An analysis of anger in relation to clinical dentistry

SHEAR

8. 9.

10.

11.

12.

TEST

OF NEW

RESIN

Smith, US: A milestone in dentistry. Oper Dent 7:14, 1982. Bowen, RL, Nemoto, KI, and Rapson, JE: Adhesive bonding of various materials to hard tooth tissues: Improvement in bond strength to dentin. J Am Dent Assoc 106:475, 1983. Bowen, RL, and Cobb, EN: A method for bonding to dentin and enamel. J Am Dent Assor 10~734. 1983. Vougiouklakis, G. Smith, DC, and Lipton, S: Evaluation of the bonding of rcrvical restorative materials. J Oral Rehabil 9:231, 1982. Nakabayashi, N, and Masuhara, E: Preparation of hard tissue compatible materials: Dental polymers. In Goldberg, EP, and Nakajima, A, editors: Biomedical Polymers: Polymeric Materials and Pharmaceuticals for Biomedical Use. New York, 1980, Academic Press, pp 85-l 11.

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14. 15.

Nakabayashi, N, Ko.jima, K, and Masuhara. E: The promotion of adhesion by the infiltration of monomers into tooth substrates. J Biomed Mater Res 16:265, 1982. Fusayama, T: New Concepts in Operative Dcntistrv. Chicago, 1980, Quintessence Publishing Co.. pp 62-85. Reinhardt, JW: Porosity in composite resin restorations. Opel Dent 7:82, 1982.

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DR. ASTERKX DOI;KCXIDAKIS CASE WESTERN RESERVE UNIXRSITI SCHOOL OF DENTISTRY CLEVELAND,

An analysis of anger in relation

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44106

to clinical

dentistry

Norman G. Araki, D.D.S., M.A.* Fort Sam Houston, Tex.

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nger is responsible for the most destructive and violent human acts. It can drive an apparently responsible person into uncontrollable rages of irrational behavior and homicidal acts.’ In dentistry, anger is a disruptive dilemma that may confront all individuals within the dental environment at one time or another. There are few dentists who have not experienced anger relationships involving patients, professional staff, family, and themselves. There has been little investigation of this all-encompassing phenomenon and the literature remains extremely sparse. Even modern psychology and psychiatry texts contain brief or no references to anger and its cause. The purpose of this article is to analyze and report a concept of psychology and relate it to the anger phenomenon. This concept is the rational-emotive therapy (RET).z The World Book Encyclopedia defines anger as an emotion that expresses extreme displeasure.3 Mentally, anger tends to interfere with logical thought and make it difficult to pass sound judgment. Physically, it may cause violent reactions in the muscles and internal organs. ANALYSIS

OF ANGER

The cause of anger is expressed in many ways depending on the various schools of thought. The

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JOURNAL

Colonel,

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resident,

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psychoanalytic school, founded by Dr. Sigmund Freud, ascribes the cause of anger to an unresolved conflict in one of the psychosexual stages.4 Perhaps it is more commonly due to an unresdved conflict during the anal stage; namely, as an anal retentive fixation. The important emphasis here is that an unresolved emotional conflict in the past (childhood) is expressing itself as a cyclic symptom of anger in the present. The behavorists describe anger as a conditioned response.5 The individual expressing anger has been reinforced (rewarded) for this behavior, and it has thus become a stimulus-response (S-R) relationship.6 A more fundamental approach indicates that people become angry when they cannot fulfill some basic need or desire that is important to them. Furthermore, when anger is frustrated, the individual often develops feelings of hostility and hatred toward others.’ These are the currently accepted approaches to an analysis of anger. Such concepts seem to satisfy most observations of anger, yet it seems that a vital element is missing. The formulator of the RET stated that behavior is due not to events, but to interpretation of events.2,8 Most people believe that an actuating event causes consequences, which is diagrammed: Activating

DENTISTRY

Consequent

behavior

(C)

However, the theory further states that in reality the person’s behavior is dependent on an unrecognized factor: the person’s beliefs.’ Thus the sequence of events should be diagrammed: ilctivating

OF PROSTHETIC

event (A) +

event (A) -

Beliefs

(B) -

Consequent

behavior

(C)

