ACT OF SURRENDER IN THE THERAPEUTIC PROCESS
M. Tiebout, M.D.
Importance of a Positive Attitude
Act of Surrender
Down The Act Of Surrender
and Grandiosity at Work in the Alcoholic
Difference Between Submission and Surrender
The Act Of Surrender To The Therapeutic Process
acts of surrender
the Surrender Reaction
Importance of a Positive Attitude
year and a half ago, I wrote a paper in which I discussed a phenomenon
which I labeled "conversion." In that paper I broadened the
concept of conversion to cover any major switch from negative to positive
thinking and feeling irrespective of a possible religious component. Two
points stood out to me as important: first, the fact that the positive
frame of mind could appear under a given set of circumstances without
special help, psychiatric or otherwise; and second, that the new state
of mind had a decidedly healthier tone to its thinking and feeling than
that which prevailed when the negative tone was uppermost. Without saying
so, I then believed that the positive frame of mind could become a legitimate
aim in therapy as, once it was brought about, the individual's attitudes
and responses were much healthier.
I no longer believe that therapy is simply a matter of reaching a positive
relationship with reality, I remain convinced that the creation of a positive
attitude is one of the essential features in a successful therapeutic
program, and that any experience that brings about such an attitude or
frame of mind deserves careful study for the light it may throw on treatment
in general. Consequently, I continued my observations on the conversion
experience and have arrived at the conclusion that the key to an understanding
of that experience may be found in the act of surrender which, in my opinion,
sets in motion the conversion switch. My paper will therefore consist
of (1) a discussion of the act of surrender, and (2) an endeavor to relate
it to the therapeutic process as a whole.
I go ahead, it may be wise to recapitulate the contents of my previous
paper. In it I described how, with the conversion switch, many aspects
of the patient's attitudes underwent profound and often remarkable alterations.
I pointed out how, in eight major ways, the individual switched or changed.
Rather than go through the whole list again, I can sum up these changes
briefly by saying that the person who has achieved the positive frame
of mind has lost his or her tense, aggressive, demanding, conscience-ridden
self that feels isolated and at odds with the world and has become a relaxed,
natural, more realistic individual who can dwell in the world on a Live
and Let Live basis. The difference in the before and after state of these
people is very real and represents, I believe, a fundamental psychic occurrence.
Act of Surrender
respect to the act of surrender, let me emphasize this point: it is an
unconscious event, not willed by the patient even if he or she should
desire to do so. It can occur only when an individual with certain traits
in his or her unconscious mind becomes involved in a certain set of circumstances.
Then the act of surrender can be anticipated with considerable accuracy,
as I shall soon show. It cannot be defined in direct conscious terminology
but must be understood in all its unconscious ramifications before its
true inner meaning can be glimpsed. The simplest way to picture what is
involved in the act of surrender is to present a case in which there was
a conversion experience that seemed to follow an act of surrender..
One Man's Story
patient is a man in his early fifties, very successful in business, and
referred to by his associates as Napoleon because of his autocratic methods
when he was stirred up. For years, heavy drinking to the point of frequent
intoxication was present, interfering to some extent with his efficiency,
but never to the degree that his business really suffered. My first contact
came some six or seven years ago when he came to Blythewood to dry out.
Pursuant to our policy of trying slowly and from time to time to educate
patients about the danger of their condition, we permitted this man to
remain just for the drying out, at the same time telling him that, in
our eyes, he was headed for trouble if he continued on his present trend.
Without putting any pressure on him and thus arousing his resistance,
we placed the facts before him and let it go.
continued the policy of letting him come and go pretty much as he pleased,
always, however, keeping uppermost before him the need to do something
about his drinking, and always making it evident that we were not interested
in drying him out, but in the real problem of helping him stop his drinking.
Later on and in retrospect, the patient, in referring to these tactics,
said, "I used to like to come here; you didn't always argue with
me. I always knew just where you stood and knew I wasn't fooling you any."
all this time, however, I was working on his life situation so that ultimately
it would provide the necessary dynamite to jar him loose from his whirl
of self-centeredness. Gradually, his wife gave up her protectiveness and,
before the time of this last admission nearly two years ago, she had determined
to leave him if his drinking continued. Moreover, as a result of some
discussion with me, his business partner had decided that he, with several
key members of the firm, would tender their resignations if the patient
did not make a real effort to mend his ways.
a particularly severe bout, the patient was induced again to enter Blythewood.
This time, however, I told him flatly that he would sign himself in for
thirty days or he would go elsewhere; we were through with him running
his case once and for all. He looked startled, picked up his hat, fiddled
with it, and then put it on his head, saying, "Where's your pen?
