Cool It

Outbursts of rage land plenty of people in prison, and daily life behind bars provides many more opportunities to lose your temper. Whch makes it the ideal place to get to grips with the often scoffed-at anger management course. Does it work? Zoe Williams follows the progress of five Pentonville inmates to find out.

Zoe Williams
Saturday November 15, 2003
The Guardian

Anger management is the least celebrated branch of the cognitive therapy tree; its main reputation is as a quasi-scientific means of controlling stroppy supermodels who've shouted at the stylist once too often. Naomi Campbell, I mean - not all supermodels are like this. Unlike cognitive training for anxiety and depression, with which it shares all the same principles and most of the same techniques, this tends to be the kind of therapy to which you are referred by an institution, rather than deciding upon yourself. I can't with complete certainty say why, but ultimately anger, unless it manifests itself in violence, is not thought of as a mental disorder that adversely affects the quality of your life. It's just put down as a filthy temper. And if it does express itself as violence, then, sooner or later, you're going to end up in prison.

Consequently, the best place to see an anger management course is in prison, and probably the best prison is Pentonville, the first British establishment to adopt the Canadian-devised Calm course (Controlling Anger and Learning to Manage it). The governor, Gareth Davies, is a kind of patrician liberal (he is patrician in the sense that he keeps Churchill speeches about prisons on his wall; liberal in the sense that Churchill was pretty liberal, prison-wise). His central interests are in making prison less agreeable for the so-called "career" offender, the lifelong criminal who sees occasional custody as an unavoidable hazard; and in making prison more productive for the spontaneous criminal, the offender who's wound up incarcerated for an offence (usually a violent one) that was unplanned and could have been avoided with the application of simple techniques for self-control.

Now, as I've said, anger-management principles are simply those of cognitive therapy. These are probably terribly familiar to anyone who's ever taken up regular therapy and got bored with slagging off their parents, but to recap: feelings come from thoughts, they do not arrive by themselves. Once this has been accepted, the thoughts can be identified - the distorted thoughts can be righted, and the feelings will cease to arrive. The tenets of cognitive behavioural therapy (CBT) are given the shorthand: thoughts-feelings, impact-action. There are three core mistakes at the root of all distorted thinking (these were identified by Albert Ellis, the 1950s "grandfather" of cognitive therapy and a major influence on Aaron Beck, the "father") - "I must do well"; "You must treat me well"; "The world must be easy." Once these assumptions have been excised, the aberrant thoughts and behaviour can be quelled.

The methodology and theory behind CBT are essentially practical - this is not about delving into anyone's childhood, or laying old events to rest, or anything else typically associated with talking cures. It is not, in short, the kind of therapy a brigadier (say) would call "stuff and nonsense" - the only real controversy there's been around the issue was that voiced by Noam Chomsky, in 1977: "Behaviourist therapy is pretty empty as an intellectual pursuit ... [but] in schools and prisons ... it provides a palatable ideology for the application of techniques of coercion." In other words, this therapy teaches people how to operate in society without causing trouble and, in the interests of so doing, teaches them not to strive for fairness, or justice, not to assume that "the world must be easy".

This is not necessarily the right way to proceed, from a political or philosophical point of view. Take as an example one statement on a psychometric test that prisoners have to fill in: "If I had had a better education, I would have a good job, and wouldn't need to commit crime" (prisoners who "agree strongly" have distorted thinking). Sure, it's kind of nonsense, since plenty of people don't commit crime, regardless of A-levels. But, on the other hand, it is the case that you don't find many people with degrees in prisons, and it's not because they have better morals (not as far as I know). Essentially, you have to train people not to think like this, since it will prevent them from addressing their offending behaviour. But from a wider perspective, someone has to think like this, otherwise there is no impetus for social change.

Anyway, I followed five offenders through a Calm course in Pentonville. On balance, I'd say that Chomsky's view of "coercion" is right, but that the benefit to prisoners is so extraordinary that it scuppers these reservations. One prisoner, in particular, who might as well have had reoffender tattooed on his forehead at the start of his sentence, admitted later on that he'd been spending all his spare time planning crimes to recoup the "earnings" he'd lost in prison and, after 10 weeks of Calm, was a different person. Maybe he was making that up for the parole hearing, but, if so, he's such a fine and perceptive actor that he's plain wasted in drug-dealing. Besides him, I'd say that one of them was never fully persuaded of his need to change; one was never going to change as much as he needed to, for all the courses in the world; and two weren't all that communicative with me, but the psychologists liked them.

