96 Forgiveness
J. Adam Rindfleisch, MD, MPhil
Abstract
Forgiveness is an essential part of healing, but it is often difficult for people to do. Research indicates forgiveness has many positive effects and can be effectively done as a step by step process, ideally guided by someone who can effectively offer support. There are resources on forgiveness that are widely available.
Keywords
forgiveness spirituality trauma-informed care mental health
Darkness cannot drive out darkness; only light can do that.
Hate cannot drive out hate; only love can do that.
Martin Luther King, Jr.
In October 2019, Brandt Jean, the youngest brother of Botham Jean, was in the courtroom giving the “victim’s impact statement” as Amber Guyger, the former Dallas police officer who shot and killed his brother, was being sentenced. He said, “If you truly are sorry, I know, I can speak for myself. I forgive you.” He then asked the judge, “I don’t know if this is possible, but can I give her a hug, please?” The judge gave him permission, and he embraced the woman who shot his brother. They hugged for over a minute, and she sobbed throughout.1
How does someone forgive like this? Forgiveness undoubtedly has great healing potential, but it requires much of the person doing the forgiving. Courage. Strength. Empathy. Altruism. And maybe more.
If you want to truly explore how forgiveness fits into your life and your practice, consider your own answers to these four fundamental questions as you read this chapter:
1. Whom do I need to forgive?
2. How can I forgive them?
3. What do I want to be forgiven for myself?
4. How does forgiving myself and others affect my health?
You will be more effective bringing forgiveness into your work with others if you practice it yourself. There are many possible ways for this to be done.
This chapter describes how forgiveness can influence health. It provides an overview of many of the key elements of the forgiveness process and describes ways clinicians and other healing professionals can make use of the power of forgiveness in their practices. Resources for further learning are provided at the end of the chapter.
If you work in a healing profession, you will meet people who have endured any number of traumatic experiences. In fact, it is estimated that more than 90% of people experience severe trauma at least once in their lives, and recent research confirms what clinicians instinctively know: Traumatic experiences can lead to lasting negative health effects.2 A 2010 review found that childhood trauma markedly increases the likelihood of several negative outcomes, including tobacco dependence, injection drug use, alcoholism, posttraumatic stress disorder, and a variety of other physical and psychiatric issues.3,4 Childhood traumatic events also are linked to a decrease in overall quality of life,5 increased incidence of chronic pain,6,7 higher risk of cardiovascular disease,8 and a multitude of other chronic physical problems.9 A 2020 review found that, in comparison to children who dealt with low adversity in early life, those who had multiple adverse experiences had 4.5 times the risk of all-cause mortality.10
Traumatic toxic stress can result in chronic activation in the stress response, which leads to chronically elevated cortisol (and eventual depletion of it), and this has a negative impact on immune system function; unfavorable neurological remodeling occurs.2,11,12 Unfortunately, the effects of trauma also have negative consequences that can have negative epigenetic effects, which can even affect the gene expression of a traumatized person’s descendants.13,14
Many traumas—such as violent crime, domestic violence, rape, child abuse, automobile accidents, and the effects of war—are perpetrated by one person or group of people. Pain inflicted by others, from minor slights and insults to the most horrifying experiences of brutality or betrayal, can have lasting negative health effects. Yet, we also know that despite horrible experiences, many people experience posttraumatic growth; they heal and even become stronger, despite being hurt.15 How can healing and growth occur in spite of, or in response to, traumatic events?
For many people, being able to forgive is vital to reclaiming wholeness after they have been injured by others. Integrative medicine is built on empathic, trusting relationships between caregivers and patients. If patients have the time, opportunity, and safety to do so, they may disclose traumatic experiences that they may not have ever shared before. Some people recognize the role of forgiveness in healing the damage caused by traumatic experiences, whereas many others do not. How and when to address issues of forgiveness can be one of the most challenging aspects of caring for those who have been traumatized; however, the potential benefits make it well worth the effort. Often, self-forgiveness, in addition to forgiving others, is also an essential part of the healing process.
