Are you concerned with what appears to be an across-the-board increase in rude and angry behaviours in society? Parents yelling at their kids’ hockey or soccer coaches; road rage; kids shooting classmates and teachers; lying and deliberate “fake news”; bullying and shaming on social media… None of this is new, but there is more of it than ever.
As a psychiatrist and a computer systems engineer, I have a particular interest in how the brain functions, and what can make it go off the rails. So I have some theories about why there may be more angry and violent behaviours in our communities.
But before the theories, there is some ground that we need to cover, together. Angry, rude, or violent behaviour is driven by anger—an emotion—which in turn is an automatic, instantaneous, and (at least initially) unconscious response to a perceived provocation, hurt, or threat. As an emotion, anger is outside of our control. There is little or nothing we can do to prevent becoming angry or to modify its course. But—and this is a big but—behaviour which is stimulated by anger is under our control, and becomes increasingly more so as we mature. With age and experience (and motivation!) we become more able to control what we do or what we say when we become angry.
So there are a number of factors at play here. Something which increases the likelihood of our perceiving provocation, hurt, or threat, will raise the frequency and amount of angry emotions. Paranoia, whether due to mental illness, drug use (think speed or cocaine), news reports, or induced by our political leaders, increases our perception of threat. Irritability, common enough but particularly increased in people in a manic episode, also increases anger. And finally, our ability to control our behaviour may be decreased by, again, mental illness, drugs such as alcohol, phencyclidine (aka angel dust), or prescribed medication.
Of course, there is also the possibility that some individuals view angry or violent behaviour as just a way to get what they want. And perhaps some who just enjoy it!
But none of this is new and thus cannot explain any increase in rude, angry, or violent behaviour. So let’s look at the things that have changed in the past couple of decades. I will be discussing the increase in antidepressant usage, changes in sleep patterns, side effects of antihypertensive medication, exposure to blue light at night and to bisphenol A, diet, and the dark triad personality.
An important trend in the richer nations is a massive increase in usage of antidepressants. According to the CDC, from 1988–1994 through 2005–2008, the rate of antidepressant use in the United States among all ages increased nearly 400%. Eleven percent of Americans aged 12 years and over take antidepressant medication. Similar trends have been documented in other western nations. While increasing rates of depression are a factor, so are indications for prescribing—which have widened to include anxiety and eating disorders.
Why is this important? Because all antidepressant treatments (or, at least, all treatments which work!) can induce a manic or hypomanic state, particularly in individuals with bipolar disorder. Irritability is a cardinal symptom of such states. Thus, the increased use of antidepressants almost certainly has led to an increase in irritability.
Perhaps more frightening is the warning appearing in the Canadian CPS (Compendium of Pharmaceuticals and Specialties): “There are clinical trial and post-marketing reports with SSRIs and other newer anti-depressants, in both pediatrics and adults, of severe agitation-type adverse events coupled with self-harm or harm to others. The agitation-type events include: akathisia, agitation, disinhibition, emotional lability, hostility, aggression, depersonalization. In some cases, the events occurred within several weeks of starting treatment.” These types of warnings were added in response to a number of lawsuits brought against drug manufacturers for failure to warn, where damages were awarded to families of victims of homicide or suicide believed to be induced by SSRI antidepressants. Having this warning in the prescribing information, of course, protects the drug manufacturers from further liability. Dr. Peter C. Gøtzsche, a specialist in internal medicine and professor at the University of Copenhagen, co-founded the Cochrane Collaboration in 1993 and established the Nordic Cochrane Centre; he provides details on many cases of SSRI-induced violence in his 2015 book “Deadly Psychiatry and Organised Denial”. Then there are psychiatrists Dr. Peter Breggin in New York state and Dr. David Healy, whose successes as expert witnesses in lawsuits against big pharma very likely stimulated the addition of those warnings.
A change in sleep habits is a trend which has been going on for much longer than the availability of antidepressant medications. There is excellent evidence that sleep patterns and affective disorders (depression and bipolar disorder) are intimately linked (see this presentation). For example, sleep deprivation is a highly effective treatment for depression, and can even induce mania. It does not have to be total sleep deprivation; partial reduction of sleep can be equally effective, if the person is woken early. It appears that the antidepressant effect (or mania-inducing effect) is due to REM sleep suppression.
