Dads, PND and Anger.

“I scared them”, says the 35 year-old dad in the chair opposite me, “but I scared myself more”

He’s talking about raising his voice at home. At the people most dear to him. In a house where his baby lives. Even the dog hid under the bed.

He hasn’t been able to look any of them in the eye since, nor look at himself in the mirror.

On the way to work the next day, he had a panic attack – sudden overwhelming physical anxiety. He thought he was dying or going crazy.

That’s how he got sent to see me, a perinatal psychiatrist, after a visit to his local emergency department.

I actually think he’s among the 1 in 10 dads with PND (perinatal depression and anxiety), which is highly treatable and best detected early. So he’s come to the right place. I’ll tell him that soon.

But right now he’s busy telling me about his biggest fear – his own anger. If my treatment is really going to work, if he’s going to get better and stay better, we have to help him with this.  While there are many other ways PND can present in men, the shame this dad feels about his anger can make getting help that much harder, and every bit of help he gets can help his whole family.

This goes beyond perinatal mental health too. Anger issues in men can be part of other major mental health conditions, including post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD) or addictions to alcohol, gambling, work or sex. Anger can also be related to unresolved grief, or complex trauma such as that seen in survivors of sexual abuse. And yet it is so often misunderstood, prejudged, placed in the “too hard basket”.

It’s certainly one of the biggest challenges in my work – at 6 feet tall and maybe 100kg of distressed dad, the physics alone is enough! Compare the body sizes involved: If a little boy or girl expresses strong anger in my office, I feel no threat, but rather a desire to understand a child’s inner life. If a mum expresses strong anger in the room with me, I may feel unsettled and try to help her be calmer if we are to work on understanding her inner life. But I won’t usually feel threatened.

Most dads, though, have longer bones, bigger muscles and deeper voices than the women and children in their lives. If a dad shows equivalent anger in my clinic it can feel threatening, scary even – he’s more physically able to hurt me or others, even if he has no intention to hurt anyone. Before there’s any understanding of any inner life, we have to deal with the fear out here in the room! Safety, both physical and emotional, comes first.

That fear of course, has history, and it’s all about safety, or lack of it. Most men experiencing strong feelings do not commit abuse, but sadly it happens. So many of my patients have suffered due to the behaviour of emotionally overwhelmed men, some of whom acted criminally. More broadly we know most victims of abuse are women and children; most perpetrators are men. And yet put a newborn boy alongside a newborn girl and it’s plain to see they are equally innocent. Where does it go wrong? Are men monsters waiting to happen?

This question haunts most men I’ve seen in the aftermath of scaring or hurting their loved ones with their strong anger. Their fear of being some kind of monster makes them want to hide in shame. Ironically, though, it’s that very fear that tells me a bloke has a set of values – deeply held beliefs about what’s right, what makes a good person.

I have learned from experience that we need a strength to start with, to prevent a man withdrawing in shame. Give us a bit of good news to begin talking, and we can approach the tricky stuff as we build an understanding. Anger, like all emotions in relationships, is rarely all located in one person and not the other, and it can be hard to resolve simplistic questions like “who started it?” with even simpler answers like “he did” or “she did”.

Make no mistake, a man must take full responsibility for the power of his body to protect or harm especially those nearest and dearest to him. But we can help him in this by starting with the positive side of anger – its protective capacity. Most parents can appreciate the “Mama Bear” side of anger, as a mother protects her cubs from predators and other dangers. Anger can motivate a dad similarly, to keep his loved ones safe from harm. It’s also a self-protective emotion, sensing unfairness and loss, or a perceived threat. I say this to parents in my practice: If someone is standing on your toes and you don’t feel angry, you’re less motivated to protect yourself. You could lose your toes – and to parent well you need to be on your toes! Parenting without enough self-protection does your child no favours.

Again, this is not excusing or permitting abusive behaviour. It is seeking to understand a dad’s feelings enough to help him choose helpful actions in the hot-seat moments of strong anger, and empower him to repair with others after the heat of the moment passes. We want a dad to be able to look his loved ones in the eye again. To look at himself in the mirror again.

It works  – as part of a carefully tailored medical treatment plan – for the vast majority of men with PND presenting to my practice because of anger issues.

I also think these learnings about men and anger, especially anger expressed around women and children, might have something to add to the bigger picture. Right now there’s a huge cultural moment under way, around gender equity, and men’s accountability for harmful behaviours now and over time, towards those over whom they have had power.

It starts at home. Here’s a little speech I might ask that dad at the start of this piece, to think about saying to his loved ones. It could also be said by any man to anyone physically smaller than him, whom he seeks to treat fairly and with kindness:

“I am bigger than you, nature seems to have made me that way. My voice is louder and scarier, my muscles stronger. I can hurt and scare you more easily than you can hurt or scare me. If I have ever hurt or scared you, I find that unacceptable, and I am sorry. I need to understand why it has happened, so I can act to prevent it happening again. I will find out about my emotions, how they work, and what I need to practice to get better at choosing actions that are not harmful to anyone, myself included. I will do what it takes to make sure I am someone safe for you. This will be the change of which I can be proudest in my life.”

 

As always, I am grateful to the colleagues who helped me develop this piece.

 

For further help:

Lifeline 13 11 14

Mensline 1800 600 636

http://www.beyondblue.org.au

http://www.panda.org.au