“When I argue with reality, I lose—but only 100% of the time.” (Byron Katie)
Depression is an established and accepted medical illness. As such, it is treated by members of the medical profession. The standard form of treatment is medication.
Surrender, acceptance, forgiveness – what do these terms have to do with depression and its treatment? They are certainly not scientific and hardly terms that are part of American medical tradition.
Our Greenwich, Connecticut DBSA group has met on a weekly basis for over ten years. During that time we have had over five hundred group meetings and close to ten thousand patient visits. All participants must be under a doctor’s care. They come to our support group not to support their recovery but because they have not recovered!
Extensive studies have revealed that after taking two antidepressants for up to 3 months, 30% to 40% of patients do not report any significant improvement in their symptoms. Only half of patients are in remission after a year of treatment with 4 consecutive antidepressants of 12 weeks each. Indeed, many of the people who have come to our DBSA group have been on or are currently on three to five different psychotropic medications and are still not recovered or even “well.” A certain number have come following hospitalization and have even received ECT without sustainable results.
It has become increasingly apparent that a broader perspective may be required to adequately address the problem of refractory depression. Those fortunate people who respond fully and relatively quickly to medication are, by definition, not refractory and are not the people who generally show up at a support group.
Perhaps it is high time for re-forging an alliance between medicine and spirituality in the area of depression, as was the case when Dr. Bob (Smith) formed an alliance with Bill (Wilson) a member of the Christian Oxford group to create Alcoholics Anonymous. Perhaps what is needed is more collaboration between these two professional areas: medical expertise and spirituality.
Three of the spiritual themes most frequently visited and revisited in our support group are surrender, acceptance and forgiveness. These themes are by no means unique to depression but we have discovered that they are essential to the process of recovery. All of these themes, or steps, are closely related to one another.
Let’s start with surrender. Many people have no idea what this means. Surrender is generally a pejorative term, especially in Western society. It is associated with loss and suggests that one who surrenders is a loser. Indeed, to even suggest that surrender is a step towards “victory” sounds absurd to most people and stands in stark contrast to Winston Churchill’s famous statement: “Never, never, never give up” or Vince Lombardi’s famous quote: “Winning isn’t everything, it’s the only thing.”
Surrender is when you decide to stop fighting and when you stop being angry at something you cannot control. In war or combat it may be useful or even essential to feel aggression in order to defeat the opposition. In recovering from depression, victory comes not from holding on to anger, but from letting go of it. When surrender happens, recovery can begin.
The irony about surrender is that surrender does not mean giving up. It is simply accepting things as they are. The “giving up” when we surrender is not losing but “letting go.” This is not easy and for some people it never happens. They simply will not surrender. They remain angry and self-pitying about their plight. Sadly, this may be the major reason why they never recover.
This may be why their medicines never “kick in.”
An extraordinary example of surrender and acceptance was a member of our group with bipolar disorder who had experienced several major episodes of the disease during her life, each requiring hospitalization and the final hospitalization requiring ECT. With everything finally going well in her life, her husband died suddenly after celebrating their 25th anniversary.
The loss was sudden, unexpected and devastating. The pain was intense; however, her attitude was extraordinary. Her initial response might have been that of many people: “Why did this have to happen to me now?” But she “surrendered” to her painful reality. As a result, her attitude was instead: “We shared 25 great years. Similar tragedies happen to many other people. Why not me?!” The group was overwhelmed both by her courage and her wisdom. Perhaps equally important in the two years since her husband’s death is the fact that she has not relapsed. Of course she was sad but she never became clinically depressed or manic.
Surrender often means letting go of an old dream or self-image in order to deal with a new reality. This is not easy for any of us. It is best done in the company of others who are on the same painful journey and have to swallow the same bitter pill. Surrendering is done most effectively in a setting of tender and vulnerable humanity liberally sprinkled with the laughter and tears of people supporting one another.
People in our group have discovered that when they stopped feeling like victims this, paradoxically, was their moment of liberation. At this moment of acceptance, they began to take charge of their lives.
The third important step is forgiveness. People need to stop judging, stop blaming, and stop viewing themselves as “bad, worthless or weak.” People must be able to forgive themselves.
There are two components of forgiveness: one must forgive oneself and one must forgive others. When we forgive others it is not so much for their sake but for our own. People who are successful in recovery also stop making self-deprecating comparisons and let go of expectations of what they should be, or should have been, or should have achieved in their lives. Recovery starts when we accept and forgive ourselves knowing this is not defeat, but the beginning of a new journey.
In conclusion, surrender, acceptance and forgiveness are liberating and empowering. They provide a much needed opportunity to exhale and experience a new sense of freedom. They also provide the energy and the motivation to try again, but in a different way with more realistic goals and expectations. As we surrender, accept our current reality, and forgive ourselves and others, we have taken three fundamental steps on the road to recovery.
This is the third of a series of articles written by Dr. John Tamerin specifically for the DBSA Leadership Circle Newsletter entitled Perspectives. Dr. Tamerin is a member of our Board of Directors and Medical Consultant to the Greenwich, Connecticut DBSA Chapter.
Dr. Tamerin, a psychiatrist with over 40 years of clinical experience, has served for many years as Clinical Associate Professor at Weill/Cornell School of Medicine teaching residents and medical students. He has consistently been voted one of the Top Doctors in America by Castle Connelly.
Dr. Tamerin has published extensively in the areas of mood disorders and the addictions. He has served on the GAP committee on Alcoholism and the Addictions, the Committee on Human Sexuality and most recently has joined the committee on Psychiatry and the Arts. His goal in this series of articles is to further integrate medicine with the Humanities and the Arts by presenting new and provocative perspectives of direct relevance to the treatment of people suffering with mood disorders.