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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Chris June 6, 2006 at 3:01 pm

When I saw this on the news last night, turn to my wife and asked "so people can't even get pissed off anymore without someone turning it into an illness?"

Its riduculous that some in the science community are trying to rationalize behavior so that no one is resposible for their own actions anymore.

Caliban Darklock June 6, 2006 at 3:04 pm

There are two factors that contribute to this, which is not a new phenomenon and certainly doesn't need to be given some trendy name.

Factor 1 is high testosterone. So this doesn't tend to happen to women, although it's certainly not impossible.

Factor 2 is low serotonin. The layman calls this "being unhappy".

This combination leads to serious anger outbursts. If you are unhappy and you have high testosterone, you are likely to break things and hurt people.

This has been known for many years to serious bodybuilders, because it's critical to the effective use of STEROIDS. If you can't stay reasonably happy while you're cycling a powerful stack, you can end up losing it and landing in jail.

So no new information here. It's just out of the underground, where it can be misstated and screwed up by the glory hounds for a couple years before it can turn into real accepted science.

But the symptoms are real, the biology that creates them is real, and if you have this problem when you're NOT taking steroids you really do have a fundamental chemical imbalance that really can be resolved by increasing serotonin levels.

But I would first question whether the low serotonin levels aren't just because your life is crap. Drugs to regulate serotonin should be a last resort; you should first attempt to evaluate your life and fix whatever is depressing your serotonin levels.

Unfortunately, teenagers are completely impotent when it comes to altering the things that make their lives suck. Oh well. Give them drugs; we can't be expected to change our lifestyles to make our children happy.

save_the_rustbelt June 6, 2006 at 4:39 pm

My father, a very wise man with a "doctorate" in common sense and civility, called this the HUA Syndrome.

HUA = Head Up the Ass

I wonder if Merck can invent a pill for this?

Garth June 6, 2006 at 6:07 pm

Disease?!?!?! Indeed, there are several words for it: "Immature" comes to mind. As does "Asshole" "jerk" "child" and some rude ones as well.

We live in a culture of victims where personal responsibility has been thrown out the window and where you aren't special unless you are afflicted.

We need to grow up and become responsible for what we do and how we feel.

Morgan June 6, 2006 at 6:13 pm

So now if I murder someone in hot blood, I can plead IED (presuming, of course, I have a history of breaking things and hurting people)?

We used to call people with IED "hotheads". The first-line treatment was an old-fashioned remedy called "good parenting". If that didn't work, social ostracism, lack of career advancement, and legal sanctions were said to be effective at alleviating the symptoms.

I don't think it's possible to overstate how pernicious this biological/mechanistic view of behavior is, because it erodes the fundamental sense of responsibility for one's own behavior. The British doctor who writes under the pseudonym "Theodore Dalrymple" has been cataloging the outcome for years – people who "just can't keep themselves" from assaulting others, stealing their property, abandoning their children; and who inisist that unless the doctor makes the desire to do such things go away they will carry on without any responsibility for their actions as all. After all, they told him about the problem, he just didn't "fix" it.

Our (public) schools have adopted this outlook whole hog. Students exhibit behavior that screams for consequences, but there are no consequences because the student is "behavior disordered". What seems to have gotten lost is that the tried and true method for modifying behavior *is* consequences.

Andrew K June 6, 2006 at 9:39 pm

Thank you for writing about this, Professor Roberts.

I accidentally just saw a CBS “News” “report” about this, including an interview with the alchemist/soothsayer/wizard who “discovered” this so-called disease.

“This is a real disorder,” said the good doctor. Uh, no, doctor, it’s not. It’s a collection of aggravations, mostly people not paying attention to their driving, and those around them. Nowhere in this horsecrap piece of pseudo-science is any consideration given to poor driving habits of third parties, of which there are plenty, thanks mostly to people like this doctor who invent excuses for people to be irresponsible and unaccountable.

And you thought lawyers were the only ones creating their own markets for their services…..

Alexander June 7, 2006 at 2:23 am

It may be that every emotion, physical expression, or attitude may be the result of electrochemical neural activities in our brains. If that's true, though, then any time anyone does something "bad" it's a mental disorder of some sort. It seems to me that most psychologists believe this (not without reason). However, if this is the case, then the story is completely unnewsworthy–the media could concoct an endless stream of stories about different positive and negative things individuals do, and then attribute them to likely chemical culprits in the nervous system.