But excessive REM sleep may have the opposite effect. Because REM sleep is controlled by one’s circadian rhythm, getting up late in comparison to one’s usual rising time increases REM sleep, thus resulting in depressive symptoms which include fatigue, lack of energy, and lack of motivation. Getting up early, on the other hand, reduces REM sleep, and may induce symptoms associated with mania such as irritability, euphoria, paranoia, disinhibition, grandiosity, and pressured speech.
The key here may be stability of sleep patterns; whether one gets up early or gets up late, if it’s consistently at the same time, one’s circadian rhythm will adjust. But modern life provides many opportunities to vary one’s rising time from one day to the next. Whether it’s shift work or late nights out on weekends followed by sleeping late, these variations in rising time lead to instability in circadian rhythms.
An example would be a typical high stool student. Suppose he usually gets up at 7 am on school days. A late Friday night precedes getting up at noon on Saturday, followed by little energy or motivation that afternoon to do much besides video games or TV. Saturday night, though, his usual energy level kicks in, and he’s ready to party! Again late to bed, Sunday also becomes a late rising day. Because of this, he is unable to fall asleep on Sunday night, perhaps until 2 or 3 am. Then it’s up at 7 am, after only 4 or 5 hours of sleep. Difficulty staying awake during the day on Monday is a consequence of sleep deprivation, and school performance suffers.
But it’s actually even worse. Let’s suppose that on the Friday, his circadian rhythm was synchronized to his 7 am rising time. By getting up five hours later than his usual rising time on Saturday and Sunday, his circadian rhythm will be delayed, perhaps by 2 hours each day. Thus, on Monday morning, his circadian rhythm will be in synch with an 11 am rising time. When he got up at 7 am, his brain was functioning as if it were 4 hours before his rising time, that is, in the middle of the night! No one’s brain functions well in the middle of the night, even if it’s not sleep deprived. Moreover, getting up this early in relation to his circadian rhythm setting on the Monday leads to reduced REM sleep and manic symptoms including irritability and disinhibited behaviour.
Fortunately, by getting up early, the circadian rhythm will advance. But the process of advancing happens more slowly than that of retarding the rhythm. If getting up at 7 am, 4 hours earlier than Monday’s circadian rhythm synchronization to an expected 11 am arising time, leads to advancing the rhythm by an hour, by Friday his rhythm will be back to baseline. Unfortunately, it’s now the weekend, and the whole cycle begins anew.
While getting up early has strong REM sleep suppressing effects, one can also get insufficient REM sleep by short sleep. People who burn the candle at both ends may therefore manifest manic symptoms. What’s worse, one of the symptoms of mania is the belief that there is nothing wrong with you, even to the point of being convinced that you’re better than ever. And because mania often reduces sleep need, this becomes a self-perpetuating condition. Frequent, irritable, and paranoid tweets sent at 4 am by grandiose elected individuals may be a manifestation.
Big pharma has been very effective in convincing physicians to diagnose hypertension and prescribe medication for it, to the point that in 2015-2016, 29% of American adults were considered hypertensive, and about 70% of this group were taking antihypertensive medication.
However, aggressive treatment is not innocuous. A good case can be made for the theory that blood pressure becomes elevated in the first place as a compensatory mechanism to maintain blood flow to vital organs such as the kidneys and the brain, in situations when other factors, such as atherosclerotic lesions inside blood vessels, decrease that blood flow. Antihypertensive medication, by lowering blood pressure, interferes with this compensatory mechanism, resulting in insufficient blood flow, and therefore insufficient oxygen, to brain and kidneys. Most noticeable is when these medications cause a sudden drop in blood pressure on standing up, which causes dizziness, faintness, or even loss of consciousness with falling. Clearly, losing consciousness means that the brain is not working properly. But lesser degrees of insufficient oxygen to the brain will be less noticeable, especially to the person experiencing it, because when your brain is not working it won’t be able to tell you that it’s not working!
