Love and Forgiveness | A Women's Journey

I’m a psychiatrist who practices at Johns Hopkins Hospital and the focus of my clinical work is treating mainly women who have depression and bipolar disorder But the Women’s Journey team came to me and said, we want you to talk about something completely different We want you to talk about love and forgiveness, because when we surveyed participants that was one of the top five topics that came up And I thought, but it’ll be easier for me to talk about depression, cuz that’s what I do And they said, no, you have to think and you have to talk about this, and I actually love them And so I said, okay, I’ll really think about it and I realized as I started reflecting that this is one of the most common psychotherapy topics that my patients bring to our work together And so I said, all right what is love and forgiveness? Well then I started thinking what’s involved Usually it’s two people with a very intense relationship This isn’t your random neighbor you barely know This is your brother, your sister, your parent, your spouse, your child Your best friend Two people that have some event that goes very poorly And then what the fallout of that is And so to think about it and think about how you move past those events and those negative experiences, I think you have to think about the two people and the events So I’ll talk about each of those in turn So the two people Here’s the problem, we know ourselves pretty well, and we know other people very poorly We project a lot of our own ideas Well I think that I’m sure they think that to Well not so much So, Hans said that there are basic personality styles and that pretty much the world divides into roughly introverts and extroverts Well, what does that mean? I’m gonna give you an example My twin brother and I obviously were in the womb together We grew up together, went to high school together, went to college together And the day we graduated from college, he launched into a new life He went to grad school, he hated it, he left, he got a job, he lived in New York He went to Europe he lived in Amsterdam for three years he came back to New York he lived in Hong Kong then it was Beijing for I’m just tired It’s like he’s all over the place doing all these different adventures 29 years ago I went to John’s Hopkins and then you can draw a little straight line of my life on Johns Hopkins Okay We are similar people, we’re both friendly, but he is a very extroverted soul I’m the queen of the introverts So what does that mean? Extroverts are adventure-seeking They want novel experiences They are bored if they’re doing the same thing over and over again And as it relates to love and forgiveness, they have quick emotions that go away quickly So they’re the ones that will say, how can you still be mad about that? It was weeks ago Introverts are different We can delay gratification, we don’t need so much excitement and novelty we want things to be predictable The extroverts want rewards, we want to avoid being in trouble And as it relates, punishment avoidant, as it relates we are the champion grudge holders of the world You’re in trouble, you were in trouble 20 years ago, you’re still kind of in trouble That’s a problem and it’s not that one is good or bad, as you can imagine as a psychiatrist I have some pretty odd conversations at cocktail parties So I was talking about this one time and a good friend of mine from college who works in business said, so the introverts are good people And I said, no, Katherine, the introverts are us The extroverts are perfectly good people too The problem is is that very few people can do a good job of understanding someone with a very different style It gets challenging because most healthy long-term friendships and marriages are with opposites So many people find themselves with the opposite kind of person as a very important person in their life and their trying to figure them out and they never quite do So you have this challenge of the introverts and extroverts So those are just a little bit about the people The other thing about the people is that you have this big event your fighting about, but each person brings a lot of previous experience to that event So people bring their experiences when they’re younger, their previous experience with other friends or maybe when a different marriage to what’s going on right now The difficulty is you know everything what’s happen to til now This other person probably knows a fraction and they’re bringing their own stuff And so they have expectations of, this should be a big deal This shouldn’t be a big deal I have no idea why this is a big deal

And so that’s a little bit tricky Just think about holidays and how you have to negotiate in a family You don’t understand, Christmas Eve is the big thing No it’s not, what kind of family did you grow up in? It’s [INAUDIBLE] Just silly stuff like that that people can just get lost in saying, we really did it differently So I care about different things because they’ve been emphasized for me Now as a psychiatrist I think it’s very important to also say we were thinking about the people, the illness can really affect how people behave So people have something very serious like a brain tumor, they can have changes in behavior, very severe thyroid disease And as a psychiatrist I think a lot about dementia, depression, and bipolar disorder So I think most people had the experience of knowing someone where they had the onset of dementia and suddenly their behavior was