Psychiatry & Psychotherapy Podcast - The science behind forgiveness and how it affects our mental health

Episode Date: April 11, 2019

On this week's episode of the podcast, I talk about the power of forgiveness. It's scientifically proven that forgiveness can impact our health. As mental health professionals, this has important impacts both personally and professionally. I have also included a downloadable PDF for you to give your patients to help you walk them through the act of forgiving. As a therapist, when I say the word "forgiveness," my patients can shut down if I don't explain it properly. Why? Because just the need for forgiveness is proof that they have been wronged. When we are wronged, it can be hard to let go of that hurt. That's why I wanted to start out by saying what forgiveness (and this episode) is not about. Forgiveness is not: It is not approving. It is not excusing the action, denying it, or overlooking it. It is not just moving on (particularly not with cold indifference). It is not forgetting or pretending it did not occur. It is not justifying or letting go of possibly needed justice. It is not calming down. It is not a bargain or negotiation. It is more than ceasing to be angry. It is more than being neutral towards the other. It is more than making oneself feel good. It is one step towards reconciliation, but it is different from reconciliation, which requires a sincere apology from all parties. It is not dependent on the one you forgive—that would give the other power to control you by keeping you in your bitterness. Consider Corrie Ten Boom, who forgave the Nazis after losing her family in the Holocaust, or Marietta Jaeger who, after her daughter was kidnapped and brutally murdered, was able to forgive. People can forgive, even when the person who wronged them is unknown or dead. It is not a one time event, but may need to be repeated (sometimes the hurt comes back, sometimes you need to start every morning with forgiveness). It is not a restoration of full trust (trust takes time to develop or to be reinstated). By listening to this episode, you can earn 0.75 Psychiatry CME Credits. Link to blog. Link to YouTube video. Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder

Hello and welcome to the psychiatry and psychotherapy podcast with over 32,000 mental health professionals listening every episode. Why? Because we need to stick together to survive the mental health field. I'm here to talk about getting rid of burnout, increasing job satisfaction, and feeling like an expert in what you do. Okay, welcome back to the podcast. Today I'm going to be talking about a topic that is near and dear to my heart. It's one of the tools in my toolbox as I go about being a mental health professional. It's something that I received mental health. from and for that I'm going to dedicate this episode to Dr. Harvey Elder. Dr. Harvey Elder met with me in medical school once a week during my third and fourth year and during my psychiatry residency he met with me once a week and into my professional life he has continued to meet with me. Dr. Harvey Elder is an HIV specialist who has spent his life working in the inner city with HIV patients, patients with AIDS. And one of the things that is that.

things he taught me was forgiveness. So forgiveness is something that when you say it, people have different definitions. And so I'm going to define it really clearly. And then I'm going to go through the science of forgiveness, the why of forgiveness and how to forgive. So forgiveness is not approving. It's not excusing the action or denying it or overlooking it. So it's not saying that what happened was right. It's not denying it. It's not overlooking it. It's not forgetting it.

It's not just moving on, especially with cold indifference. Forgiveness is not moving on with cold indifference. Forgiveness is not forgetting or pretending it did not occur. No, forgiveness is actually saying, yes, it did occur. Okay. It is not justifying or letting go of, possibly needing justice. It's not calming down. It's not bargaining or negotiating. It's not

ceasing to be angry. It's not being neutral towards the other. It's more than making oneself feel good. It's one step towards reconciliation, but it's different from reconciliation. Reconciliation requires a sincere apology from all parties. If someone wronged you, they need to say they're sorry and they need to mean it. You need to be able to feel from them that they actually are sorry. That is reconciliation. Forgiveness is different.

