When I met Juan, I was struck by his inability to sit still. Some part of his body was always in motion. For most of our meeting, his right leg bounced rhythmically. He picked at his fingers. He chewed gum, too — the kind of intense chewing you see in baseball players during a game. I could see the muscles of his jaw tighten over and over again. Despite this activity, Juan didn’t look animated. He looked exhausted.
Juan knew that family members and coworkers described him as a hothead and that he reacted to many commonplace exchanges with impatience. He appreciated that his job allowed him to spend hours interacting with his computer and not with people. He would occasionally have lunch with a colleague, but more often he would eat at his desk, working between bites.
Eventually, after I'd spoken for a while, Juan spoke.
“I really don’t want to be that guy,” he said. “The computer guy with anger issues.”
A lot of people suffer from jumpiness and irritability — in a variety of professions. Some make it through the workday without exploding, saving up their tension for unfortunate family members at home. Some aren’t hostile at all but find interpersonal interactions so stressful that they want to jump into bed and pull up the covers after a trip to the grocery store. Some drink. A lot. (These are the people who need to “take the edge off.”)
I’ve always suspected that these kinds of people are underrepresented in therapy offices — in part because therapy sounds like 50 long minutes of irritating interaction, but also because they fear labels. Something is terribly wrong with you, they imagine me saying. Here, let me show you this textbook that explains the word for people who can’t handle being around others.
But every person who’s come to my office has been endlessly complex and interesting — and shorthand labels, even diagnoses, can never capture a soul’s complexity. There’s no judgment here: People with chronic interpersonal stress are usually relieved to know that their tension is not a character flaw or a personal failure. It’s simply a problem with what I’ll call the “calm” neural pathway. This kind of constant relational stress is related to low tone in the smart vagus.