Changes and limitations that chronic disease places on you can make your blood boil. And that's ok--anger is a healthy response. But sometimes it gets out of hand. Here's how to get a grip on anger before it squeezes the life out of you.

I am angry because of the pills, I have to take. Angry about my hair falling out, angry because it hurts to drive a car, says Pat Oppermann. Since learning that she has rheumatoid arthritis. She is a 47-year-old Ohio woman has sturggled with her emotions. She resents that RA may cut short her career as a caretaker for mentally retarded adults and seeths about the years of good health she "wasted."

After recovering from the shock of how drastically this disease could change her life, Oppermann's anger set in. "There is so many things I'm angry about," she says. Oppermann's bitterness is predictable for someone recently diagnosed with a chronic illness. Anger, a perfectly common and healthy reaction, is part of the grieving process. And grief is an understandable response to the losses and changes arthritis of any kind brings.

Anger is ok, it can even be corralled into force for positive change---like getting mad enough about your difficulties maneuvering stairs to sign up for classes to strengthen your legs.

While anger is typically a stepping stone toward successful coping, there's always the danger of getting stuck there. Hostility creates its own set of problems. Seething, inappropriately expressed anger can alienate the people around you. It can hampter your ability to manage symptoms, and it can ignite flars. It can even make you more susceptible to life-threatening health conditions.

Fortunately, most people with chronic illness move beyond anger to an acceptance that allows them to fight the disease while remaining hopeful about their lives. others may need a little help. Here's some expert advice to help you get a grip on anger before it gets a grip on you. ********************

Seeing Red Anger is not a big issue for everyone with any type of arthritis. But is is for many people--and they dont even know it. Those who struggle with emotional highs and lows may not even realize anger is the culprit. Why? Anger can hid behind other feelings that come with the territory of chronic illness: fear, anxiety, sadness, frustration, depression, confusion, disappoitment, even guilt or embarrassment. Also, many people are uncomfortable acknowledging or expressing anger because society often regards it as a bad emotioin or a personl shortcoming. Pinpointing anger can be especially tough for women, says Tracey Revenson, Ph.D., associate professor of psychology at the Graduate School and University Center of the City University of New York. "Clinical studies across the board show that women are more socialized to express anger," she explains. "Some women may express anger in terms of sadness or depression."

But sometimes its tough to pinpoint anger no matter what your gender. Ask yourself if you have an anger problem. "Anger becomes a problems when it interferes with your wellbeing and your ability to carry out the daily activities of life," Reverson says. Signs of lurking hostility may include the tendency to go ballistic over everyday stresses such as careless drivers or rude store clerks; feeling the world is out to get you; strained relationships with others or difficultly sleeping because you cant stop thinking about situations that make you made.

A better understanding of the grieving procress may also help to take stock of your emotional well-being. In classic grief psychology, the first stage of grief is denial or disbelief. "(You think), 'This cant be happening to me,'" explains Redford Williams, MD, a Duke University psychiatry professor and co-author of Anger Kills: Seventeen Strategies for Controlling the Hostility That Can Harm Your Health (Harper Perennial, 1993). "The next stage is anger." 'How dare this happen to me.' The next stage is depression. 'How sad that this is happening to me.' Then, hopefully, the last stage is acceptance. 'This has happened to me. I have to live with it and accept it and do the best I can.' This is the stage you hope this process should take.

There is no rule about how long this process should take. Some people fare better than others; some never get there at all. And that could indicate a problem. "At some point you should come to some explanation or understanding that allows you to accept the illness so that you wont be so angry," says Melanie Greenberg, Ph.D., associate professor at the California School of Professional Psychology in San Diego. "Maybe the explanation you reach is that it's God's will, or that the disease has broght you closer to your family or allowed you to help otehr people," Greenberg continues. "Some people never find that. Years and years later they are still asking 'Why me"' They end up being unhappy. The anger you feel in the beginning should lead to some kind of answer."

But anger is not just for beginners. Even seasoned veterans of chronic illness experience setbacks that bring on anger relapses. "One of the characteristics of arthritis that occasionally you experience a flare that creates a whole new set of problems," Walt Hanks, a 38-year-old Springville, utah, man with osteoarthritis and RA. Early in his illness, Hanks once become so enranged that he grabbed a doctor and shook him. Now an Arthritis Self-help Course instructor who teahes others to deal appropriately with anger, Hanks has a better grip of his emotions. Frustrations such as flares that prevent Hanks from pitching baseballs to his son still makes his blood boil. The difference now is that he realizes "anger was a normal response to the losses I experienced, but I needed to do something with it other than hold it in or express it inappropriately.