Mark was an attempted arsonist in his late 40s. He'd served most of a four-year term for an offence that slightly changed texture every time you spoke to him. In each version, he was in a pub and had an argument with the landlord, who kicked him out. As he was being ejected, he threatened to burn the place down. Sometimes, he claims to have changed his mind on the way to the petrol station; other times, he's bought the petrol, abandoned it and been arrested on his way home; the truth is (and he will sometimes agree with this) that he was arrested with a can of petrol on his way back to the pub.

When I first meet him, Mark has missed one week of the course, having wounded his hand spectacularly by punching a wall. So far, he's the perfect subject for anger management - prone to spontaneous, manifestly self-destructive bursts of rage, and full of delusional notions about where they come from. He has some cockeyed theories, among them that he has a psychic ability not to feel pain down one side of his body, so long as he decides not to. Sometimes, he tells you complete nonsense - he was in the Foreign Legion, only they kicked him out because his skin was too fair and he kept getting sunburnt; his parents were blown up by the IRA, and his mother's head landed in his lap. Other times, he comes out with this very clear, unmelodramatic, melancholy picture of himself, and of how other people see him. "Whenever I read anything in the paper about a guy who's done something or other, and his neighbours are calling him a loner, and nobody in his job really knew him, and nobody could tell you what he did with his time - I think, I'm like that. I think I'll always end up in some sort of trouble. I don't think I'll ever get along with people."

Rodney is in his mid-30s, and is also coming to the end of his sentence. He's in for GBH - as far as he's concerned, it was a one-off event, and he's never had a problem with aggression before or since. He is self-assured, fastidious about his words and his clothes (harder than it sounds when your uniform is a tracksuit of the old school), articulate, persuasive - he reiterates his relatively non-aggressive nature every time I see him. It really gets on Simon Vallance's nerves (Simon is the course leader and a prison officer). "You say that," Simon eventually intercedes, "but you're in here, aren't you? You wouldn't be in here if you had no problem with anger." "I made one mistake. Everyone can make one mistake."

In fact, a lot of prison officers agree with this line, just in passing - that it's an accident of the stars, who happens to be outside a pub, on what particular night, when which particular fight breaks out. They're very "there but for the grace of God ..." Like the police, a lot of prison officers are ex-army - the police like to make out that they had to go into prisons because they weren't good enough for law enforcement. I think they're just not judgmental enough.

Rodney's back story is that he spent 20 years as a karaoke guy, who went round pubs with the machine. "I had every single bit of racist abuse you can get; I have been called everything under the sun that you can call a black man. And then it was just this one guy, following me around, saying this thing, over and over again ..." He never wavered from the line that, otherwise, he was a fairly placid individual. On the one hand, this is a classic example of the distorted thinking that anger management exists to overturn; on the other hand, as I say, he was very convincing - maybe there are some stresses that would drive anyone to violence. (Having said that, I never found out the full extent of the offence - the victim said Rodney had glassed him, and that's what he was sentenced on. Rodney said he'd just punched him.)

Adrian was in for a drugs offence, which wasn't an anger-management issue. But over the course of his term, he had notched up 68 extra days for outbursts of fury. This, technically, made him an inappropriate referral - "Calm is not intended for offenders who have a poor institutional history of anger and aggressive behaviour alone. The programme is aimed at those whose anger or poor emotional control lead to a criminal offence" (my italics). That said, he was the gold-star of the group. By about the third session, he'd noticed a change of behaviour in himself that he says he didn't really plan, it just happened. "Before," he said, "I used to go everywhere with a sharpened pencil. If people called me 'teaboy', or anything, I'd have a sharpened pencil. Now I only ever take a pencil if I'm going to a lesson. Sometimes, I take a pen." Teaboy is what people get called when they're on tea duty for the officers - it's a good job, allowing prisoners great freedom of movement, and unlimited access to the phone. However, communicating with officers, which you have to if you're going to find out how they want their tea, is the third worst thing you can do in prison, above grassing and having committed a sex offence with a child. So it's a bit of a mixed bag, and other prisoners, er, call them teaboy.

