خشم در خط سیر شفا از بدرفتاری در دوران کودکی

When a girl is abused during childhood, she may not experience anger, only helplessness or numbness. Only later may the emotion of anger surface. Little is known about anger cognitions or behaviors as they occur across the years of the healing trajectory from childhood maltreatment. Data for the present secondary analysis were derived from a large narrative study of women thriving in adulthood despite childhood abuse. The purpose of this analysis was to examine the phenomenon of anger and its role in the recovery process of 6 midlife women. The 6 cases were purposefully selected because their interviews contained rich descriptions of anger experiences. Because each woman was interviewed 3 times over a 6- to 12-month period, 18 transcripts were available for in-depth examination. A typology was constructed, depicting 5 types of anger. Anger ranged from nonproductive, self-castigating behavior to empowering, righteous anger that enabled women to protect themselves from further abuse and to advocate for abused children. Study findings are relevant to extant theories of women's anger and feminist therapies.

ANGER IS A universally experienced and complex emotion. The study of this emotion has generated considerable interest from researchers within various fields of physical, mental, and behavioral health, as it has been shown to have a significant impact on these aspects of people's lives. Researchers have categorized different types of anger, as well as numerous forms of anger expression and suppression (e.g., Deffenbacher, 1995 and Spielberger, 1999). The consequences of anger and its various dysfunctional manifestations can have a profound impact on the individual who experiences the emotion, as well as those in contact with that person. Historically, there have been conflicting views on what is adaptive versus maladaptive anger, as well as how clinicians can best address it in a therapeutic and health-promoting way. Views of “effective” anger management vary greatly according to gender, status, social roles, and cultural context (Thomas, 2006). Despite the publication of several otherwise excellent books (e.g., Kassinove, 1995), little attention has been devoted to managing anger after childhood abuse. This study was prompted by a gap in the literature about anger of women who have experienced childhood maltreatment. In the larger study from which this analysis was drawn, narratives of women's recovery from childhood abuse provided a temporal view of the processes and interpersonal relationships involved in “becoming resolute” and, ultimately, “thriving” (Hall et al., 2009, Roman et al., 2008 and Thomas and Hall, 2008). This unique sample of 44 women had achieved remarkable success in life despite egregious childhood abuse. The first author, an anger researcher, had observed some vivid anger stories in the narratives and decided to return to the data to explore these more fully. Before turning to the results of the data analysis, a brief review of anger literature is necessary to provide a background. Review of the literature Maladaptive and Adaptive Anger De Rivera (2006) theorized that anger involves a perception of a challenge to what ought to exist and an impulse to remove that challenge. Although anger is a normal human reaction to challenges, such as unfair treatment or insults to one's integrity, few people learn how to manage it effectively while growing up (Thomas, 2006). Both men and women have deplored inadequate instruction by role models in expressing anger adaptively (Thomas et al., 1998 and Thomas, 2003). Adaptive anger entails a clear statement of the perceived offense, stated in “I” language, delivered without blaming or attacking the other person, followed by a reasonable request for amends. To state the obvious, adaptive anger does not involve property destruction, verbal or physical aggression, or use of weapons. Maladaptive anger, characterized by irrational cognitions and out-of-control behaviors, is widespread in America, as evidenced by loud cursing in workplaces, road rage on highways, and brawls at sporting events (Thomas, 2006). Deleterious health consequences of mismanaged anger have been identified by researchers. To cite just one example from a vast literature, hostility (which entails pervasive negativity and frequent anger) is a predictor for cardiovascular disease, as well as poorer general health and earlier mortality ( Jackson, Kubzansky, Cohen, Jacobs, & Wright, 2007). In addition to focusing attention on the general tendency to be readily “aroused” to anger, researchers have clearly described maladaptive forms of anger “expression,” focusing mainly on “anger-out” (venting at others) and “anger-in” (holding anger inside; e.g., Siegel, 1985). Both of these have adverse health consequences. For example, a recent study by Lazlo, Jansky, and Ahnve (2009) found that both suppression and the outward expression of angry feelings increase the risk of poor prognosis in women with coronary heart disease (CHD). Although explosive outbursts have received greater attention than anger suppression, especially in the research on CHD, a study by John and Gross (2004) implied that anger suppression can be maladaptive to an individual's functioning on an emotional and social level. Suppression of any emotion, anger included, has been shown to lead to decreased positive emotional experiences, compromised social functioning, and memory impairment for social information (John & Gross, 2004). Gross and Levenson (1997) found that habitual suppression of anger is as problematic as the tendency to have explosive outbursts. Not surprisingly, there is a known link between poorly regulated anger and many of the personality disorders, as well as to depressive illness, although it is not clear whether poorly regulated anger is a precursor or byproduct of depressive illness (Plutchik et al., 1989 and Koh et al., 2002). Anger is also