Stress and The Biology

Most of the diseases of abnormal immune function are remarkably linked to psychological stress.

Treating the whole person - mind, body, and spirit

About twenty-five years ago, during a lecture on the mind-body connection, one surgeon interrupted the presentation 'with a loud, "You don't seriously believe all this bull#@*, do you?" Doctors, I have learned, have rules they live by set procedures and "decision trees" established by evidence-based research (and insurance companies). As such, they wholeheartedly put their trust in the scientific method: is it measurable, predictable, and reproducible? However, God is not bound by their rules and continues to create new and improved ways of healing people, including awakening us to the reality of the role that the mind (our faith/belief system) can and does play in the healing process. Some physicians think more dynamically about healing and disease, and in doing so conclude: "When it comes to cancer, attitude is everything."

Though not to everyone's satisfaction, attitudes toward holistic health care have certainly changed since the 1980s, to the point where the mind/body connection is now seen as "a perfectly respectable scientific hypothesis." We have also come a long way since the early 1960s when it was common for doctors not to tell patients that they even had cancer. Today's best treatments, by contrast, are modern, holistic, and patient-centered approaches to the disease.

Old-school cancer treatments treated the tumor only. Newer cancer treatments treat the whole person body, mind, and spirit. Holistic cancer treatment is also called "integrative medicine," and it's the best cancer treatment available right now because, simply put, there is no silver bullet. There is no knockout punch that drops cancer to the mat, which isn't an easy thing to tell cancer patients or their friends and families. That's one reason, I suppose, that "fighting cancer" is the predominant metaphor when people speak about the disease: it really does require attacking it with everything you've got.

To underscore this point, “For some time, we cancer doctors have known that two different patients with the same cancer, with the same stage of the disease, and treated with the same therapy, might have completely different outcomes. One dies and the other doesn't …. there are innumerably frays in the...battle for life, but the true war is fought by the most important warriors of all- ones’ spirit and one’s faith.

Some doctors understand the complexity of cancer in a way that few others can but they also recognizes the role that patients play in their own healing. If you want your best chance to win in the fight against cancer, it is critically important to think dynamically about the disease, as well as to become more intimately aware of how and why our bodies do what they do. Those who value holistic health care seem to better appreciate the intricacies of the body (hormones, stress-related diseases, the role of nutrition, and the like) as well as the interrelatedness of its systems (e.g., the relationship between the endocrine and immune systems).

In short, holistic cancer treatment appreciates the complexity of the disease while recognizing the incredible resources that a patient can bring to the fight. Until a silver bullet is discovered-and we all hope that is soon-wise counsel dictates that cancer patients begin to think dynamically and treat holistically if the option is available. A hospital program relating to forgiveness, then, fits well into the category of mind/body/spirit medicine. David Servan-Schreiber, MD, a survivor of stage-IV brain cancer and author of Anticancer: A New Way of Life puts it this way: "The first step in [nurturing a patient's will to live] involves locating and treating past traumas.

Why do you suppose he underscores the importance of treating past traumas first? Because the painful past is the genesis of disease? Yes! Servan-Schreiber goes on to say that "these poorly healed scars drain a significant portion of energy, and they hamper the body's capacity for self-defense." Recent research has identified "a number of chronic health conditions ... with social and interpersonal etiologies [causes or origins] and consequences. Forgiveness interventions offer important insights for management and treatment of these conditions." Including cancer? Absolutely, according to Dr. Servan-Schreiber and many other researchers. Without a doubt.

What is the payoff

Before getting into the science of stress, we should answer one question right off the bat: Why bother? Why learn about stress, its effect on our bodies, and the role that forgiveness plays between the two?

The short answer is that there can be a huge payoff. The long answer may include any (or all) of the following examples:

1. Forgiveness is the key to happiness. "Forgiveness is the trait most strongly linked to happiness," writes University of Michigan psychologist Christopher Peterson. "It's the queen of all virtues, and probably the hardest to come by."? Some people have been unhappy for so long they don't even remember what it feels like to be happy.

2. Forgiveness heals painful memories and creates the opportunity for the healing of relationships. For some people, the fabric of their family has been destroyed by painful memories of the past.

3. Forgiveness offers "the way out." Some people are sick and tired of being angry about the past and would make the effort to change their attitude if only they knew how.