I'll go to Hilltop where I belong," referring to the cottage where
he had dried out on previous occasions. Within three or four days he was
off the liquor and thinking reasonably straight. He was then informed
of his wife's decision and, instead of ranting around and making it clear
where she could go, he discussed for the first time the real hell he had
put her through and really seemed regretful. By the end of the first week,
quite prepared for trouble, the partner told him of the pending resignations
if the drinking persisted, only to be surprised and pleased with the patient's
quiet acceptance of their decision and an acknowledgment of his own real
wish to be different. He soon joined A.A. and is now an active member
of that organization in his home community. The patient has stayed sober.
What Happened ?
in discussing his experience the man in the story explained, "You
did something to me when you made me sign that card. I knew you meant
business. I knew my wife was getting sore and that Bill his partner
was fed up, but when you showed me you were through fooling, that
was a clincher. I knew I needed help and couldn't get out of it myself.
So I signed the card and felt better right off for doing it. I made up
my mind that I wasn't going to run my own case any longer but was going
to take orders. Then later I talked with Chris his wife and
learned how she felt, and then Bill came along and I knew deep inside
my heart they were right. But, I didn't mind. I didn't get angry and want
to argue like I used to. I kind of surprised myself by agreeing with them.
It sure was nice not to have to fight. I felt calmer and quieter inside
and have ever since, although I know I'm not out of the woods yet."
is the story of a patient who has been through a conversion experience
and is still in the positive phase. His own account of what happened stresses
the signing of the card as the turning point in his experience, and I
am also convinced that he is right. We can sum this man's experience up
by saying that after trying to run his own case to his own ruination,
he gave up the battle and surrendered to the need for help, after which
he entered a new state of mind that has enabled him to remain sober.
Down The Act Of Surrender
man's experience, which is not limited to alcoholics, raises three questions:
qualities were there in his nature that so long resisted help and
finally were forced to give in?
were the circumstances that brought about the final act of surrender?
does a positive phase follow the surrender experience?
answers to these questions are derived primarily from my studies of
alcoholics, but not entirely, as I have witnessed surrender with a
typical aftermath in at least four cases among the students at Sarah
Lawrence. I hope through my discussion in reply to these questions
not only to define the act of surrender, but also to give you some
feeling for it as a psychological entity or event.
turn then to the first question, "What are the qualities in a
patient's nature that make him or her put up such a battle before
finally surrendering?" In the alcoholic, my observations have
led me to see that the two qualities that Sillman selected as characteristic
-- defiant individuality and grandiosity -- may very
well explain that the alcoholic is typically resistant to the point
of being unreasonable and stubborn about seeking help or being able
to accept help even when he or she seeks it. Defiant individuality
and grandiosity operate in the unconscious layers of the mind and
their influence must be understood if one is to see what probably
goes on at the time of surrender.
may be defined as a quality that permits an individual to snap his
fingers in the face of reality and live on unperturbed. It has two
special values for handling life situations. In the first place, defiance,
certainly with alcoholics, is a surprisingly effective tool for managing
anxiety or reality, both of which are so often a source of anxiety.
If you defy a fact and say it is not so and can succeed in doing so
unconsciously, you can drink to the day of your death, forever denying
the imminence of that fate. As one patient phrased it, "My defiance
was a cloak of armor." And so it was a most trustworthy shield
against the truth and all its pressures.
the second place, defiance masquerades as a very real and reliable
source of inner strength and self-confidence, since it says in essence,
Nothing can happen to me because I can and do defy it.
people who meet reality on this basis, life is always a battle with
the spoils going to the strong. Much can be said in favor of defiance
as a method of meeting life. It is the main resource of the chin-up
and unafraid type of adjustment and, as a temporary measure, it helps
people over many rough spots.
the second quality noted by Sillman, permeates widely throughout the
reactions of the alcoholic. Differing from defiance -- which seems
almost uniquely structuralized in the psyche of the alcoholic -- grandiosity
springs from the persisting infantile ego. As in other neurotic states,
grandiosity characteristically fills a person with feelings of omnipotence,
demands for direct gratification of wishes, and a proneness to interpret
frustration as evidence of rejection and lack of love. The effect
of this persistence in the alcoholic is not a bit different from the
effect of any other neurotic. Perhaps in the alcoholic the typical
arrogance and sense of superior worth are kept nearer the surface
by the associated defiance that feeds the childish ego constantly
by its succession of victories. By and large, however, there is nothing
in the alcoholic's grandiosity that distinguishes him or her from
the neurotic, whose infantile ego survives to become a significant
factor in adult life; it is part of the typical egocentricity of that
group, and its presence is confirmed by any careful study of them.
