Staying sane while staying home: Why people lose their temper and ways to manage anger

SINGAPORE — A 14-year-old teenager threatening to kill his father after being asked to lower the volume of the television. A heated argument between siblings ending with physical wounds. A heavily pregnant mother under stress screaming uncontrollably at her four children.

These cases of anger-fuelled conflicts are just a fraction of what the Singapore Children’s Society has seen since the Sars-CoV-2 coronavirus that causes Covid-19 upended life here.

Not only are people fighting the new coronavirus, they are grappling with another threat in the form of out-of-control rage.

Anger management issues are one of the growing psychological concerns some mental health experts and social agencies here have been attending to since the start of the outbreak earlier this year. 

Senior clinical psychologist Kim Lian Rolles-Abraham of Better Life Clinic, for instance, believes that these might not ease even after June 1 — when Singapore exits in phases the circuit breaker that controls movement of people and limits activities.

“Life is not going back to normal in an instant,” she said.

The remaining restrictions may contribute to a certain level of frustration that, if left unattended, can result in an escalation towards anger outbursts.

Also, certain altercations that had occurred during the circuit breaker period may be left unresolved, causing existing feelings of anger to fester, she added.

MORE AGGRESSION, CONFLICTS, VIOLENCE

In the last few months, Yishun Family Service @ Children’s Society — one of the 12 service centres run by Singapore Children’s Society — has observed a substantial increase in domestic violence cases and family conflicts involving anger and aggression.

From an average of seven cases a month in the last three months of 2019, it has grown to an average of 14 cases a month from January to April this year.

The majority of the cases involved violence against spouses, followed by children and siblings, its spokesperson said.

These cases are referred from other agencies such as the police and the Family Justice Court, and from walk-ins, letters or emails.

In a case seen by the Singapore Children’s Society, a 16-year-old youth reached out to one of the service centres when his older sister wounded him during an argument. There had been conflict between the two siblings. A counsellor helped him to work out a safety plan, such as things he could do to avoid harm. The teenager was also told when to call the police and contact numbers were given to him to get help. A counsellor would check in on him weekly.  

In another recent case, a mother called in seeking help for her 11-year-old son. He had thrown a remote control and started screaming at her after she nagged him about not completing his homework and playing computer games. The Singapore Children’s Society is still working with the mother to support her and the child.

In a statement last month, the Ministry of Social and Family Development (MSF) said that it has seen a 14 per cent increase in referrals and enquiries related to domestic conflicts and violence in the first two weeks of the circuit breaker period compared with the two weeks before — although the increase did not necessarily mean a corresponding rise in actual acts of violence.

WHAT’S PUSHING THE BUTTONS

Experts said that uncertainty and disruptions to daily lives can escalate emotions and being cooped up at home does not help.

Dr Rolles-Abraham said that some of her patients who were previously getting treatment for mood or anxiety disorders are now seeking help to manage their anger, given that they are spending more time at home with people they were in conflict with before the circuit breaker.

“It is a known fact that when individuals, even those previously on good terms, are facing each other in a confined space for an extended period of time, conflicts can arise,” she said.

Excessive alcohol use, either as a means to cope with sadness and frustration or because the days are seamless, has also been linked to anger, aggression and violence, she added.

Dr Rolles-Abraham pointed out that expressed anger or aggression could also point to grief. Anger is one of the five stages of grief described by Swiss-American psychiatrist Elizabeth Kubler-Ross.

“Instances of lashing out over something as seemingly inconsequential as bubble tea, for example, are also really manifestations of a deep grieving over the loss of what was previously so simple or accessible,” Dr Rolles-Abraham said.  

Ms Peh Lay Siew, social worker at Yishun Family Service @ Children’s Society, said that when a family’s equilibrium is disrupted, it can cause emotions to escalate and increase tensions at home.

While parents deal with financial challenges, increased caregiving, educational responsibilities and changes in their job demands, their children also face challenges.

Ms Lee Hwee Nah, assistant director of Youth Service @ Children’s Society, said that many teenagers typically cope with stressors by socialising with their peers. With the sudden adjustments to stay home, they are stripped of this coping mechanism and are left with little skills to manage otherwise.

It has also been observed that families with more resources are better able to buffer the impact and be more resilient when adapting to the changes, Ms Peh said.

For example, parents can engage the help of private tutors to teach their children through video calls. They can order groceries and cooked food online to save time or buy games to keep their children engaged. These goods and services allow parents to “buy time” so that they can focus on other demands, she explained.