4. Forgiveness offers emotional, spiritual, and physical healing. We might whisper to ourselves about another person, "You make me sick!" but we don't stop to think about the truth behind those words. Hating other people does make us sick.

5. Forgiveness has an immediate, wholesome effect and long- term benefit. The stress of unforgiveness affects the immune system negatively, as the ammunition that our bodies use to combat disease begins to run out. A strengthened immune system can positively affect healing from cancer.

If we're looking for a high rate of return, the possibilities presented by forgiveness offer an extremely high yield-perhaps more than any other process, when we consider the effort involved. The payoff is nothing short of personal peace-with others, ourselves, and possibly even with God. Its benefits are priceless.

But how does it all work?

The Science of Stress – The connection between the mind and the immune system

The connection between the mind and the immune system Robert Ader, director of the Center for Psychoneuroimmunology Research in the department of psychiatry at the University of Rochester Medical Center, coined the term psychoneuroimmunology (PNI) to describe the connection between the brain and the immune system.

PNI sounds awfully complicated until we break the word down to its component parts. The first part, psycho, relates to the mind, as in common terms such as psychology, psychiatry, and psychic.

The second part, neuro, refers to neurons, which are the cells in the brain that relay electrical impulses, and has the same root as the word nerve. Neuro refers to the physical makeup of the brain, whereas psycho relates to the makeup of the mind. Finally, immunology is the science of the immune system.

Though researchers have yet to find "definitive evidence that psychosocial factors influence disease via changes in the immune system," Ader believes that "psychological experiences, such as stress and anxiety, can influence immune function, which in turn may have an effect on disease course."

Certain data indicate that factors such as suppressing emotions of anger and hatred (which are the ingredients of unforgiveness) negatively influence a person's susceptibility to disease. But even though studies have begun to show a link between the mind and the immune system, Ader says, "if you're an immunologist and you read a lay magazine about how psychoneuroimmunology means you can boost your immune system and make you healthy, wealthy, and wise, you're not going to want any part of it."? His remarks are fair, and something we should keep in mind.

It is not the intent of this post to overplay the benefits of forgiveness as a "psychosocial therapeutic technique," but neither do we intend to underplay it. Forgiveness will not make you "healthy, wealthy, and wise," and I am not suggesting it as a cure for all the world's problems. It is, however, a helpful way to cope with the stress created by hurtful emotional wounds that others have caused us – or that we have caused ourselves- with significant health benefits.

A commonsense observation about forgiveness as it relates to cancer is that unforgiveness, including the suppression of negative emotions, is very stressful. It takes a lot of energy to keep lavalike anger and hatred inside. Without a doubt, the retention of negative emotions is emotionally hard and toxic.

The stress response

What is stress-or, as it has become better known, the stress response? Does it affect the immune system; and, if so, how? More important, can stress cause the immune system to under function to the point that it either creates cancer or enhances tumor growth?

In order to answer these questions, we need to better understand the human endocrine system and its role in the secretion of hormones, which help the body to survive life-threatening situations.

Everyone has strengths and weaknesses, things about their personalities that can either work for them or against them. The same is true at the molecular level. Hormones can help us; but if they are overused, they can also work against us.

What follows is a brief overview of the roles played by particular hormones that can affect a person's immune system as a response to stress. The science is far more complicated than our current discussion can fully explain, but I hope to at least shed some light on how our bodies can respond to unforgiveness.

The endocrine system

The endocrine system is one of the main communication systems for controlling and coordinating the body's work. It teams up with various other aspects of the body to maintain and control a whole host of functions, among which are body energy levels, homeostasis (the internal balance of body systems) and-most important for our purposes-the response to surroundings, injury, and stress.

The endocrine system accomplishes its work through hormones- chemical messengers, created and stored in the endocrine glands, that release molecular signals into the bloodstream when they're needed. We're all basically familiar with how the nervous system conveys information along neural pathways; similarly, the endocrine system uses the blood vessels to convey information throughout the body by way of hormones.

A word on hormones

The word hormone comes from the Greek hormon, which literally means "to excite or spur on," which is exactly what hormones do. The human body has more than thirty of these amazing hormones busily orchestrating and regulating functions ranging from puberty and weight to how well we sleep and when we feel hungry or full. Furthermore, some hormones (two in particular) control how we handle stress. These are adrenaline and cortisol.

