Overview
My patients often tell me that they want to stop having certain emotions. This understandable, because experiencing certain emotions can be unpleasant. However, most people don’t realize all emotions serve a purpose. They communicate our needs in a given moment, not only to ourselves, but also to others. They act as our compass through life, so people who tend to suppress or ignore their emotions often describe feeling aimless or having a tendency to act against their self-interest. Much of this was the premise of the Pixar movie, Inside Out. We have six core emotions: joy, sadness, anger, fear, disgust, and surprise (excluded in Inside Out). In the mental health profession, the three we deal with most often are sadness, fear (anxiety), and anger, which I will discuss below.
Sadness
Sadness is the emotion of loss. This can include the death of a loved one, a break up, a close friend moving away, or the loss of a job. For some, this can include the mourning of a fantasized reality. For example, if an adult imagined themselves growing up to have a loving spouse, a home in the suburbs, 3 children, and a job that pays over $200,000, they may have a sense of sadness when faced with the reality of their divorce, their underpaying job, or their lack of children.
Sadness communicates “I am suffering and need comforting.” Its associated impulses are behaviors like crying and having a scrunched posture. Sadness draws people toward you. This is why when you see a stranger sitting on a bench, crying, your automatic impulse is walk over to them with the goal of finding out what’s making them cry and attempting to alleviate their suffering.
Anger
Anger is the emotion of aggression and defense. The primary trigger is being hurt or threatened, emotionally, physically, financially, etc. This can include actual physical harm, insults, attempts to control a person, and harm to a person’s reputation or financial standing. The trigger can also be these threats/harm to a loved one. The impulse that comes with anger is the “fight” part of the “fight or flight response.” The goal of the impulse is to stop the threat or the pain already being inflicted. This often manifests as yelling, threatening, insulting, or physical violence. Internally, people often notice feeling warm in their face, increased heart rate, and muscle tension, including clenched fists. Depending on the emotional state of the original aggressor, when the person being attacked starts to fully experience their anger, the aggressor may suddenly notice their own impulse to “back off.”
FEAR/Anxiety
Fear and anxiety are two sides of the same coin. Fear is the “flight” part of the “fight or flight response,” meaning the triggers overlap with those of anger, (i.e. an external threat of physical harm), but the impulse is to escape or avoid. Anxiety, as we understand it, is the fear of our own internal states. By far the most common trigger of anxiety is anger. I realize that sounds a bit confusing. Essentially, someone in our life triggers our anger, we get the impulse to hurt this person, we immediately realize this is incompatible with our desire to maintain a relationship with this person, and then we become afraid of the anger and its accompanying aggressive impulses. All of this occurs unconsciously, so all people end up consciously experiencing is the anxiety and its physical manifestations, such increased heart rate, shortness of breath, sweating, nausea, headache, ringing in the ears, and mental cloudiness (aka “dear in headlights” experience). The more someone has the need or desire to maintain a relationship with the person triggering the anger (such as a family member, boss, or significant other), the more likely their anger will drowned by anxiety.
Defensive vs True Emotions
This is where things get more confusing. Both anger and sadness can be appropriate or “true” emotions, as described above, or they can be “defensive” reactions that cover up our true emotions. The easiest way to identify whether an emotion is true or defensive is to look at the trigger.
Let’s say someone’s best friend passes away. The person finds that they are now lashing out at their spouse, coworkers, or family members. In this case, the person isn’t angry at those around them, they’re sad that their friend died. In therapy, we would help this person recognize that their anger is only stopping them from fully experiencing their sadness. Once we are able to help this person fully experience their grief, the irritability and lashing out will stop.
When I was in training, several of my supervisors over the years said to me “depression is just anger turned inwards.” The most common examples that I see of this are when someone cries as their boss, teacher, or loved one berates or insults them. Since we know that crying is an impulse associated with sadness, but the trigger here is a threat to our self-worth or reputation, we know that sadness isn’t the true emotion. Just like with defensive anger, the therapeutic goal is to help the person let go of the defensive sadness and allow them to fully experience and tolerate their anger.
A Few Final Notes
Often the first question I get when encouraging people to “fully experience” their anger is, “So you want me to act on the impulse and hit the person?” Obviously, I would never encourage acting out violent impulses on another person. When someone “fully experiences” an emotion, they allow the physical symptoms to occur (warmth, increased heart rate, muscle tension, etc.), they become fully aware of the their impulse, and then they just passively observe these feelings without acting on them, suppressing them, or trying to distract from them. What we will notice is that, as uncomfortable as these physical feeling and impulses are, they are only temporary. And since they communicate to us our needs, the more we pay attention to them, the more we will be able to make healthy decisions for ourselves. For example, a patient that initially presented with depression and anxiety disclosed that their boss was frequently berating them in front of coworkers. Initially, this patient thought “I must deserve to be treated this way” (anger turned inwards) and “If I say something, I will get fired” (anxiety, helplessness). Once this person was able to experience their anger toward their boss in therapy, they made the healthy decision to talk to the HR department about the situation. The boss was reprimanded, but only became more covert about the verbal abuse. The patient experienced no sadness, minimal anxiety, and tolerated their anger. They used the anger as motivation to actively look for another job. They successfully found new employment, where their coworkers are supportive and their boss provides much more useful feedback.
Anxiety is arguably the most complex of these three emotions, so I will go in more depth about it in future writings.
I do not believe anything in medicine/mental health is 100% certain or applicable to everyone. There are certainly people for whom no amount of therapy alone will alleviate their depression or anxiety symptoms. My goal is always to minimize the amount of medication people are taking, but when it is necessary or simply the preferred treatment by a patient, then I have no reservations about using it.