Unfortunately, the areas of the brain affected by low blood pressure may be the fronto-temporal lobes (Neurology Today, 2002), responsible for what is called executive function. The constellation of symptoms which can result, called frontal lobe syndrome, may include disinhibition, anger, excitement, depression, and difficulty in understanding others’ points of view.
Recent changes (November 2017) to the guidelines for diagnosing hypertension, published by the American Heart Association and the American College of Cardiology, mean that an additional 40 million or so Americans have become eligible to receive antihypertensive medication. How many of these will manifest anger and disinhibited behaviour?
Blue light at night
It’s long been known that bright light during the night suppresses melatonin. More recently, the critical factor has been identified as blue light of around 480 nm wavelength, a big component of the white light emitted by LEDs and other lamps described as daylight or cool white. Now that this has been recognized, smartphone, tablet, and computer manufacturers have begun taking steps to reduce blue light emissions from their screens in the evening and during the night (on Apple devices, this feature is called “night shift”).
Why is this important? Because melatonin suppresses insulin secretion, so when blue or white light at night suppresses melatonin, insulin levels will be higher. Because insulin is the signal to cells to take up glucose from the bloodstream and convert it into fat (in the case of fat cells) or glycogen (muscle cells), high insulin levels cause overweight and obesity, and may cause type 2 diabetes. In turn, these conditions are associated with cancer, cardiovascular disease, and dementia. Obese people are also more likely to develop obstructive sleep apnea (OSA). Impaired brain functioning, of course, is a hallmark of dementia, but milder degrees of cognitive impairment can be caused by vascular disease and OSA. When the affected parts of the brain includes the frontal lobes, expect to see increases in irritability and disinhibited behaviour.
Bisphenol A (BPA)
Bisphenol A (BPA) may no longer be used in Canada for the manufacture of baby bottles because it is known to disrupt hormones, especially estrogen. Perhaps less well known is that BPA stimulates insulin secretion. BPA use has greatly increased since its commercial introduction in the 1950s, so that today it is ubiquitous in our environment. An environmentally important use is in the coating on paper used for receipts produced by thermal printers, whether at the grocery store, the gas pump, or anywhere one uses a credit card. Other thermally printed items include bus and train tickets, parking tickets, boarding passes, lottery slips and vegetable weight stickers. BPA has also been detected in paper products other than thermal paper including currency bills, food contact papers, food cartons, napkins, paper towels, and toilet paper. These products are typically made from recycled paper which includes thermal printer paper.
Handling any of these paper products can cause BPA to be absorbed through the skin. Greasy skin, including use of hand lotions, increases skin absorption. The alcohol found in many hand sanitizer products also increases absorption. Hand washing only removes some of the BPA from the skin. Both epidemiologic studies as well as laboratory studies with animals suggest that current environmental exposures to BPA may be contributing to the current worldwide epidemic of obesity and type 2 diabetes.
Just as for blue light at night, there is reason to believe that this is due to increased insulin, and that BPA may therefore contribute to mild cognitive impairment manifesting as increased anger, irritability, and behavioural disinhibition.
First, some basics and some terminology. I will be discussing what are called PUFAs, which stands for PolyUnsaturated Fatty Acids. The important PUFAs in human nutrition are omega-3 and omega-6 fatty acids, considered essential fatty acids because we lack the capacity to synthesize them, even though these substances are building blocks of brain tissue, and also precursors of pro-inflammatory (omega-6) and anti-inflammatory (omega-3) signalling molecules.
However, it’s the long-chain (LC) forms of these PUFAs which the body needs, whereas much of the dietary intake of PUFA is medium-chain (MC). Those MC-PUFAs must first be converted to LC-PUFAs by way of an enzymatic pathway common to both omega-3 and omega-6 FAs.
Fatty fish, such as salmon, tuna, mackerel, or sardines, are an excellent dietary source of omega-3 LC-PUFAs. However, beginning in the 1930s, there has been a decline in fish consumption. Simultaneously, we have experienced an increase in consumption of grains as well as meat from grain-fed animals. Since MC omega-3s are found in the leaves of plants, while MC omega-6s are found in the grains or seeds, these dietary changes have resulted in an increase in the dietary omega-6 to omega-3 ratio from 2:1 or 3:1 to 12:1 or even higher.
