Of Loose Cannons and Tight Coronaries

Medical research has discovered new evidence of a connection linking physical, emotional, and spiritual health. A study by Duke University psychologist Edward Suarez found that apparently healthy men and women who were prone to anger and hostility were significantly more likely to have elevated blood levels of C-reactive protein, which is an indicator of arterial inflammation implicated in the pathogenesis of coronary artery plaque formation.1 Reporting in the same journal, Stephen Boyle and colleagues found that patients with coronary artery disease who scored highly on psychological measures of cynicism, hostility, and aggressiveness experienced over time significantly higher rates of coronary mortality.2

Coronary artery disease results from years of slow deposition of cholesterol-laden atherosclerotic plaques within the inner lining of the arteries that supply blood and oxygen to the heart. When sluggish blood flow is unable to meet increased cardiac demand during stress or exercise, chest pain may result. Where the vascular lumen is narrowed, clot formation can acutely shut off blood flow to part of the heart, resulting in a heart attack—the most frequent cause of death. Risk factors for heart disease (for stroke also) more firmly established than anger include high blood pressure, a family history of heart attack or stroke, diabetes, tobacco smoking, and high levels of cholesterol or triglycerides.3 These risk factors are neither absolute nor exhaustive; having a risk factor increases the probability of illness, while not having a particular risk factor is no guarantee against illness.

Evidence suggesting that one’s emotional and behavioral response to stress might occasionally contribute to heart disease should interest Christians. One reason is that it makes sense within the biblical understanding of human nature as a holistic unity. Embodiment entails continual interdependence between body and spirit. To touch one aspect is to touch the whole. Although reductive physical interpretations may be satisfied to imagine genes and cholesterol molecules as explanatory endpoints, a Christian view of health appreciates that the patient is not just an aggregate of ailments but also a suffering soul. Sir William Osler was correct in noting that, “It is more important to know what sort of patient has the disease than to know what sort of disease has the patient.”

Secondly, this connection is yet another example of how moral behavior has consequences for physical health. These new findings revive an old suspicion. Dr. William J. Mayo wrote in 1930 that he believed there was a relationship between the emotions and the heart. Some of the earliest medical descriptions of angina pectoris, such as that of Heberden in 1772 and Trousseau in 1882, emphasized the role of strong emotions—particularly anger—in precipitating chest pain or sudden death.

Negative emotions such as anger, hostility, resentful suspicion, cynical distrust, and rash impatience rouse the sympathetic nervous system, which generates the “fight or flight” response of brute survival. Recurrent surges of adrenaline elevate blood pressure, increase heart rate, increase muscle tension, and strain the endocrine and metabolic systems. Extreme outbursts can imperil heart and health. Habitual indulgence can lower one’s threshold to unleash rage at even slight provocation. Sometimes easily triggered anger that occurs when feelings of guilt or inadequacy are exposed signals that the person feels threatened. Unresolved anger turned inward can insidiously fester into bitterness and depression. Unrestrained anger suspends joy, overrides reason, fractures friendships, embitters marriages, and isolates us from others and from God.

Anger as a weapon is most hazardous to its wielder. The psalmist knew this when he wrote of the wicked who draw the sword in order to bring down the poor and needy: “But their swords will pierce their own hearts” (Ps 37:14-15). A stark biblical example of a coronary-prone angry personality is Nabal of 1 Samuel 25:2-39. Nabal, whose name in Hebrew means fool, was “surly and mean in his dealings” and “hurled insults” at David’s messengers. He was described as “such a wicked man that no one can talk to him.” Shortly after treating David with cynical contempt, “his heart failed him and he became like a stone,” suffering what seems to have been a heart attack and a stroke leading to death ten days later. And medicine has not forgotten the eighteenth-century cardiovascular surgeon John Hunter, who once exclaimed; “My life is in the hands of any rascal who chooses to put me in passion.” Hunter soon proved those words prophetic when he died from a violent coronary artery spasm during a heated exchange at a faculty meeting at the Royal College of Physicians in Glasgow, Scotland.

Thirdly, anger is instructive because it is by design a moral emotion. Its connection to the heart draws attention to its seriousness. Anger cries out for justice in response to violation. Just as a knife intruding into bodily tissues triggers pain, transgression of personal boundaries or ethical rules provokes an urgent, compelling, disagreeable signal that cannot be ignored. Whereas pain is vital to physical survival, anger is critical to moral life because it convicts us that unethical violations matter and guards us from becoming indifferent to evil.

It is important to distinguish between cheap anger in response to interference with personal wants and righteous indignation in response to gross moral violation. An example of the former is the easily offended “road rage” driver. An example of the latter is the infuriated parent whose child has been killed by a reckless drunk driver. The one frets in frustrated pride. The other laments, longing for justice and restoration. Both forms of anger insist upon a standard of truth. The question is whether one seeks one’s own truth or God’s truth, whether one’s daily habit of thought is, “my will be done,” or “Thy will be done.”

The relevance of anger to health thus touches on profound questions that, I would like to suggest, find their ultimate answers within Christian theology. Anger itself is not sinful. But take care, for at the moment one angrily condemns another in his or her heart, sin has crept in (Gen 4:7, Matt 5:22). “An angry man stirs up strife, and a furious man abounds in transgression” (Prov 29:22, NKJ). Furthermore, “anger fails to bring about the righteous life that God desires” (Jas 1:20).