unpredictable or really different In my own family we have a famous story of my great-grandfather He built a golf course in Pittsburgh, that was the family business It’s better to have a golf course in Florida than Pittsburgh There’s a whole part of the year that it’s covered in snow and not very usable, but at one point he decided that there should be a zoo at the golf course So he bought two ratty old sun bears from I don’t know where, and put them in a little pen And recently I saw the family film, where really there are these really old sun bears And so that’s when my mother and my aunt had the challenge of saying something’s really wrong with our dad Now, that’s traumatic You wouldn’t miss it, but people get that If you’re in family businesses or even watching someone their finances or decisions, you start saying, wait a minute, I’m worried about this And so that’s when families take action off, and then there’s an evaluation, and shortly after that he was diagnosed with Alzheimer’s disease Depression or bipolar disorder are sometimes more subtle, 20% of women will have a depressive episode in their life So, it’s really common So, what happens with depression? You change how your mood is Some people are irritable, some are sad Changes in physical things, like sleep, appetite, and energy But, maybe most importantly, you have this change in how you feel about yourself You lose your confidence and sometimes that affects how you’re interacting with others The other thing it does is it makes people intensely sensitive to the comments and behaviors of others So a little offense will get a giant response So if you’re the person getting the response, like that was not that big a deal But, depression really does intensify negative responses and negative thinking And so, you might be getting a blast when it shouldn’t be that big a deal With bipolar disorder you’re not only have those alone moods of depression but, all the super high moods to mania And then mania there’s often a lot of forgiveness, I mean that seriously because, people have very out of control behaviors They’ll have spending, they’ll do things that are very uncharacteristic, and often lose their good sense And they’ll lose their judgment, and they’ll lose a sense of any consequences I’ll share with you, perhaps, the stupidest thing I’ve ever said as a psychiatrist I’m happy to say it was about 18 years ago, not last week But I was taking care of a man in the hospital when he had been very, very manic He spent a lot of money He had an affair He was making terrible business decisions So I was sitting down, I was meeting with his wife and I was explaining he has classic mania, all these things had happened And this is the stupid thing I said to her, I said so I think these things, the business decisions, the spending, the affair, they weren’t really personal, they were coming out of his illness All right, well that was stupid, because this wonderful woman looked me in the eye and said, Dr. Schwarz, he cheated on me, I think that’s pretty personal And I said, you are correct And I will never say that again in my career And that’s the difficulty Something can be coming out of illness, where the person didn’t really make the choice to do it But, the fallout is still there for the family And so for those particular psychiatric illnesses, it’s so critical they get recognized and treated And that education comes along with this So when people say, are you telling me there’s an illness where someone loses their ability to make good choices? There is, but I don’t think that’s something we just automatically accept So that’s problematic So what are the kind of events? People do not get upset about small things It’s not being cut off in traffic, although I do understand in the St Petersburg/ Tampa area the traffic is so- And there are a lot of bridges, and that’s a problem So in general, I would say, not traffic, but I’m revising for here When you’re thinking about events, these are big things These are betrayals, these are times you feel that someone has just treated you very disrespectfully I do wanna make the point that there are really terrible, violent actions that really are not forgivable in the sense of you’re gonna have an ongoing relationship with that person

I’m talking about things like harming a child or someone who’s been physically or sexually abusive Those are a whole different realm and there when you’re talking about forgiveness you’re not necessarily going to reconcile with that person They may have proven to be so untrustworthy that you don’t have a relationship with them Then it’s your own work to say do I want to be defined by the rest of my life by this event, or this period of my life? Or am I gonna be able to move on and have that not be the most defining thing about me So it’s your own process Not necessarily, and that other person doesn’t even have to participate, which I think is very important The other thing that happens with the events again is that people have experienced events before I remember being with a group of people at a luncheon and someone said, my husband came home a little buzzed last night And he’s silly and he didn’t drive, so it was fine My other friend just flipped out And then what became clear as we were talking a little bit more was that she had had a dad who was a big drinker and was very violent when he was intoxicated So the same behavior, because she was saying I can’t believe you tolerate from, I could not be married to someone that drank at all Well yeah, those