The Act of Surrender in the Therapeutic Process….. BY: HARRY M. TIEBOUT, MD AA GV DA JUNE 1974

 

The Act of Surrender in the Therapeutic Process…..

BY: HARRY M. TIEBOUT, MD

AA GV DA JUNE 1974

 

The first psychiatrist to recognize the work of Alcoholics Anonymous, Dr. Harry Tiebout used many AA concepts in his own practice

 

THE ACT of surrender is an unconscious event, not willed by the patient even if he should desire to do so. It can occur only when an individual with certain traits in his unconscious mind becomes involved in a certain set of circumstances. Then it 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 which seemed to follow an act of surrender. The 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 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 the patient about the danger of his 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 at that.

 

We 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 interested, not in drying him out, but in the real problem of helping him stop his drinking. Later on and in retrospect, the patient said, in referring to these tactics, "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."

 

During 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, the 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, who was really a junior in the firm, 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.

 

After 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 his 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 making it clear where she could go, he discussed for the first time the real hell he had put her through and seemed really 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 acknowledgment of his own real wish to be different. He soon joined AA and is now an active member of that Fellowship in his home community. The patient has to date stayed sober.

 

Recently, in discussing his experience, he said, "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 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."

 

Here 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 convinced that he is right. We can sum up this man's experience 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 which has enabled him to remain sober.

 

This man's experience (which, incidentally, is not limited to alcoholics) raises three questions:

 

1. What qualities were there in his nature which so long resisted accepting help and finally were forced to give in?

2. What were the factors which brought about the final act of surrender?

3. Why does a positive phase follow the surrender experience?

 

My 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.

 

To turn, then, to the first question: What are the qualities which make the patient put up such a battle that he finally has to surrender or die? In the alcoholic, my observations have led me to see that the two qualities which Sillman selected as characteristic--i.e., defiant individuality and grandiosity--may very well explain the well-known fact that the alcoholic is, among the not-so-sick, the most unreasonable and stubborn about seeking help or being able to take it even when he seeks it. Both of these qualities operate in the unconscious layers of the mind, and the influence of both must be understood if one is to see what probably goes on at the time of surrender.

 

Defiance may be defined as that quality which permits the individual who has it to snap his fingers in the face of reality and live on unperturbed. It has two special values for handling life situations, whether inner or outer.

 

In the first place, defiance, certainly with alcoholics, is a surprisingly effective tool for managing anxiety or reality, which is 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.

 

In 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." With 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, helps over many rough spots.

 

Grandiosity, the second quality noted by Sillman, permeates widely throughout the reactions of the alcoholic. Differing, however, from the defiance, which seems almost uniquely structuralized in the psyche of the alcoholic, the grandiosity springs from the persisting infantile ego, which, as in other neurotic states, characteristically is filled 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 in any other neurotic. In the alcoholic, perhaps, the typical arrogance and sense of superior worth are kept nearer the surface by the associated defiance, which feeds the childish ego constantly by its succession of victories. But by and large, there is nothing in the alcoholic's grandiosity which distinguishes him from the run-of-the-mill 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.

 

We are now in a position to discuss how these qualities operate in the alcoholic. 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 it cannot master and control; on the other side, the facts demonstrate unmistakably the opposite.

 

The dilemma of the alcoholic is now obvious. His unconscious mind rejects, through its capacity for defiance and grandiosity, what his conscious mind perceives. Hence, realistically, the individual is frightened by his drinking and, at the same time, is prevented from doing anything about it by the unconscious activity which can and does ignore or override the conscious mind.

 

Let us see how this clash between the conscious and unconscious responses 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 in awareness as worry, distress, fear, and concern. In this state, the patient is filled with a desire to quit and eagerly grabs at any kind of help. He is in a state of crisis and suffering.

 

In 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 mentation, 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, that the worry of others is silly and a gratuitous invasion of their rights, until, finally, memory of their own acute period of anxiety is swallowed up by the defiance and the grandiosity and thus loses its effectiveness 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 unimpaired vigor.

