Anger—Is it Better to Let It out or Hold It in?

Dr. Manny Alvarez: It’s no secret that how you handle stress has a big impact on your health; however, what if the key to having an optimal health is in how you communicate during those stressful times? My guest today says her patients’ inability to communicate was literally making them sick, Dr. Neha Sangwan is the author of Talk RX: Five Steps to Honest Conversations That Create Connections, Health & Happiness.

Communication is the key to good health. It is indeed. Tell me, how does communication directly affect anybody’s health?

Doctor Neha: When your communication breaks down, your heart rate speeds up. Whether it’s with yourself, someone else, or you notice something in a room that’s not okay, right away physiologically you feel the change inside yourself. Most people are really good at numbing that out. They don’t notice it quite as much, but if you think back to a time when you really got into some conflict, could you feel your body?

Dr. Alvarez: Right. So you’re saying, and again I don’t want to put words in your mouth, introverted people, people that hold all their feelings back … like I’m always yelling and screaming and people always say, “You’re gonna get a heart attack.” I say, “Nah, no I’m not. You’re gonna get a heart attack.” So it’s better to be sometimes outspoken if you will?

Doctor Neha: Either way can cause you stress. If you don’t say what you need to say, it can cause you stress or if you feel like you’re yelling all the time, it can cause you stress. Both of those are linked to different ailments. Heart disease is linked to anger, some of the silencing leads to a suppressed immune system. So it’s about the quality of communication that you have and our ability to express ourselves.

Dr. Alvarez: You mentioned a story about your mother having migraines and when she became aware, I guess, of her internal language, she was able to handle them and they went away, right?

Doctor Neha: That’s true.

Dr. Alvarez: How did it happen?

Doctor Neha: The interpersonal dynamics that happen in a family can complicated. My mom was the quiet one and my dad was the one that is more like you.

Dr. Alvarez: Right, the yeller.

Doctor Neha: The yeller right? She just thought it was her role to be quiet and take it. She developed migraines. Her doctor actually said there’s no physical cause for this (always the first step is to make sure you get checked out when you have physical symptoms). When you get a clear bill of health, but you still don’t feel okay, it’s time to pay attention to the communication aspects of your health. As soon as the doctor sat my mom down with my dad and they discussed what happens physiologically inside her body when my dad is yelling, the doctor basically told her, “I believe there’s two reasons for your migraines. The first one is you don’t know how to handle your own emotion, you don’t express yourself. The second is you’re in the presence of repeated anger, what feels like an assault to you because somebody else is expressing themselves so much.” Once they figured that out, she said she walked out of that office and never had another migraine again.

Dr. Alvarez: Give me some tips that we can tell people how to improve their communication skills.

Doctor Neha: For me, I never knew that throat constriction was related to my communication. I used to have the sensation of being short of breath all the way through medical school and partway through residency. I even got scoped twice but that was the part of me that wouldn’t speak up and say, “This isn’t okay,” or “No, I can’t do this.” The first step is people have to notice the physical sensations happening in their body and figure out what those mean to them. I go into much more detail in it in my book TalkRx. The second thing is that when you notice you’re getting upset at someone, you use those physical signals as clues. Do you know what those physical signals are in your body?

Dr. Alvarez: I do.

Doctor Neha: Name one of them. Physical signal.

Dr. Alvarez: I daydream that I want to kill them.

Doctor Neha: That’s a thought you have. So what about a physical signal, do your muscles get tight, does your heart race?

Dr. Alvarez: Backache.

Doctor Neha: Backache, okay.

Dr. Alvarez: Knee pain.

Doctor Neha: Okay. If you start detecting the first signals that tell you you’re getting upset, at that moment, you get curious not furious. So you’re sitting in a room and notice that your knee starts hurting and your back is hurting. Nobody else knows but you. Are you going to use those signals to get curious not furious? Here’s what you’d say is if someone does something or says something and it upsets you, “Hey, I noticed that I was talking and you got up and walked out of the room, I’m wondering what happened?” Get curious not furious instead of making up a story like, “I want to kill them; they just were disrespectful.”

Dr. Alvarez: I got it. I see how internal stress and lack of communication can really affect your head. These techniques that you go into detail in your book, you also talk about how ultimately they could lead you to alter the medications that you take, right?

Doctor Neha: Absolutely.

Dr. Alvarez: Because a lot of people get chronically hooked to medicines whether they’re antidepressants-

Doctor Neha: Sleep meds.

Dr. Alvarez: …or their back aches, sleep meds, this is a whole big industry and-

Doctor Neha: Anxiety.

Dr. Alvarez: Right. And as doctors we sometimes say, “You know, you don’t need these things.” But in reality the patient says, “Yes I do because my pain is still there. I still have difficulty.” And you say it’s all about communication, right?

Doctor Neha: There is such a big component that is communication. Think about it: when you go to sleep at night, it’s almost like a surrender of your thoughts. If your thoughts are racing and you’re worried about what’s going to happen next, until I help you quell or soothe that worry, you’re going to be up all night. You’re going to need something to knock you out. I have found that once my patients resolve what’s at the root of their stress—which is often broken communication, toxic work environments, or some people will say to me, “Doc, I’ve been in a relationship that has long since expired but I don’t know how to get out”—they can reduce or get off their meds.

Dr. Alvarez: This is a very good topic, I think communication, internally, externally, communally.

Doctor Neha: Socially. Politically.

Dr. Alvarez: … is the the key to a lot of stresses. Thank you. Where can people get more info?

Doctor Neha: Everywhere., Barnes & Noble, my website is

Dr. Alvarez: Thank you so much for coming.

Your Awareness Prescription

  1. Name the earliest physical signals in your body that tell you you’re getting angry.
  2. Take three deep breaths to help manage the discomfort.
  3. State what you’ve heard, seen or observed (what changed).
  4. Keep your judgments to yourself.
  5. Get curious, not furious. (This way, you have a chance of building a bridge rather than a divide).

To using anger constructively,

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