Douglas Berger – Tokyo Psychiatrist

Topics on counseling, psychology and mental health


mental health

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.


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:

Doug Berger, M.D., Ph.D. – Tokyo Psychiatrist: How the economy impacts mental health

We know you have written about the economy and mental health before, perhaps we can ask you to elaborate on a few questions.

1.  How is mental health linked to economic success and failure?

One’s ability to be stable economically may be closely related to one’s personality and/or other mental health issues. First here is the issue of getting on a career path, and next is the issue of how one spends and invests their income.

While some persons make a reasonable living no matter what path they study or train for, persons who have a plan and obtain some kind of recognized credential tend to be more stable and thrive better than those that do not. Persistence, drive, and focus are important qualities here. In addition, while it is favorable to be affable and friendly no matter what occupation one is in, some occupations are more dependent on one’s charisma in terms of their ability to exude trust, likeability, and collect a set of followers.

Regarding saving and spending, planning and organization is a crucial quality for success. Persons who spend out of their means and/or wish to have a lifestyle that is out of their income level without thinking of the consequences will naturally have financial trouble.

For investing, it is always more adaptive to live within one’s means and invest with minimal risk. Investing companies will recommend to take some risk with a proportion of one’s assets. This may be more of a function of an investing company’s desire to make commission from the turnover of brokering stocks than the success of the investor. Small amounts of assets invested in higher risk stocks might be ok, but one would need to assume the monies invested in this fashion may likely be lost or risk the possibility of considerable mental stress related to loss. Persons who feel they must “get rich” from investing are at high risk for loss and the mental anguish associated with loss.

2.  What can investors do to safeguard their mental health during a trying economic time?

This is really a function of what persons have done with their careers and finances before the trying economic time comes around. The more flexibility persons have in the work they can do, the more economic redundancies a family has, i.e., both partners in a marriage have jobs that are less vulnerable to economic downturns, the more they have some stable income from safe investments, and the less they have over extended themselves in loans and purchases, the less chance of having unstable mental states.

3.  Do you recommend regular vacations or digital holidays to recharge the mental battery and decompress?

Yes, both of these are good ideas. Weekend trips and taking at least a few days every few months to be in a new environment and see new things is very important to stay excited about life. Knowing when to get away and turn off your PC or phone is a good thing.

If you can’t turn off your phone regularly, then having an old mobile phone just for calls is one way to avoid the kind of “phone addiction” we see in so many people recently. Of course the digital age comes with many conveniences and efficiencies, however, looking at a small screen (or any lit-up screen) for hours is a strain on one’s eyes, and time spent reading content or seeing videos with minimal intrinsic value can keep people from normal social interaction or using their mind in more valuable stimulating ways.

4. After the stock market crash in the 30s, there were lots of mental health issues. Similarly in 2008, after the financial crisis, there was a rise in suicides.  Why are we not getting better at separating our emotions from the economy?

This is an interesting question. Unfortunately, I don’t think so. People are still hooked on making quick and easy income and tend to focus on the stories that they hear about big winners. In this sense, the stock market is similar to a gambling casino in giving the promise of reward. If you look at a slot machine, there are usually images of lots of money or happy people, and investment groups usually put out graphs of increased earnings.

It is rare to see a slot machine or investment graph that emphasizes loss and grief. The average person is also not aware of the influence government, large investment banks, and other entities have on pumping up stock prices into a bubble that eventually leads to a fizzle-out, or worse, a bust. Humans evolved to get the next meal as soon as possible, not to look at nuanced and complicated things. The best thing we can do is educate the public, unfortunately, there are few entities willing to spend the resources for an education campaign. Perhaps the best way to do this is to make a lecture series on this topic mandatory for high school students.

Read more on Dr. Doug Berger’s comments as it relates to mental health and the economy here:

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