are past experiences that greatly influence the present And if the other person doesn’t know about it, they may not know how they have to respond I also think whether or not you blame someone or really think they’re at fault, versus thinking there was some sort of accident matters I’m sure many of you have children Imagine your child calling you up and saying, I wrecked the car If the next sentence is, I’m okay but a drunk driver hit me, you’re just grateful If they say, I’m okay but I was driving the road was pretty wet I was going a little too fast Then you’re getting a little annoyed If it’s the I’m okay but my friends and I, there are too many of us in the car It was too loud I didn’t hear this person honking and it’s kinda my fault versus the ultimate which was I was texting If you get to I was texting, then you want to kill them Because What are you doing? That’s really silly You shouldn’t have been doing that So how much you think the person is at fault also comes into this And we’re talking about the kinds of things that effect your most important relationships, as I said this is not about a random coworker you barely know or someone who lives two blocks away We’re talking about the kind of things that really generate emotions So what happens if you are in a unforgiving state? You’re in a state where you’re angry and upset A couple things One is the percent of your thoughts that are negative goes way up You’re thinking about it all the time, these negative thoughts are spinning in your mind Another thing that happens is you get really stuck in the past You’re not thinking about going forward, you’re thinking about what happened a month ago, two months ago, whenever it was It also limits that relationship It affects communication and sometimes it can even risk the relationship I wanna reinforce that people can only tolerate for being in big trouble for so long And if they are always in big trouble at some point they’re going to decide that the relationship just isn’t worth it for them And then the last thing it can do is actually have health consequences Which, is why it’s relevant for today So, when people are in that angry state Just think about it You’re just angry, you’re geared up, adrenaline’s going You think there’s probably a lot of cortisol going through your body So the body itself has two basic states, we have our sort of middle ground but you can go into a sympathetic state or a parasympathetic state The sympathetic state is also called fight or flight It’s when you get geared up It’s when that person almost hits you on the highway and you’re really going What happens? Blood is rushing to your arms and legs, your mouth gets dry, your heart’s pounding, you’re going And that is where you’re having adrenaline, so epinephrine, norepinephrine released in your body But your blood pressure also goes up And so you’re in that Think about that We’ve all been there That’s to contrast with the parasympathetic or the rest and digest Best example of that is about two hours after Thanksgiving dinner There’s no blood anywhere but your GI system >> [LAUGH] >> No blood in your brain, no blood in your arms and legs just all doing its job And you’re in shut down mode Yeah, you really and if you look, heart rate’s slower, barely moving from the couch, just shut down mode So obviously being in this angry state all the time is really very unhealthy But this is meant to be a positive talk, this is talking about how do you actually move past that, because it doesn’t take a lot to see that, that is not where you would want to be living all the time

So what is forgiveness? There are two psychologists who have really made this their life’s work One is Doctor Enright at the University of Wisconsin, and the other is Doctor Fred Luskin who’s published about this extensively who’s at Stanford and runs the Stanford forgiveness project One of Doctor Enright’s definition of forgiveness is that you make a conscious and deliberate decision to release feelings of anger or resentment towards another person or a group of people who has harmed you Regardless of whether they deserve it or not That piece is really important Forgiving someone is not absolving them It’s not saying that what they was okay It’s not saying that you’re okay with what happened It’s that you are saying I’m not gonna stand this angry bitter anymore cuz it’s not good for me Forgiveness that allows a relationship to build often involves having empathy for the person you are forgiving Empathy is the process of really thinking about how the other person feels It’s putting yourself in their position and really trying to understand what they were thinking and what they were feeling, why they did what they did Right? And I think this idea that some people say well if I forgive them then they’re going to think they can do it again That’s not the implication either The implication is that hopefully you’re moving forward, you’d have an opportunity to talk about why that upset you so much and there can be some change in behavior So this is a fairly Universal process It is not pathologic It’s a medical illness to have depression, dementia, bipolar disorder This is not, this is something that every one of us has to face in our lives And I think that’s very important Occasionally gets complicated by another illness or very complicated circumstances but most of the time when people are working with this They’re doing the work on their own or maybe talking to a close friend or a spiritual leader And it’s where that