Topics and Issues

Just For the Health of Pilots

ANGER:

How to Control a Killer Emotion

by Glenn R. Stoutt, Jr., MD

Senior FAA Aviation Medical Examiner

Anger can run the spectrum from mild irritation to rage, and rage is a form of temporary insanity. None of us can think or act effectively if we are angry. If pilots are both hurried and mad, their engine(s) may take them directly to the scene of the crash.

Anger is a perfectly normal human emotion. It is an adaptive survival response to threats and danger that helps us defend ourselves. It becomes a problem when it becomes inappropriate, prolonged, excessive, or out of control.

Prehistoric man needed to develop a storm of anger to fight fiercely with a cave bear or saber-tooth tiger. But, he calmed down a few minutes after the fight ended (either calm or dead). His anger released a surge of adrenaline, preparing him for fight-or-flight. His blood pressure went up, blood was diverted to his muscles, blood clotted easier. The Neanderthal became a formidable fighting machine—but for an appropriate time only.

Contrast this with present-day man—not unlike Homo sapiens aeronauticus—who may get road rage and then stay angry for hours after the traffic incident (perceived as a personal insult) has long passed. He or she may stay mad at a boss, spouse, or even a frustrating situation for days, even weeks. Some people stay in an almost perpetual state of anger, with simmering irritation just waiting to explode.

All anger results from some sort of frustration with other people or even external events such as assembling an "easy-to-assemble" appliance or waiting in line or struggling to loosen a rusted nut and bolt. One thing is certain: Angry people have a low tolerance for frustration.

The natural response to frustration is anger. Here's the problem though: How much of it is normal or appropriate? Do we stay mad all morning because our car keys are lost? Does a rude sales person merit ruining an hour or so of your time? You can't lash out at everyone who irritates or inconveniences you. Throwing a lamp through the front window is extreme; being sarcastic or sulking is a milder form of the same thing.

We are each born with certain largely unchangeable personalities. Some of us are laid-back and calm; others bristle easily, have a "short fuse." Our undesirable traits—such as proneness to anger—can (and must) be controlled to a degree. Do you express the same degree of anger to the president of your company as you do to a subordinate? So, you really have some degree of control. You don't scream at the boss.

Here's an almost fatal example of the toll anger can take: An airline captain, who was known for his violent temper, was making a tricky approach in marginal weather and was off on his heading and altitude. The first officer was afraid to say anything until just before the situation became dangerous. In other words, he was not as fearful of a controlled flight into terrain as he was of incurring the fury and explosive tongue of his captain.

An angry pilot—even a mildly irritated one—is prone to make procedural errors. After several maddening delays at home one morning, a corporate pilot made four "procedural errors" driving to the airport. He overshot his regular turn, pulled in front of another motorist, was driving way too fast, and spilled hot coffee in his lap. Luckily, he calmed down before climbing into a Citation.

Life is full of natural frustrations. Life is not easy. There will always be pain, loss, injustice, and disagreements. If this frustration load leads to excessive or prolonged anger, two things can occur: The anger can be directed outward in the form of irritability or aggression; or it can be directed inward, resulting in fatigue and depression. In fact, long-standing unresolved anger is the main cause of being tired and depressed. It raises havoc with our general health.

In July 1997, the Beth Israel Deaconess Medical Center at Harvard Medical School reported that "anger is the affective state associated with myocardial ischemia [lack of blood flow to the heart muscle] and life-threatening arrhythmias [irregular heart rhythms], with at least 36,000 (2.4% of 1.5 million) heart attacks precipitated by anger in the United States [yearly]." Blowing up over something minor could put you in the hospital—or the morgue.

If you think you feel steamed most of the time, or if your anger is often out of control and you don't know why, make an appointment with a competent psychotherapist who deals in anger management. The cost may be the same as a new set of tires for your car plus a new transmission. But, it may be the most important thing you will ever do for your marriage, job, health—or your life.

More than 90 percent of success in life is getting along with people (find what they like and do more of it; find what they don't like and do less of it). No one enjoys being around someone who is—much of the time—cynical, demanding, suspicious, defensive, and hostile.

Understanding what triggers your anger will take a lot of time and motivation. Controlling your anger is as important as controlling your aircraft. After all, you didn't get to be a hotshot pilot overnight. Be cool.

• First, what doesn't help? "Letting it all blow" is a myth. It is like throwing gasoline on a fire. Conversely, holding lots of anger in (suppressing it) for a long time does lots of havoc with your mood—and blood pressure.
• Of course, meditation, counting to ten, deep breathing, exercise, visualizing happy scenes and experiences, or yoga all may help some. But these recommendations are in all anger-management articles—things to do when you are already mad, but hardly able to think rationally. Use them, but remember what you really want to know is how to keep from letting crippling anger get started in the first place.
• The bottom line is learning how to prevent excessive and unreasonable anger, dangerous anger. Learn your own anger pattern so that you can prevent smoldering anger or blow-ups. What gets you angry? How do you handle it? Is anger a big problem in your life?
• Anger-prone people often feel they deserve special consideration from others and become highly irritated when they don't get it.
• Respect yourself, be assertive— but not aggressive. Talk to an offending person when you are both calm and in a reasonably good mood. Say something like, "Chris, I like you and think you really can teach me a lot, but every day you seem to put me down, and I don't hear anything positive about what I am doing. I go home tired and discouraged. What can we do to work things out?" Go on from here . (One woman did and then got fired, but her next job was sheer pleasure and she got $11,000 more a year.) Nothing works all the time.
• Healthful anger is OK. Just try to be objective and say how you feel about things. Calmly let others know what your needs are.
• Realize that no one ever wins a power struggle.
• You can't always help being around obnoxious people, but you can control how you react to them. You are the boss of your emotions and responses.
• Absolutely best of all: Try to avoid things that get you steamed. Try to identify, when you are calm and rational, the things that make you angry, and plan what you can do to avoid or control them. For instance, leave earlier for your job, and go home later if traffic drives you nuts. Better to spend the time at work than on the expressway. Devise strategies to avoid nasty people and frustrating situations as much as you reasonably can.
• Ask yourself, "Is this frustration enough to ruin my whole day, even an hour?"

Yours for good health and safe flying,

Dr. Stoutt is a partner in the Springs Pediatrics and Aviation Medicine Clinic, Louisville, Ky., and he has been an active AME since 1960. No longer an active pilot, he once held a commercial pilot's license with instrument, multiengine, and CFI ratings.

Note: The views and recommendations made in this article are those of the author and not necessarily those of the Federal Aviation Administration.

The Federal Air Surgeon's Medical Bulletin • Summer 1999