Letters to the Editor
Reply: Ancient Wine but Still Potent?
Dear Editor:
We are grateful for Dr Jerome’s contribution to the debate about road rage and its relation to psychiatric distress. He makes the important point that a significant literature exists on psychiatric issues and driving and correctly notes how several different psychiatric problems—such as explosive disorders, attention-deficit hyperactivity disorder (ADHD), and impulsive behaviour— may relate to road rage (for example, 1,2).
Road rage is sometimes portrayed as a new phenomenon, but as Dr Jerome points out, it has a long history. There are literary and historical references to road rage that point to a relation with psychiatric distress. In Sophocles’ play Oedipus the King, written about 420 BC, a road rage incident is the ostensible reason for which Oedipus kills his father (3). Oedipus is characterized as impulsive and easily provoked to violence. Sophocles based his Oedipus story on a folk tale, and he may have included the road rage incident because his audience would believe and accept it. The poet Lord Byron was involved in a serious road rage case in 1822 (4). It concerned a dispute over the right-of-way on a road, lasted several hours, and resulted in a serious injury to the supposed perpetrator. Lord Byron was subject to depression at many times during his life, but it is not clear whether this contributed directly to the road rage incident. Byron was also subject to irritation and sudden bouts of violence (4).
We have used the General Health Questionnaire (GHQ) in our own research (5). The GHQ, a general psychiatric screening instrument for identifying people experiencing psychiatric distress, has proved very useful in survey research (6). However, it does not assess impulse-control disorders, explosive behaviours, or aggression. Virtually all its items deal with depression, anxiety, and feelings of stress. No questions probe aggression, hostility, or impulse control. Future research in this area would therefore profitably consider these potentially important factors.
Much remains to be done in research on road rage and psychiatric distress. Both victims and perpetrators of road rage should be examined with psychiatric instruments that allow for the identification of ADHD and impulse-control disorders as well as depression and anxiety. As Dr Jerome suggests, mood disorders may underly impulsivity. At present, we also know nothing of how road rage behaviour in young people may relate to various psychiatric problems. It is also important to note that our work does not allow the disentanglement of cause–effect relations; thus we must keep in mind the importance of considering road rage as a cause of such problems as depression and posttraumatic stress disorder (PTSD) (for example, 7).
Available evidence makes it clear that motor vehicle collisions wherein road rage may have played an important role (8) are a major source of injuries and premature death in Canada and also a major source of psychiatric problems such as PTSD (9,10). Additional efforts to understand the role of psychiatric problems as both precursors to and results of motor vehicle collisions should be considered as a research priority. We completely agree with Dr Jerome that further understanding of road rage may have important implications for public health and psychiatric practice.
References
1. Nada-Raja S, Langley JD, McGee R, Williams SM, Begg DJ, Reeder AI. Inattentive and hyperactive behavior and driving offences in adolescence. J Am Acad Child Adolesc Psychiatry 1997;36:515–22.
2. Jerome L, Segal A. Benefit of long-term stimulants on driving in adults with ADHD. J Nerv Ment Dis 2001;189:36–64.
3. Roche P. Sophocles: the complete plays. New York: Signet; 2001.
4. Marchand LA. Byron: a portrait. New York: Alfred A Knopf; 1970.
5. Smart RG, Asbridge M, Mann RE, Adlaf E. Psychiatric distress among road rage victims and perpetrators. Can J Psychiatry 2003;48:681–8.
6. Pevalin DJ. Multiple applications of the GHQ-12 in a general population sample: an investigation of long-term retest effects. Soc Psychiatry Psychiatr Epidemiol 2001;35:508–12.
7. Breslau N. Epidemiological studies of trauma, posttraumatic stress disorder, and other psychiatric disorders. Can J Psychiatry 2002;47:923–9.
8. Smart RG, Mann RE. Deaths and injuries from road rage: cases in Canadian newspapers. CMAJ 2002;167:761–2.
9. Health Canada. The economic burden of illness in Canada. Ottawa: Health Canada; 2002.
10. Mayou R, Bryant B, Duthie R. Psychiatric consequences of road traffic accidents. BMJ 1993;307:647–51.
Reginald G Smart, PhD
Mark Asbridge, PhD
Robert E Mann, PhD
Edward Adlaf, PhD
Toronto, Ontario
|
