The Anger of HIV

The Very Rev. Father Drew A. Kovach, MD, MDiv.,

Director of HIV Services

Kaiser Permanente Hawaii

Anger is only one letter short of danger.

-- Unknown

Why Talk About Anger?

• Common complaint

• Not a isolated emotion

• Inward

• Outward

• Blocking good numbers

• Blocking good life

• What can be done about it?

Anger in HIV• Anger at Diagnosis• Anger at Disclosure• Anger at Symptoms• Anger at the Disease• Anger at Disability• Anger at Behavioral Problems• Anger at God• Anger at Anyone and Everyone• Anger at Self

Anger at Diagnosis

• Directed inward

• Directed outward

• At getting the HIV diagnosis

• At who I got HIV from

• Not knowing I had HIV

• Who is to blame?

John’s Story

If you are patient in one moment of anger, you will escape a hundred

days of sorrow.-- Chinese Proverb

Anger at Disclosure• Who do you tell?• How do you tell?• What is their reaction?• Judgment “just under the surface”• Relationships

– Past – Present– Future

• Isolation

How much more grievous are

the consequences of anger than the causes of it.

-- Marcus Aurelius

Anger at Symptoms

• Fatigue and decreased energy• Lipodystrophy

– Lipoatrophy– Fat accumulation– Lipid disorders

• Wasting syndrome• Neuropathy• Gastrointestinal symptoms• Neuro-Cognitive changes

Anger is a wind which blows out

the lamp of the mind.-- Robert G. Ingersoll

Anger at the Disease

• Medications

• Labs

• Trips to the clinic/hospital

• Long term effects of the medications

• Long term effects of the disease

• Access to medical care

• Cost of medical care

Speak when you're angry,

and you'll make the best speech

you'll ever regret.-- Lawrence J. Peter

Anger at Disability

• Food

• Clothing

• Housing

• Medical care

• Being the disabled person

The continuance of anger is hatred.

-- Unknown

Anger at Behavioral Problems

• Anxiety

• Depression

• Substance abuse

• Cognitive disorders

There is no passion so much

transports the sincerity of judgment

as doth anger.-- Michel de Montaigne

Anger at God

• Why me?

• What did I do to deserve this?

• Judgment

• Loss of faith

• Falling away from organized religions

• Isolation

Heat and animosity, contest and conflict, may sharpen the wits, although they rarely do;

they never strengthen the understanding, clear the perspicacity, guide the

judgment, or improve the heart.-- Walter Savage Landor

Anger at Anyone and Everyone

• Lashing out

• Loosing control

• Can’t contain the anger

• Innocent bystander

Anger: an acid that can do more harm to the vessel in which it is stored than on anything on which it is

poured.-- Seneca

Anger at Self

• Acknowledge

• Forgive

Resentment is like drinking poison

and waiting for the other person to die.

-- Cindy Clabough

Anger and CD4 Count

• 130 sexually active gay and bisexual men

• 75 were HIV+

• Given a battery of psychosocial questionnaires (including Anger Expression Scale, Hardiness Test, and Profile of Mood States) and had blood drawn for CD4 counts

Levy E, Knapp P, Linde R, Mayer K, Stoddard A, McCusker J; Boston University School of Medicine, Boston, MA, USA Int Conf AIDS 1989 Jun 4-9; 5:810 (abstract no. D.713)

Anger and CD4 Counts

• Both anger-in and anger-out were associated with fewer CD4 cells in the HIV+ groups

Levy E, Knapp P, Linde R, Mayer K, Stoddard A, McCusker J; Boston University School of Medicine, Boston, MA, USA Int Conf AIDS 1989 Jun 4-9; 5:810 (abstract no. D.713)

Hurt leads to bitterness, bitterness to anger, travel too far that road, and the way

is lost.-- Terry Brooks

Emergency Measures

• A,B,C of Anger control

• D,E,F of Anger control

• Other suggestions

A,B,C of Anger Control

• A = Avoid loud speech.

• B = Breathe. Take a series of deep breaths.