The function of adrenaline and cortisol is to generate strength and speed to survive a life-threatening situation, whether real or perceived. Specifically, adrenaline stimulates the heart to beat faster and stronger, in order to ensure strength and speed; while cortisol actively improves the brain's use of glucose and changes how we store energy.

As a side note, these hormones are the reason that two simple lifestyle choices-exercise and increased water intake can help reduce stress.

The fight or flight response

In order to increase the flow of blood to the brain and muscles- the organs that need it most in a life-threatening situation- adrenaline expands the blood vessels that feed these organs while constricting the blood vessels that feed other vital organs that have suddenly become less important. Cortisol also works to temporarily suppress unnecessary systems and bodily functions.

Let's say, for example, that we're enjoying a tranquil morning hike through the woods when an angry bear leaps out on the trail in front of us. Digesting the eggs and bacon we had for breakfast suddenly pales in the importance of focusing our thoughts and preparing our legs for a high-speed chase through the underbrush. In such a situation, adrenaline and cortisol set us up for a period of sustained arousal that can help us survive the threat.

Along with suppressing the digestive system, the stress hormones also suppress the immune system. When confronted by the overwhelming and sustained threat of a bear breathing down our necks, cortisol marshals how our energy is spent and signals the immune system to significantly reduce the production of NK cells, the body's foot soldier in the fight against cancer.

One researcher, Robert M. Sapolsky, says, "It is not that stress makes you sick, but that it increases the likelihood of contracting a disease that makes you sick. ... In this scenario, stress-related disease arises because the defending army of the stress response runs out of ammunition.

The net result is that our energy becomes focused on survival by addressing the most important threat: the bear. Fighting cancerous tumors and destroying cancer is important; but at the moment of stress, the bear presents a more immediate danger and thus eclipses even the need to fight cancer.

Here's the big problem: Our minds cannot distinguish between a real bear and an imaginary bear. To the extent that we see cancer, or any other problem, as a clear and present danger or threat, our bodies react accordingly, producing both adrenaline and cortisol, and yielding similar results: a body placed on high alert and ready for the fight of its life. However, as understandable as the concern may be, it is unhelpful to respond to the threat with overwhelming anxiety. A more helpful response would be to recognize the threat and, with faith and trust, calmly face the adversary. Cancer is not a "bear" that will destroy you; it is a disease that can be conquered.

Chronic stress

It isn't that stress in and of itself is bad. Our bodies have been created for stress. If we couldn't handle stress, we'd have to isolate ourselves from every other human being, becoming the type of person that Simon and Garfunkel immortalized in their song I Am a Rock: "Hiding in my room, safe within my womb, I touch no one and no one touches me."

Thankfully, God not only provided us the ability to experience productive, healthy stress, but he also designed our bodies to cope with external stressors though only short-term ones. It would seem that God did not create us to maintain a state of hypervigilance in which our bodies would be continually flooded with stress hormones.

As an illustration, if our bodies are like cars, we have gas in the tank (glucose) and a gas pedal (endocrine system) to move us down the road. When we need to pass another car or avoid one for whatever reason, we have a passing gear that dumps copious amounts of fuel into the carburetor, allowing us to move quickly around and away from the other car. But we were never intended to keep the gas pedal continually pressed to the floor.

Chronic stress is beyond God's design for our bodies; it is the subject of numerous Bible passages, most of which have to do with avoiding worry and fear and encouraging trust and joy.

When I think of how intricately our bodies are made, I am reminded of and humbled by the words of the psalmist: For you created my inmost being; You knit me together in my mother's womb.

I praise you because I am fearfully and wonderfully made; Your works are wonderful; I know that full well."

STRESS, CANCER, AND MEMORY

Fight, flight, or ... freeze

Much has been written about the fight-or-flight response. There is, however, a third option: freeze.

There's a true story about a lion that was chasing a zebra across the African plain. The zebra, running for its life, looked back to see if it had been able to outrun or outmaneuver the lion, only to find the predator closing in for the kill. The lion made a stretching swipe at the left hindquarter of the zebra, touching it ever so lightly, at which the zebra fell to the ground in a catatonic stupor, limbs limp, completely helpless, succumbing to the threat without continuing to struggle for life.

