The face of rage is revealed, layer by layer
Roland Maiuro works on anger like a carpenter pulling up floorboards. Pry up a plank here, ease out a section there. Now and again put some serious muscle into it and yank out a big, splintery, rotten section. His trade is called "anger management and violence intervention," which has a calm, mannerly ring to it, even though the work takes him to some dark and gritty places.
The Harborview Medical Center psychologist has spent more than 20 years taking anger apart to probe its foundations and incarnations, teasing out why the same situation makes one person fume quietly and another fly into a homicidal rage. Domestic violence and workplace conflicts are his primary specialties, and he has become a de facto expert on the subject of road rage, that belligerent newcomer to anger management.
He has pulled anger up in emergency rooms, run into it in remote Alaskan villages and culled it out of police reports. Some emerges in knee-to-knee confrontations with clients in his cluttered office, other bits surface during group-therapy sessions.
He sorts through causes, effects and patterns, calibrating ferocity using scales of his own making. And he does it all with a certain deliberate speed, as if to get more, better answers before any more madness works loose.
"Anger," he likes to say, "is as contagious as any germ. And other emotions, like joy, are not."
DRESSED IN dark slacks and sport coat, Maiuro moves through the overlit Harborview hallways with a springy walk, a beeping pager clamped on his low-riding belt. If he got a sharper haircut, maybe a silk shirt, and lost the practical walking shoes for some slick leather slip-ons, he might pass as an extra on "The Sopranos," the HBO mobster series he confesses to loving.
Maiuro (pronounced my-YOO-roh) is a bearded, not-tall Italian-American who grew up in a part of New Jersey where job titles are single words that actually describe one's work: Builder. Welder. Printer. He has the directness of that blue-collar world, but is armed with a copious vocabulary and a gift for the well-timed dramatic pause. He can be a bit of a ham. (Family members affectionately liken him to the psychologist played by Robin Williams in "Good Will Hunting.") Yet Maiuro listens with a concentration almost fierce in its focus. He comes alive when it is time to answer, his responses unfailingly articulate, never dependent on the therapeutic "hmmmm" to fill in between thoughts. His family name, appropriately enough, derives from the Italian words meaning "never shout or yell."Now 51, Maiuro has spent his career speaking and writing eloquently about some of life's most personal aspects — anger, intimacy, jealousy, fear, honesty — but he does not talk about his own encounters with those things. He nods, yes, he was married once, way back when he was a graduate student. He alludes to his life as one full of close friends and beloved pets. As people in his line of work are wont to say, he keeps very good boundaries. He has found a way to be both charismatic teacher and private man.
Maiuro guides people through carefully crafted, innovative exercises and tests he's developed on his own or with colleagues. Many are widely used by other therapists and social workers and have helped him earn an international reputation.
The men he treats — and they are mostly men — are batterers, yellers, bullies, stalkers, guys who threaten co-workers or pound fists on their desks or run other drivers off the road. Maiuro, who is unwaveringly polite, interrupts anyone who refers to the men in these ways. "Not 'stalker,' " he says firmly. " 'Client.' We remain human despite our inhumane behavior."
The scene in the institutional-yellow Harborview waiting room, where one of his three regular men's groups gathers, neatly makes Maiuro's point that domestic-violence perpetrators cut across all manner of societal divides: age, class, race, profession. "Want another myth-buster?" Maiuro asks. "Forty percent of the clients here come from the Eastside."
In fact, the room looks more like the coach section of a commuter flight to Chicago than anything else. There's a grandfatherly white guy who tips his John Deere cap; youngish executive in Armani knockoff chewing his nails; slim black man in hand-tooled cowboy boots, wisecracking and passing out candy bars.
Twelve in all, they chat with the ease that comes from spending nearly a year of weekly sessions together, laying out their fears and confessing the ways their rage has cost them their jobs, families, freedom and health. Outsiders are not permitted to join the groups, so must rely on those who can for descriptions of the work that is done there.
Most are ordered to Maiuro's circle by a judge who encountered them after their anger led to a crime and an arrest, but some seek help independently or are nudged by an acquaintance who found a way out of his own wreckage with Maiuro's help. Insurance sometimes covers the client's cost, but more than a few pay the approximately $2,500 for the year-long program from their own pockets.
This is not a one-size-fits-all arrangement. Maiuro evaluates each client to better understand the nature of his anger problem, and what situations and feelings lead to objectionable or dangerous behavior.
One test, the Brief Anger-Aggression Questionnaire, is a six-question interview Maiuro developed a decade ago with University of Washington colleagues Peter Vitaliano and Timothy Cahn. (Maiuro is an associate professor in the UW School of Medicine.) It measures anger that is prone to be expressed as violence and asks subjects to rate questions such as "At times I feel I get a raw deal out of life" on a numbered scale. His Sadistic Hostility Scale is a newer, 10-item questionnaire now being evaluated by his peers. It measures what he calls a "meaner, more malignant" form of cruelty found in some violent and abusive individuals.