Defiance and Grandiosity at Work in the Alcoholic
are now in a position to discuss how these qualities operate in alcoholics.
On the one side, the defiance says, It is not true that I can't
manage drinking . On the other side, the facts speak loudly
and with increasing insistence to the contrary. Again, on the one
side, grandiosity claims, there is nothing I cannot master and control,
and on the other side, the facts demonstrate unmistakably the opposite.
The dilemma of the alcoholic is now obvious: the unconscious mind
rejects -- through its capacity for defiance and grandiosity -- what
the conscious mind perceives. Hence, realistically, the individual
is frightened by his or her drinking and at the same time is prevented
from doing anything about It by the unconscious activity that can
and does ignore or override the conscious mind.
us see how this clash between the conscious and unconscious response
manifests itself in the clinical setting. A stimulus from reality,
such as a recognition of the downhill pattern of the drinking, impinges
upon the conscious mind and creates acute anxiety which, for the moment,
dominates the conscious processes and is recorded as worry, distress,
fear, and concern. The patient, in this state, is fired with a desire
to quit and eagerly grabs at any kind of help. He or she is in a state
of crisis and suffering.
the meantime, however, the stimulus of reality is hitting the unconscious
layers of the mind and is stirring up the reactions of defiance and
grandiosity. Since, characteristically, it takes a certain amount
of time before the unconscious responses are sufficiently mobilized
to influence conscious mental activity, there is always an appreciable
lag before the conscious mind evidences signs of the underlying unconscious
activity. Then slowly and gradually these attitudes supervene. Patients
express less concern about their drinking, complain that they were
rushed into seeking help, that they're no worse than anybody else,
and that the worry of others is silly and a gratuitous invasion of
their rights. Finally, the memory of their own acute period of anxiety
is swallowed up by the defiance and grandiosity. Thus the patient
loses the effectiveness of the anxiety as a stimulus to create suffering
and a desire for change. This cycle will go on repeating itself as
long as the defiance and the grandiosity continue to function with
now come to the second question: "What were the circumstances
that made that patient give in and sign that card?" Let me review
them for you briefly. He had been drinking for years, and he knew
his drinking was getting worse in the eyes of family and friends.
However, he knew that his condition had reached the point where both
his wife and his business associates were leaving him and thereby
withdrawing their support and protection. He was threatened with the
task of managing himself and his condition entirely on his own, so
he sought my help and protection to dry him out and thus allow him
once more to resume his role of successful defiance and grandiosity.
This time, however, I refused to follow my previous role. I had established
myself as not arbitrary, not willing to fit what he needed. But when
I asked him to sign the card, I knew that his other circumstances
were different and that I represented the one way for him. When I
told him, in essence, that he was not running his case or me anymore,
his last prop was thus removed. He had no place to take his defiance
and his grandiosity; nor could he become defiant with me: someone
who stood for his last bit of hope and who actually had become established
as an ultimate resource when he was in difficulty. So he staged a
brief inward debate and then signed the card.
short, the patient signed the card, first, when all support was withdrawn;
second, when he could not in anger defy those who withdrew their support
because he knew they had been patient and long-suffering; and third,
when he found himself desperately needing help and had no grandiose
ideas left about being able to drink like non-alcoholics. He had neither
unconscious defiance nor grandiosity left to fight with. He was licked,
and he both knew it and felt it.
The Positive Phase
now reach the third question, "Why does the positive phase follow?"
Here, we frankly reach speculation. I know the positive phase comes,
but not just why. Surrender means cessation of a fight, and cessation
of a fight seems logically to be followed by internal peace and quiet.
That point seems fairly obvious, but why the whole feeling tone switches
from negative to positive without all the concomitant changes is not
so clear. Nevertheless, despite my inability to explain the phenomenon,
there is no question that the changes do take place and that they
may be initiated by an act of surrender.
THE DIFFERENCE BETWEEN
fact must be kept in mind, namely, the need to distinguish between
submission and surrender . In submission,
an individual accepts reality consciously, but not unconsciously.
He or she accepts as a practical fact that he or she cannot at that
moment lick reality, but lurking in the unconscious is the feeling,
there'll come a day , which implies no real acceptance
and demonstrates conclusively that the struggle is still on. With
submission, which at best is a superficial yielding, tension continues.
an individual surrenders, the ability to accept reality functions
on the unconscious level, and there is no residual of battle; relaxation
with freedom from strain and conflict ensues. In fact, it is perfectly
possible to ascertain how much acceptance of reality is on the unconscious
level by the degree of relaxation that develops. The greater the relaxation,
the greater the inner acceptance of reality.
can now be more precise in our definition of an act of surrender.
