Forgiving Yourself by Dr Ira Byock

All the passages below are taken from Ira Byock’s book, “The Four Things That Matter Most”, published in 2004

One of the most important lessons I have learned over the years from people who were dying is the wisdom of self-forgiveness. This single lesson can boost our sense of self-worth, transforming our lives.

Susan Armstrong, a wife and mother dying of ALS—­amyotrophic lateral sclerosis or Lou Gehrig’s disease—­wrestled with inner doubts and a sense of guilt about her diagnosis. For the first six months of her illness, she was unable to find any peace within herself and she felt guilty for not being at peace.

The Search for Emotional Peace

     When I sat down with Richard Armstrong to talk about his late wife, he told me that although the Four Things are mostly about a person’s relationship with others in his or her life, Susan had needed to say and feel them within herself.

“We married in our mid-thirties,” he explained. “I know that somehow Susan grew up not feeling good about her­self, but I never really understood why she felt the way she did. It was ironic. For instance, she was absolutely gor­geous, but we hardly have any pictures of her. She was self­-conscious and, as I learned in our first years of marriage, not really at peace with herself.”

Everyone who met Susan saw a vibrant 42-year-old woman who seemed calm and self-possessed, even in the face of her scary diagnosis. Like many shy or self-conscious people, Susan had learned to show a confident face to the world. Strong social skills enabled her to function effec­tively at work and maintain satisfying friendships.

She and Richard were actively involved in their commu­nity. They had met at a Special Olympics fundraiser and discovered they both loved sailing and skiing. They soon became good friends, then best friends and soul mates. They were married within the year. The joy of their mar­riage redoubled when their daughter, Allison, was born.

Susan was no stranger to illness and death. When she was 14, her mother had died. When it happened, it was a shock. Yet, no one talked to her about it at the time. Richard explained, “I asked her about her mother’s death. Sue said she knew her mom was very sick and in pain, but there wasn’t a lot of discussion about the illness, before or afterwards.” Susan told Richard that she felt abandoned in her grief after her mother died. She couldn’t talk to her father or her aunts and uncles about how sad she was that her mother was gone.

Susan also knew from firsthand experience that dying does not have to be hidden—and that even when dying is hard, it doesn’t have to be horrible. She had done volunteer work, offering massage to patients with a hospice and an AIDS foundation. She had helped comfort many patients with cancer or AIDS in their dying.

“Susan was simply the best person I have ever met,” Richard said, “and the most loved. But she just never felt to herself like the person that everybody loved. There’s so much complexity to her history and to the person Susan was that I never did figure it all out. Maybe if we had had another forty years—” His voice cracked and he paused. “About a year and a half after her mom died, her father re­married and his new wife also had three kids, so they be­came the ‘Brady Bunch.’ I think there was a lot of love in her family, but there was also a lack of communication and difficulty relating to each other.”

When Allison was born, Susan “retired” from her mas­sage practice to be a full-time mom. She had never at­tended college, which Richard felt was a source of personal regret and low self-confidence. Ironically, six weeks before her symptoms began she had finally enrolled at the univer­sity. That fall, with Allison six and well established at school, Susan had finally embarked on a long-range plan to earn a BS in biology and go on to graduate school in physical therapy.

Honoring and tending the physical body, her own and others, were central for Susan. She cooked and served fresh, mostly organic foods to her family. She never smoked. She stretched and meditated every day, and ran six to ten miles at least four times a week.

In October of 2000 she noticed her running stride was off. At first she thought it was her shoes, but within a week it was clearly worse. A neurologist at the University of Cali­fornia at San Francisco ordered a series of tests. “He thought it was probably MS,” said Richard, “but said we should wait and see. We didn’t have to wait long. The symptoms rapidly progressed, and two months later he di­agnosed ALS. Two months after that, she needed a cane and then a walker. Every doctor we saw remarked about the peculiar, alarming rate of progression.

“We read everything we could. I was on the Internet for hours on end and called and faxed records to specialists around the country. There was really nothing to be done that wasn’t available and being offered where we were.

“Susan did her best to absorb the bad news and maintain a good attitude. She was a trooper in adapting to the physi­cal limitations, but it all moved too fast. She didn’t just ad­just bravely. She fought like hell while things were being taken away from her faster than she could ever fully adapt to. She had what we came to call trailing adaptation. In late spring, a month or two before she died, she said, `March wasn’t that bad now that I can look back on it. I would go back to that.’

“But, in fact, she was never happy with March. She wanted to accept her illness and adapt in a psychologically healthy way, but, in fact, she was furious. I can’t tell you how many copies of Tuesdays with Morrie we were given.

There was a catchphrase that she used to express her frus­tration, `I’m not Morrie, Goddamn it!’ she said. `No one’s going to write a book about how I handled this philosophically.’ She was a realist, dealing with it as best she could–­but fighting with dealing with it every day.”

No illness affects two people in exactly the same way. Richard explained the pattern of symptoms and pace of progression of Susan’s ALS. She had some symptoms that aren’t talked about much in ALS literature. ALS isn’t sup­posed to be painful, but Susan was plagued with back pain. It was worse at night because after the first few months, she couldn’t turn herself in bed. Richard slept in short bursts in order to turn her. The usual medications just made Susan groggy. She preferred the pain. As bad as it was, physical pain was not her main problem. Her anger, which she turned inward, was.