Some people view cancer as a similar threat. In fact, the diagnosis of cancer can trigger post-traumatic stress disorder (PTSD) in some people. Perceiving a cancer diagnosis as a death sentence, they sometimes give up without a fight, in much the same way as the zebra. Touched by the ultimate fear, they lie down and wait to die.

Robert Scaer, MD, author of The Trauma Spectrum: Hidden Wounds and Human Resiliency, writes, "Because helplessness is a state of reality or perception that is essentially required for the freeze response, one might also classify these medical syndromes as diseases of helplessness,':" But freezing is at the extreme end of feeling helpless.

Experts suggest that successful treatment of PTSD involves helping the person discharge the experience of freezing. Some of the same techniques we use in our forgiveness program are also used in the treatment of PTSD. I'll come back to that later in another post for discussion.

Painful memories: Sensory overload

One can't begin to address the healing of trauma without understanding our response to trauma as an aberration of memory that freezes us in a past event and thereafter dictates our entire perception of reality.

Painful memories, it is important to note, consist of two parts: the [gain itself and the memory. Picture a glass filled with cool, clear water. Imagine placing a drop of black ink into the water, creating a murky cloud. Now imagine that, through some sort of process of distillation, you can remove the ink from the water, creating clarity again.

Such is the process of forgiveness. The ink represents pain and the glass of water represents our memory. Successfully forgiving someone removes the pain from the memory, but the memory remains.

Because of the way our long-term memory works, we will probably never forget the situation that caused us pain; but that does not mean the pain must last forever. Like a scar on an arm or leg, we will never forget how the initial pain was created-whether it was by broken glass, a fall off a bicycle, or in a kitchen fire-but, the scar no longer hurts.

Figuratively, when someone hurts us emotionally, our hearts, are wounded. Forgiveness allows the wounds to heal, but then will be scars. Though the wounds will heal, the memory remains. Forgiveness, then, is the healing of memory.

Ruminating about our past

Charlotte Witvliet, Ph.D., is a leading researcher in the field forgiveness, particularly with respect to the physiology of forgiveness-or, to phrase it differently, how forgiveness and unforgiveness affect us physically.

She writes:

In the wake of an offense, people often ruminate about the hurt, experience, and express hostility toward the perpetrator, use hurtful strategies to cope with stress responses and attempt to suppress one's negative emotions and feelings of vulnerability.

Unforgiveness draws people like magnets to ruminate about past hurts, embellish those narratives with bitter adjectives and adverbs that stir up contempt, exhibit avoidance, and revenge motivations, cogitate about negative features of the offender and offense, and even rehearse a repertoire of grudge and revenge plots."

Rumination is one of the ways that people attempt to understand what happened to them and why, as well as what life might have been like had they not been victimized.

We often call this What If? Game. These completely understandable thoughts often push the gas pedal of unforgiveness to the floor, sending a flood of stress hormones through our bodies, and giving credence to the conclusions offered by several researchers that unforgiveness is unhealthy. Dr. Everett Worthington, the author of more than twenty-five books on forgiveness, writes, "Chronic unforgiveness causes stress. Every time people think of their transgressor, their body responds. Decreasing your unforgiveness cuts down on your health risk. Now, if you can forgive, that can actually strengthen your immune system.'?"

Until our memories are healed through forgiveness, we will continually be affected by what has happened to us. Even though the painful memory may not consciously come to mind, it doesn't mean it has gone away. Memories are waiting below the surface and can be triggered by many things. A New Yorker doesn't have to go very far or speak with many people in order to trigger memories of 9/11. The sight of snow can remind me of my snowmobile accident, and the sight of a lake or a ski boat quickly brings me back to my boating accident. A divorcee need only turn on the TV to find any number of triggers that can bring painful memories to the forefront.

We’ve noticed that cancer patients often suffer from "monkey mind" -you know, the tendency to jump around from this thought to that thought like so many branches in a tree-and often find it difficult to quiet their thoughts. Such are often easily distracted, and a monkey mind can prove fertile ground for negative thoughts to ruminate on the pain of the past. The word ruminate literally means "to chew the cud." Much like cows that chew their cud, we chew on past memories.

When we chew on our painful memories, they become a regular part of our consciousness. We often remember what happened- and how, or we try to figure out why it happened. We think about ways to get even and find joy in dwelling on the people who have hurt us-wishing them ill at best and fantasizing about harming them at worst. But we only end up hurting ourselves in the process. Every time we revisit the person or event that caused us harm, we relive the experience emotionally, along with all the potentially harmful side effects.

