Poorly managed rage is a staple of presentations to mental health practitioners. Whether that rage is internally or externally directed, the regulation of anger is at the heart of much psychological distress, particularly in Anglo-Saxon culture, where rage is expected to be suppressed.
Drug and alcohol problems are often ways of coping for people who are unable to tolerate frustration. Self-harm occurs most commonly among those who believe their rage must be internalised, that it is not acceptable to communicate it outwardly. Patients inevitably speak of a sense of relief, a release of a steady crescendo of frustration, after they engage in cutting, for example. Even eating disorders usually occur in people who present in a formal, business-like manner indicative of their obsessive traits, but the exterior masks a primal, psychic screaming.
The British psychoanalyst Adam Phillips writes of the importance of interpreting rage in the therapeutic setting: “Tell me what makes you enraged—what makes you feel truly diminished—and I will tell you what you believe or what you want to believe about yourself … what you imagine you need to protect to sustain your love of life.”
Patients require hate objects almost as much as they require love objects. A key feature of therapy is helping people to tolerate the aspects of themselves that they may consider hateful, and to recognise the origins of some their resentments as internal. This can make the external world less frightening. This insight overlaps with some of the emotional currents we are seeing around the world, often called populism.
In an essay for the Guardian titled “Welcome to the Age of Anger”, the Indian author Pankaj Mishra writes that “our dominant intellectual concepts and categories seem unable to process an explosion of uncontrolled forces”. Mishra suggests economics has been relied on too heavily to explain people’s motives.
The decline of other modes of thinking such as psychoanalysis, which is about how the attempt to tame and satiate primitive instincts underlies behaviour, has elevated the place of reason in human affairs. As Mishra notes, Freud warned in 1915 that the “primitive, savage and evil impulses of mankind have not vanished in any individual”.
We live in a time when all the old structures such as traditional family, religion and civic society are in decline or marked transition. Collective institutions such as churches, unions and political parties have been dramatically diluted. A small minority of the population belongs to such groups. The patients who walk into my office are trying to make sense of their lives without the security of the old structures.
It mirrors a change in the last half-century in life’s project, away from seeking salvation through God or a fixed commitment to family and community to one of individual self-fulfilment. Instead of individuals being described as having characters, with the connotation of morality, of good or bad, we have personalities, with a different connotation of self-presentation.
As part of the decline in collective institutions the tensions that depict the political fault lines are no longer that of, say, labour and capital. They are often illustrated in the consulting room through the relationships individuals have with society at large. People communicate their politics through the food they eat and the brands they buy, and have little involvement in collective, organised movements. Some might argue that social media campaigns have replaced more traditional activism, but the levels of commitment are very different.
A key trend of recent decades is the rise of what is known as “concept creep”, the steady dilution of the meaning of terms like trauma, abuse and prejudice. For example, the trauma in post-traumatic stress disorder (PTSD) was originally constructed as a sudden, objectively life-threatening event such as a wartime battle, but it has since shifted to one of great subjective distress barely connected to the gravity of any actual event. It is no wonder that the diagnosis of PTSD in British screening tests has tripled in the past decade, according to a 2014 NHS study, particularly for young women. The Australian Centre for Post-Traumatic Mental Health believes PTSD is now the second-most common mental health disorder after depression, with an estimated 800,000 sufferers at any one time. The Centre’s website goes as far as stating that 15 million Australians suffer from trauma, which would mean almost every adult in the country. Trauma in this use of the term means any upsetting experience.
Another important feature of PTSD diagnosis that has implications for the wider culture is that it was previously thought such a diagnosis was primarily related to innate vulnerabilities in a sufferer’s personality, rather than the trauma itself. The change in the meaning of PTSD after the Vietnam War is important beyond the technical aspects of psychiatric diagnosis, because people are now more likely to interpret their psychological distress as being caused by the outside world.
This overlaps with the rise of identity politics, the emphasis on recognition and a belief that the psychological distress of marginalised groups is principally related to established power hierarchies. The boundaries between private distress and public politics have been dissolved. This shift is mirrored in the rise of personal testimony, especially of oppression, which is increasingly a weapon to challenge the primacy of dispassionate argument.
Both the decline in the notion of the autonomous self and the dilution of the meaning of psychological terms, while utilised with good intentions, have helped promote a culture where ordinary people interpret distress in a medicalised or pathologised way. They are also more likely to believe the source of their distress is in the external environment, and to project their psychic unease onto their partner, their work or society at large. This is a critical contributor to the rise in resentment-based movements such as men’s rights, white nationalism or Islamic extremism.