The Health Benefits of Forgiveness
In the past several years, increasing numbers of studies have demonstrated that forgiveness favorably influences a number of physical and mental health outcomes. A 2018 review of 128 studies that included more than 58, 500 people concluded there is a significant positive relationship between forgiveness of others and physical health.16 Additional research has found that the effects of forgiveness may be even stronger for mental health outcomes.17 Examples of some more specific research findings include18:
• Longevity: A 2012 review of data from a nationally representative sample of 1232 U.S. adults concluded that “conditional forgiveness of others is associated with reduced risk for all-cause mortality, and … the mortality risk of conditional forgiveness may be conferred by its influences on physical health.”19
• Vital signs: Simply imagining oneself granting forgiveness alters physiology. Blood pressure is lowered, heart rate decreases, and skin conductance changes.20
• Immune function: Self-forgiveness is associated with decreased blood viscosity and improved ratios of helper T to cytotoxic T white blood cells.21
• Brain function: Forgiveness has been found to influence the function of neurons in the lateral and ventromedial prefrontal cortex and temporoparietal junction.12,22
• Mental and emotional health: People who are more inclined to forgive seem to experience less stress.23 They are less likely to experience depression and anxiety,24 not to mention posttraumatic stress.25 In women suffering from spousal emotional abuse, forgiveness therapy was found to lower depression, anxiety, and stress and to improve self-esteem, emotional mastery, and the ability to find meaning in suffering.26 Forgiveness improves mental health in part by decreasing the tendency to ruminate, and it probably improves social relationships as well.21 People with borderline personality27 and eating disorders28 are often less predisposed to forgive and may benefit from forgiveness training.
Pearls
A strong relationship exists between traumatic experiences and the emergence of physical and mental health problems. Strong evidence also indicates that forgiveness negates the harmful effects of trauma.
• Sleep: A 2019 review found that both forgiveness of others and self-forgiveness were associated with better sleep.29
• Chronic pain: A 2019 review of seven studies found an inverse association between forgiveness and participants’ overall levels of pain, as well as improvements in pain tolerance.30
• Cardiovascular effects: Forgiveness is associated with lower cardiovascular risk, possibly because of decreased anger and hostility.31 It has even been linked to improvements in lipid measures and found to have the opposite effects to anger when it comes to cardiac function measures.32 A recent study reported decreased anger-induced myocardial ischemic events in those practicing forgiveness.33 In a 2015 study, forgiveness was found to be cardioprotective, at least in part because it decreased aortic blood pressure.34
• Substance use disorder: Forgiveness has been shown to decrease anger, depression, anxiety, and vulnerability to drug use in people with a history of substance abuse.35
• Oncology and palliative care: A 4-week intervention helped terminally ill older patients with cancer to enhance levels of hope and quality of life.36 Use of a course entitled “Restore: The Journey Toward Self-Forgiveness” led to significant favorable changes not only in levels of self-forgiveness but also acceptance, self-improvement, and outlook.37 A large majority of people report wanting to address issues related to forgiveness at the end of a loved one’s life.38
• Other chronic health disorders: Investigators have suggested that forgiveness therapy may hold great potential in the treatment of fibromyalgia and chronic fatigue.39 A small 2014 pilot study found that a forgiveness intervention decreased fibromyalgia symptoms.40
• Miscellaneous benefits: Meta-analyses have pointed out the benefits of forgiveness for healing intergenerational pain, recovery from sexual abuse and incest, and abortion-related guilt.41,42 In two small studies, forgiveness of co-workers lowered levels of stress and conflict in the workplace; it also improved productivity.43 One study focused on racial disparities found that forgiveness was even more protective of older African Americans than whites; the benefit was less, however, if a person lived in a relatively unsafe neighborhood.44
Although forgiveness seems to have benefits for people with an array of health conditions, it also should be noted that, as is the case for many therapeutic approaches, one need not have a specific health problem to make good use of forgiveness for supporting overall well-being. Forgiveness likely has preventive benefits as well.