considered to be a core issue in posttraumatic stress disorder (PTSD; Franklin, Posternak, and Zimmerman, 2002) and is linked to alcohol misuse and misuse of over-the-counter drugs (i.e., chemicals used to dampen unpleasant emotional arousal; Grover & Thomas, 1993). High anger, in conjunction with impulsivity, contributes to suicide risk (Horesh et al., 1997). Anger in Women The body of knowledge about women's anger is relatively small, especially if compared with the voluminous literature on women's anxiety and depression. Available evidence indicates that suppression and diversion of anger are more common in women than in men, in part because of gender role socialization for femininity, which inculcates the notion that anger is unfeminine and unattractive (see Thomas, 2006, for a summary of this literature). Angry women receive pejorative labels such as bitch ( Lerner, 1985), whereas women who conform to the feminine ideal are unfailingly pleasant and nice. Thus, women experience a fundamental tension between adaptive function and societal inhibition ( Cox, Stabb, & Bruckner, 1999). Although some may argue that there has been substantive loosening of rigid prescriptions for women's anger behavior since the classic works of Lerner, 1985 and Lerner, 1988), a large 2010 study of American and Canadian women found that only 6.2% viewed externalization of anger by women as appropriate ( Praill, 2010). In addition to continuing societal disapproval of unfeminine behavior, another barrier for women with regard to anger expression has been the socially constructed belief that women are responsible for preserving relationship harmony (Bernard, 1981 and Jack, 1991). This long-held belief has had an impact and taken its toll on women by encouraging suppression of anger in intimate relationships (also called silencing the self; Jack & Dill, 1992). Decades ago, feminists such as Miller, 1976 and Gilligan, 1982 elucidated women's strong need to affiliate with others. Ventilating anger can be frightening because it creates the feeling of being “separate, different, and alone” ( Lerner, 1988, p. 64). According to Lerner, women so fear a loss of connection that they inhibit anger and feel incredibly guilty when it does erupt. A societal myth ensued that many women do not even know when they are angry. The first large, comprehensive study of women's anger (Thomas, 1993) refuted this and other myths. Women do know when they are angry, as evidenced by hundreds of pages of transcripts of women's stories and their eloquent descriptions of anger that were collected over years of additional studies (Thomas, 2005). This program of research also refuted the claim that anger is always an irrational emotion, as some experts like Ellis (1962) have claimed. Women's anger is actually typically based in reality and is often legitimate and justifiable. Specifically, the primary causes of women's anger were demonstrated to be powerlessness, injustice, or irresponsibility of other people toward them. It is not irrational to become angry when one's values and rights have been violated. Validating Lerner's claims, however, many women did inhibit expression of anger for fear of alienating significant others. When women did vent their anger, revenge was not the primary aim, as Aristotle, 1941 and Lazarus, 1991 have claimed. Instead, women were seeking relational reciprocity (Thomas, 2005). These studies also helped to further refute the notion that women's anger is almost always pathological. The research revealed the fallacy of this idea through the revelation that there are, indeed, “constructive” uses of anger. One such use was found to be restoring justice, respect, and relationship reciprocity. Anger was shown to propel some women to take constructive action about situations of inequality in their workplace or families (Thomas, 2005). With regard to the current information about the known negative effects of maladaptive forms of anger and anger expression, there is a recommendation that women should at the least be encouraged to discuss their anger regularly with a confidant. This practice has been shown to have benefits with regard to reduced blood pressure, lower body mass index, better general health, and greater self-efficacy and optimism (Ausbrooks et al., 1995 and Thomas, 1997). Unfortunately, this verbalization of anger can be an overwhelming hurdle to cross for many women if they are long-accustomed to suppressing this emotion and may be even more difficult for women who have experienced childhood abuse (Morgan & Cummings, 1999). Anger in Women Who Experienced Maltreatment in Childhood Little research has been devoted specifically to the study of angry emotion in women who have experienced some type of abuse in childhood. The above-described program of research by Thomas (2005) primarily focused on nonclinical samples, and other researchers have relied too heavily on college student samples, generating unanswered questions about anger in abused women. The oppression they experienced in childhood undoubtedly has an additive effect to the above-described anger inhibitors experienced by ordinary nonabused women in the general population. Surely, they have been silenced to a much greater extreme. Because the rates of childhood maltreatment remain high, it is imperative that providers more fully understand anger in this population. The experience of childhood maltreatment is pervasive and has significant repercussions on its victims, including substance misuse, eating disorders, depression, and PTSD (van der Kolk, McFarlane, & Weisaeth, 1996). The Department of Justice (2009) released statistics from a recent national survey reporting that 60% of respondents were exposed to some type of violence that year, that nearly one half had been assaulted at least once in the past year, and that one tenth of them had experienced some kind of childhood maltreatment. It is logical to posit that anger is a common emotional