Sean was the only lifer in the group - he was in for murder, and had mainly taken the Calm course because he'd already done Enhanced Thinking Skills and found it very helpful. (ETS is the standard cognitive training all prisoners get - it's mostly about problem solving, attitudes to criminality and basic cognitive skills.) He didn't want to be interviewed for this piece, but agreed to have his picture taken. And Leon dropped out of Calm after two sessions, since his main problems were with addiction, and addicts have to be referred to drug programmes before anything else. Prison is not by any stretch the best place to go to come off drugs. In the words of John Hardwick, "Don't do drugs, because if you do drugs you'll go to prison, and drugs are really expensive in prison."

Apart from the fact that Adrian's aggression seemed to have surfaced inside prison, rather than outside, all the prisoners represented the ideal profile for an anger-management course. None of them was really a serious, constantly reoffending career criminal - anger-driven offenders tend not to be, since it's spontaneous, not a career decision. None of them was serving time for using violence instrumentally (that is, bouncers and gangsters, people who use aggression as a means to an end, rather than as an expression of anger). None of them was psychotic. The problems with trying to teach cognitive skills to psychotics are many, but sometimes the outcome is comically bad, as vividly illustrated in a story Simon remembered from a previous ETS course. "The worst one was when they sorted out a grass - basically, this guy was a grass, so they'd knocked him out and poured boiling water on his face and all over his neck. And then, when he'd woken up, he'd started screaming, but there was nobody around him to get in trouble for it. And the guy who did it later said he was actually really pleased he'd done ETS, because otherwise he'd have tried to do him in front of everybody, and he'd never have been able to do so much damage."

I spoke to the group before and after each session - I didn't sit in. Debbie Marsh and Ian Whitaker, forensic psychologist and prison officer tutor respectively, described the shape of the course. The first section is aimed at alerting the angry to the ways in which they could recognise their feelings of rage before losing control. The angry prisoner, in the interminable psychometric testing done at the start of the course, will agree strongly with statements such as "My anger is caused by what other people do"; "Once I get angry it's impossible for me to control myself"; "I have a fiery temper"; "I fly off the handle"; "I feel like I'm about to explode." His firm belief will be there was nothing he could have done to prevent his outburst.

Once the therapist points out the physiological changes that occur at the outset of rage (sweaty palms, faster heartbeat), these function as proof that the uncontrollable fury didn't just possess him, it built up from more wieldy emotions. When he's identified these, he can be called upon to locate the thoughts that triggered them; he can now address the thoughts, and see whether or not they're reasonable - mostly, they won't be, or there will be some way of rationalising them that prevents an escalation to blind rage.

Debbie Marsh says this is the most dramatic bit of the course. "Most groups are turned as soon as we start doing the arousal stuff. They're sitting there going, 'Oh my God, that's how I can tell I'm getting angry, because my heartbeat's going and my hands are sweating', and as soon as they see the physical cues kicking in, that's it for them - they're on board, they're active, they're completely gobsmacked by the idea that they can control it themselves." Results from the Focus On Violence course at Foston Hall women's prison shows that female prisoners tend towards depression at this point, as they revise all the aggressive behaviour of their past and realise that they could have controlled it, that it was all their own fault. Sure, male prisoners don't like it, either, but depression doesn't seem to follow on so much. "Obviously, it's hard," Debbie says, "because they've spent their lives blaming situations, other people, and all of a sudden they've got irrefutable proof - 'It's me. All my life I've wound myself up.' When they get to that point, you've got to be really quick to come in behind them and say, 'Well, if you created it, you can control it.' You have to give them a sense of their own power."

This is where some standard techniques, some of them recognisable from anti-panic attack systems, are introduced. It's no great surprise that anger and panic share approaches, according to Ian Crane, Simon's co-teacher of this group. "With anger, jealousy, anxiety, elation, whatever, it's very hard to differentiate between them, because the physical cues are exactly the same," he says. "When you're anxious, you're sweating, you're clenching your fists, you've got a knot in your stomach. When you're angry, it's exactly the same. So how can we tell the difference? Through our thoughts. What thoughts brought us there, and what were the distortions?"