Richard said that during the early months of the illness Susan was most angry at feeling that the things that made her “Susan” were being aggressively taken away from her. She couldn’t work, run, or do housework. She couldn’t cook for her daughter or even brush her hair. She began to feel like a bad mother.

Richard explained that Susan’s real torment in those months after the diagnosis was self-imposed. She struggled with questions of what she had done to bring this on her­self. She wouldn’t talk about it. “A few times early on when she had mentioned feeling this way, I couldn’t stop myself from reflexively reassuring her,” said Richard. “It was prob­ably the wrong thing to do, but how was I supposed to re­spond? I mean, we had both read all the articles. The cause of ALS is not known. She was in perfect health, had never knowingly exposed herself to any toxins. It just didn’t make sense. But it wasn’t a rational concern, at least not in the medical sense.”

Many of my patients have expressed similar sentiments. It’s an interesting quirk of human psychology. We know that death awaits us all. Furthermore, we know—either be­cause we have read about or personally known young peo­ple who died—that sometimes people contract lethal illnesses for no apparent reason. Yet when illness strikes, it is natural for people to ask, “Why me?”

Richard’s memories spoke volumes about his own an­guish at the existential maze in which Susan was trapped. Few people are as selfless and giving as Susan Armstrong.

“It is terribly hard to hear that someone you love and know is pure of heart is suffering from self-doubt and guilt,” I said.

              My comment struck a chord. “Absolutely!” he said. “The only thing I could ever say that made any impact was to point to various children we know who have had bad things happen, from birth defects, to mental retardation, to a brain tumor. I would say, `What did those kids do to de­serve that?”‘

Reading Your Biography

As people come to the end of life, it is so common to have at least a few regrets. People wonder what sort of person they have been. Inevitably there will be things we wish we had a chance to do over, this time “getting it right.” There are things that we’ve said that we will wish we could take back.

When you think of it, how could it be otherwise? No­body comes to the end of life perfect, any more than we could be perfect throughout our lives. We don’t have to give up striving to do things well and set things right to ac­knowledge that we are, after all, just human. The fact is, we will die imperfect. Sad but true. That’s not a failing on any of our parts. Imperfection is an inescapable part of being human.

In working with people who are living with an illness that will likely shorten their lives, I sometimes ask them to conceptualize their life as a long, rich novel. I ask them, “If you were reading this novel and you knew that there was just a chapter or perhaps two left, how would you hope to see it end? Let’s assume that as the reader, you were able to see the difficult circumstances that the main character was dealing with and you knew his or her motives were good. You could see that some things had not worked out the way he or she had wanted throughout life. How would you feel toward the protagonist? Wouldn’t you feel some degree of mercy?”

I’ve yet to have someone say no. So I ask, “Can you ex­tend to yourself the same mercy that you would have to the protagonist in this story?”

In one sense, they—and you—are not just the reader, but also the author of this story. We are all at least coau­thors of our own life stories. We don’t set up the circum­stances and can’t control the external events. We can only write our part in the story as well as we can. But it will never be perfect. We will never write the perfect story or the perfect biography. It wouldn’t be believable if we could.

What we can do, from this moment forward, is live as authentically as possible. This means removing the mask we use to protect ourselves from the world, and from being truly seen by others. It means encountering others and the world with honesty, without pretense or ulterior motives. The psychological mask and emotional armor we wear to protect ourselves from hurt diminishes the integrity and in­tensity of our lives. When we are willing to allow others to see us as we are and when we trust our clear, good inten­tions and reflect them in our words and deeds, we are au­thentically ourselves. In so doing, we need never have regrets.

Like so many others, Susan asked herself “Why me?” ten thousand times, running through every conceivable reason, physical and metaphysical, in a futile effort to ex­plain the unexplainable. Ultimately, she gave up. Maybe her anger simply lost steam, or she realized that angry or not, life was going on around her. No one can know if Susan fully resolved her anger, but she was able to put it aside. Instead of looking inward, she decided that there were people out there who commanded her attention. She decided to focus outward and invested the last of her life in the people who gave her meaning. In doing so she found renewed meaning and a measure of peace in her remaining life.

Worthy Right Here, Right Now

A piercing lesson we can all take from Susan’s story is that none of us need wait to accept ourselves. We are worthy of self-acceptance and of love right now. Even with our imperfections. All of us have the things we wish we hadn’t done, even dark secrets that we hide in shame. You may think that other people don’t have them, but they do. Yes, you are flawed, you have made many mistakes, some seri­ous. So what? Who hasn’t? It only proves you are human. Please forgive yourself and show yourself some love.

Feelings of unworthiness and self-loathing cause untold suffering. They can make people feel alone and unwanted in a roomful of friends. That’s why it is so important to get over it—admitting that you are who you are and that’s good enough—because until you are able to feel worthy, other people may love you, but you will be unable to believe them, or feel their love. And you deserve to feel their love! You are worthy of love right here, right now. It can—and must—start with loving yourself. [78-86]