Maiuro insists on meeting with the client's partner, most often a wife or girlfriend who has been on the receiving end of the man's anger. He asks both to describe their relationship and incidents that led them to this point. Not surprisingly, their versions tend to differ, but that usually changes as the partners actually listen to one another. "One of the things we see with this kind of intervention is that versions of the story get closer; they begin to see more eye-to-eye," Maiuro observes.
Clients, it seems, are frequently surprised by the things Maiuro tells them. They are particularly jolted by his pronouncements that anger is in itself not a bad thing and that repressing it does not work.
Maiuro tells them that anger is hard-wired into humans for a number of reasons. "It is part of our flight-fight mechanism that keeps us alive. When something wrong or unjust has occurred or when we're threatened in some way, we're mobilized to change it through anger." For some clients, hearing anger defined as an acceptable phenomenon is a first. Many come from families where anger was bottled up — until it finally erupted, often with frightening results.
"Anger is so powerful a coping mechanism that repression and suppression are not successful," Maiuro says. "The more you try to avoid it, the more time and energy you're going to spend with it. It's a paradox."
The work of managing anger, as Maiuro has defined it, is learning to use it as sort of an early-warning system for incoming explosions that end in abuse and violence. "The point," he says, "is to take anger and use it as a signal, a motivation."
One of the first steps up the learning curve is taken when Maiuro asks the men to list words they usually hurl in anger. He writes the slurs on a whiteboard, prodding the men when, at first, they sheepishly hang back from saying the harsh words. The process quickly becomes competitive, the men holler out epithets and the list grows.
Maiuro then steers the discussion, pointing out how often the insults are sexualized and dehumanizing terms. Why is this word used, he asks the men. And what happens when you say it?
Looking up at that board filled with hateful words has its intended shock value on most group members. "It's an eye-opener," said Tim, a 38-year-old salesman and former client. "Guys realize that they've been saying these things for a long time and never think about what it means."
The whiteboard exercise is not just a way to create group synergy; it's a way to identify and disconnect the dangerous currents that run through many of the men's lives, says Maiuro. "The most toxic thing in their relationships is often the ongoing psychological and verbal abuse. It's not that some guy comes home and without warning hits his wife — that scenario is part of the mythology of domestic violence." The move from verbal assaults to physical is an "escalation of weaponry" that must be interrupted for positive change to happen, he says.
Much of each session is spent in open discussion, similar to 12-step recovery programs. But in Maiuro's groups, a member who holds back or seems to be wrestling with something particularly troublesome will be called on by his peers to talk.
Members are then challenged to role-play new ways of thinking, talking and behaving; then their performances are critiqued. During their year together, the men learn how anger affects physical health (rage can be measured in the bloodstream for hours, in the form of higher cholesterol, adrenaline and other changes) and how it looks and sounds to others. As the men mimic their angry facial expressions, Maiuro takes digital photos and flashes them on a large screen. Like the whiteboard exercise, it can be a jolt.
Some of the men embrace the work sooner and more efficiently than others. But Maiuro does not require that everyone start on the same page, just that they start. And that they show up and participate fully in every meeting — which means learning to talk about what they feel and what they do with a directness and honesty most have never experienced. Measuring success in Maiuro's world is an exercise in negatives, reminiscent of that tacky old joke that asks, "Do you still beat your wife?" But while it isn't easy to reliably tabulate the success rate of a program that sets out to change a societal problem such as domestic violence, Maiuro believes the results to date are encouraging.
"I don't think that I can predict who this work helps, but our research data show that it helps more people than it doesn't," he says. "When I first started doing it, people thought none of the clients I worked with could be helped — that these negative patterns were so ingrained that it would always be that way. But now our national data and our own findings indicate otherwise."
His overall approach differs from that of many therapists who won't work with clients who deny that their out-of-control anger is a problem. "Some treatment providers will say that if the client is engaging in distortion they are not amenable to treatment, but I don't agree," Maiuro says. "We miss a lot of people we could help if we take that attitude." Or as longtime friend and colleague Vitaliano puts it, "Roland made a choice to deal with a segment of the population that a lot of people won't bother with."
IF IT'S A STRETCH to say that Maiuro's life is largely defined by fixing things that other people tend to avoid or discard, it's a pardonable one.
Some of his neighbors still reminisce about the late Corky, a schnauzer with paralyzed hind legs who used to trundle around on a dog-sized wheelchair Maiuro built for him. "He went through four sets of wheels, then I got him an all-terrain pair because he wanted to go running with me in the morning," Maiuro recalls with obvious pride.
Then there is the special watering device called a "Lizard Licker" he invented for his Old World Cameroon chameleons, a rare African breed of lizard that drinks only moving water. (Maiuro looks more than a little hurt at a suggestion that the lizards are ugly. "But, they're wonderful!" he enthuses. "They have the characteristics of a mammal, a bird and a reptile.")
