One of the biggest challenges that we face in life is the emotion called "anger," and how we deal with this primitive, yet incredible complex mixture of psychological and physiological responses. Many of these responses are "wired" into our systems, like the release of adrenaline in preparation for fight or flight, and are beyond our conscious control. 

These responses have deep roots in our evolutionary pre-history. They also have shallower roots in our cultural and family histories, especially the ways that anger was handled within our families of origin. 

We must look at what triggers our anger. Triggers include the perceived cause of the anger, and also who the recipient of that anger will be (friend or stranger; equal or a superior or subordinate). Still other factors are timing and setting, which require greater control around the release of our anger.

In the brachial plexus injury (bpi) community there are many points of view represented: the individuals who have been injured; their families; various medical professionals; therapists who work with physical and emotional consequences of the injury; and hopefully readers from the corporate world and general public. From so many points of view there are great differences in vulnerability and how one’s life is affected by a birth injury or trauma. These issues stir up our most basic survival needs: safety and control. Those of us affected by the injury may have strong emotional responses to the issues that come into play. For some, the response will be assertiveness. For others, it may be defensiveness. Someone else may respond passively.

The greatest impact will be on the individual and the family. Their lives are affected in so many ways by the injury. And when that individual cannot speak for him or herself, as in the case of an injured baby, the family’s role as advocate becomes even bigger. Because of this, the anger of the families can be overwhelming to themselves and to the people they come into contact. This may include medical professionals (who are blamed), and also the world of friends, neighbors, schools, etc. whose reactions often do additional harm (see below "anger at community").

In preparation for this article an anger question was posed on the United Brachial Plexus Network, Inc. (UBPN) website (www.ubpn.org). The response was a significant outpouring of feelings which speak for themselves. They reveal the tremendous anger within the bpi community. Often there is significant overlap of the common issues, though sometimes the anger is very personal and individual. The most common themes that emerged in the recent Anger Survey about bpi were:

• Not educating expectant parents about the risks and options

• Injuring my baby – for his or her whole life

• Injuring me

• Changing the rest of my life

• Causing a preventable injury

• Hiding important information, and limiting my choices

• Wasting opportunities for immediate therapy, by delaying and avoiding explanations of what occurred

• Lying to families and destroying trust

• Not accepting moral or financial responsibility

• Abandonment of patients and families

• Not educating themselves so that these birth injuries stop

• Conspiring to protect each other

• Making it so hard to collect legitimate claims

• Putting distressed families and clients through court battles

• Delaying payments, leaving families overwhelmed by medical bills

• Limiting therapy regardless of need

• Requiring continuing progress to authorize continued therapy

• Never-ending battles over these life-long injuries

• Lack of consequences for the doctors who cause these injuries

• Juries and judges who believe the doctors’ lies.

• Permitting doctors’ attorneys to blame and slander the mother

• Unfair and inadequate financial settlements

Anger at other professionals for:

• Nurses who lied in court about events during the delivery

• Therapists who insist on "going by the book", and don’t observe

• Orthopedists who design appliances without considering specific client needs

• Social Workers who don’t help with long range plans

• OT and PT staff who label kids "behavioral" just for resisting

• Media who won’t tell our story

• Being in denial

• Not taking a more vocal stand

• Running away

• Being unsupportive

• Blaming the mother

• Telling me how I "should " feel

• The stares, looks, snickers, and comments

• Excluding children with injuries from parties and activities

• Competition within the bpi community about right to opinions

• Not having known enough to prevent this

• Having to neglect my other children

• Wasting so much time with this anger

• That my child has to go through so much pain

• That my child will miss out on so many things

• That my family is suffering

• At the unfairness of innocents’ suffering

• That the life, career, and family I planned were taken from me

Sometimes the anger can be a powerful catalyst that precipitates action and change. Other times, the anger can be a trap, from which it can be difficult to escape. There are ways to help deal with anger, so that we don’t get stuck with these feelings. Our time and emotional energy then can become available for other purposes that will help us move forward. This often starts by making a list of what one is angry about, as was recently done on the UBPN website. It can be helpful to clarify one’s anger and to express it verbally or in writing. Sometimes the anger statement will include who specifically is being blamed, but often the anger is generalized, such as the unfairness of what happened, or the frustrations and feelings of helplessness.