It doesn't require the other party to be present. So forgiveness is not dependent on the one you forgive. So it's not dependent on them coming. coming to you and asking forgiveness, that would give them the power over you by keeping you in bitterness. Consider Corey Ten Boom, who forgave the Nazis after losing her family in the Holocaust, or Margarita Jagger, who, after her daughter was kidnapped and brutally murdered, was able to forgive. People can forgive, even when the person who wronged them is unknown or dead. Forgiveness is not a one-time event, but may need to be repeated.

you did. Sometimes the hurt comes back. Sometimes you need to start over every morning with forgiveness. And forgiveness is not a restoration of full trust. Trust takes time to develop or to be reinstated. So what is forgiveness? That's what we're going to be talking about today. But before I go into what is forgiveness, I'm going to tell you why I care about this. We know that people with a history of maltreatment have upregulated inflammatory responses to stress compared to those with no history. And we know that unforgiveness is reflected in specific cortisol levels, adrenaline production, and cytokine balance. We know that there's a cause-effect relationship between pain and anger. In a similar way that anger is also linked to depression. Some studies also show that just the

anticipation of pain is associated with anger. So just anticipating pain can be associated with anger. Chronic pain is what I see a lot in my practice. I run a program, a partial program, and a datumatic program for people with psychosomatic issues and pain issues. And pain often arises from injury, accident. And anger is often associated with the pain from the experience. That's generated the pain. And it's often part of the chronic pain. So I see it a lot. I see it on people's face as they describe the incident that led to the pain and the subsequent things afterwards. The general intensity of the anger is important, but also specific targets of the anger seem to be essential factors in understanding adaptations to chronic pain. And some research has shown

that anger turned inwards is more common in those with chronic pain, compared to those individuals with different targets of anger other than just turned inwards, okay? In another study, it showed that the people who turned the anger on themselves showed higher amounts of anger than those who turned their anger out on other people. And when I mean turn the anger on themselves, I often see people as they describe something, you can see the anger flash on their face, the micro-expression of anger,

and then they are talking about how bad they are, and it's like guilt. They're describing an experience of guilt or what they did wrong, and those are the people often that showed chronic pain as well. So, for example, chronic lower back pain. One study of some adult people with chronic back pain, showed that those with higher scores of ability to forgive had lower levels of pain. So all this being said, anger is related to pain, and a lot of people have pain.

You can see that by the amount of opiates that are used. We have an opiate epidemic. So it's quite possible that there's a lot of anger associated. Now, if you tell someone that there's anger, that they have anger, a lot of people don't want to hear it. they don't want to hear it. A lot of people, they defend against the idea that they might be angry in any given situation. And I would, you know, I hope that you've listened to other episodes of my podcast where I talk

about anger. And I really talk about how it's not a good or a bad thing. It just is, okay? And so it's okay to be angry. Anger is actually, properly, it's the energy to mobilize yourself towards a goal. Often though, the problem is. is that we get stuck in the anger when the obstacle came up in the way towards our goal,

the obstacle being an injury or some life event, okay? And the goal being things often like connecting with other people, doing one life, having a family, so on and so forth. So the anger comes out towards all sorts of people. It comes out towards the self, but it also comes out towards other people, health care providers, attorneys, insurance companies, employers, significant others, God, the whole world. In one study, they looked at the intensity of the anger and the most intense anger was felt

towards the self. The second most intense was felt towards health care providers. And so this is kind of like if you're a health care provider, this is what you feel sometimes. You feel this intense affect directed at you. and of course we represent that in a mere neuron way we feel that and that leads sometimes to burnout. So what are clues that you might be bitter? And as I'm teaching about this, of course we're learning about this in order to help other people, but we're also learning about this to help ourselves. Because I've found, as I've been able to forgive, some really horrible things that happened to me.

it's like it has no power over you anymore. You don't wake up in the middle of the night, clenching your fist and anger. You don't hold on to the pain. You don't try to avoid someone. You don't continually replay past hurts over and over. You may not quickly get angry with someone like you used to. You may not verbally malign someone behind their back. I often find that for myself and for other people, the level of the bitterness is associated with the proximity of the person who wronged you rather than the magnitude of the event.

So if someone wronged you who was supposed to love you, that's some of the most difficult stuff. And so I would ask what percentage of your emotional energy is spent on this topic? This is a question I always ask any patient who I kind of sense this is a big issue. And a lot of them will say 50, 60, 70% of their emotional energy throughout the whole day is bent being angry. And when they say that, they usually realize, oh, I'm replaying past hurts. I'm holding on a pain. I'm avoiding. I'm getting quickly angry.