Fourthly, anger points to a standard of justice. By that standard, all fall short. While human anger is sometimes justifiable, only God is capable of truly righteous anger. Human perceptions of moral violation are often distorted by selfish interests or may be unaware of the other person’s intent or circumstances. Scripture assures us that, although in our misjudgments we tend to overreact or neglect to react, the law of the Lord is perfect (Ps 19:7) and he will judge the world in righteousness (Ps 96:13). Whereas human anger tends to dominate, God is never capricious or controlled by anger. God’s anger is a measured response to sin, and a necessary response, for he is holy.

Fifthly, because we experience human anger, we are able to recognize that God withholds his. Imagine how terrible it would be if God exacted immediate justice for human wrongs. God’s silence, for now, in the face of evil does not mean that he is absent, but rather is compelling evidence of his mercy. Every biblical mention of God’s anger is incomplete, as wrath is never his final word. Scripture maintains that God is “slow to anger,” but “abounding in love” (Neh 9:17, Ps 103:8, Joel 2:13, Jon 4:2, Nah 1:3) and “faithfulness” (Ex 34:6, Ps 86:15), “forgiving sin and rebellion” (Num 14:18) and “rich in love” (Ps 145:8). “Time after time he restrained his anger” (Ps 78:38) when Israel was unfaithful. The Lord assured wayward Israel that, “In a surge of anger I hid my face from you for a moment, but with everlasting kindness I will have compassion on you” (Isa 54:8). “For his anger is but for a moment, his favor is for life” (Ps 30:5, NKJ).

Sixthly, we have an advocate who understands how we feel when angry (1 Jn 2:1). Without sin (Heb 4:15), Jesus displayed anger at the corrupt money changers at the Temple (Jn 2:15-17) and at the stubbornness of unbelieving hearts (Mk 3:5).

Jesus, the Great Physician, is able to release the heart caught in anger’s grip. To receive his peace, we must first let go our pride. The clarity of perspective is helpful. If we in our hostility were to glimpse the living God, whose righteous anger shakes the mountains (Isa 5:25), we would shrink in shame and lay down our paltry gripes and petty grumbles. When injustice cannot be prevented, trusting in the sovereign Lord’s promise of justice relieves wounded hearts of an onerous burden. The humbled heart is then open to receive and share God’s love, which overcomes all sorrow.

Christians dedicated to reflecting God’s heart, when provoked to anger, should in most instances choose the superior act of restraint. That choice may even be healthy for the heart. Solomon wrote, “Be not quick to anger, for anger lodges in the bosom of fools” (Eccl 7:9, RSV). Who are we to hurl contempt at someone to whom the Lord would show mercy (Jn 3:17)? It is far better to honor the life-renewing words of Scripture. “Bear with each other and forgive whatever grievances you may have against one another. Forgive as the Lord forgave you” (Col 3:13), and not less than seventy-seven times (Mt 18:22). “Love your enemies and pray for those who persecute you” (Mt 5:44, Lk 23:34).

Occasional exceptions may be justified where measured force is necessary to prevent great harm such as loss of life. In such cases reasonable nonviolent strategies should first be exhausted, provided there is time, and the use of force should be proportionate to forestall evil and not intensified to gratify ire.

Seventhly, we Christians have an obligation to take good care of our bodies, wherein dwells the Holy Spirit (1 Cor 6:19). Avoiding injurious and self-destructive behavior is responsible stewardship. To that end, James (1:19) writes, “Everyone should be quick to listen, slow to speak and slow to become angry.” To this Paul adds, “Get rid of all bitterness, rage and anger, brawling and slander, along with every form of malice. Be kind and compassionate to one another, forgiving each other, just as in Christ God forgave you” (Eph 4:31-32). Paul, whose persecutions gave him ample opportunity to feel angry, instructed the believers in Philippi, “Let your gentleness be evident to all. The Lord is near. Do not be anxious about anything, but in everything, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus” (Philippians 4:5-7).

It is difficult and often impossible with one heart to embrace anger and fellowship with God, to wear the mask of anger and see the face of God, to shout in anger and hear God, to shake fists in anger and fold hands in prayer, to pursue vengeance and receive mercy. The state of our hearts depends on what we do with our anger. If we hold onto it, it may lay hold of us. If instead we submit our anger to the lordship of Jesus Christ, and trust in his justice, his peace will rule in our hearts (Col 3:15). 

Author's Note: Except where indicated, Holy Scripture citations are taken from the New International Version.

1 Suarez EC. "C-reactive protein is associated with psychological risk factors of cardiovascular disease in apparently healthy adults." Psychosomatic Medicine 2004 Sept/Oct;66:684-691. Mundell EJ. "Anger linked to heart disease inflammation." HealthDay, September 23, 2004, available at http://www.forbes.com/lifestyle/health/feeds/hscout/2004/09/23/hscout521357.html

2 Boyle SH, Williams RB, Mark DB, Brummett BH, Siegler IC, Helms MJ, Barefoot JC. "Hostility as a predictor of survival in patients with coronary artery disease." Psychosomatic Medicine 2004 Sept/Oct;66:629-632. http://www.americanheart.org/presenter.jhtml?identifier=4648

3 Mayo WJ. "Observations on the sympathetic nervous system." British Medical Journal Oct 18, 1930, p. 627.