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Douglas Berger – Tokyo Psychiatrist

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Doug Berger – Tokyo Psychiatrist Discusses Anger Management

Dr. Doug Berger, a psychiatrist in Tokyo Japan discusses anger and anger management for us.

1. How large of a role does stress play in anger?

We could look at anger as a so-called, “stress-diathesis model” wherein persons have differing levels of tolerance or a threshold to where they will feel but not show, or feel and then show anger to others. Diathesis means the predisposition or sensitivity someone may have to a certain feeling state or behavior. So, depending on the type of stress, and the intensity of the stress, some persons may be prone to feel and/or exhibit angry feelings. Regarding the type of stress, someone may for example get angry when they are ignored, but not when they are criticized or vice-versa. It all depends on the mix of an individual’s psychological issues and how they are wired neurologically.

2. Is society angrier than it used to be?

I can only really answer this regarding the two countries I am familiar with, Japan and the United States. Japanese society in general is not outwardly an angry country like the U.S. There are of course angry individuals anywhere, and certain groups with a specific political agenda, that are and have been angry for a long time. There is also considerable discrimination against non-Japanese but this has not led to many protests or incidents, is tolerated as “matter-of-fact” by the Japanese population, and the non-Japanese population as a whole seems to quietly accept and/or not fully understand the situation for various reasons perhaps too complex to discuss in this forum.

Regarding the U.S., specific social changes and demographics can inflame resentments and anger segments of the population. Lately racial tensions are at the forefront, however, each generation has its own memory and it can be easy to forget that tensions and anger were also very high during the civil rights era and other times past. The advent of radio, TV, and now the internet and mobile social media has allowed the fire of resent and anger to spread quickly through the population. I am not sure this means that society is inherently angrier than it used to be, although the spread of firearms in the population has probably led to an ease of expressing anger in a larger proportion of the population and in more dramatic ways.

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3. What is the difference between mild anger and serious anger management issues?

The outcome of a serious instance of anger may be to become more aggressive, but the underlying reasons may be the same whether mild or serious. Besides the social issues discussed above, personal social stress can also lead to anger. Work stress and relationship stress are the most common causes. Resentment in these and other social situations are a common cause of angry feelings. Certain psychiatric conditions may also show irritability and anger as an expression of this irritability. Hyperactivity disorder, depression, manic or hypomanic states, certain personality tendencies, and drug use and withdrawal can show irritability.

4. How does one combat, alleviate anger in adults? In children and adolescents?

This naturally depends on the cause. Removing a specific stressor or conclusion of a stressful social situation can alleviate anger in any age group. If one suffers from a psychiatric condition such as those described above than specific treatment targeted at that condition is necessary. This may mean psychotherapy, medication, social environment changes, or some combination of these. We should not conclude that it is just “normal” for young persons to be angry in a persistent or intense manner.

5. Anger is often a sign of deeper problems can you explain how anger manifests in relation to mental illness, physical illness and situational stress?

In addition to mental illness and the situational issues covered above, persons with physical illness are also prone to become angry. Failure of medical care to alleviate pain and suffering, frustration with serious illness, medication side-effects, and family/caretaker stress are all common reasons for persons with physical illness to become angry. In addition, patients may become angry if a clinic or hospital is not run well or if the “bedside manner” of the medical staff is curt, rude, or negligent in some way.

There is no specific way to provide “anger management” in a “one size fits all” method. First the causality should be delineated, and then specific counseling, psychotherapeutic, family intervention, treatment of substance abuse, and care for psychiatric or medical conditions can be initiated as appropriate.

Read more on Dr. Doug Berger‘s comments as it relates to anger management here: http://www.megurocounseling.com/TF/2016/Feb_2016.pdf

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Dr. Doug Berger: Advice for Interracial Couples

We know you frequently see couples having trouble, many of whom are mixed-cultural couples, and that you have written on this topic before.

1. For couples who come from distinct, separate backgrounds, what are some tips for them to make their relationship work?

Of course mutual respect and interest in the culture of one’s partner is crucial. Mutual participation in culturally significant events and enjoyment of this participation is important. Even if learning the language of the partner is a daunting task, some effort in this regards shows that one values the other’s culture. If people are flexible and loving, then there should be little trouble to make the relationship work.

2. What are some of the challenges that interracial couples face?

Here in Japan, common challenges might be broken down into, 1. the logistics of the expatriate partner’s ability to socialize, work, and thrive in the foreign culture, and 2. mutual tolerance of each other’s different cultural and language challenges when dealing with the culture of the other side.

The occupational choices available to an expatriate in Japan will necessarily be limited compared to their country of origin, except of course the ability to teach English if the expatriate is a native English speaker. Non-Japanese persons tend to be transient or eventually move to another country such that long-standing social ties are hard to maintain if one is in a foreign country.

Mutual tolerance will always be necessary because one’s ideas about the world may be colored by the culture and educational background one grew up in. Just to reiterate from the answer in question 1, flexible and loving persons will usually do well in cross-cultural relationships.

3. Can couples counseling help reconcile some of the issues these couples face?

Yes, brainstorming and coaching can help to overcome the logistic challenges noted on question 2. Some persons, however, get negative and pessimistic easily. I try to have them take the challenges at hand as a chance to do something they may not have been able to do before. For example, learn Japanese, take up a sport or martial art not available in their home country, enjoy the chance to meet expatriates from many countries, see new things etc. Of course there are always persons whose career and/or life style does not really fit into living in Japan at a specific point in time. For those persons, the flexibility they need is to accept is that they and/or their family will function better if they move back to their country of origin. They can always consider moving back to Japan at some future time when the logistics are a better fit.

If the problem a couple faces is more complex than what help coaching can provide, then the same kinds of evaluation and problems these couples face need to be addressed just as any individual or couple, be they personality problems, depression, attention-deficit hyperactivity disorder, substance abuse, etc., that are common problems seen in the population as a whole. Our default position is to try keep families together, however, there are always couples who have come to see us who are really already well on the way to splitting up, for these persons we try to help this process unfold amicably.

What are some exercises or activities that couples can engage in together to better understand each others’ perspective?

Here in Japan, the answer is language and etiquette study on the part of the expatriate. Simple things like how to properly take off one’s shoes in a Japanese house, how to do simple greetings, participate in the yearly ceremonies that Japanese families tend to do together, etc. These are generally easy enough to do and can be fun in and of themselves.
Japanese persons need to be tolerant that their partner’s family and country of origin is not likely to behave or function like Japan does. As long as each side can respect each other and see that there is something to gain by the fusion of culture in the relationship, then things should go well. This is a principal that should be applicable to an international couple anyplace.

For more information on this topic, please visit the discussion with Dr. Doug Berger that appeared in Tokyo Families Magazine, seen here: http://www.tokyofamilies.net/2011/11/do-japanese-western-relationships-work/.

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