Fake Science on Rage

by Russ Roberts on June 6, 2006

in Health

Here’s how the AP story begins:

To you, that angry, horn-blasting tailgater is suffering from road
rage. But doctors have another name for it — intermittent explosive
disorder — and a new study suggests it is far more common than they
realized, affecting up to 16 million Americans.

think it’s bad behavior and that you just need an attitude adjustment,
but what they don’t know … is that there’s a biology and cognitive
science to this," said Dr. Emil Coccaro, chairman of psychiatry at the
University of Chicago’s medical school.

I love that phrase: "there’s a biology and cognitive science to this." It’s scientific, don’t you see? It’s not just a matter of vague concepts like anger, or self-control. It’s part of your biology. Never mind that the the phrase has no real meaning.

But how would you actually diagnose this disorder to make sure it’s a disorder rather than say, merely an attitude or an immaturity?

The study was based on a national face-to-face survey of 9,282 U.S.
adults who answered diagnostic questionnaires in 2001-03. It was funded
by the National Institute of Mental Health.

About 5 percent to 7 percent of the nationally representative sample
had had the disorder, which would equal up to 16 million Americans.
That is higher than better-known mental illnesses such as schizophrenia
and bipolar disorder, Coccaro said.

The implication is that intermittent explosive disorder or IED is a lesser-known mental illness. So a guy who gets really angry sometimes isn’t just suffering from a disorder. He has an illness. A mental illness. How do you diagnose this "illness?" Well, there’s no real lab test. And in this study, it was a face-to-face survey. That’s supposed to imply, I guess, that it’s more accurate than a mail-in survey or a computer survey or a phone survey. But how would you survey someone about getting really angry?

What questions would you ask?

The AP story doesn’t say. It’s hard to find a news report that does say. But the WebMD story by Miranda Hitti tells you how the authors defined IED:

To qualify as intermittent explosive disorder, those attacks must not have been linked to drugs, alcohol, or conditions such as depression.

Survey questions included how often participants had experienced anger attacks in which they:

  • Lost control and broke or smashed something worth more than a few dollars
  • Lost control and hit or tried to hurt someone
  • Lost control and threatened to hit or hurt someone

That’s scientific? Come on. What exactly does "lost control" mean?  Yelling furiously "I’m going to kill you?"  Does that qualify? Is it just an expression or a threat? In the study, you had to have at least one of these three "symptoms."

If someone asked you these questions to your face, how would you respond? Hey, maybe the incidence of IED is underestimated because people were too embarrassed to tell an interviewer about their rage. Or maybe the face-to-face interviewer helped the respondents overcome their reticence and gave them encouragement when an interviewee asked, what exactly do you mean by "lost control" or "tried to hurt." So maybe it’s overestimated.

The ending of the AP story is almost comical:

Coccaro said 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, Coccaro said.

Most sufferers in the study had other emotional disorders or drug or
alcohol problems and had gotten treatment for them, but only 28 percent
had ever received treatment for anger.

"This is a well-designed, large-scale, face-to-face study with
interesting and useful results," said Dr. David Fassler, a psychiatry
professor at the University of Vermont. "The findings also confirm that
for most people, the difficulties associated with the disorder begin
during childhood or adolescence, and they often have a profound and
ongoing impact on the person’s life."

Jennifer Hartstein, a psychologist at Montefiore Medical Center in
New York, said she had just diagnosed the disorder in a 16-year-old boy.

"In most situations, he is relatively affable, calm and very
responsible," she said. But in stressful situations at home, he
"explodes and tears apart his room, throws things at other people" to
the point that his parents have called the police.

Hartstein said the study is important because many people are not aware of the disorder.

Really? I’m surprised. According to my friends who are parents of teenagers, this is typical behavior for 16 year-olds. Maybe not of parents, who don’t always call the police, but lots of 16 year olds do storm around and occasionally throw things. The parents I know have a different name for this disorder. They call it "puberty" and for boys, it’s more related to testosterone rather than seratonin.

The real story is found in the very last line of the WebMD story (kudos to reporter Hitti):

The journal notes that the study was funded in part by the drug
companies Eli Lilly and Company, GlaxoSmithKline, Bristol-Myers Squibb,
and Ortho-McNeil Pharmaceutical Inc.

So take something that has been part of the human experience since Cain killed Abel, classify it as at least a disorder or maybe it’s a disease, a mental illness, and suck up to the drug companies and the anger management therapists whose track record of success is unknown. Gussy the whole thing up with talk of biology and serotonin and you’ve got a new way to "cure" people.

If serotonin is a big part of the story, a real scientist would have looked at the correlation between levels of serotonin and answers to that face-to-face survey. Without that, there’s no there, there.

Psychiatry is intellectually and morally bankrupt.


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