What WOULD be newsworthy would be a story showing how road rage has a demonstrable chemical source while other negative behaviors have no such link. But when the article gives us no reason to believe that road rage is special, nor does it even prove that road rage is chemically founded, I don't really see what the big deal is.

Russell Nelson June 7, 2006 at 2:25 am

I've noticed a pattern … wherein doctors suffer from the things they specialize in. Chiropracters have bad backs, podiatrists have bad feet, ophthalmologists are nearsighted, and psychiatrists are crazy. Q.E.D.

Half Sigma June 7, 2006 at 10:19 am

Are you saying that laissez faire competition in the phramceuticals industry is producing BAD RESULTS that HARM SOCIETY?

Hmmm, interesting. I thought you were a libertarian. I guess not.

Keith June 7, 2006 at 10:41 am

"Are you saying that laissez faire competition in the phramceuticals industry is producing BAD RESULTS that HARM SOCIETY?"

I think the point is that socialism makes people think nothing is their fault or responsibility and that everything should be fixable by somebody else. The pharmaceuticals industry is simply filling a market need based on their customers' irrational beliefs. There's nothing wrong with individuals having irrational beliefs until the socialists decide everybody is required to have them.

B's Freak June 7, 2006 at 11:27 am

Another reminder of the timelessness of the Rolling Stones' "Mother's Little Helper".

Swimmy June 7, 2006 at 3:52 pm

"Are you saying that laissez faire competition in the phramceuticals industry is producing BAD RESULTS that HARM SOCIETY?"

People should be free to waste their money on medicine that quack scientists have sold them on, certainly. And libertarian bloggers should feel welcome to criticize said quacks. What should not happen is a change to our legal structure or penal system because a doctor has waved his moneymaking wand.

Bob White June 8, 2006 at 2:18 pm

This is isolated anecdotal evidence, but a dozen years ago when I first started taking anti-depressants, I tried taking two Prozac capsules per day rather than one. I became subject to seemingly uncontrollable fits of rage. Rationally, consciously I could feel myself overreacting and thinking to myself, "Stop shouting. This isn't getting you anywhere". When I adjusted the dosage, the urge to "explode" went away.

This is not to say that I couldn't have controlled the urge, but what felt so bizarre was just having the strong urge to begin with.

Luckily, my experience was induced pharmaceutically and was easily corrected. To say that others could not possibly be dealing with similar afflictions seems ignorant and dismissive to me.

Half Sigma June 8, 2006 at 4:50 pm

"People should be free to waste their money on medicine that quack scientists have sold them on, certainly."

It's amazing how stupid people are. I know someone who insists upon a highly bogus diet because she's convinced it's for her health, and nothing I do can talk her out of it.

I think there is a huge negative externality when people make money by getting other people to do stuff that actually HARMS their health.

Keith June 9, 2006 at 9:50 am

Quote from Half Sigma: "I think there is a huge negative externality when people make money by getting other people to do stuff that actually HARMS their health."

Well, as long as we have a huge population of do-gooders like yourself that are more than willing to step in to protect us, then we should be just fine.

Tell me, do you have any little vices that maybe we could save you from?

Marie June 10, 2006 at 8:32 am

Keith, she said "friend" and that's what "friends" and family do. We interfere in each others' lives. We tell you that your boyfriend is all wrong for you and such. We are not the state or a large corporate body. Friends, true friends, interfere because they love/care for their friends. You can't buy or regulate love which is why I (and I guess others) are opposed to the State or some mass of strangers who don't care about me as an individual making decisions that would harm me.
Didn't know that libertarianism was anti- friends and family.

Sheldon Richman June 11, 2006 at 9:40 am

Good post, Russell. Of course, Thomas Szasz has been writing about this witch-doctory for roughly half a century. Someday his courage will be appreciated — maybe even by libertarians.

George Anderson June 15, 2006 at 12:53 pm

I like your site and agree with most of the comments. I am a major provider of anger management classes for volunteer and mandated clients.
These classes begin with a pre and post test which focuses of stress, anger, communication and emotional intelligence. The class teaches skills in these four areas.
Anger is a normal human emotion. It is a problem when it is too intense, occurs too frequently, is harmful to self or others or leads to violence.

