An Interview with Ron Potter-Efron , author of Rage

New Harbinger Publications: In your book, Rage you say that rage is not just extreme anger. What is it, then, and how do you differentiate it from intense anger?

Ronald Potter-Efron: The two are quite different in several ways. First, anger is goal directed. By that I mean that an angry person wants something specific. Rage is threat-directed. The individual believes he or she is threatened and is trying to relieve the threat. Second, rage is a Dr. Jekyll-and-Mr. Hyde experience. The person having it feels like the rage is happening without his or her consent. There’s a sense of disbelief, a what-is-happening-here-to-me event. Third, people struggling with rage sometimes lose conscious awareness of their activity. They have rage blackouts that last from seconds to hours. This doesn’t happen with anger. Fourth, ragers often lose control of themselves in amazing ways. It’s not unusual, for instance, for them to report that it took seven grown men to pull them away from the person they were attacking. I’ve even had 120 women tell me this.

NHP: A section of your book is entitled "The Raging Brain,"and in it your talk about the differences between the brains of those who experience rage and those who do not. Can you explain this?

RPE: Think of all of us having less-than-perfect brains but some brains are even less perfect than others. Three types of brain problems may be associated with raging, but none all the time. Damage to the temporal lobes on the sides of the brain, which are easily injured, can lead to instant total meltdowns, seemingly triggered by nothing at all. Fortunately, these symptoms can often be treated with anti-convulsant medication such as Tegretol. Under-functioning pre-frontal lobes can cause rage symptoms, too. This brain abnormality affects a person’s problem-solving ability and makes him or her more likely to blow up in total frustration. Finally—and here’s a mouthful!—these symptoms can be caused by over-functioning anterior cingulated gyrus. This problem leads to obsessive thought processes, an inability to let go of insults that can slowly or quickly build up to a rage episode.

NHP: What are some of the psychological and emotional factors involved in rage, and are there common experiences that those who experience rage report having in childhood or in their early lives?

RPE: Each type of rage has its own psychological issues, so let me defer on that question until later when we discuss the four types of rage. Children can and do rage, probably more than adults because they have relatively poor controls over their anger. Let’s make a distinction between a goal-directed tantrum ("I want that ice cream cone!) and a true rage ("I can’t stop screaming even though I don’t know why I’m doing this"). And, of course, early childhood traumatization sensitizes children to become adults who rage.

NHP: You talk about the four different kinds of rage. What are they?

RPE: Survival rage is a response to a threat to physical survival such as rape, assault, and so forth. Here’s an example: A client of mine was about to be beaten by his father when he was sixteen years old. The last thing he remembers is screaming "NO!"Two hours later he awoke from his rage state to discover his father lying unconscious (not dead) on the floor. His father weighed more than 250 pounds!

When someone at a great loss for control over his or her life, he or she may experience impotence rage. Frustration builds when someone feels helpless to alter significant problems. One example could be finding out your child has terminal cancer.

In shame-based rage, the perceived threat is to one’s respected place in the community (and to his or her self-respect). Some people react with rage to times when they feel disrespected.

Finally, abandonment rage can occur when someone feels threatened by the possible loss of an intimate relationship. "I can’t live without you!"often precedes jealousy and desperate attempts to maintain a relationship.

NHP: You say that treatment for each of these varieties of rage is a little different and you offer a step-by-step plan for addressing each one. What are the approaches you suggest for the different kinds of rage?

RPE: Treatment for survival rage needs to focus upon helping individuals feel physically safer. This can be done with therapies such as EMDR and relaxation therapy. Most important is creating places of real safety in the person’s life—at home, in the therapy session, and so forth—and then helping that individual actually feel the safety at the level of bodily response.

Treatment for impotence rage is two-fold: First, you help people find some ways they can actually feel effective in the world, and secondly, you help them recognize that their limited power in the world is a reality that they must accepted.

We address shame-based rage by helping clients accept five critical messages about themselves: I am good, I am good enough, I belong, I am lovable, I exist. The last is ultimately the most important and the most difficult to achieve.

To deal with abandonment rager, we help clients learn to tolerate temporary separations from their partners (sometimes beginning with as short as a few minutes in duration). We help them fully encounter their own feelings of emptiness within a safe environment.

NHP: Is raging more common in men or women, or does it occur at about the same rate in each sex?

RPE: Probably the rates are about the same. Since men are stronger, they may be more dangerous when raging, but some women are amazingly powerful when raging and weapons increase the risk of harm no matter who wields them.

NHP: Let’s imagine a hypothetical client who comes to you and says, "My rages are ruining my life. I can’t control them. They’ve nearly ruined my marriage and gotten me fired from jobs."What’s the first thing you do with this client to get their rages under control?

RPE: I have that client work through the questionnaires in the book to help him or her identify whether he or she is experiencing rage, what kind of rage he or she has, and the details of his or her specific rage. Getting as much information as quickly as possible can is the first step.

Then I ask the individual what he or she has done in the past to stop or lessen rage. He or she probably knows from past experience what works best. I often hear answers like getting away for a couple days, going to an AA meeting, or taking a medicine.

I then try to get the client to promise to do whatever works immediately to avoid going into a rage, reminding them of the risks if he or she fail to do so. I find out if he or she really can and will take these immediate safety measures.

If there is any doubt, I get him or her to agree to an emergency referral to a psychiatrist for appropriate medications.

These initial steps buy the client time to develop a longer-term plan for recovery.

NHP: In addition to the four types of rage we’ve already discussed, you include a chapter called seething rage, personal vendettas, and rampage. This title calls up scenes from the frightening news stories we’ve all seen about a disgruntled employee or an angry ex-spouse who snaps and unleashes a torrent of violence. How do you prevent this kind of rage?

RPE: Seething rages are like underground fires. People seethe often without anybody realizing how furious about life they are. Then they sometimes explode in a hail of gunfire, going on Columbine and Virginia Tech-type rampages. The best approach here is to get people to discuss their resentments before they build up into hatreds. Those prone to seething need help learning to let go of the past and get into the present. Forgiveness work helps with some people, but it is a long-term process. Also, like impotent ragers, they need to direct their fury in some effective direction such as politics or advocacy.

NHP: Last year a study came out about that concluded that intermittent explosive disorder is more common than previously thought. What is IED, how many people who experience rage actually have it, and why is there controversy surrounding this diagnosis?

RPE: The study you’re referring to reported that IED effects perhaps 7 percent of the population over a lifetime. It’s the only diagnostic category for anger and violence in the psychological diagnostic book, the DSM-IV TR. As such, IED has become something of a catch-all category. IED fits best for people who usually are in control but periodically melt down. That’s what most people who experience rage do, so it’s the best single diagnosis for rage.

NHP: What role does substance abuse play in rage?

RPE: I have one client now who got drunk three days in a row and had the only three rages of his life on those days. But he’s the exception, not the rule. Usually there’s not such a clear correlation between substance abuse and rage. Instead, intoxication lowers internal restraints against raging and clouds one’s judgment at the same time. Long-term use might contribute to brain damage that then increases the likelihood for rage.

The bottom line, as I wrote in the book, is that rage is a dangerous and often life-threatening pattern. I strongly encourage anyone who experiences rage to get help somehow. And if any of your readers know someone who experiences rage, they should do what they can to try and get that person to seek help for his or her problem.