For a time he was one of the few Northwest experts on the finicky species, prompting the occasional call for midwife services and some very odd phone messages delivered to him by a worried-looking Harborview receptionist: "It's a message from the Little Mermaid; 'the chameleon has dropped her eggs.' "
Maiuro, you could say, is perfectly content with being an intelligent oddball. And therein lies much of his professional success.
In his chosen field, this outsider status comes from his conviction that domestic violence and its related maladies are public health problems as well as crimes. Domestic, workplace and road violence affect society at large and require similarly broad treatment, he says.
The healthcare-treatment universe, however, is notoriously turf-conscious. Cross-pollination of ideas and methods is inhibited by personal ego as well as the insularity of the professions and the large academic and medical institutions in which they operate.
"Violence and Victims," the bimonthly professional journal he edits, reflects this wide-ranging and evidence-based approach. Criminologists, nurses, legal experts, doctors and social workers contribute to a typical issue. Maiuro finds the breadth of viewpoints stimulating rather than threatening. "It helps me keep my sanity," he says, perched on the edge of his office chair. "There are plenty of opportunities to do interventions, and many pathways and causes of violence. One profession can galvanize and enter at one level, and another profession can enter at another level."
Maiuro and the Harborview programs have been nationally known for some time, and in the past decade have attracted international interest. Earlier this year he was invited to the University of Hong Kong as keynote speaker and trainer of social workers and others starting the work of preventing and treating domestic violence. It wasn't until last year that China passed laws criminalizing domestic violence.
The notion of being among the first Western practitioners to train Chinese counterparts in domestic-violence prevention and anger management does not seem to daunt Maiuro. Vast cultural differences separate his daily world and that of a social worker in Beijing, but the universality of anger closes that gap, he believes.
The appeal of working with the Chinese at this time in history, Maiuro says, is the opportunity to save them "many evolutionary steps and much suffering" by offering technical expertise on how best to identify and change the root causes and paths of domestic violence. The hunger for ideas he saw during his visit invigorated him: "China is eager for new ways to conceptualize things and is very much into applied research, as I am."
Maiuro's description of himself as an applied or clinical researcher is an innocuous enough sounding label, yet it is one more way he is set apart from many others who study human behavior. His studies are drawn from life, not laboratories in which subjects are observed in predetermined situations. "I don't believe in experimenting on people," he says flatly. "I believe situations occur naturalistically, so you don't need to create pretend situations. I prefer to be involved with real-life phenomena."
He got a good look at some of that real life in 1978 during a long-winter's post-doctoral internship based in Ketchikan, Alaska, and visiting outlying villages. It was then that his commitment to his field crystallized. "There had not been a mental-health professional in those villages for a long time," he recalls. "There I saw life with everything stripped away, and the social context was very thin."
MAIURO DID NOT start out to be a psychologist, but the mysteries and science of human behavior lured him away from the full scholarship and accelerated doctoral program in veterinary medicine he was offered by Rutgers University while still in high school.
He majored in biology and psychology instead, then received his doctorate in clinical psychology from Washington University in St. Louis. There, a class with the brilliant psychoanalyst and curmudgeon Saul Rosenzweig, a pioneer in the study of aggression, completed his move into the study of anger. The next move was to the University of Washington for internships and post-doctoral work. ("I had a run on Washingtons for awhile.") He has been in Seattle and at Harborview since.
He cares deeply for both, but blames the city for the one thing he says makes him hit the boiling point: traffic.
Only, he doesn't say it quite like that. Like most of Maiuro's ideas, this point emerges so finished that it is tempting to turn around and see if he's reading off a teleprompter.
He is perturbed by clogged roads, sure. And he sees the effects in the form of road rage. But it is Seattle's "ambivalence and failure to engage in the bold work of becoming a city" that is the real problem.
"It is robbing people of their sense of place. The traffic and gridlock take away time at home where you recharge your batteries. If the city is not well-engineered, then people are wasting their lives on the road. We're losing our quality of life."
MAIURO MIGHT well call "wasting lives" a sin, if he used the vocabulary of his childhood Catholicism, which he does not. His work weeks are long, divided among nearly 50 clients, hospital duties, editing and teaching — all of which is interrupted constantly by impatient bleats from his pager.
When he does have a breather, it is that precise moment when two or three of his young interns usually decide to squeeze into his 10-by-10 office, crammed with memorabilia from New Jersey and Italy, to pepper him with questions.
It's really a kind of thinking-man's chaos, but he prefers to call it "variety" and swears by it: "Doing research, studying the data, working with my students, it allows me to give, it allows me to have fun, to be a discoverer of new things. It is how I stay healthy and how I stay alive."
But what becomes clear over time is that he is really most alive in those moments when he listens to the stories that few people want to hear, the ones that tell of the countless ways a person can use voice or fists to hurt those closest to him. Most of us want to nail the boards down tight over these dark things and get on with life. Roland Maiuro knows better.
Kimberly B. Marlowe is a Seattle Times editor.