“In contrast, the lack of such resources adds more stress on our vulnerable families and adds on to their already very taxed minds. So, a likely consequence will be difficulties in regulating their emotions.”

REDUCED ACCESS TO SUPPORT

Dr Adrian Wang, consultant psychiatrist at Gleneagles Medical Centre, said that at a time when counselling and psychological services are “very essential”, the non-essential status of counselling and psychological treatments in the initial weeks of the circuit breaker period would have had an impact on people with anger management and other mental health issues.

These services were later re-categorised as essential services from April 29, about three weeks after stay-home restrictions began.

“Patients who have been seeing counsellors for anxiety-related problems have been experiencing a worsening of their symptoms during this time. Many are getting depressed, sleeping poorly and may even be having conflict with family members. To deny them of psychological treatment during this time will cause their illness to worsen,” Dr Wang said.

A VALID EMOTION, BUT RESPONSE MATTERS

Experts said that anger is a valid emotion and normal response. However, it is important to find ways to regulate this emotion as it can become a disorder when it wreaks havoc on everyday life and relationships. 

Ms Gloria Ng, head of centre at Community Services and Programmes @ Children’s Society, said: “Anger is a normal response. However, we worry when someone responds in an aggressive manner when triggered. Aggression is when someone behaves in a way that hurts or threaten oneself or others.”

Dr Wang said that anger becomes a disorder when it causes harm to the person’s ability to function. For instance, when there is prolonged anxiety and low mood or it impacts physical health such as causing poor sleep, elevated blood pressure and frequent headaches.

However, personality is also a big factor, Dr Wang said, adding that certain personality types such as those with perfectionistic tendencies or have a habit of worrying are more prone to anger outbursts.

“In other words, they tend to have low frustration tolerance and their threshold for anger is lower. But it shouldn’t be an excuse. It should really be a reason for learning to develop coping mechanisms such as breathing and meditation techniques. If (anger outbursts) happen repeatedly, counselling can help,” he said.

Dr Rolles-Abraham said that professional help is required if anger manifests as severe aggression and physical violence such as throwing or smashing of objects or causing physical hurt, self-harm.

HOW TO MANAGE ANGER

Pointing out that “there are no negative emotions, just negative behaviours”, Dr Rolles-Abraham said that learning to identify one’s emotions can help to prevent anger from escalating. 

“People do not go from zero to 100 in an instant. While it may appear so, it is really a graded process.”

For example, the beginnings of an outburst could entail a specific thought, which may lead to a physical sensation such as racing heartbeat, clenching of fists and finally, an outburst with potentially severe consequences, Dr Rolles-Abraham said.

“If one is able to become more aware of this process, he or she can intervene during the earlier stages to prevent an escalation,” she said.

She added that some healthy ways of intervening and managing anger include:

• Delaying your response. Always take a time-out because responding in the throes of anger often results in unintended and potentially damaging consequences. Studies show that when people waited it out, they were calmer and used fewer harsh words compared to those who responded immediately

• Engaging in a calming, de-stressing activity while mulling over your response. For example, a warm shower, playing with your pet, writing down your thoughts to help you de-compress

• Getting a different perspective. The ability to reason and see alternative perspectives are limited when one is angry, due to intense nature of the emotion. Speaking to a neutral party can help. This can be anyone who is not part of the conflict, such as a counsellor or friend

• Exercising as a healthy outlet to release pent-up and restless energy so that it does not manifest in the form of negative behaviours fuelled by rage

If the anger has escalated, these strategies may be used to defuse the situation:

• Approach from a place of care and concern. For example, say, “I notice that you’re feeling quite angry. Is there anything I can do to help?”. This can help soften the heart of an angry person, Dr Rolles-Abraham said

• If the conflict escalates, experts suggested disengaging from the situation. Where possible, physically remove yourself from the situation to protect yourself as well as the other party
  
  Ms Rachel Tan, group lead of youth development and director of The Fort @ Children’s Society, has the same advice for parents if their children are arguing heatedly and fighting. She suggested speaking calmly and not to lecture or take sides. Instead, give each party some time to speak, but do this separately

• Call for help if you need someone else to step in to mediate

MSF lists on its website phone lines for people to call when they need help. They include:

• MSF Child Protective Service: 1800-777-0000

• Tinkle Friend Helpline (for Child Abuse): 1800-274-4788

• Pave Integrated Services for Individual and Family Protection Specialist Centre: 6555 0390

Anyone who needs help may also contact their nearest family service centre, also listed on MSF’s website. In case of immediate threat, call the police at 999.