Some people express anger directly and openly, usually in private, though Dean has cried in church. “Tremendous anger wells up in me,” Dean says. “I cry during hymns, reading those words. At home alone, I lose my temper, bang doors, throw things, yell. It’s important to me to release my anger, but I try to be careful not to hurt anything.” Steven uses almost identical words: “I feel anger building up on a weekly basis. I want to run up and down the road and cry. When I’m really angry, I beat on the bed with a piece of hose, which is noisy and very satisfying.       Or I go in the bedroom and jump up and down and yell.”     Other people express anger more obliquely. “I’d cry every morning and night in the car on the way to and from work,” said Helen. “Sometimes I’d have to pull over to the side. And I went through a period where I snapped at my customers in the post office. When they asked why, I’d say, ‘Oh, the stupid Xerox machine won’t work.’ ” In fact, people generally express anger not at the true causes, at unfairness or at loss of control. Instead, like Helen and the Xerox machine, they get angriest at little things: “My husband expressed a lot of anger about things so small, they were all out of proportion to what he was angry about,” said Lisa. “I’d fix him oatmeal, and it was not what he’d wanted, or it wasn’t hot enough.”     People also get angry at whatever is nearest. Sometimes, like Lisa’s husband, they get angry at their caregivers. Some people turn their anger toward the medical system. They say that government medical assistance requires that you first become impoverished before you can get help, and that you fill out an amount of paperwork equaled only by the IRS. They say that hospital clinics make you wait for hours, that the clinic doctor you felt you had rapport with last time has been replaced by someone else, and that the clinic clerks are rude. The drugs have unpleasant side effects, tests are painful and invasive, and so are the procedures. Hospitals do not allow a sense of control and privacy. Doctors seem impersonal and inattentive, nurses too slow. The rooms are too hot or too cold. And, Steven said to his doctor angrily, “Why are they taking so long to find a cure?”     Some people, like Alan Madison, say they are not particularly angry. They are uncomfortable with expressing an emotion which is, after all, overwhelming. They worry that giving in to anger means losing face or losing self-control. Their anger at unfairness and loss of control, however, often has not disappeared. Instead of getting angry at co-workers or the medical system, these people turn their anger on themselves. They feel depressed or guilty or they dislike themselves: Alan felt hopeless and stopped seeing his friends. Some eat too much: Lisa gained twenty pounds after her husband’s diagnosis. Others rely too heavily on alcohol or drugs. Some continue the behavior that put them at risk for the infection in the first place: for a while, though she denied doing it, Helen went back to injecting drugs intravenously. In general, when people are depressed, they quit taking care of themselves.

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