L K Tucker December 4, 2006 at 7:56 pm

IED has existed as Culture Bound Syndromes for centuries. CBS's are disturbing behaviors that are limited to ethnic cultures. Many of the syndromes involve attacks on people and things. Amok is a sudden violent attack in Malaysia. Often the attacker must be killed to stop the attack. Going Postal is the name used for the same event in the United States. Here the shooter often commits suicide.

Understanding causation is more complex. The phenomenon to cause these syndromes was accidentally found in the 1960's. Office workers using newly designed close-spaced workstations began having mental breaks. The designers of Systems Furniture, cubicles, believe the phenomenon only causes a harmless temporary period of confusion and pseudo-psychotic behavior.

Those designers and psychologists did not understand what they found. They failed to understand it is a problem of physiology not offices. The "special circumstances" that allow exposure from Subliminal Distraction are so simple they can be created anywhere even primitive societies.

When the mental event happens in ethnic cultures they attach a local explanation and reason for causation. Often this involves magic, hexing, or the breaking of taboos.

The office design problem is unknown in any area of mental health professional services. No one is screening patients for exposure.

My site, VisionAndPsychosis.Net, is a collection of cases to establish that the phenomenon is a major stressor for many disorders.

Alcohol Testing Den December 10, 2006 at 10:53 pm

In your post entitled “Fake Science on Rage,” you said that according to the WebMD story “To qualify as intermittent explosive disorder, those attacks must not have been linked to drugs, alcohol, or conditions such as depression.”

Question: When people experience fits of rage while driving and these outbursts of anger ARE associated to alcohol, drugs, or depression, what do the psychiatrists call this?

You concluded your post with the following: “Psychiatry is intellectually and morally bankrupt.” Have you been reading a little too much information about Tom Cruise and his scholarly views about psychiatry?

J April 23, 2008 at 11:38 pm

I have IED, and it is nothing I am proud of or boast about. I do not consider myself a jerk, nor do most other people (unless they are lying to me). I work on a customer service oriented IT help desk where I consistently receive communication telling me that I am one of the nicest and most helpful people they have ever spoken with. Yet, when certain events hit me just right (generally very stressful events) my thoughts becomes incredibly hazy and for some reason I end up screaming and generally breaking something (either an object, or something on myself), and only then am I able to think clear enough to understand the situation.

It is not completely a matter of "good parenting." My parents are two of the most thoughtful caring people I know of. When I was diagnosed with cancer as a child, I constantly depended on their love and support, and they never let me down. Don't get me wrong, I am not saying they are perfect, but I have never done drugs or drank, am fairly spiritual, and have been told that I have very high morals. To the point that when no one else in my wife's family would, we took in her ailing grandmother, moved her out of her condemnable, decaying house and was by her side when she had a heart-attack and passed away in our home.

Psychologically, I have no history of depression, never had serious suicidal/homicidal thoughts. No previous family history of mental disorders outside of my uncle who was a Vietnam vet, and even his have been easily controlled. I have no constant thoughts on hurting people, or any regular desire to destroy property, mine or otherwise. I do not have any hormonal conditions related to high testosterone. In fact, I am on the borderline for low testosterone. Yet when the situation is right, I cannot control myself, I have no clear thoughts on the situation, and when enough damage is done (which is grossly disproportionate to the situation that set me off), I will calm down.

I do not claim any lack of responsibility on my behavior, I openly admit (and regret) the results of the episode, and do what I can to repair them at any cost. I have gone to anger management counseling and it worked for a long time, but eventually the problem was no longer controlled by therapy or calming techniques. I am now on a path of trying different medications in combination with stress/anger management techniques.

I have a problem, I admit I have a problem, and am trying everything within my power to fix it. I do not see how I am not claiming responsibility for my actions. I am using every available avenue of help I can to fix the problem, not just for me, but for my family and friends, because they deserve better than that.

However, according to Chris (Comment 1) the medical community is rationalizing a reason for me to be lax in my responsibility.
According to save_the_rustbelt (Comment 3), there is no issue and either I or the professionals trying to help me, just have our "heads up our asses". According to Garth (Comment 4), I am just immature, a jerk, and an asshole and I just need to grow up. And according to Morgan (Comment 5) my parents should be taught better parenting skills, I need to socially ostracized, fired from my career, and legally punished to fix my problems.

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