One caution in expressing anger is the effect on those receiving or witnessing it. Depending on who is present and how it is directed, the display of anger may create fear, defensiveness, and resistance. So it is important to be practiced, familiar and clear with expressing one’s anger. Eventually one can modulate it and use it for productive means. If one needs to release anger or blow off steam it might be best to contain it until it can be expressed "safely" – for you, and safely for others. Or, use the intensity of it where it can do some good, e.g. media, politics, etc.

Making one’s anger public can also be very therapeutic, so that we are not carrying it privately or keeping any secrets – from others or ourselves. Of course it must be expressed in a way that maintains dignity for the cause and for us. Sharing one’s pain and anger with others also can lead to increases in our resources, our sense of empowerment (helping us not to get stuck), and can help change the world.

This leads to another important phase in the healing – letting go of the anger. After all the work to make the anger conscious and to learn from it and to express and direct it, one finally reaches the place where it is important to begin to let the anger go, so we can move more freely. It can be very difficult to let go of something that has been such a big part of our life. But if we do not actively let anger go, then it can attach to us and becomes a habit that influences our mood and movements in ways that hurt us, and those around us. This is a place where we really need the help of others. It can be done as part of a support group or community of peers, or with a professional therapist or counselor who is trained in working with people’s anger, and who has some understanding of the situation. Or with both – a therapist and a support group. This is also a good place to bring in spirit or religion. Over the ages there have been many useful rituals, prayers, songs, and meditations that can greatly help the process of letting go of anger and grief.

The kinds of therapy which I would recommend to individuals who are injured and to their families would address not only the emotional and intellectual trauma, but also the physical and spiritual. The pains and experiences of a birth injury or severe trauma, and the subsequent struggles to recover can create floods of emotion or blocked emotions. These emotions can carry over into our bodies, affecting our health, movement, thinking (different from feeling), and our beliefs (philosophical and spiritual). There are wholistic therapies that do address the whole person, and through these the individuals and their families can express and explore the full spectrum of their reactions to those traumas. GOOD THERAPY IS AMAZINGLY LIBERATING, AND OPENS UP NEW CHOICES AND CHANGES. 

Ideally, therapies would include a blend between talk therapy, body awareness, and expressive modalities, such as dance and movement, art, psychodrama, working with breath and voice. By alternating between "left-brain" (cognitive-verbal-intellectual) processing of the trauma, and "right-brain" (emotional-spatial-artistic-intuitive) processing, the pain, fear, and anger can be resolved more deeply and more permanently. Some of the best therapeutic approaches available today are: Rubenfeld Synergy Method®; E.M.D.R. (Eye Movement Desensitization and Reprocessing); and several others described by the U.S.A.B.P. (United States Association of Body Psychotherapists). Information about these therapies can be found on the internet or in bookstores.

At the very least, it is recommended that you provide yourself with the best possible self-care. That would include making sure that you have adequate nutrition, rest, exercise, and even some "time off". Encourage your loved ones to do so as well. Without good self-care how could anyone expect to sustain the difficulty and the length of the journey?

I want to thank all of those who responded to the Anger Survey for their truthful and insightful responses on the UBPN website. I also thank those individuals who I personally interviewed, and for their generosity in wanting to help others who are going through this kind of ordeal.

Mike Schlesinger, Ph.D. is a Licensed Psychologist and Certified Rubenfeld Synergist with a practice in the Philadelphia area. He has over 30 years of experience working with trauma, anger, and recovery, and uses a body-oriented approach with psychotherapy.