Often not at the person that caused the wrong, but at other people. I'm often gossiping. I'm ruminating. And that's like, that's like 50% of my emotional life. And when they say that out loud, it's like, it clicks like, oh, this is a problem. I need to do something about this. And if you feel like, well, I can't forgive, I just can't let go of that. There's no way I can ever let go of that.

Well, you're not alone. They did one study of people who went through a divorce. one half of women and one-third of men, ten years after the divorce, were still intensely angry at their former spouse. And the anger becomes an ongoing dominant presence in their children as well. If you've worked with couples going through your child custody battles,

there is nothing more torturesome, both for yourself and for the couple. Because often the anger and the bitterness and the unforgiveness is so, so, it's painful. And you see it affecting the kids. You see it, it can't not affect the kids. Forgiving people have been found to have lower blood pressure at baseline. In one study, when they had people recall experiences of betrayal, the ones who had issues with forgiveness were associated with greater cardiovascular reactivity as indexed by greater diastolic blood pressure, mean arterial pressure, and higher trait

forgiveness was negatively associated with lower resting blood pressure and better post-stress recovery. So in this one study, they showed that forgiving changed the physiological variables, blood pressure, what the heart is pumping, how the heart is pumping. Forgiveness helped that. one thing that they found is that people who measured high in hostility 20 to 25 years later had the highest rates of heart disease. It actually is the one factor in type A personality that I think can be addressed the most in good therapy.

And it's the type that is sometimes it's the most damaging. You can be type A and be okay if you don't have that hostility. Now if you're type A, you may say, I don't have that hostility. Okay. Ask your closest friends who will actually tell you the truth about yourself. I work with a couple entrepreneurs and a couple high functioning businessmen. And some of these people have intense, intense energy, just energy for life, right? Just business entrepreneurs, they have to have high energy. And some of them also struggle with this hostility.

and it can be changed. Some of it is, some of it's from torturesome childhoods that they initially think there is no capacity to go there and forgive. So in another study, they show that when discussing the narrative of injustice that the person had gone through, those with an understanding of forgiveness showed less anger expressions. that's a real change right so if you can if you can what i what i look at to know if someone still has bitterness is as they tell their story do they flash tons of micro expressions of anger

and then do they defend against the anger in one way or another that allows me to know where to go what to focus on so enright here's a quote from him he's a he's one of the top researchers on forgiveness, he says, people unrationally determining that they have been unfairly treated, forgive when they willfully abandon resentment and related responses to which they have a right and endeavor to respond to the wrongdoer based on the moral principle of beneficence, which may include compassion, unconditional worth, generosity, and moral love, to which the wrongdoer by nature, or of the harmful acts or act has no right.

So it's basically saying that when someone is unfairly treated, when you choose to forgive you, abandon your resentment and related responses, an endeavor to respond to the wrongdoer with the moral principle of wishing them well, compassion, generosity, moral love, which the person you're forgiving doesn't deserve. They just don't deserve it. There was a study where they looked at two types of forgiveness, decisional forgiveness and emotional forgiveness.

Decisional forgiveness is experience of granting forgiveness without eliminating the emotion. So the resentment may continue. And a lot of people when I ask, oh, have you ever forgiven that? Oh, yeah, I've forgiven them. And then everything they say is just full of rage and malice and bitterness.

Decisional forgiveness involves a cognitive model where the therapist works with the client one time to make a decision to forgive. Contrast that with emotional forgiveness. Changes in emotion and motivation towards the offender. There was a study where they looked at decisional forgiveness and it was shown to reduce hostility, but it was only marginally effective in improving stress levels or emotional health. Whereas individuals who accomplished the full process of emotional forgiveness, sometimes it took over 20 encounters, had much higher effectiveness at reducing their stress,

improving their emotional health, and reducing hostility. So what are the results of forgiving? There's been a lot of studies on this, actually. There's changes to anxiety. inner peace comes you have reduced depression anger paranoia when you have genuine forgiveness it leads to increased emotional maturity increased capacity for courage nurturance for others and love it reduces fear impulses of anger and revenge subside and are replaced with more appropriate expressions of anger hypertension may be reduced in one study

