The Yale Journal for Humanities in Medicine

Spirituality, Religious Wisdom, and the Care of the Patient

Anger in the Context of Illness: Perspectives in Jewish Tradition[i]

Solomon Schimmel[ii]
sschimmel@hebrewcollege.edu

I would like to thank Drs. Astrow and Sulmasy for organizing this series and for inviting me to participate.

My focus this evening will be on attitudes towards anger, and approaches to dealing with anger, in Judaism, and how these teachings might be useful to individuals experiencing anger in environments of illness.[iii]

Among the many aspects of anger addressed by Jewish tradition are the following seven:

1. What should be one's proper attitude towards anger?

2. When is anger justifiable and when is it not justifiable?

3. What are the causes of anger?

4. What are pragmatic, religious, or spiritual reasons for controlling anger?

5. When is the overt verbal expression of anger desirable and when is it undesirable?

6. How can anger be prevented, or if aroused, be dissipated, or channeled to some constructive end? More generally, what methods can be used to control one's anger?

7. How should one respond to another's anger?

Given the limitations of time, in my opening remarks I will address Judaism's attitude towards anger and some methods it suggests for preventing, dissipating or controlling it. I will also discuss anger at God. In the discussion period we can address other dimensions of anger as well, insofar as they will emerge from our consideration of the clinical examples upon which we have been asked to reflect.

Anger can manifest itself in illness settings in several ways.

1. The anger of the patient, which can be directed at one or several entities - the physician, other caregivers, the family, the, patient him or herself, and God.

2. The anger of the physician or other caregiver, which can be directed at one or several entities - such as the patient,[iv] the patient's family, the physician him or herself, other caregivers, and third parties such as insurance companies, or lawyers in malpractice suits.

3. The anger of family members of the patient at the caregivers.

Judaism maintains that for the most part we are responsible for our emotions and their consequences. We are capable of training ourselves as to how to emotionally respond to situations we encounter, and we are charged to control and channel our emotions in ways that are considered religiously and morally desirable. One of the early examples of this with respect to anger, and the injury it can produce is God's warning to Cain, who is angry at God for having accepted Abel's offering and rejecting his, and angry at and envious of Abel for having been preferred by God over himself. As Cain prepares to displace his anger at God onto his brother Abel, he is forewarned:

"So Cain was very angry, and his countenance fell. The Lord said to Cain, 'Why are you angry, and why has your countenance fallen? If you do well, will you not be accepted? And if you do not do well, sin is lurking at the door; its desire is for you, but you must master it'." (Genesis 4:6-7, NRSV).[v]

Cain fails to heed the Lord's admonition, and kills his innocent brother Abel. Anger has resulted in two casualties. Abel is dead. But Cain himself is a casualty of his own anger and his failure to control it. He has become morally corrupted, a less worthwhile person than he would have been had he controlled his anger.

Overall, Judaism has a negative attitude towards most manifestations of anger. Maimonides writes:

"There are some dispositions in regard to which it is forbidden merely to keep the middle path. They must be shunned to the extreme.Anger.is an exceedingly bad passion, and one should avoid it to the last extreme. One should train oneself not to be angry even for something that would justify anger.The ancient sages said, 'He who is angry - it is the same as if he worshipped idols' (Babylonian Talmud Pesahim 66b).The sages therefore, charged us that anger should be avoided to such a degree that one should train oneself to be unmoved even by things that naturally would provoke anger; and this is the good way." (Maimonides, Mishneh Torah, Hilkhot De'ot, Chaper 2:3).

Elijah de Vidas, a sixteenth century Jewish ethicist and mystic opens his extended discussion of anger with the assertion that it is a vice because it is rooted in arrogance. Arrogance is incompatible with the religious values of Judaism which emphasize the virtue of humility. Because of our sinful pride we expect people to do things our way, to defer to our authority or knowledge, and we are offended when they don't do so.

If, for example, physicians or other caregivers were to internalize the value of humility they would be less prone to respond with anger to real or perceived challenges to their expertise or competence in caring for their patients. 

Jewish moralists provide numerous suggestions as to how to avoid or control anger. First and foremost is to internalize the value that anger is undesirable. Second, they assume that learning how to deal with anger is a process that includes acquiring values, attitudes, and affective, cognitive and behavioral skills. One needs to train oneself in advance to anticipate anger-generating situations in order to be prepared to deal with them appropriately. For some people this might involve a major revision of their world view.

Zelig Pliskin has culled and organized many teachings about anger in Jewish tradition, which he deftly integrates with insights from counseling psychology. Some of the teachings assume a religious belief system, whereas others speak plausibly even to a person who is not necessarily religious. I would like to quote eight passages from his book Gateway to Happiness.[vi] Later we can consider how some of these teachings might be applicable to clinical cases.

1. Frequently people say, "He made me angry.".No one can make you angry. You make yourself angry by what you tell yourself about a given situation (p. 198).

2. Frustration does not cause our anger, it merely provokes it. We still have the ability to tell ourselves calming self-statements which will prevent our becoming angry (p. 201).

3. Whenever you get angry at someone it is because you are blaming him for doing or not doing something. By making it your habit to judge people favorably, you will be able to assume that perhaps the other person made a mistake, he had different intentions than you suspect, or he had a good reason for failing to do what you wanted him to do (p. 203).

