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Mr. Morrow was right. The connection between anger and cardiovascular disease is well established.

In a multicentre U.S. study, patients carried heart monitors strapped to their bodies while they kept diaries of their physical and emotional experiences as they went about their daily lives.

Intense anger was found to be powerfully related to the heart muscle being deprived of its oxygen supply. The relative risk of a heart attack has been shown to increase more than two-fold in the two hours after an episode of anger.

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In a recent Israeli study, episodes of anger and hostility were linked to an increased risk of strokes -- something long recognized by folk wisdom, which has employed the word "apoplectic" as a synonym for enraged. Apoplexy is an archaic word for stroke.

At the other extreme are people who hardly ever experience or express anger. They are at increased risk for a wide range of illnesses from migraine headaches to cancer, irritable bowel syndrome, Crohn's disease and many of the rheumatic conditions.

Not infrequently we read about such people as having died before their time. It may be no coincidence that Roger Neilson, the gifted and much-loved hockey personality who died of cancer in 2003, was described as perhaps the only coach in the National Hockey League who never swore or lost his temper.

In many international studies, the inhibition of anger has been associated with markedly heightened risks for cancer. It has also been linked to the presence of rheumatoid factor, an antibody directed by a person's own immune system against the self in rheumatoid arthritis.

How would the extreme outpouring of anger or its direct opposite, anger repression, increase the risk for illness? Because mind and body are an absolute unity, and emotions are physiological events with a wide range of effects, including the release of stress hormones, nervous system discharges and blood flow changes.

Eruptions of anger can contribute to heart disease or strokes by many mechanisms, among them elevated blood pressure, sudden spasms of blood vessels and increased clotting of the blood.

In 2003, Korean researchers reported that anger plays "an important role" in the calcification, or hardening, of the coronary arteries.

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Conversely, the suppression of the normal aggressive impulses associated with anger can inactivate or confuse the immune system, enabling the development of cancer or autoimmune disease.

An important class of immune cells called natural killer cells is more active with the healthy expression of aggression -- as, for example, in people who do martial arts. The activity of these NK cells is depressed in people whose anger is inhibited.

How, then, to escape this human dilemma? Is there healthy anger and, if so, how do we find our way to feeling it and expressing it?

"The key is to experience anger without anxiety," says Allen Kalpin, a Toronto general practitioner/psychotherapist who has studied anger and works with patients who have anger problems of all kinds. "What many people think of as signs of anger are actually manifestations of anxiety."

My brother, George Maté, a Vancouver businessman, concurs. A few months ago, he began anger-management counselling after, in a fit of rage, he kicked in a door in his house.

George has diabetes, a stress-related disorder and a risk factor for heart disease.

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He says he has learned that "the anger you think just sneaks up on you doesn't just sneak up on you. It's not volcano-like. There is buildup inside, with certain physiological signs: tightness in stomach, tension in my body and my mouth will go dry."

Such signs denote anxiety, as do the shallow breathing and tightness of throat and vocal cords that also accompany anger in many people. They do not occur with healthy anger, which is described by Dr. Kalpin as "a surge of calm energy, an empowered and energized feeling without tension or anxiety."

And it is anxiety, not anger as such, that triggers the nervous discharges, the abnormal outpouring of hormones and the other harmful physiological consequences.

People discharge their anger outwardly because they fear fully experiencing it internally. Both the unbridled expression of anger and its automatic suppression arise from an anxiety we first feel in early childhood. It is inherently anxiety-producing for a small child to be angry with those he is dependent on, Dr. Kalpin points out.

Especially in families where normal expressions of anger were discouraged, a child will learn automatically to repress aggressive impulses, even when appropriate. A child may also become frightened of anger if his parents are given to displays of rage.

There are two keys to the healthy experience of anger. First is to permit ourselves to feel calmly, without anxiety, the surge of aggressive energy that arises with anger. The second is not to allow the emotion to dictate our behaviour.

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"Anger does not have to be acted out," Dr. Kalpin says. "We can allow ourselves to experience anger without venting, without losing control."

Ultimately, it's a question of who is in charge: the person or the emotion. When anger seizes hold of us, or when we are so frightened of anger that we habitually suppress it, we are at risk for disease.

Vancouver physician Gabor Maté is the author of When The Body Says No: The Cost of Hidden Stress.

Mad maxims

Don't be afraid of your anger: Allow yourself to feel the surge of aggressive energy that arises with it.

Don't let the emotion control your behaviour: Talk about your anger, rather than act it out.

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Note the signs of anxiety that precede anger outbreaks (such as dry mouth, tight stomach).

If you never experience anger or are given to rages, seek counselling.

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