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Anger and Aggression

Dr. Joanne Paul- MBBS (UWI), FRCPCH (UK), FRCP (Edin)

 

 

So, I love to travel. Just to go through that airport and watch people from different counties walk by, speaking different languages, having different lives, varied ages, varied sizes and so many variations is what they are wearing, how they are walking and where they are going. And when I reach to the destination country, just the mental reset to experience a change in rhythm and pace and food and culture, albeit for a short while. The temporary loss of insularity makes one understand more and have a wider perspective. At least it has the potential of doing so.

During the pandemic though, the effects showed up not more differences but amazing similarity. It was like a script for a play on the stage or a playbook for a sporting session. Each country was going through the same things in almost the same order, some at exactly the same time and some lagging behind but following the same script. Increasing numbers of covid, implementation of public health measures, variation in mask wearing protocols, variations of lock downs, protests by some groups on lock down, frustration and fatigue with lockdowns, celebration of opening up, wariness of upcoming variants and next potential surges, acceptance of living with covid.

With regards to post pandemic psychological effects it is the same similarity; isolation and depression, especially with the elderly and adolescents, increased anxiety, fear, confusion with covid social customs, variations in pace of returning to new normal and what the new normal entails. And of course, anger. And aggression. Anger generally signals that we feel threatened, deprived, and robbed of expectancies. With the disruption of daily life and the uncertainty that was the theme of the pandemic, compounded with economic distress, social inequity, and political conflicts, we became immersed in fear, sadness and resultant anger and aggression. When that anger is unresolved, it turns into hidden trigger points within us, like a time bomb which can go off when we least expect it.

With fear, anxiety, depression, and isolation, we would usually resolve these with friends and family and other coping mechanisms like carnival or a party or a lime or just chilling in the neighbourhood on a night watching the blood moon. But the lockdown and social distancing led to isolation from these outlets. We also had to isolate at home where there was little opportunity to express these frustrations and pent-up negative emotions. So increased stress and less coping outlets made us go into fight or flight response. The fight response has been the most obvious and is being expressed worldwide with increases in intimate partner violence and child abuse in addition to increasing violence in schools. The flight response is the less obvious one which represents as withdrawal. When we look back, we must admit we saw a lot of withdrawal with family and co-workers, but we just ignored it as we were eager to get back to an opened society and we had no idea how to deal with it. The increase in anger is harder to ignore but the withdrawal is equally important

There is the frustration-aggression hypothesis by Berkowitz in 1989 that suggest that aggression is the common outcome of the frustration from stolen or removed individual goals. In fact, this aggression outcome was an expected trajectory with psychology pandemic forums and there was a fair amount of research going on intra pandemic to assess the aggression increase as the pandemic frustration levels increased. The world trend now with the school environment is increased crying and disruptive behaviours with younger children and increased bullying and violence with the adolescents. The world trend now with the home environment is increased intimate partner violence even with persons previously considered low risk. Some research showed 6th to 8th fold increase while some found 10 times increase.

So here is the story. We are lagging behind the rest of the world but following the same script, which gives us an advantage in terms of what to expect and maybe some extra time to prepare for the trajectory. With the BA.4 and BA.5 Omicron variants causing an increase in covid infections, we can look at the script from South Africa, USA, and UK and even Europe. The script has to be modified to suit out culture, climate, population density, congregation propensity, public health guidelines uptake and vaccine uptake but the script is still showing great similarity. The script is now showing a surge in Omicron infections, mostly milder infections, some increase in hospitalisation and no clear trend yet on the response in ICU admissions. It means we are going to continue with the up and down of covid infection levels and uncertainty, frustration and the anger, aggression and withdrawal can be projected to continue for a while.

As fellow columnist Martin Daly often says in his Sunday articles, we already have the expertise. We have the script. We need more multistakeholder think tank meeting retreats to grind out sustained real solutions that can work for us. Then increased awareness and action plan at an individual, household, school, community, regional and national level. It is the onion theory where we attack at each layer. No 5 days. No 9 days. Sustained and real impact. Because here is the story. There will be more. This surge may not end soon.

Dr Joanne F Paul is a Lecturer, a Paediatric Emergency Specialist, and a member of TEL Institute.

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