with fibromyalgia were taught forgiveness education and had greater decrease in symptoms. In one study, incest survivors showed significant improvement after a one-year forgiveness education process. So in one study, that looked at 20 women who were significantly emotionally abused and were either divorced and remarried or divorced and single. And they took these women and they randomized them to a forgiveness therapy program or just kind of an alternative program like anger, validation, assertiveness, interpersonal skill building. And the study found that in the forgiveness therapy group, it showed a greater improvement in forgiveness, self-esteem, state anxiety, trait anxiety, depression, environmental mastery,

finding meaning, post-traumatic stress symptoms. So in the forgiveness therapy group, they had an effect size of 1.8, which represents a a really significant shift in the before and after treatment. So I want to come in this portion to the spiritual connection. So in multiple religions, they speak about forgiveness. And I was thinking from the Christian perspective, you know, if you've read the words of Jesus, Matthew, Mark, Luke, and John, he talks about forgiveness all the time.

He really does talk about it all the time. and one of the classic verses, which even as a non-Christian, you have to appreciate this, because Jesus becomes the archetypal male for all men who follow Christianity. And Jesus says, on the cross, while he's being crucified, he says, Father, forgive them, for they do not know what they're doing. Father forgive them, for they do not know what they're doing. And so there's this idea in Christianity, which gets to repeat. he did later on in the Bible. Paul says, be angry, but do not sin. It's this idea of be angry. It's

okay to be angry. And there's a way to do it which doesn't hurt other people. And later he says, let all bitterness and wrath and anger and clamor and slander be put away with you along with all malice. Malice is being willing to hurt yourself while you're hurting the other people. And he goes on, be kind to one another, tenderhearted, forget. giving each other, just as God in Christ also has forgiven you. So if you are spiritual and you don't think you have the power to forgive, consider praying for the strength to forgive. So I often come to people who are spiritual people, who are Christians, who are, there's a lot

of Christians in the area that I live. And they tell me they don't think that they have the power to forgive. And I ask them, well, do you think you could pray to receive? to receive the grace to be able to forgive. And so that's where they start. So why do I bring up the spiritual connection? Well, it's something that I think is really important. To talk about forgiveness,

I think that just like there's traditions for millennium, like meditation that have been found to be clinically effective, there's traditions like forgiveness that have been found likely for millennia to be effective. And that's probably why there's so many verses in the Bible that remind us to forgive. And not just one time, right? How many times you forgive? Seven times 70 times?

So it's like you continue to forgive. And the other thing is another spiritual sort of truism is that it's really important to ask for forgiveness. The word that's often used is repentance. And repentance is, not just speaking the words that you're sad, but actually experiencing maybe some of the pain that you caused in yourself and turning from the action as well. That's repentance.

So repentance is not just stopping the action, or it's not just saying that you're going to stop the action, but it's actually turning away from and going the opposite direction. And I think it's important because if you read Gottman's work on how to deal with marital infidelity. A lot of it has some of these core tenants in there. People are just repackaging this stuff in different therapies, but there's truths that are there that have been there for a long time.

And so I hope that, I hope bringing up the spiritual side doesn't rub you the wrong way. I hope if it does, you could let me know. But I think it's important to show the historical context of these things. And if you read Enright's book, he goes, through pretty much all the spiritual faiths and shows the linkage between them and spirituality. So what are the steps in forgiveness? So now we're going to get to what is forgiveness, the actual steps. And all of this stuff is going to be free in my resource library. To get there, you could just go to Psychiatrypodcast.com. It's in one of the top tabs. If you've already signed up for that

free resource, it doesn't hurt to sign up again. You'll get access to the tab emailed to you, or you can look for the first time it was emailed to you, the resource you just put in your email and your name and you get access to it. And usually I really appreciate if you like write a little note to me there. And I read those notes and I often will send emails back to people who write notes. So all of these things will be up there for free and you can have them and distribute them. I ask that you distribute them as is unless you're going to be kind of reading multiple. sources and putting together your own notes, but I really encourage you to share this material.