• C = Curtail swearing.

D, E, F of Anger Control

• D = Drink a glass of cold water.

• E = Exercise. Burn off the anger. Run, walk, swim, bike, dance, etc.

• F = Find a friend and talk it out.

Other Measures

• Sit quietly and collect your thoughts

• Practice “buying time”

• Lie down until the anger passes

• Look in the mirror

• Beat on a pillow

• Roll up the windows and go for a “drive-and-scream”

Anger Toolkit

• How am I feeling right now?

• What happened to make you angry?

• Who are you angry at?

• How did the situation make me feel besides angry?

• What about this angers me the most?

• Now, what about this angers me the MOST?

Blowing out another's candle

will not make yours shine

brighter.-- Unknown

How am I Feeling Right Now?

• Anxious

• Worthless

• Hostile

• Depressed

• Mean/Evil

• Revengeful

• Bitchy

How am I Feeling Right Now?

• Bitter

• Rebellious

• Paranoid

• Victimized

• Numb

• Sarcastic

• Resentful

Sticks and stones may break your bones when there's anger to

inpart. Spiteful words can hurt your feelings but silence breaks

your heart.-- Unknown

How am I Feeling Right Now?

• Frustrated

• Destructive

• These are some of the names we give to feelings of anger.

• There is no cure for any of them

• First step is to identify is as anger

The thought manifests as the word. The word manifests as the deed. The

deed develops into habit. And the habit hardens into character. So

watch the thought and its ways with care. And let it spring from love, born

out of concern for all beings.-- Buddha

What Happened to Make you Angry

• If we can focus on the specific incidents which triggered the anger, it becomes more understandable and easier to manage

Who am I Angry At?

• My self?

• My partner/spouse?

• My boss?

• The kids?

• God?

• The Human Race?

• My life?

No one can make you feel inferior without your consent.

-- Eleanor Roosevelt

Who am I Angry At?

• All men?

• All women?

• Other races?

• Miscellaneous?

Not respecting yourself, is the same as committing suicide

at a slow rate.-- Unknown

Anger Involves 5 General Areas

• Our anger at others

• Others anger at us

• Our anger at ourselves

• Residual anger from the past

• Abstract anger

How did the situation make me feel besides angry?

• Sad?• Stupid?• Unappreciated?• Unworthy?• Powerless?• Guilty?• Inadequate?• Many others…fill in the blank

The world is too dangerous for

anything but truth and too small

for anything but love.-- William Sloan Coffin

What about this angers me the most?

• Peel down to the next layer

• Put your anger in clearer perspective

Now, What about this angers me the MOST?

• Down to the bedrock; one word

• The fundamental issue which underlies all of the others

• It often turns out to be a feeling: stupid, worthless, helpless, inadequate, powerless

• We lose our self respect and hold ourselves in contempt

Replacing the “Feeling”

• Replacing the feeling of worthlessness

• Even unworthy of our own respect with the antidote

• The only antidote for self contempt is self respect

Ways to Deal with Anger

• Talk about your feelings with others, such as people in a support group, or with a counselor, friend, pastor or social worker.

• Try to get some exercise--like working out, walking, or dancing--to relieve some of the tension and angry feelings you may be experiencing.

• Avoid situations-- involving certain people, places, and events--that cause you to feel angry or stressed out.

Ways to Deal with Anger

• Why are some people more angry than others?

• Is it good to “let it all hang out?”• Relaxation• Cognitive restructuring• Problem solving• Better communication• Using humor

Ways to Deal with Anger

• Changing your environment

• Easing up on yourself

• Assertive rather than aggressive

Hatred paralyzes life; love releases it.

Hatred confuses life; love harmonizes it.

Hatred darkens life; love illumines it.

-- Martin Luther King, Jr.

In Conclusion

• You can’t eliminate anger• In spite of all your efforts, things will

happen that will cause you anger• Life is filled with frustration, pain, loss, and

the unpredictable actions of others and events

• You cannot change that; but you CAN change the way you let such events affect you.

Thank you