********************* Letting It Out Venting anger is an important aspect of coming to terms with it. The challenge for many is knowing how and when to verbalize feelings without doing more harm than good. For example, by expressing your anger inappropraitely, you risk distancing family members, doctors, co-workers and other people who help you make it through the day. That's when it pays to know the difference between anger and assertiveness, Dr. Williams notes. Anger, he points out, arises from the perception of damage or hurt. You believe an injustic has occurred, that you have been threatened, victimized, treated unfairly or your rights have been violated. Anger is a subjective emotion.

Assertiveness, however, is an action--a non-aggressive means of expressing anger to change a situatioin that's making you anger. "Assertion is a very effective coping skill that will maximize your chances of getting someone to change their behavior," says Dr. Williams.

***************** Tools for Managing Anger You can't change your diagnosis no matter how much you assert yourself or chill out. But you can change the way you feel about it. That's where assertiveness and acceptance come in. Ultimately, most options to help you deal with anger boil down to those two choices. Assertion could mean anything from learning more about your condition or finding easier ways of doing everyday taks to getting involved in an activity you enjoy. None of these things is going to change your diagnosis, but they can positively affect your ability to cope with the accompanying anger.

Take Denise Jolly, for instance. For would blame the 56-year-old Camby, Ore., woman for feeling bitter about her RA diagnosis--it also struck a blow to her income by rendering her ineligible to seel her rare type of blood. But instead of wallowing in anger, Jolly threw herself into tutoring an adult literacy student--a form of assertion. "Arthritis doesn't make the rules in my life," Jolly says. "The worst thing I could do was roll over and become a victim." Community serve is just one of 17 anger "survival skills" Dr. Williams endorses. Volunterring to help others can reduce anger by making you more empathetic and reinforcing your "connectedness" with people, he says. Other tactics include reasoning with yourself, being tolerant, caring for a pet, laughing at yourself and becoming more religious.

Diane Chamberlain would agree with the last option. Before the Vienna, Virginia-based novelist began living with RA and fibormyalgia, she explains she had no spiritual side. "This disease has awakened a spiritual side in me that was never there before," Chamberlain says. "It's made me very much at peace." The philosophical approach also helped 33-year-old Tina Underwood of Akron, Ohio deal with this anger she felt when RA forced her to quit her nursing job. "Somene gave me advice," Underwood says. "You take 20 minutes every morning to mourn--sometimes it doesn't take 20 minutes--and then you get on with your day."

Besides her morning meditation, Underwood looks to an online support group for empathy, advice and commiseration. Like many people, she's found support groups can be a safe place to get her feelings out into the open. For similar reasons, some people benefit from expressing their feeligns in writing. "A diary lets you get in touch with your feelings in a safe context in which you dont have to worry about offending anybody," Greenberg explains. "It also helps you organize thoughts and differentiate between the feeligns you're experiencing. It's a time just for you that allows you to be relfective. Lots of people never take the time to look at their feelings." Being good to yourself, in general, can have a calming effect on anger." Anger can result from feelings of deprivation, like you are taking care of the whole world and you aren't getting enough for yourself," Greenburg notes. "Try to organize some pleasant activity for yourself or take someone to rest."

And don't hesitate to ask for help if the job proves too big. Most communities offer easy access to professionals, including psychologists, nurse educators, social workers, and clregy, who can help you deal with unhealthy anger. Sometimes just finding a friend who's a good listener can help you sort through your feelings. Regardless of how you deal with it, the important thing about anger is to stay on top of it. Arthritis may be incurable, but your anger about it doesnt have to be.

__________________________ Footnote... Anger can be hazardous to your health Anger isn't just an emotional downer. You can pay for it physically, too. Research about people with "type A" personalities, for example, indicates that chronically angry people are at greater risk for heart disease. Of the personality traits that describe type-A people--tense, driven, competitive and hostile--researchers have determined that hostility alone causes health problems.

Why? Chronically angry people are always "juicing up" the chemicals or neurotransmitters that can cause hypertension, notes Donald Meichenbaum, Ph.D., professor emeritus of Clinical psychology at the University of Waterloo in Ontario, Canada, and a leading authority on anger management. Anger, an emotional response to a real or perceived threat from your environment, activates your sympathetic nervous system. That unleashes powerful hormones causing your body to prepare itself for "fight or flight." You feel a faster and harder heartbeat, quicker breathing, sweating, chest pains, flushed skin or an adrenaline "rush"--the physical signs of anger. In and of themselves, these chemicals reactiosn are good, enabling humans to react to threats and dangers. The problem arises when ongoing anger subjects yuour body to "fight or flight" hormonal secretions for extended periods. Researchers believe that causes long-term wear and tear that leads to coronary disease.

Anger may take a more immediate physical toll on people with various forms of arthritis. "The flares associated with autoimmune diseases in genreal seem to be triggered by emotional upset," says Redford Williams, MD, a psychiatry professor at Duke Unversity. What's more, anger can interfere with your ability to manage pain through relaxation or other mind-over-body techniques.

This is an article currently running in "Arthritis Today" March-April 1999-----which is published bimonthly through the Arthritis Foundation of America