So, okay, the first step in forgiveness is to acknowledge that the offense was unfair, that you have a right to feel the emotion, that you acknowledge that emotions of anger, sadness, disgust, bodily sensations, all of that is valid to feel, and that you're entitled to feel those things. And so when I'm working with a patient, they may not even know that we're doing forgiveness therapy if I'm doing that part. I mean, that's just empathy, right? You're basically just validating that note. I think you're entitled to feel angry. And where I've had some interesting things is when you deal with people who do not allow themselves to feel anger, sadness, or disgust. So what they'll often do is they'll turn the anger on themselves so quickly that they don't allow themselves

to feel it towards the other person. Sometimes it's because it's too painful, sometimes because they were told from a young age that they weren't allowed to feel these ways, that they weren't allowed to feel. Maybe the emotions that they were having weren't mirrored back to them. So with my kids, when my kids are feeling angry,

I say to them, you're feeling angry, I hear you're feeling angry, I hear you're feeling angry. I want them to put a word with the emotion that they're feeling. If they're feeling pain, I'll say, you hurt yourself, you're feeling pain. That would really hurt you're feeling pain. If they're feeling disgust, I would say,

ugh, you just want to spit that out. That is disgusting. You feel like that's disgusting. Okay, so I help them put words to it. And I do this with my patients as well. I try to decrease, I try to help them feel the emotion and to feel emotions that maybe they haven't been allowed to feel.

And so when you're working with patients, what you'll find is that shame is at the door. Shame is right there with these things. And shame is something that they felt in the midst of it. It's hard not to be abused and not feel shame. And so you can do things to reduce the shame. You can say you're entitled to feel the way you're feeling. That reduces shame.

You can say it can be hard for us to express these things. That reduces the shame. I have a diagram of a tree in the handout. And they can put in the tree, some of the early life things that happened in the roots and as they go up the tree they can put later offenses, right? And if I'm working with a patient on this, maybe they will start with something that's a little bit easier.

Maybe they'll start with what they want, what they feel like they're capable of starting with. So at first we look at family of origin stuff, marriages, significant others, current family, you know, what happened in the school time, different communities that they were, involved in. Usually it's interpersonal. Most forgiveness stuff is like interpersonal trauma of sorts that they need to release. So the first step is just allowing yourself or allowing them to feel

the emotion. And I would say also it's important to look at ways that you have protected yourself from feeling the anger. For example, denying that the event occurred, blocking it out of your mind, siding with a person who hurt you and adopting their point of view. I call that joining the aggressor. I mean, I didn't title it that. Actually, one of my therapists titled at that. David, you're joining the aggressor. And I'm like, what?

That was like totally news for me. I was like, oh my gosh. You can project your own emotion onto other people. Other people are angry at me. I'm not angry at me. You can focus on other things other than the anger. Like you can focus on the pain rather than the anger that comes with the pain. You can focus on the bodily sensations.

It's a lot easier to, there's something easier psychologically to have something bodily going on than something emotional going on, especially if emotions were shamed early on in life. So in this process, it's normal to feel strong emotions. And presence is probably the most powerful thing. Presence and empathy. being present with them, being empathic with them. And so if you're reading this and you're thinking, you know what, I need to go through this process myself,

you know, find a friend, find someone to walk through it with you. Maybe share this episode and then say, hey, can we meet up and start to work on this together? For me, it was working on it honestly with Harvey Elder. And it was a bidirectional thing for me as well. it was both going through and apologizing for things that I had done and also forgiving people who had done things to me. So it was bidirectional. And it was a very life-giving process. And Harvey Elder, I expected Harvey to often meet me with judgment or meet me with criticalness.

And I was so surprised when often he just, it was just like pure love. I experienced from him. So in this process, it is normal to feel strong emotions. That's okay. That's part of it. So that's step one. Step two is to reflect and assess whether to make a decision to forgive. So you may go through and you may write down reasons to forgive,

reasons to remain bitter, angry, and hurt. It's a choice. And you need to realize that it is a choice. Forgiveness is a decision. you can choose not to forgive. And if a patient chooses not to forgive, then I say, okay, it sounds like for at this point in time, like that's your choice, that's okay. You're making that choice.