A great deal of the modern therapy that occurs in the rooms of psychological professionals is aimed at helping people understand the internal origins of their unease. One way to consider this therapeutic shift is helping them see themselves as outside the crowd.
In considering politics Freud was greatly influenced by the police psychologist Gustave Le Bon’s ideas in his classic work The Crowd: A Study of the Popular Mind. Le Bon’s book was published in 1895, a time when the masses, by strikes and large demonstrations, were challenging the notion of the rational individual that self-government required. His book showed how rumours, irrational passions and false prophets can mislead the masses.
The social theorist Eli Zaretksy, author of Political Freud, notes that this characterisation of the dim-witted irrationality of the lower classes has a long history in political theory. It is instructive that the word vulgar, so commonly used to describe Donald Trump, has its roots in the Latin vulgaris, which means of the masses or the common people. Le Bon’s notion of the crowd was a forerunner to today’s populism. Crowds help distract us from our daily frustrations and disappointments and are inevitable in democracies.
What Freud added was the importance of a father figure or a leader, which in psychoanalytic terms was when members of a group substitute their own ego ideals with that of the image of their leader. As members of a group come to share ego ideals, Freud argued that this identification with each other constituted a crowd. He also saw such crowds as being more primitive and prone to reverting to unconscious desires.
Donald Trump and Bernie Sanders stirred in groups the belief that they were oppressed by an elite that was uninterested in their concerns. This was partially based in reality, but the passions stirred took on a primitive edge.
Some patients of mine in western Sydney, drawn to white nationalist groups, illustrate some of the patterns that Freud alluded to a century ago. One man in his forties had been made redundant from a factory job after suffering a back injury. While on worker’s compensation he was consumed with a free-floating anger that took shape in the form of racism against immigrants. He had occasional thoughts of self-harm, which was why he was referred to me, but he was the epitome of the white working-class resentment that has become the focus of obsessive study by the commentator class.
Underneath my patient’s distress was a long history of personal failure from failed marriages to poor job performance. Unable to tolerate his own shortcomings, he channelled his frustrations outwards with the idea that immigrants were encroaching on his opportunities or resources. A notable theme during our interviews was how unrecognisable his local neighbourhood had become. He expressed anguish at seeing all that was familiar and comprehensible replaced with the unknown and foreign.
This overlaps with David Goodhart’s recent book The Road to Somewhere, which hypothesises that the biggest fault line in society is between the well-heeled internationalists and others who are strongly rooted to place. He describes the internationalists as those with “achieved identities, based on educational and career success which makes them comfortable and confident with new places and people”.
The somewheres tend to be older and less educated. They are the farmers, the blue-collar workers in outer metropolitan areas and the suburban housewives for whom the upheavals of modern life are deeply unsettling. Goodhart writes:
They have lost economically with the decline of well-paid jobs for people without qualifications and culturally, too, with the disappearance of a distinct working-class culture and the marginalisation of their views in the public conversation.
Another patient of mine was a tall, crewcut man in his twenties who had formed a tribe with several friends called the “Slavic Brotherhood”. They were worried about the rising numbers of Muslims in Australia and had participated in several protests. When he gave me a detailed history it emerged that the four members of his “brotherhood” were all from fatherless families raised by single mothers. This may have been circumstantial, but the pining for authoritarian leaders is, for a psychiatrist, a potential yearning for the primordial father figure. Across the Western world we have a generation of young men, predominantly in the working classes, who have grown up without the presence of their biological fathers. The rise in authoritarian leaders across the world ranging from Putin to Erdogan to Trump represents in part a longing for a protective father at a time of great upheaval.
Populism is not entirely irrational. As best encapsulated by American writers like Thomas Frank and Jonathan Haidt, both of whom identify as progressive, the modern Left has become representative of the professional classes. The mission for greater recognition or equality has been directed towards minority groups such as gays, blacks and Muslims and away from the historical mission of serving the working class. Progressives have over-estimated to what extent society can be transformed into a rational, fair-minded polity ruled by an evidence-based, data-driven professional class.
The public have soundly rejected this notion. Trump’s unpredictable nature, comfortable with aggression, is evidence that he connects with people’s primitive unconscious, particularly with what Freud categorised as the “id”. In contrast Hillary Clinton came across like a headmistress, chiding the naughty kids supporting Trump as “deplorables”. She was the super-ego giving moralising sermons and offering do’s and don’ts. To expand further on the Freudian theme, our politics is desperately looking for political versions of the reasonable ego, “the rider on the horse” to tame the id and super-ego as represented by the far Right and the far Left.
Tanveer Ahmed is a Sydney psychiatrist. His book Fragile Nation was reviewed in the April issue.