you actually need professional help with it So sometimes the situation is so complex that getting a really objective person helps So what are the steps of going forward and trying to work on forgiveness? Well, the first one Is learning about yourself You really need to know if you are an extroverted soul who lets things go maybe too quickly, or are you a grudge holding introvert? And that’s your trap Because you might really be angry about it ten years from now and that’s not going to help anything The other thing you need to do is you need to speak with someone impartial It really gets someone else’s idea, like well, what do you think about this situation? Now as I said, that might be a friend, that might be someone from your religious community, all kinds of different people can do it If your best friend can be super impartial, I urge you to get a new best friend, though Because you want your best friend on your side, okay? [LAUGH] >> Because we all need the people that are champions, that’s not the same as, but you really need someone impartial that can say gosh, I think that was a little much I want to share with you a story, I was giving this talk at another Woman’s Journey event, and a number of people came up afterwords to talk about situations that were quite serious, and some of them very poignant Involving families and illness and all kinds really serious thing This woman came up to me and said I’m still really angry at my good friend from a year ago I said my goodness what happened? We were on a trip together and she set her alarm to go off two hours earlier than I thought she should And I said okay? Well I’m still very angry about it [LAUGH] I said what? [LAUGH] I just heard all these serious things and I said well do you think she did this to annoy you or cause you trouble? No she’s a nervous traveler and she always wants to get up we’re going into tour and I said, so you’re telling me you wasted a year being angry about your friend being a nervous traveler And it has nothing to do with you I’m not sure she enjoyed that answer but someone needed to say it to her Seriously That’s where you need an impartial person saying I said I really think you need to call your friend This is and usually I can’t have that much advice in that short of time, but come on That was Another thing that happens is that time should pass That should have been about a week, let me tell you But time needs to pass because the emotions need to simmer down If you have really intense emotions they just need to be a little less intense As I said earlier, you have to challenge yourself to think about the other persons perspective Why might they have done this? What’s going on with them? Why would they maybe have done this? But then at the end of the day, you’re making the choice to forgive You’re saying, I’m gonna change how I’m thinking about this I’m gonna change how much energy I put into it I’m gonna change how much time I’m gonna put into it

And that’s without negating how painful it is, it’s really saying, I’m done being a victim I’m not gonna define myself that way anymore I’m going to think about a future in which this does not take so much of my time and my energy And I’ve worked with a lot of women who have gone through very serious things where they were victims But they’re saying, I can’t have every day of my future, where this is the main thing I think about So what are some of the things you’re doing when you’re doing that? You’re challenging the ideas You are literally trying to change your thoughts about it None of us can control what ideas come to our mind, but we can have some control whether we keep thinking about them and letting them spin Whether we try to change the channel There’s a type of psychotherapy called cognitive behavioral therapy, that has as its premise, that your thinking can affect your feelings and your behavior And so the idea there is when you have one of those really negative thoughts, that you’re going to flip it and challenge it, and then not allow yourself to act on it And I think that’s a big piece of this, so you’re doing that, you’re challenging and changing your thinking patterns And then you also see, are there patterns of behavior that you’ve gotten into because of how you are thinking and working on those? And I think that one of the most useful things that’s helpful in this process, for people, is to reflect on people who have forgiven them And when they’d been in the other position and think about that it’s remarkably helpful if it’s maybe the same person If it’s your mother, or it’s your sister or it’s your husband Sometimes that’s very, very helpful, but sometimes the relationships go in a way that it feels like it’s much more one way or the other So who are the least likely people to forgive? Well, really intense introverted souls who get really negative emotions and get stuck So sometimes they really do need some professional help to work on what is fueling that Depression really fuels that quite a bit so that’s one thing to think about As I said before, depression and reconciliation are not equivalent, and so what you have to decide is are you moving on? Where are you going to put your energies? Now, I do wanna emphasize that it’s the relationships we care about the most that this is the most relevant for, I’ll share a family story with you About two years ago, my mother was having all these side effects from her beta blocker that she takes for her blood pressure And we tried to change it one time before and my poor mom