I think it's important to think about how life may change if you do forgive, if you do let go, versus if you decide that you want to spend, you know, whatever percentage of your day feeling some of that anger, bitterness, hurt. So let's say you commit to forgive. You come to the end of stage two and you decide I'm going to commit to forgive. Then stage three is to continue the commitment to forgive. So forgiveness is a process. There's layers.

So you can forgive one layer and then it'll come back to you in the middle of the night and your fist will be clenched. And I would recommend just saying it out loud. Feeling the emotion. I'm entitled to be angry, but I'm choosing to forgive. And that is a daily thing that takes place. Let me give you an example of how that took days for me, for one small thing. I was in college and I was at a party. And some guys jumped me.

Some guys jumped me from behind. And they broke a vodka bottle over my head. And I ended up going to the hospital. Had some stitches. Luckily, I did not have a traumatic brain injury. It's one of the biggest fears of my life be to have a traumatic brain injury. But it really shook me up. And, you know, I was so angry. I was so angry. I wanted judgment. I wanted, like, wrath. And, you know, it's funny. I felt convicted. I felt very convicted after about two days of it that I needed to forgive

that it was clear to me that if I did not forgive I would not be able to keep moving forward in life like it would consume me I could find these people I could track them down I could involve legal means but honestly I was so busy with rowing

I was so busy with being pre-med and I knew that it wasn't me in particular that these guys were going after. I was just a bystander to some degree. And that also was crazy making. You know, it'd be nice if, like, you caused something that made people so angry that they attacked you. But it was just one of those kind of freak incidents.

So I decided to forgive. And it took me about a week. And I would wake up in the middle of the night. I would get on my knees. I would forgive. I would repeat. I would repeat. I would repeat. And after a week, it was completely gone. I haven't had any nightmares about it. I haven't had any flashbacks. I feel right now, I feel pretty calm talking about it. Like I'm feeling no micro-expressions of anger on my forehead. So that's one example. And that's a small example. I'm not going to go into the big examples right now.

but that's one small example of how I continued the commitment to forgive. And there were layers. There were layers. So, you know, I mean, that's like a relatively small event compared to the big things that I've had patients work through. And some of the things that are deeper down are just harder, things that are developmental, things that are layered, things that go on for years. So be okay with it being a process. Be okay with it being a process. And I would say if you get stuck by the thought,

like I don't have the strength to forgive, then if I were with you, I would say, you know, I get it. It's hard. It's hard to make the choice to let something go like that. If something happened to you where someone broke the law, you can forgive and still take them to court, right? So, like, I chose to not pursue those guys because I wasn't 100% sure who they were.

It was Halloween and there were masks. But I would say if something happened to you, you can forgive and still take them to court. You can still allow the law and the justice to take place. Okay. And a good example of that would be like sometimes the most loving thing you can do is to put a violent, repetitive criminal in jail and let them work it out in jail rather than continuing to be allowed to harm other people out of the public. Right. And not just violent, like if they were sexually violent or that kind of thing.

You know, it's like often jail is like the most loving thing you can do is to go through those legal. necessary steps to get them into a place where now the other people can be safe to not have to go through the same thing. And step four is to consider reconciliation. So I wouldn't do this until you've done step three and until you feel emotionally different.

But you can consider reconciliation. And I don't think reconciliation is always necessary because sometimes the person doesn't want to reconcile. They don't want to apologize. They don't want to say anything's wrong. And often, if you go to them and tell them, they'll get angry at you and it'll be like retramatizing. So they may not be a safe person.

They may attack you. They may be blind you. And so reconciliation is not always the best option. Forgiveness is something that I would always recommend. Reconciliation is something that I'm having. hesitant with a lot of patients to recommend. You know, is this a safe person? Has this person shown signs of true remorse?

Right? Like, they actually, like, it's important. I was talking to my own therapist about this recently. And we're talking about forgiveness. And we're talking about the importance of seeing some of the emotional pain in the other person as a, as a form of like, okay, they are empathizing with you and you're suffering. So reconciliation. may look like, you're sharing a little piece of it and seeing how they respond.

