In the Western world - well, outside Italy - people are told to reduce their anger or suffer its ill effects, such as stress, but new research using surveys from the US and Japan suggests that anger may actually be linked with better health. 

Displays of anger are strange to people in the West, especially stoic Americans. You can chop off the arm of an American and in many cases they will tell you to have a nice day. A recent incident on a Korean Air flight bound for Seoul illustrates the distinction. Heather Cho, former vice president of Korean Air and daughter of Korean Air Chairman Cho Yang-ho, went into a rage when she was improperly served a bag of macadamia nuts by the chief flight attendant.

In an angry outburst, Cho ordered the pilot to take the plane back to the gate so that the flight attendant could be kicked off the flight. Disproportionate? To the West, sure, but not in Korea. She believed the details were important and she had the power to correct the problem. Many Koreans were not surprised because she had a great deal of authority in Korea.  It doesn't make her unhealthy, if anything she is probably healthier than a Korean who has to suffer real indignity and say nothing.

Credit: UCSB

"Many of us in Western societies naively believe that anger is bad for health, and beliefs like these appear to be bolstered by recent scientific findings," says psychologist Shinobu Kitayama from the University of Michigan, co-author of the paper in Psychological Science. "But our study suggests that the truism linking anger to ill health may be valid only within the cultural boundary of the 'West,' where anger functions as an index of frustration, poverty, low status and everything else that potentially compromises health. These findings show how socio-cultural factors go under the skin to influence vital biological processes."

In other words, it's the circumstances that elicit anger, and not anger itself, that seem to be bad for health. In previous work, Kitayama and colleagues found that anger can function as a signal of high status and privilege in Asia -- drawing on this, they hypothesized that greater expression of anger might be associated with better health among Asian participants.

To explore the link, the researchers examined survey data from American participants in the Midlife in the United States (MIDUS) survey and data from Japanese participants drawn from the Midlife in Japan (MIDJA) survey. To measure health, the researchers looked at biomarkers for inflammation and cardiovascular functioning, both of which have been linked to anger expression in previous research. The combination of these two factors served as a measure of overall biological health risk.

The researchers also looked at measures that gaged various aspects of anger, including how often participants expressed angry feelings through verbally or physically aggressive behaviors (e.g., "I slam doors," "I say nasty things").

The survey results revealed that greater anger expression was associated with increased biological health risk among American participants, as previous studies have shown, but greater anger expression was associated with reduced biological health risk among Japanese participants. And the association was not explained by other potentially related factors -- such as age, gender, chronic health conditions, smoking and alcohol consumption, social status, and experience of negative emotions more generally.

"The association between greater anger and compromised biological health, taken for granted in the current (Western) literature, was completely reversed so that greater anger was associated with better biological health among Japanese," explains Kitayama.

The researchers did not find a link between other facets of anger, such as chronic propensity toward anger or the extent to which participants suppressed feelings of anger, and health outcomes.

Together, these findings suggest that the link between anger expression and health reflects different experiences across cultural contexts. In the US, expressing anger seems to reflect the degree to which people experience negative events, while in Japan it may reflect the degree to which people feel empowered and entitled.

"Our point is that anger expression is a complex phenomenon likely motivated by a variety of factors, many of which could be culture-specific. These cultural factors must be taken into account to achieve a full understanding of the link between anger and health," the researchers write.

Kitayama and colleagues hope that future longitudinal research that follows participants over time will help to shed light on the relationship:

"Such research will help us address whether improving personal and social life styles so as to reduce anger may entail long-term health benefits."

Study co-authors include Jiyoung Park of the University of California, San Francisco; Jennifer Morozink Boylan of the Unviersity of Pittsburgh; Yuri Miyamoto, Christopher L. Coe, Gayle D. Love, and Carol D. Ryff of the University of Wisconsin-Madison; Cynthia S. Levine of Northwestern University; Hazel Rose Markus of the University of Michigan; Mayumi Karasawa of Tokyo Woman's Christian University; and Norito Kawakami of the University of Tokyo.

This research was supported by a grant from the National Institute on Aging (5R37AG027343) to conduct the Midlife in Japan survey for comparative analysis with the Midlife in the United States survey (National Institute on Aging Grant P01-AG020166).