Isn't elation good? Once in a while? "No, as daft as it seems, intense happiness can lead these guys into exactly the same situations that anger can. It can lead all of us like that. You get carried away by euphoria, you think you're superhuman." Debbie illustrates with some thoughts on love: "It's like the saying, 'Love is blind' - it stops you thinking rationally. We want them always to be thinking. If you're thinking, you're in control of yourself." It's when emotions are too intense, for too long and too often, that there's a problem, Ian concludes sagely. It's not the stuff high drama is made of but, as everyone keeps coming back to, where did high drama get you? It got you in here.

The basics are as follows: thought-stopping - which does exactly that, puts a halt on negative thoughts that are getting out of control and directs them elsewhere - fogging (learning to hear criticism without absorbing it), broken-record, negative assertion and negative inquiry (all assertiveness techniques). Most of them work best in conjunction with one or more of the others, and all of them will only work with constant practice, in real situations, not just in role-plays with psychologists who are only pretending to be annoying. Luckily, if you're looking for situations of heart-stopping frustration and rage on a day-to-day basis, prison is just the place.

So they're all given these work sheets, split into columns such as Situation/Physical Cues/Thoughts Experienced/Action Taken, and they spend as much of their week as keenness and bad situations allow reporting these incidences of rage. Minute but constant annoyances abound - being told to do two opposite things by two people of equal authority (not on purpose; it just seems to happen quite a lot), waiting an hour for the phone, having to go on a tea break when you're not thirsty. Mark describes an argument between two officers, neither of whom wanted to do some unspecified task - they kept sending him to tell the other one to do it. "I was piggy in the middle. And I want to say, 'When you two kids have sorted yourselves out, come back and let me know,' but I felt as if I was being used. It was a confrontation between two officers - it shouldn't have been anything to do with me." Now, this sounds like anger management, but the way Mark is talking, it's actually the opposite - the more he's remembering it, the more pissed off he's getting and the more ways he can think of in which they wronged him. In his parole hearing, he's told that he still has a problem with brooding - he replays situations in his mind, which makes him liable to hit out at someone who just happens to walk past and look at him funny. In fact, he's still thinking about those officers by the time of his parole hearing, and about the time he punched the wall; but he never stops trying to find a way to deal rationally with these events.

Rodney, being so placid, uses up very few worksheets. Adrian uses up loads - he was educated in Jamaica and has the incredibly neat, copperplate handwriting that the famously strict schooling there bestows. "I want to stab him in the eye," he writes, in flawless italics. "I want to kill him." Action taken? A mixture of fogging and thought-stopping. About four sessions in, Adrian's situation has changed markedly - crucially, he has stopped arguing with his girlfriend. He used to fight with her every time they spoke, and he used to beat her up before he got sent to prison. Their argument was always the same - he'd call the house, she wouldn't be there; he'd think, I have only one chance to phone, now I'm going to have to call her mobile, she knows I can't afford to call her mobile, she's doing it on purpose; then he'd call her mobile and she wouldn't be there, either; he'd think, she's left it at home because she's having an affair (he describes this with such mournful frustration that I'm getting angry with the woman myself, even though he's the one who's in prison and she's looking after three kids and can go where she likes); then he'd call the house again and she'd pick up, having missed it the first time because, whatever, she was upstairs. All it takes is for him to think, "Maybe she's upstairs", before he has all the other thoughts, and that's a screaming row they haven't had. But you need a lot of worksheets to get to "Maybe she's upstairs".

Giving up aggression is, at the final count, a lot like giving up smoking - you can accept that your life would be better without it and you can train yourself to a point where it's not a knee-jerk reaction, but you can't deny that it did have something going for it while it lasted. Aggressive people, when they're not in prison, do get their own way a lot of the time - relinquishing violence means accepting that you can't control other people. Clearly, everything's easier before you accept this. Ian Whitaker gives this example: "The classic case was a prisoner who felt that his partner was going to leave him. So, he knew he was responsible for his own anger, and he'd accepted that, but he also had to deal with the fact that where's it written that she can't leave you? She can. He can try as hard as he likes to change his behaviour completely, and she's still got every right to go. He'd always controlled her with his anger; even from prison, the pure threat of violence was enough to keep her at home. Whereas now, he'd got past his anger, but it left him with nothing to control her with. You can't control someone with assertiveness. And we don't have any miracle cures. We can't change any of their circumstances. And we certainly can't change the fact that they're in prison, and that's a good time for their partners to have affairs."