experience for adult women who have been sexually, emotionally, or physically abused in childhood. Research has, in fact, shown that anger is one of the most pervasive emotional consequences of childhood sexual abuse (Scott & Day, 1996). Not surprisingly, a study by Murphy et al. (1988) showed that survivors of childhood sexual abuse had significantly more problems dealing with this emotion than did a nonabused control group. Although research is scant, existing studies indicate much variability in the ways in which anger is expressed by this population, and like anger research in general, there are conflicting views on how it should be addressed in a health-promoting way. Several possible anger expression styles have been identified among abuse survivors. Scott and Day (1996) reviewed some of these as follows: “Survivors may deny their anger, disguise its expression by being overly compliant and perfectionistic, fear expressing anger, identify with the power of the perpetrator and manifest self-destructive, self-blaming patterns, or inappropriately and indiscriminately express anger” (p. 209). Some clinicians assert that externalizing anger and expressing it in some way toward their abuser contribute to survivors feeling less depressed (Morgan & Cummings, 1999). In contrast, Van Velsor and Cox (2001) contend that empowerment for survivors of sexual abuse has less to do with blame toward an abuser and more to do with a survivor's access to the genuine response of anger. Regardless, they recommend that therapists attend to the process of uncovering and expressing anger as an integral part of the recovery process. Scott and Day (1996) found that adult female survivors of childhood sexual abuse who tend to suppress their anger report significantly more abuse-related symptoms than do survivors who appropriately express their angry feelings. Inwardly directed anger was correlated with higher scores on measures of guilt/shame, vulnerability/isolation, emotional control/numbness, sadness, and sense of powerlessness. In contrast, outwardly directed anger, either toward other people or objects, was not significantly correlated with scores on the symptom scales. Yet another study examined the effects of group therapy on change in anger among female survivors of childhood sexual abuse. In this study, Morgan and Cummings (1999) found significant decreases in measures for depression, social maladjustment, self-blame, and posttraumatic stress responses but surprisingly found no significant change in anger outcomes. A limitation of this study, however, was the lack of testing throughout the 20-week study process. The authors postulate that anger could be labile; thus, there may have been temporary increases in anger scores for some of the women and decreases for others throughout the 20 weeks. These findings do not allow for a clear picture of the continuum of anger over time. The lack of qualitative information in this study affirms the need to study the nature and manifestations of this emotion more in-depth. The present study aims to ameliorate the dearth of research in this area by adding to the knowledge base on the process and continuum of anger in abused women. Method This secondary analysis involved data from a larger, federally funded, feminist narrative study of female abuse survivors (Hall et al., 2009). The methodology and procedures of the larger study, as well as details about institutional review board approval and protection of human subjects, have been discussed in detail elsewhere (Hall, 2011 and Hall et al., 2009). In brief, a series of in-depth qualitative interviews, spaced over a period of 6 months to 1 year, were conducted with 44 abuse survivors by psychiatric nurses with graduate preparation. For this secondary analysis, 6 cases were selected for careful examination of the phenomenon of anger. These cases provided rich descriptions of anger experiences across the trajectory of healing from childhood maltreatment. Using criteria commonly applied to quantitative studies, 6 women may be considered a small sample, but the aim of a qualitative investigation is not generalizability to a population. Rather, the aim is to refine or expand theory or to illuminate the particularities of a phenomenon that is not well understood. Both Yin, 2009 and Creswell, 2007 have alluded to the long history of deriving useful clinical insights from a small number of cases, citing notables such as Freud and Piaget. Yin (2009) specifically recommends choosing the cases from whom you can learn the most. Each woman had participated in three interviews, yielding 18 lengthy transcripts. Initially, the hundreds of pages of typed text were read in their entirety for the sense of the whole narrative. Subsequently, anger stories were excerpted from the text and were scrutinized line by line to achieve understanding of anger cognitions and behaviors. Riessman's (2008) approach to analysis of narratives guided this stage of the analytic process. As in this instance, narrative analysis is often case centered, with a focus on “bounded segments of interview text about an incident” (Riessman, 2008, p. 75). According to Riessman, prior theory can serve as a resource for interpretation; therefore, the first author's knowledge of anger theories and research was viewed as an asset rather than something to be set aside during data analysis.

This research inductively derived five types of anger exhibited by female survivors of childhood abuse, which were drawn from interview narratives. The five types were (a) self-castigating anger, (b) displaced anger, (c) anger of indignation, (d) self-protective anger, and (e) righteous anger. It is hoped that the typology presented in this article stimulates further theorizing, research, and application by mental health clinicians. Survivors of abuse may be heartened to learn that other survivors were empowered by their anger to take significant steps in their trajectory of recovery.