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Book Forum: Anger/Hostility/Violence   |    
Prisoners of Hate: The Cognitive Basis of Anger, Hostility, and Violence
THEODORE NADELSON, M.D.
Am J Psychiatry 2002;159:688-688. doi:10.1176/appi.ajp.159.4.688
View Author and Article Information
Boston, Mass.

By Aaron T. Beck, M.D. New York, Harper-Collins, 1999, 354 pp., $26.00; $14.00 (paper).

Aaron Beck is widely known for his contributions to psychotherapy. His cognitive therapy is perhaps the most widely used mode in psychotherapy practice. In this book Dr. Beck focuses exclusively on the application of the principles of the cognitive approach to anger and hostility.

The well-known cognitive principle applied to angry outbursts between partners starts with the premise that there is a very rapid but analyzable train of thoughts that occurs between a perceived initial insult and hostile behavior—with an escalation of hot thoughts demanding justice in counterattack. The usual sequence is a perceived attack on self-esteem followed by a feeling of weakness, a feeling of being let down and wronged, and a fixing of blame on the partner, resulting in attack. That may be followed by a deep sense of guilt or continuing resentment, which can build to another attack.

The author is not presenting a new scientific study but an application of his principles for cognitive therapy to a particular interpersonal problem. Dr. Beck suggests that those principles are also helpful for communities or nations. Countries are moved toward war for the same reasons that couples argue. War, of course, is far more complex and destructive than family arguments no matter how complex or internecine the familial relationships. Dr. Beck also accepts war as a complex process but is inclined to include individual psychology as a major part of a war’s genesis.

During the Cuban missile crisis, President Kennedy, angry at Khrushchev for introducing missiles into Cuba, said, “He can’t do that to me,” and the world unknowingly stood on the cusp of massive war. Calm heads prevailed, however (1). A cognitive therapist, Beck could say, might have provided a more comfortable margin against catastrophe.

The prelude to many hostile acts is shame and loss of self-esteem. James Gilligan (2) wrote about that brilliantly with regard to a contemporary epidemic of violence among adolescent boys. Self-esteem is essential to people (they will kill for it), and the therapist’s appreciation of this fact can be sharpened by reading this book.

Many therapists might say that they already use the cognitive approach to patients and couples, including those who are angry. Indeed, cognitive “analysis” has a place in all therapies. The contribution of this book is in the underlining of the value of cognitive examination for a specific behavioral problem—whether a cognitive approach is the totality of the treatment or a part of it.

Dr. Beck also writes about hostile responses as part of evolutionary adaptation and fitness but not in great depth. His discussion of the anger-prone patient makes no reference to borderline disorders. The concept of distal origins, whether evolutionary or residing in certain personality types, is peripheral to Dr. Beck’s prime thesis. He suggests that therapists deal with angry behaviors only in the present. There are, of course, therapists who want to do both—tracing angry interactions to roots in individual experience as well as identifying the contemporary cascade of thoughts from hurt to an irresistible need for justice. This book may not be a revelation to all readers/therapists, but it serves well to underscore the practical helpfulness of a cognitive mode with a particular form of dysfunctional behavior.

Kagan D: On the Origins of War and the Preservation of Peace. New York, Doubleday, 1995
 
Gilligan J: Violence: Reflections on a National Epidemic. New York, Random House/Vintage, 1997
 
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References

Kagan D: On the Origins of War and the Preservation of Peace. New York, Doubleday, 1995
 
Gilligan J: Violence: Reflections on a National Epidemic. New York, Random House/Vintage, 1997
 
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Prisoners of hate. Behav Res Ther 2002;40(3):209-16.