So, given that anger has things in common with addiction, a fair amount of the course is given over to relapse prevention. In the final session, everyone obviously thinks they won't relapse, but the prevention module is as much about not getting demoralised by one relapse as it is about not relapsing at all. Mark and Adrian are explaining why they'll never get into a fight again. "I hate to say it," Mark starts, "but in this day and age, nobody fights on a one-to-one basis. It's all gangs of eight. You think it's just one, and then you come out of the toilet, or whatever, and he's got six of his mates with him." Adrian agrees, "That's true, it's all gang-related. It's a system. You can't have a one-to-one fight with someone, he'll always get his mates, and they'll find the best place and the best time to attack. So it gets that there's no justification to fight." Even a guaranteed one-to-one Mark's dubious about: "OK, you might have just hit him once or just pushed him out of the way, but say he falls and bangs his head on the edge of the table, or on the edge of a kerb, or ... whatever, and that person dies, then the long-term consequence is you coming back to prison for a life sentence."

It's not a very moral business, managing anger - there's a section on the course about victim issues and envisaging the full reach of the life you may have ruined, but mostly it's about very pragmatic strategies for not ending up back in prison. The best way not to come back to prison is to make sure that everything you do is something you've consciously decided to do. If this has consequences for the greater social good, then that's good, too.

I undervalued Mark's achievements all the way through, it turns out, since his parole officer is astonished by the progress he's made: "He really worried me when I first met him. I thought this was a Broadmoor case, I never thought I'd be finding him somewhere to live so soon." Debbie said she thought he'd need fairly close watching and the parole officer replied, "Yes, I'm pleased we've found a hostel above the main parole office. I don't know how happy they'll be about having an arsonist, but there we go."

Adrian is the psychologists' favourite, though. "You were excellent, you really were," Debbie started. "We couldn't fault you, and we try to fault everybody," Simon continued. Adrian looked sheepish. I don't know, maybe I'm mad, maybe I imagined this, but I thought his landing officer had tears in his eyes. Adrian no longer smokes dope, and says, "I can look at myself in the mirror easier now." He doesn't get into any fights, and he doesn't fight with his girlfriend on the phone. He's been quietly supportive to the others in the group. Debbie says after he leaves, "He really is excellent. I'd trust him to do my bathroom." (He's a decorator, besides being a drug-dealer.) Until about two-thirds of the way through the course, he confesses that he'd been planning how best to retrieve the goods and time stolen from him by society - when he was arrested, the police fashioned some absurd scale (he says) to calculate his earnings, and then seized this amount in goods and money after he was convicted. He'd figured out how much society owed him by applying the police's earnings-scale to the time he'd spent in prison, and was intending to thieve or drug-deal exactly that amount in revenge, before he went back to his regular business of, erm, drug-dealing. "I'm not going to do that now. I'm very calm. I've got no plans like that."

Calm may have no moral agenda, it certainly has no interest in stopping people smoking dope (as far as I could make out), but anger is a defining interest - your future is defined by revenge strategies; your social life and addictions are determined by the need for a respite from all the strategising. Just like anxiety, it governs your life.

Rodney wasn't up for parole yet, but on the last day, just before the relapse session, he was having an argument with some other guy who wasn't doing Calm but was doing a course next door. Rodney was in a definite state of non-agreement, but wasn't going to burst any blood vessels over it, like the other guy was. The issue, as I found out from a third person, by no means a reliable one, was this: the blood-vessel guy was on kitchen duty with Rodney (another attractive job, better in some ways than teaboy, because nobody calls you teaboy). Blood-vessels and his associate had got caught cooking crack in the microwave, and now the whole detail (including Rodney) had been kicked off kitchen duty. Anyone would be annoyed by that - most people would be more annoyed than Rodney. Maybe he was, as he said, a placid person who got pushed too far one time. Maybe the whole crack story was cooked up for my amusement. I never got to the bottom of that (he clammed up a bit towards the end of the course). But Mark and Adrian were not the same when they left Pentonville as they were when they came in. It may be full of a thousand daily frustrations but, if you feel like it, you can get a lot more out of incarceration than GCSEs

· Some names have been changed.