Maybe not the biggest piece, maybe just a little piece. And if they respond defensively, then you may need to regroup and decide, you know what, I don't think reconciliation is going to take place. And so trust might not ever come back, right? Even after reconciliation, you may not trust the person in the same way. And it may take time for trust to rebuild, and that's okay. So we're coming to the end of this episode, and I'm thinking about what I would really want you to take away.

And I would really want you to get this handout and to go through it and to really think through your own life, first and foremost, because talk about burnout, talk about emotional exhaustion that we have as providers. And I think if we're holding on to emotional stuff from our past, it just kind of weighs us down. So I would want you to be free. I would want you to not spend even 5% of your emotional energy ruminating on the past. I would want you spending 100% of your emotional energy, feeling gratitude, loving other human beings, and empathizing with other people who are struggling.

Of course, going through your own struggles, but not have this sort of added burden of past stuff creeping in. The other thing about empathy that, or, you know, I often talk about empathy. And empathy is really the first stage of the forgiveness in the way that we both allow ourselves to experience what we're experiencing and also how we empathize with someone else is going through it. That's a very important step. And I would say empathy is, if you are seeking reconciliation from someone else, you have to listen to how you harmed them, and then you have to suffer.

You have to feel some of the suffering. some of the pain, and they need to know that you feel it to some degree. So empathy is there. And I would come back to what are the results of forgiveness? Like, why is this so important? And I'm going to go ahead and tell a story of someone who forgave themselves. This person was one of my first patients. He was a VA vet, and I'm going to change a couple variables to protect his identity, of course, he was in a war where he hurt a child accidentally. And when he told me that, he had never told anyone else that. And I asked him, you know, what, what are the ways that you cope with stress? And for him, he was a very spiritual person. But he had never really brought

this before, you know, his spiritual higher power, God. And he asked me if we would pray together. And so I prayed with him. And he asked God to forgive him. And for him, that was necessary. You know, for me, I was thinking in part like, man, it was an accident. But that's what he wanted to do. And I sat with him in his distress.

And it's interesting because the guy came in. And one thing he told me was that he hadn't slept for years. He said he had slept for years. three to four hours, you would get it multiple times, you would check the doors, check the locks. And, you know, I was, I was blown away. And because when this guy, when we got done with the prayer, he turns to me and he says, you know, Dr. Puter,

I feel like a new person. I feel like I just encountered an angel. I feel amazing. And I was seriously questioning whether, this guy actually would have long-term change. So I wrote down his MRN and I looked him up later and I called him about three months later and I'm like, hey, how have you been doing? You know, I'm Dr. Peter. I met you, blah, blah, blah.

He was coming in the hospital for another reason. And he told me that he had slept like a baby every single night since that one encounter. And it was just one encounter. it was pretty amazing. And so I remember just feeling the sense like, okay, this is something that's valuable. I need to read research on this. I need to study this.

And so I did. And so I'm sharing this with you guys today. I'm dedicating this episode for Dr. Harvey Elder who walked me through this stuff, who taught me this on a deeper level, who introduced me to some literature on this. That was amazing. and yeah i would love to hear your thoughts jump on social media i'll have a have a post on this i'd love to

if you don't feel if you don't feel uh okay posting publicly send me a direct message i want to hear i want to hear a little bit about your story or or how this has affected you or you know we're community we're community of mental health professionals we're we're walking this this road together and I think it's important that we connect with each other. Hopefully, as time goes on, we'll find more ways of connecting. Just recently connected with some doctors in Pakistan and Kuwait. Shout out to them. And hopefully I'll be traveling there, you know, maybe not in the next couple of years, but eventually.

And then I'll have friends in Kuwait in Pakistan. That's amazing. I like that. They're already sending me like pictures of the beautiful things there. I'm like, okay, that looks like amazing. but maybe a cup of coffee would be good as well. All right. We'll leave it there for today.

We'll put up all the notes, and the link will be in the show notes. The link will be in Psychiatrypodcast.com. Yeah, have a great day.