It is to be viewed as a moment when the unconscious forces of defiance
and grandiosity actually cease to function effectively. When that
happens, the individual is wide open to reality; he or she can listen
and learn without conflict and fighting back. He or she is receptive
to life, not antagonistic. The person senses a feeling of relatedness
and at-oneness that becomes the source of an inner peace and serenity,
the possession of which frees the individual from the compulsion to
drink. In other words, an act of surrender is an occasion wherein
the individual no longer fights life, but accepts it.
defined an act of surrender as a moment of accepting reality on the
unconscious level, it is now possible to define the emotional state
of surrender as a state in which there is a persisting capacity
to accept reality. In this definition, the capacity to accept
reality must not be conceived of in a passive sense, but in the active
sense of reality being a place where one can live and function as
a person acknowledging one's responsibilities and feeling free to
make that reality more livable for oneself and others. There is no
sense of "must"; nor is there any sense of fatalism. With
true unconscious surrender, the acceptance of reality means the individual
can work in it and with it. The state of surrender is really positive
sum up, my observations have led me to conclude that an act of surrender
is inevitably followed by a state of surrender that is actually the
positive state in the conversion picture. Because of the two always
being associated, I believe they represent a single phenomenon to
which I attach the term "surrender reaction."
RELATING THE ACT OF SURRENDER
THE THERAPEUTIC PROCESS
at last made as clear as I could my use of the term "surrender,"
I must now try to relate that concept to the therapeutic process.
While, a recognition of the dynamic force of the event has proven
enlightening in many directions, it has been particularly helpful
in understanding the fluctuations in moods of patients and in certain
aspects of therapy.
following patient's problem took on meaning for me when I grasped
the fact that he had experienced an act of surrender at the time he
attended his first A.A. meeting. A man in his middle thirties, he
tells his story this way:
was licked. I'd tried everything, and nothing had worked. My wife
was packing to leave me; my job was going to blow up in my face.
I was desperate when I went to my first A.A. meeting. When I got
there, something happened. I don't know to this day a year
later what it was, but I took a look at the men and women
there and I knew they had something I needed, so I said to myself,
I'll listen to what they have to tell me. From that
time on, things have been different. I go to meetings, work with
other drunks, and study all I can about alcoholism. I know I'm an
alcoholic, and I never let that fact escape me."
if you stop and review this man's account, you will note the statement,
"I'll listen to what they have to tell me." In that comment
to himself, the patient initiated his act of surrender. There was
no lip-service in his willingness to listen; he really wanted help.
There was no defiance or grandiosity available at the moment to dilute
his listening. He was accepting, without inner reservation or conflict,
the reality of his condition and the need for help. And, significantly
enough, at this point he goes on to say, "From that time on,
things have been different." Subsequent events clearly indicate
that this man did experience the typical change I have been calling
conversion , and from that time on "things were
different." His wife, commenting on this change, said feelingly,
"It's the most remarkable thing I ever could imagine. The only
trouble is that I still have to keep my fingers crossed because it
still doesn't make any sense to me."
patient, however, consulted me because he "didn't like the way
things were going." By that, he meant that he was finding himself
cranky at home and irritable in business, signs that his A.A. experience
had taught him were ominous. When I asked him why he gave up drinking,
he replied that he had made up his mind to quit so he, did, although
he had to admit that A.A. was helpful. A little surprised at this
simple assertion and doubting it somewhat, I plied him with further
questions and got the real story, which showed to me that he had a
typical surrender experience, followed by a typical positive aftermath.
But I also saw that the change did not last and that, after several
months in which the patient had lived in a state of surrender, he
slowly reverted to his former attitudes and ways of feeling. In other
words, the surrender reaction did not fix itself into his personality
and thus allowed the return of his previous state of mind.
Differing acts of surrender
fate of the surrender reaction is in itself an interesting study.
With some, the surrender experience is the start of genuine growth
and maturation. With others, the surrender phase is the only one ever
reached, so that they never lose the need to attend meetings and to
follow the program assiduously, apparently relying on the constant
reminders in their daily existence to supply the necessary impetus
to the surrender feeling, at least insofar as alcohol is concerned.