ended up in the cardiac step down unit and she’s an introvert who doesn’t like change And so she said, I’m not doing that any more I said, but it makes you dizzy and I think it would be better So her internist said, Karen can come home for a week and she can just check your blood pressure at home I said, really? Can Karen come home for a week? That’s not the forgiveness part, but I was a little like, okay So I did that, I took a week off, we saw my mom’s internist, we had this whole plan And about two thirds through this week, one of my closest friends from Hopkins called and said, how’s it going? So well things are going really well with my mom I actually think it’s helping, I’m glad I’ve done it But let me share a couple numbers with you Said okay, what are these numbers? I said 2.5, 25, 250 2.5, 25, 250? What are you talking about? I said those are the number of hours each of my mother’s children has devoted to this effort this week 2.5, 25, 250 My sister showed up for a couple hours with my nephew he’s adorable My brother came for a day was very entertaining and I was there for ten days I don’t know what I was expecting but what my friends said to me was I fight you were suppose to be with little forgiveness And I said, excuse me [LAUGH] >> [LAUGH] >> Really I was expecting sympathy, maybe not empathy, but at least sympathy She said, your sister’s a lawyer, does she know how to take a blood pressure? And then we just devolved, this is not how this conversation was supposed to go >> [LAUGH] >> She’s not my best friend, but she was very impartial >> [LAUGH] >> These nurses, she’s the nurse I listen to most, darn it And, I said But, the piece of that that I want to share, and it really did make me think about it When this past year, when my mom’s health has really failed, the fact that I’m done counting hours and comparing has made an enormous difference for my own family You really have to think is everyone doing what they can do, and sometimes people are not able to do the same things, and so that really makes a big difference I just wanna ask you all to think whether as you’re hearing this talk and hearing me talk about things Are you thinking about time that you have been the person who’s been wronged So, I think most people do Amazingly, we probably are not all perfect

We have probably occasionally been the person who did the wrong thing but I don’t think that’s how most people hear this So I want to challenge you all to realize that sometimes you’re not the injured party, but rather the person who will need forgiveness And it is so important that when you’re in that position that you ask for forgiveness, that you apologize, because in those relationships it will really, first you’ll model good behavior And second, it just changes the communication pattern So how do you actually ask for forgiveness? Well an apology is so important, I can’t even say But an apology is not just saying I’m sorry That is an apology from a four year old And they don’t really mean it and they were really quite ready to move on A real apology, you acknowledge what you did You say you’re sorry for it You acknowledge how it upset the other person and why Cuz then you have really to think, look, I know I did this and that wasn’t great, and I understand it upset you for this reason Because then you’re actually demonstrating empathy and that’s all critical The last piece of it doesn’t actually happen that day, but is even more important than how articulate you are in your apology You actually have to change your behavior Cause how many of us have heard beautiful apologies five times for the same thing? Gets really old after awhile I worked with a gentleman who could not apologize He was incapable of it but he could change his behavior And given the two, I think I’m going to prefer that He really would take it in, incorporate and say, okay, I’m gonna do it differently Both is better but no behavior change is really pretty tedious So in the work that Dr Anrich and Dr Luskin have done, what have they been able to show? They’ve been able to show that if you actually go through forgiveness training, work on this, people that have done this try to change their thinking, change their behaviour, change how they are acting with others Have a low blood pressure, have lower heart rates, are taking fewer over the counter medicines In one of their studies, they were using fewer substances like alcohol and other drugs And so it ends up being very, very healthy to potentially change these things So here are the take home messages of what you can do to promote forgiveness Learn about yourself, know what your own patterns are Speak with someone impartial that can be helpful, challenge yourself to consider the other person’s point of view Move past defining yourself as someone who’s been wronged Confront the negative ideas you’re having either about the event or that person Be prepared to apologize for your part of it cuz it’s often not a 100%, 0% It often is a complex situation And I think most importantly have some compassion and respect for the person that really needs to apologize to you There’s no need to embarrass someone in this Really these are important people and important relationships that are worth this effort and investment For these important relationships, I urge all of you to think them through, think about yourself, think about your role, their role, and see how you can move forward It’ll be the healthiest thing you can do, is to actually forgive Thank you very much >> [APPLAUSE]