 

We now come to the second question: What were the circumstances which 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 his condition had reached a 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 fit 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, as willing to fit what he needed. But when he was asked to sign the card, I knew that his other circumstances were different and that I represented the one way for him. And then I told him, in essence, that he was not running either his case or me any more. His last prop was thus removed. He had no place to take his defiance and his grandiosity, neither could he become defiant with me, who stood for his last bit of hope and who actually had become established as an ultimate resource when in difficulty. So he staged a brief inward debate and then signed the card. The act of surrender had occurred.

 

In 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; third, when he found himself desperately needing help and had no grandiose ideas left about being able to drink like anybody else. He had neither unconscious defiance nor grandiosity left to fight with. He was licked, and he both knew it and felt it.

 

We 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 fight, and cessation of 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, with all the concomitant changes, is not so clear. Nevertheless, despite my inability to explain the phenomenon, there is no question that the change does take place and that it may be initiated by an act of surrender.

 

One 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 accepts as a practical fact that he cannot at that moment lick reality; but lurking in his 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.

 

On the other hand, when the ability to accept reality functions on the unconscious level, there is no residual of battle, and relaxation ensues, with freedom from strain and conflict. In fact, it is perfectly possible to ascertain how much acceptance of reality is on the unconscious level by the degree of relaxation which develops. The greater the relaxation, the greater is the inner acceptance of reality.

 

We 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 can listen and learn without conflict and fighting back. He is receptive to life, not antagonistic. He senses a feeling of relatedness and at-oneness, which 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.

 

Having 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 be conceived of, not 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"; neither 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 and creative.

 

To sum up, my observations have led me to conclude that an act of surrender is inevitably followed by a state of surrender, which is actually the positive state in the conversion picture. Because the two are always associated, I believe they represent a single phenomenon, to which I attach the term "surrender reaction."

 

Having at last made as clear as I could my use of the term "surrender," I now try to relate that concept to the therapeutic process. While a recognition of the dynamic force of the event has proved enlightening in many directions, it has been particularly helpful, in understanding the fluctuations in moods of patients and in certain aspects of therapy.

 

The 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 AA meeting. A man in his middle thirties, he tells his story this way: "I 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 AA 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."

 

Now, 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 which I have been calling conversion and that from that time on, things actually 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."

 

The patient, however, consulted me because, he said, 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 which his AA 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 AA was helpful.

 

A little surprised at this simple assertion and doubting it somewhat, I plied him with further questions and so got the real story, which showed me that he had a typical surrender experience, which was 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 the personality, and thus the patient was allowed to return to his previous state of mind.

 

The 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 that 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 was before, except for the fact that he doesn't drink and has no battle on that line. His surrender is not to life as a person, but to alcohol as an alcoholic.

 

Many other differing aftermaths undoubtedly occur, but study of any or all of them would, I am sure, disclose the same basic fact: namely, that the surrender experience is followed by a phase of positive thinking and feeling which undergoes various vicissitudes before it becomes established in some form or other in the psyche or is lost completely, to become merely a memory and a mirage.

 

The act of surrender is temporary; it is slowly supplanted by a new crop of resistances or negative feelings; further change in the unconscious structures is required before the act of surrender becomes a settled state of surrender, in which defiance and grandiosity no longer raise havoc with adjustment, and serenity and the capacity to function as a human being are permanently able to take over.

 

To recapitulate, my studies of the conversion experience have led me to see:

 

1. That it is the act of surrender which initiates the switch from negative to positive.

2. That the act of surrender occurs when the unconscious defiance and grandiosity are for the time being rendered completely powerless by force of circumstance or reality.

3. That the act of surrender and the change which follows are inseparable, since it is safe to assume that if there is no change, there has been no surrender.

4. That the positive phase is really a state of surrender which follows the act of surrender.

5. That in several places, the so-called improvement or feeling better is actually a state of surrender induced by an act of surrender.

6. That the state of surrender, if maintained, supplies an emotional tone to all thinking and feeling that does insure healthy adjustment.