For a few, there seems to occur a phenomenon of what might be called
selective surrender . After the effects of the initial
surrender experience have worn away, the individual returns to pretty
much the same person he or she was before, except for the fact that
the person doesn't drink. His surrender is not to life as a person,
but to alcohol as an alcoholic. Many other differing aftermaths undoubtedly
occur, but a study of any or all of them would, I am sure, disclose
the same basic fact: the surrender experience is followed by a phase
of positive thinking and feeling that undergoes various vicissitudes
before it becomes established in some form or other in the psyche
-- or it is lost completely, becoming merely a memory and a mirage.
Recognizing the Surrender Reaction
the standpoint of therapy, recognition of the surrender reaction throws
a challenging light upon many clinical phenomena that are generally
held to be of significance in the process of getting better. For instance,
in catharsis it is not what is revealed but the act of surrender (that
preceded and permitted the revealing to come to light) that, in my
opinion, produces the characteristic afterglow of positive feeling.
It also explains its temporary effect just as with the conversion
experience of the alcoholic. Again, the frequent unexpected lifts
derived from seemingly ordinary first interviews, while they may be
considered transference phenomena, seem to me more in the nature of
"surrender reactions" based upon the fact that the client
found the interview palatable, and the client made a decision to continue,
which by implication means "surrender", to the psychiatrist.
The very decision to come to a psychiatrist, through its surrender
significance, often has an ameliorating influence and certainly accounts
for the remark of a patient who said, "Once I rang your doorbell,
I felt 75 percent better". The phenomenon of release, which makes
people realize that, in losing their lives they are finding them,
becomes explicable if one sees that the surrender that preceded the
sense of release stills the inner fight and hostility, thus permitting
the spontaneous creative elements of the Inner Self outlet for expression.
is in the area of resistance, however, that an understanding of the
surrender reaction sheds the greatest light on the therapeutic process.
Regularly, therapy goes ahead by fits and starts. For a while there
is a period of resistance that is worked through, permitting progress,
insight, and awareness of the emotional interplays in the unconscious
life. Then another point of resistance is encountered, and again it
must be ferreted out and dissolved before further constructive steps
may be taken. Meeting resistance and working it through are the everyday
tasks of therapy.
Breaking Through Resistance
before the patient has been in full resistance -- bucking treatment,
difficult to manage, getting nowhere -- suddenly there is a marked
change, almost like the sun bursting through the clouds, bringing
everything into focus and making what was once a confused jumble take
on form, significance, and meaning. For the time being, the resistances
have disappeared and the treatment proceeds apace.
have been accustomed to saying that the patient has a flash of insight
and understanding that brought clarification and a greater awareness
of his or her individual emotional makeup. Actually, if you examine
the state of mind that breaks through when the resistance melts, you
will find it is strikingly parallel to the positive state of mind
an individual may have after a conversion experience. In fact, the
parallel is so striking that I am more and more becoming convinced
that the two are identical. In other words, I now believe that the
giving up of resistance during treatment is in reality an act of surrender
that typically, as in the conversion experience, is followed by a
positive state of mind where elements of resistance are no longer
present. This "giving in" may be sudden, causing the patient
to enter the positive phase so rapidly as to constitute a sudden turnover
with dramatic results. Generally, as in the conversion change, the
change is slower, but the alteration is in exactly the same direction.
one recognizes more than I do the sweeping nature of any such observations.
No one is more aware than I am of the need to substantiate these observations
with clinical material. Someday I may be able to support more conclusively
my present hypothesis with case material. I can point out, however,
that the positive aftermath of the so-called "successful interpretations"
is no more lasting than the positive phase of the so-called "conversion
experience". They are both temporary; they are both slowly supplanted
by a new crop of resistances or negative feelings. Also, they both
require further change in the unconscious mind before the act of surrender
becomes a settled state of surrender in which defiance and grandiosity
no longer raise havoc with adjustment, serenity, and the capacity
to function as a human being.
To recapitulate, my studies of the conversion experience have led
me to see that:
- It is
the act of surrender that initiates the switch from negative to positive
- It occurs
when the unconscious defiance and grandiosity are for the time being
rendered completely powerless by force of circumstance or reality.
act of surrender and the change that follows are inseparable since
it is safe to assume that if there is no change, there has been no
positive phase is really a state of surrender that follows the surrender
- In several
places, as in catharsis, the so-called improvement or feeling better
is actually a state of surrender induced by an act of surrender.
state of surrender, if maintained, supplies an emotional tone to all
thinking and feeling that does insure healthy adjustment.
have tried in this paper to establish the fact that there is such a psychic
event as surrender and that once the fact is appreciated in all its ramifications,
it is illuminating clinically and provides a basis for understanding much
that goes on in the therapeutic process.