But it’s actually much worse. The large quantities of MC omega-6s swamp the common enzymatic pathway that converts MCs to LCs. As a result of all these factors, many people have elevated omega-6 to omega-3 FA ratios in their bodies; this is associated with increases in inflammatory conditions such as psoriasis and inflammatory bowel disease, but also with depression and irritability! Who knew! And, again, more depression leads to greater use of antidepressants.
Besides the contribution of PUFAs to mood and behaviour, there are other, more indirect, dietary influences. I’ve written elsewhere on how what we eat influences healthy longevity. Insulin appears to play a central role, so diets which reduce insulin may slow or delay conditions of aging such as type 2 diabetes, cardiovascular disease, and dementia. As we’ve seen in previous sections, mild cognitive impairment related to these diseases may manifest as disinhibited behaviour, irritability, and paranoia.
With the decline in family farms, there has been a net displacement of people from rural areas to the cities. Rates of depression are significantly higher in urban areas compared to rural; one possible explanation is that sleep patterns are more consistent for rural folk, and more closely tied to actual sunrise times. More depression, of course, leads to higher antidepressant use, whereas greater variability of rising times can give rise to manic symptoms including irritability, impaired judgment, paranoia, and disinhibited behaviour.
It’s not only antidepressants that may cause violent behaviour. Birth control pills (hormonal contraceptives) containing synthetic estrogen have also been linked to increased emotional manipulation and acts of physical violence (Welling et al, 2012). Statins, used to treat high cholesterol, have been immensely profitable for drug companies, with 2005 sales of US$18.7 billion in America alone. Lipitor was the best-selling prescription drug in history as of 2003. But statin use has been associated with alterations in mood, personality, and behaviour, and side effects “can include irritability/aggression, anxiety or depressed mood, violent ideation, sleep problems including nightmares, and possibly suicide attempt and completion” (Cham et al, 2016).
Western countries have also seen massive occupational shifts, from primarily blue-collar work in manufacturing and resource extraction, to white-collar jobs or jobs in service and retail sectors. Flex-time, shift work, and later starting times are associated phenomena, and contribute to later and more variable arising times.
Decreasing rates of religious observance in many societies mean more opportunity for getting up late on weekends. And for a variety of reasons, school starting times are getting later. While this means less variability between school-day and weekend rising times, it also subtly encourages late rising times as a societal norm.
Let’s talk about the angry and rude behaviour manifested by individuals who enjoy it, or who do it because it they can benefit from it. As a Republican Party strategist told author Martin Amis way back in 2012, “There is no downside to lying.” This was well before the current administration. There is good reason to believe that certain individuals do this well, and do it often, because they can.
For most of us, to deliberately behave in a way that may hurt others, is difficult! We have built-in inhibitions against doing so, even as infants. Individuals without such inhibitions are often said to have no conscience or no empathy. The commonly used label for such people is “psychopath” or “sociopath”; or they may be described as having “antisocial personality disorder”. The clear implication is that there is something wrong with these individuals, an impression that is reinforced by the many studies of psychopathology in criminal populations.
I would like to propose the hypothesis that individuals with these traits are members of a more or less genetically separate subspecies of homo sapiens. Thus, not a disorder or disease. If one looks beyond the criminal population, there are many people who manifest similar behaviours but are smart enough to avoid prosecution. Think former executives of Nortel who laid waste to the pensions and benefits owed to employees while enriching themselves with bonuses.
Of course, it helps to be well-connected, as in networks of highly placed individuals in business and governments, including elected politicians. However, people who move in these circles are unlikely to be labelled psychopaths, at least in public discourse. The term “dark triad” is used by social sciences researchers; the triad refers to the personality traits of narcissism, Machiavellianism, and psychopathy.
But again, this label may miss the mark, because it still conveys the flavour of pathology or disorder. Instead, let’s look at my alternative formulation of a separate subspecies.
