a study which shows their drug mitigates the symptoms of IED. ABC funds half of Dr. Chairman's departmental research program. Dr. Chairman does research which is well designed and backed by his monumental credentials. Well, this research is well-designed to benefit ABC, because ABC benefits Dr. Chairman and his department. ABC can now convincingly sell you a drug you need for a disorder you didn't know you had and you haven't even heard of!
Many people expect way too much of psychiatric medications. These people want to have a diagnosis to which every bad day and every bad behavior can be attributed. They expect that the right pill will fix everything. And when something goes wrong with the pills, think how rich they'll get from the class action lawsuits!
Sure beats taking responsibility for yourself, right? Unless you're like Tom. Forget pills, drugs, booze, tobacco, aspiring instead to learn and practice control of your own behavior. What a completely old fashioned idea, and maybe one which needs to be revisited by our overmedicated society.
Nope, don't remember the dandelion. But the way I know Tom, I don't need to remember things like that.
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More cynical yet, drug company ABC markets drug XYZ and does a study which shows their drug mitigates the symptoms of IED. ABC funds half of Dr. Chairman's departmental research program. Dr. Chairman does research which is well designed and backed by his monumental credentials. Well, this research is well-designed to benefit ABC, because ABC benefits Dr. Chairman and his department. ABC can now convincingly sell you a drug you need for a disorder you didn't know you had and you haven't even heard of!
Many people expect way too much of psychiatric medications. These people want to have a diagnosis to which every bad day and every bad behavior can be attributed. They expect that the right pill will fix everything. And when something goes wrong with the pills, think how rich they'll get from the class action lawsuits!
Sure beats taking responsibility for yourself, right? Unless you're like Tom. Forget pills, drugs, booze, tobacco, aspiring instead to learn and practice control of your own behavior. What a completely old fashioned idea, and maybe one which needs to be revisited by our overmedicated society.
Nope, don't remember the dandelion. But the way I know Tom, I don't need to remember things like that.
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