591

DISCUSSION A girlfriend may say to her boyfriend, “You made me angry by wearing shabby clothes to my mother’s birthday party.” In reality, it was the girlfriend’s beliefs and judgment (interpretation) that caused her to become angry. In essence, she made herself angry by her belief system. Moral justification for her behavior rests on the culture in which she lives, because in other cultures shabby clothes may be perfectly acceptable. Ellis” states that people have many conscious and unconscious beliefs of how things should be or ought to be. Many of these beliefs are a “jehovan (or Godlike) demand” of how reality should be. Even the most congruous individuals become irate at some point and thus prone to impose to a God-like jehovan demand as to how reality should be or how things should go. Anger results when an event is extremely displeasing and divergent from an individual’s belief system; the person is unprepared to accept this occurance and rebels in anger. Words such as “should” and “ought” express cultural, social, and moral obligations as imposed by a mass belief system. These are cultural laws and expectations.x “’ This is an area in which an unsuspecting dentist may have difficulty. For example, suppose it were possible to make a full inventory of all the beliefs that the next 100 patients will have regarding what a dentist should or ought to be. A dentist should be kind, pleasant, trustworthy, highly skilled, compassionate, knowledgeable, intelligent, forgiving, honest, responsible, amicable, dedicated, hygienic, patriotic, mild tempered, painless, and possess a host of other virtues. It must be stressed that many of these jehovan demands are unconscious to the patient. The dentist is nonetheless vulnerable to the expectations. In essence, the dentist has made an unspoken mental contract with the patient. The conflict arises when the dentist fails to live up to the patient’s expectations. For example, the dentist may have proved to the patient that he or she is untrustworthy because the patient experienced pain. The dentist can be judged to be dishonest for charging an excessive fee or unpleasant because of an extensive rehabilitation that is unpleasant and costly. Patients become angry when their threshold of tolerance is exceeded. It must be remembered that different people have different thresholds of tolerance and different belief systems. Another area of possible conflictual relationships is the patient’s expectations regarding their prosthesis. A denture ought to be comfortable, reasonable in cost, esthetic, simple, functional, durable, kind to the mouth, and hygienic. In addition, it should “allow me to express my true personality, make me feel good about myself, make others think well of me, not make me stand out as a person with artificial teeth, make my spouse accept my appearance, ease my fears about losing my sexual 592

identity, free me from further dental treatment, function as well as mother’s teeth. She is older you know!” Certainly it would be difficult for the dentist to live rip to the first list of expectations. Imagine how difficult it !s to live up to both lists. Thus dentists can begin :t> understand why they are unable to maintain a continually high acceptance rate and then become aware 01 many hidden stress factors that are elusive to define in the practice of dentistry. Dentists are aware of the high stress factor but are at a loss to describe its source. Perhaps this analysis will help to define the prohlrm. Dentists must also be willing to accept a certain amount of anger and rejection. It is inherent trr dental service, Perhaps the greatest surprise is that dentists d<) not encounter anger and hostility more frequently, which may be related to the generosity of human nature shown by our patients in not expressing all that they feel. SUMMARY This article discussed anger and its cause. Experience and observation of human behavior denote valid points in the four concepts considered. The introduction of the RET has added the belief system and interpretation of events to the classic approaches. This concept adds further insight into why people become angry or, more accurately, allow themselves to be moved by anger. With this new knowledge should come an awareness of the need to converse with and know patients better and to prevent undesirable anger relationships from occurring. Dentists are able to modify the patient’s belief system, if it is erroneous, by educating them toward more realistic expectations. This makes it possible to add to the patient’s happiness by reducing cnnflictual relationships in the acceptance of reality. REFERENCES Nathan. 1’ I and Harris. S: Ps)chop;\tholo!;y ;md SWXIV. ~(1 ? New York, 1980, McGraw-[Iill Book (:
pp 180- 19 I.

I-lolling, C:. K. ‘I‘rxtbook ul Psychiatry for Medical Pr,wttr, r.ri 3. Philadelphia, 1975. J. H. L’pt incotr CZo.. pp 105-201. Ellis. .j., and Harper, R.: ,\ Guide to Rationat Living. Chicq) 1975.Prrmtcr-Hall. pp 11%121. Ellis, .‘I.: Hum;mistic Psyhothrrapy. Thr Rational-Enit,ticr, .~\pprod~. New York, 1973. ,Juli,rn Prrs~ p 173. ‘l‘;ivis. (Z -1nqer~. The ~~isuntlerstwd lGnotinn Ne\v 1 ,A 1’)82. Slrnorl and Srhuster. pp .+64X

APRIL

1965

VOLUME

53

NUMBER

4