Memories and metaphors

A word of caution about our memories: they are not as reliable as we might think. Contrary to popular perception, our memories are not like photographs, with details precisely captured, honestly portrayed, and easily recalled. Memory is more like a collection of impressionist paintings rendered by an artist who takes considerable license with the subject.

It's important to grasp the pliability of memory because the memories we have (for the most part) have been laundered- they've been affected by perceptions, distorted by pain, and often caricatured to fit a scenario in which our own role is as positive as we can make it.

Why do we do this? In order to live with ourselves. No one wants to think badly of themselves, so we cook the books and reframe the picture in the most positive light possible. We all do it. It's an emotional survival technique that prevents us from doing more self- harm than we already do.

This explains, in part, why two children living in the same home can have very different memories about growing up. The same set of facts, seen from separate perspectives, are constantly being reframed and distorted, an impressionist painting in which truth is mixed with the paint of self-protection, making the memory of the event unrecognizable to others who were there.

Another factor to be considered, according to Dan Gilbert, author of Stumbling on Happiness (2005), is the way in which we store large amounts of memory. Memories are collapsed-think of large files on a zip drive-and then given a label, such as Bad or Good. Childhood is filled with a wide range of experiences, some good and some not so good. The mistake we often make is placing a label on fifteen years of experiences by referring to it as a bad childhood when in reality there were plenty of good, happy experiences along the way.

Often when we work on forgiveness, the memory we are trying to heal is a distortion of what actually happened. The process of forgiveness, then, includes revisiting past situations or relationships to make sure that we are being truthful about what did or did not happen. Regardless of how we've distorted our memories, to the extent that they are painful, they need to be healed. The truth can-and will-set you free.

Time does not heal emotional wounds Years ago, while I was serving in one of several churches in the South, I met a young woman, in her mid-twenties, who was divorced and now married to a genuinely nice guy. In addition to our casual conversations, she had sought me out for counseling on several occasions. Every time we spoke, it was about the same thing: the way her first husband had sexually violated her. Although this had happened in her late teens, the topic came up in nearly every conversation with many people. She simply could not stop talking about it. In fact, in her role as one of our youth leaders, she finessed a way to speak about it to our youth group, under the guise of" date rape."

One of the biggest misconceptions about time is that it heals all wounds. The truth is that time does not heal all wounds, particularly deep wounds. The more severe the trauma, the less likely that the mere passage of time will be of much help at all. Over the years, James Pennebaker, professor of psychology at the University of Texas at Austin and author of Opening Up: The Healing Power of Expressing Emotions, has extensively explored the relationship between memory and emotions, as well as emotions and their effect on well-being-including their effect on the immune system.

Here is a brief introduction to important research.

In one classic study, Pennebaker and his team sought to measure the benefit (if any) of writing about the traumas in one's life, which is often referred to as narrative therapy. Students in a freshman psychology class were sorted into three groups. One group, the control group, did not write about anything, creating a baseline.

Another group was asked to write about whatever came to mind. The third group was asked to write specifically about their life's trauma, which was often related to their adolescent sexual trauma. Over time, Pennebaker and his team correlated the information with the number of times each student got sick and went to the infirmary. Not surprisingly, the students who wrote specifically about their past trauma almost never got sick, whereas the control group-those who did not write at all-were the most frequently ill. The conclusion reached by Pennebaker and his team-that withholding negative emotions correlates positively with suppressed immune function-has been the subject of many subsequent studies. For our purposes, it's clear that unforgiveness, at its core, is the withholding of negative emotions, such as anger, hurt, and hatred.

Some disclaimers

The initial research to correlate stress with the suppression of the immune system came from animal experimentation. In one such study, mice exposed to stressful situations showed a higher incidence of tumor growth. In fact, the noisier their environment, the faster their tumors grew. Another study exposed rats to electric shock in a variety of circumstances. Those without the ability to escape became lethargic and complacent, exhibited helplessness and a lack of desire, and lost their ability to resist cancer.

Is there a direct-line relationship between data like these and the effects of stress on humans? If you ask the researchers, you'll likely receive a nebulous response: maybe, maybe not.