4. If you are angry at someone for wronging you, try to correct that person, and this will help you overcome your anger.It is easy to condemn others. It is not as easy to assist them to improve, but much more beneficial (p. 206).

5. Frequently when we get angry at someone we fail to realize that he sees the situation much differently than we do.Keep asking yourself, "How does this person perceive the situation?" You might still strongly disagree with him, but understanding his point of view will help calm you down (p. 206-207).

6. If a person wrongs you, do not silently hate him. Rather it is proper to [ask him] "Why did you do such and such against me?" .By calmly confronting a person and telling him how you feel about what he has done, you will frequently be able to bring about a conciliation (p. 208).

7. If you know that someone might do something that is likely to get you angry, mentally picture the situation in advance and accept it. Be aware of your options for constructive behavior in those situations (p. 209).

8. Calming someone who is presently angry is an act of kindness. The most effective way to calm someone is to become aware of his perspective of the event, and either to skillfully change that perspective or to change the actual situation sufficiently enough so that he will calm down (p. 215).

In accordance with the assumption that learning how to avoid or control anger is a long term process, training programs for physicians and other health care professionals on anger management might be incorporated into their curriculum of professional study. Such a curriculum should include insights from various religious traditions, in addition to those from general psychology.

Anger at God

The wise premise of this entire series of panels is that to varying degrees all caregivers should be attuned to the religious and spiritual dimensions of their patients' lives. Given this premise I would like to turn now to anger at God.

Some religious people experiencing or witnessing severe illness and chronic pain, become angry at God. Anger at God can be cathartic, which is often psychologically useful. However, if the anger is deep and sustained it can have an adverse effect on the patient's well being, as all anger can. Moreover, it can also engender guilt in the patient, since she, as a religious person might feel guilty that she feels and expresses anger towards God.

It is important for the caregiver to understand the patient's experiences, and to let the religious Jewish patient know - and perhaps the devout Christian as well -  that from a biblical perspective it is legitimate to cry out to God in anger. It is OK to protest the fact that God appears to be unjust in subjecting the patient to illness and suffering. In the biblical Book of Job, Job expresses intense anger at God's apparent injustice when he is afflicted with horrible misfortunes, including debilitating illness. Although by the conclusion of the book, Job is reconciled with God, his initial feelings of anger at God are praised rather than condemned.

However, deep and sustained anger at God is probably unhealthy for the religious patient.

A group of psychologists studied the relationship between difficulty in forgiving God - in other words, harboring an unresolved anger at God - and the negative emotions of depression and anxiety.[vii] The researchers found that people who reported having difficulty forgiving God also scored higher on measures of depression and anxiety. The findings suggest to the authors that insofar as certain religious beliefs and attitudes serve as adaptive skills for coping with stress and traumatic events[viii] the ability to forgive God, after having developed anger at God, might be emotionally adaptive.

In addition to legitimizing expressions of anger and protest at God, Judaism also provides beliefs that help alleviate this anger.

In order for us be angry we usually have to believe that the perceived injury we suffered is indeed an injury. Whether or not something is an injury, is not always an objective question with a simple and straightforward answer. Our perception and interpretation of events and experiences determines whether we consider them to be hurtful to us. Patients who can incorporate their pain and suffering into a framework of meaning and significance might be more capable of coping with it. One way, that Judaism addresses the problem of the apparent absence of divine justice in the context of illness and suffering, is to teach that what might appear to be evil and tragic is not really so. Mortals can only see bits and pieces of experience, fragments of a greater reality. Were we to 'know' the world the way God knows it, in its fullness, and view it from his perspective, we would realize that suffering, even of innocents, serves some ultimate good end beyond our mortal horizon.

Immortality of the soul is another consoling belief. The sufferer in this life will enjoy eternal and incomparable bliss in an afterlife, so that in retrospect the suffering will be seen to have been experienced for a mere fleeting speck of time when compared to eternity.

Another idea is that the suffering might have a spiritually constructive consequence.

Such beliefs help mitigate the anger that a religious patient might feel towards God.

Another way in which some individuals resolve or at least attenuate anger at God, is by adopting a revised conception of God. Harold Kushner in his book When Bad Things Happen to Good People suggests that a theology which conceives of God as compassionate but with limited power, can help people feel close to and supported by God, while not holding him responsible for their suffering, and hence not becoming angry at him.

An appreciation of the psychology and the theology of anger directed at God, and of the place of suffering in a broader religious world view, as outlined above, might assist some of you in helping religious patients cope with the anger generated by their illnesses, by discussing with them the teachings of their own religion.  When the caretaker shares basic religious beliefs with the patient, it is easier to invoke these religious teachings in order to both comfort the patient and assuage the patient's anger. However, when the caretaker does not share the religious beliefs of the patient the task is more difficult. It raises the question of when and how, if at all, a caretaker should adopt, as a therapeutic strategy, the religious worldview of a patient, even though the caretaker doesn't personally subscribe to that world view.

In summary, many of the spiritual concerns, psychological insights, ethical goals, and practical suggestions of Jewish teachers from biblical to present times can be relevant and applicable in contexts of illness today.  

Sarah Coakley, "Anger in the Context of Illness- An Anglican Perspective"
Anger: Introduction
Table of Contents

Published: January 12, 2005