Its members typically are charming, good-looking, intelligent, and excellent salespeople, highly successful at gaining the trust and confidence of others. They are masters of “emotional contagion”, the phenomenon believed to be the basis for empathy, and therefore for conscience. Rather than being unconsciously influenced by emotional contagion from others, these individuals are resistant, as you or I might have resistance to a disease. At the same time, they have powerful tools for creating emotional contagion, for “infecting” others with their enthusiasm, energy, and creative ideas, but also their paranoia, hatred, and lusts.
Throughout history, we can identify individuals with these characteristics. Because they are resistant to emotional contagion, they are much less affected by guilt and shame, the two emotions which are the basis of conscience. In consequence, it is easy for them to engage in angry, rude, belligerent, or bullying behaviour, including lying and taking advantage of others, whether financially, emotionally, or sexually. They are predators, and the rest of us are their prey. Although in many cases, the relationship may be more akin to parasite and host.
Whether predator-prey or parasite-host, the population sizes of each subspecies are highly interrelated. I suspect that the productivity of the preyed-upon species is the main factor. The first major productivity increase was the agrarian revolution, approximately 10,000 years ago. When individuals were able to grow more food than they needed for themselves and their families, it did not take long for the predator subspecies to figure out that if they could convince the prey species to grow food for them, whether by violence or threats of violence, they would themselves be free to enjoy other pursuits, such as building civilizations, developing written language, and so on.
“Food surpluses made possible the development of a social elite who were not otherwise engaged in agriculture, industry or commerce, but dominated their communities by other means and monopolized decision-making” (Wikipedia).
Since then, successive productivity increases, such as the industrial revolution and today’s digital revolution, have enabled more predators to thrive with fewer prey needed. And the predators have no difficulty increasing in number: they are extraordinarily successful at reproducing, because they are excellent salespeople and because they are physically more attractive (eg, facial symmetry). Having lots of money doesn’t hurt, either!
There are a host of possible explanations for an increase in angry and rude behaviour. In researching the facts for this article, I’ve been struck by how often these explanations are interconnected, and may have synergistic effects. What are their relative contributions, and what can be done to mitigate or reverse their effects? Clearly, if we are the perpetrators of angry, rude, or violent behaviour, and we are motivated to do something about it, we can make changes to our sleep patterns and our diet; minimize our exposure to blue light at night; avoid handling thermal receipts; and talk to our doctors about discontinuing or decreasing antidepressants, antihypertensives, or statins. Birth control pill users might consider other forms of contraception, possibly less damaging to their relationships.
But if we are victims, what to do? Up until recently, very little. But the #MeToo movement shows that it’s possible for victims to be heard and to be taken seriously. People who engage in bullying behaviour can no longer do so with impunity.
However, we can predict that dark triad individuals will fight back. All over the world, dictators, warlords, and terrorist organizations are stepping up the level of violence. And when the rest of us engage in rude or angry behaviour, it only serves to normalize their violence. Should we just turn the other cheek? Emphatically, no! But there are ways to detect and expose people, including those in government, who prey upon us. People like Edward Snowden, Chelsea Manning, and Julian Assange, disruptive organizations such as WikiLeaks and Anonymous, many news organizations, and innumerable “hive” workers in large business organizations, governments, militaries, and spy agencies who are working to expose illegal or antidemocratic practices or breaches of the rule of law, need to be celebrated and defended, especially when denounced as “traitors” by their dark triad bosses.
I must admit that the above sounds pretty dismal. But given that our happiness is most strongly determined by the quality of our relationships with family, friends, and community, there is a great deal we can do in our own spheres.
For example, pointing out rude behaviour, including racist remarks or misogynistic jokes, when safe to do so; taking the time to praise good service or complain about indifferent or bad service; celebrating the efforts of volunteers, like our children’s sports coaches or referees, even if we take issue with their decisions. Particularly with young people, our hope for a better future, we can model civility. Even on the street, making eye contact and verbal greeting can promote civil discourse; so can acknowledging kind and polite behaviour. It’s been said that it takes a village to raise a child; it’s up to us to help make our communities like those villages!
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