One study in particular reported a link between major stressors and the onset of colon cancer in humans five to ten years later. But other researchers do not necessarily agree with the conclusions of that study. It makes for a situation that is both frustrating and limiting.

Let me be clear: when it comes to measuring the effects of stress in human subjects (regardless of whether the stress is induced in a laboratory by electric shock or created naturally by unforgiveness) predictability of response will always vary. Part of what makes humans different from animals is our ability to think, reason, and ruminate about the past, as well as anticipate the future. Unfortunately for research on stress-related topics, people are different-they can and do make very different decisions based on the same information.

In working with patients, who are all unique, one does not assume that what helped one person will help another. They each are seeking help, hope, and understanding-and, usually, a way out of an emotional and physical mess that has ensnared them. The counsel that is offered is evidence based-that is, results are drawn from rigorous research-but it is not a forgiveness pill they can take, and then everything will be fine.

To the extent that stress and cancer are related, a silver bullet cure for cancer seems unlikely, simply because people respond differently to the same situations. We may have the same biological makeup, but beyond that, we all respond differently to various stressors: What makes one-person cry makes another laugh; what makes one person lie down and die makes another stand and fight.

The one consistent thing about us as humans is our inconsistency. Even after accounting for age, sex, personality type, and other factors, the problem that continues to plague research involving human emotions-including our own forgiveness project-is predictability. The best we can do, it seems, is to collect data through observation and clinical tests, analyze the facts as they are presented, and then make general conclusions based on rigorous assessment. In other words, we can narrow our conclusions, but we can't create a one-size-fits-all solution.

Additional problems arise from the difficulty in getting data from subjects, especially with respect to a cancer patient population. Long-term studies are difficult because many of the patients do not survive their disease; short-term studies are often limited in scope, which leads to less-reliable conclusions.

Don't let a good hypothesis die

The engine that drives the research of all kinds is hypothesis-that is, a theory or reasonable assumption-and that engine should not be allowed to run out of control. It should always be kept on track by skepticism, suspicion, and a willingness to test the results with reasonable questions. When it comes to researching a topic as unpredictable as human emotions-such as our forgiveness research-skepticism is often well warranted.

It's one thing to test a hypothesis, however, and quite another to ignore obvious conclusions, even though adequate proof seems elusive and absolute certainty unpredictable.

For example, studies have concluded that the overwhelming majority of breast cancer patients attribute their cancer to the effects of stress. Throughout this chapter, I offer compelling quotes from credible physicians and researchers that support these assertions; but can we absolutely prove there is a link? Some researchers- would say yes, and others no. Does that make those battling breast cancer wrong? They know their bodies-before, during, and after the disease-but drawing a definitive line between stress and cancer remains difficult.

When we add to the mix the role of chronic stress created by suppressing or withholding negative emotions (which is the essence of unforgiveness), the additional variable makes it quite difficult to draw conclusions. And quite frankly, those conclusions may never be proven to the level of a skeptic's satisfaction. Nevertheless, we shouldn't let a good hypothesis die at the hands of overeager skepticism.

Herb Benson, MD, proves the point when he says, "Sixty to 90 percent of visits to physicians is for conditions related to stress. Harmful effects of stress include anxiety, mild and moderate depression, anger and hostility, hypertension, pain, insomnia, and many other stress-related diseases.?"

Dr. Benson is highly credentialed and well respected, particularly in the circles of mind/body medicine. When he says 60 to 90 percent of doctor visits are stress-related, it sounds impressive and convincing, but not very precise. What we can glean, however, is that stress appears to make a lot of people sick. If that's the point, I'm 100 percent sure he's right.

If I want a high quality of life

This post is not primarily about stress or cancer or God. Instead, it's a primer about personal peace gained through forgiveness and a study of the influence of forgiveness on relationships. In closing this post, I'll tell you the same thing we tell my patients/clients: I'm fifty-nine years old, and I'm not going to make it to 158. Neither will you. Death awaits us all. But I am committed to enjoying my life until my final breath. I am determined to drink the last drop from the cup of life.

And if I should find myself trudging through an emotional tar pit of anger and hatred, I will do whatever I can to free myself from the messy goo so that I can live the joyful life that God intends for me. I may not live forever in my earthly body, but I can make choices about how I live. One thing I've decided is that I refuse to be angry at others, including God. Forgiveness is the key that unlocks the door.