If forgiveness is strongly related to health,1–5 and being wronged is a common experience, and interventions, even do-it-yourself workbook interventions, are available and effective,5 then one might make the case that forgiveness is a public health issue. From a societal perspective, the public health impact of an exposure or intervention is often assessed as a function of (1) how common the exposure or experience is, and (2) how large its effects are. Because being wronged is common, and because the effects of forgiveness on health are substantial, forgiveness should perhaps be viewed as a phenomenon that is not only of moral, theological, and relational significance6,7 but of public health importance as well.
CONCEPT OF FORGIVENESS
Forgiveness is generally understood as a victim’s replacing ill will toward the wrongdoer with goodwill or as the reducing of negative thoughts, emotions, and behaviors and replacing these with positive thoughts, emotions, and behaviors toward the offender.1–3 For example, forgiveness of someone who has insulted you may involve replacing a desire for that person to be dismissed from work with a desire that the person change or reform.
Distinctions are sometimes drawn between “decisional forgiveness,” the intention to forgo revenge and to treat the offender as a person of value, and “emotional forgiveness,” the replacement of negative, unforgiving emotions with positive, other-centered emotions, typically with the former preceding the latter.2 Forgiveness is often distinguished from condoning, reconciling, forgetting, forbearing, justifying, not demanding justice, and excusing.2,3,6,7
For example, after the 2015 shooting massacre at Emmanuel African Methodist Episcopal Church in South Carolina, relatives of those who were slain by Dylann Roof told him that they forgave him and were praying for him, while also expressing the extraordinary suffering he had caused. Such forgiveness did not mean foregoing legal proceedings, nor did it ignore what had taken place, but it was a movement of goodwill of the members of the church and an expression of hope that he would repent, change, and realize the wrong he had done. The distinction between forgiveness and other concepts are important in considering the morality of forgiveness.
FORGIVENESS AND HEALTH
Both observational studies using longitudinal analyses and randomized trials of forgiveness interventions provide evidence for a causal link with health.1,4,5 Observational studies suggest that forgiveness is associated with lower levels of depression, anxiety, and hostility; reduced nicotine dependence and substance abuse; higher positive emotion; higher satisfaction with life; higher social support; and fewer self-reported health symptoms.1 The mechanisms are generally thought to be beneficial emotion regulation, with forgiveness being an alternative to maladaptive psychological responses like rumination and suppression. Most forgiveness research has been carried out with cross-sectional data, but stronger evidence comes from randomized trials of forgiveness interventions. Numerous forgiveness interventions have been developed and evaluated in randomized trials, extending even to very difficult settings, for example, helping adult incest survivors who desire to forgive to do so.2
A recent meta-analysis of 54 intervention studies suggested a fairly sizable average effect of these interventions on forgiveness4 but also found evidence for an effect of the forgiveness interventions on decreasing depression and anxiety and on increasing hope. Although the effects of forgiveness on physical health are not yet entirely clear, the effects on mental health are now well established by these randomized trials.
FORGIVENESS MODELS
Two prominent intervention classes are premised on specific models of forgiveness, including Enright’s Process Model3 and Worthington’s REACH Model.2 In Enright’s Process Model, treatment takes place over 20 steps organized into four phases: uncovering negative feelings about the offense, deciding to pursue forgiveness for a specific instance, working toward understanding the offending person, and discovering unanticipated positive outcomes and empathy for the forgiven person. Interventions using this model have been shown to be effective with groups as diverse as adult incest survivors, parents who have adopted special needs children, and inpatients struggling with alcohol and drug addiction.
In Worthington’s REACH model, each letter of “REACH” represents a component of the process:
Recall the hurt one has experienced and the emotions associated with it.
Empathize with the offender and take the other’s perspective in considering reasons for action (without condoning the action or invalidating one’s feelings).
Altruistic gesture of recalling one’s own shortcomings and realizing others have offered forgiveness.
Commit to forgive publicly.
Hold onto, or maintain, the forgiveness through times of uncertainty or through the returning of anger and bitterness.
WORKBOOK INTERVENTIONS
Although most forgiveness interventions require a trained professional, there is some preliminary evidence from a small, randomized trial that even workbook forgiveness interventions that can be done on one’s own are effective in bringing about forgiveness and perhaps in alleviating depression.5 Such workbooks are freely available online (http://www.evworthington-forgiveness.com/diy-workbooks). More research is needed, but if these workbook resources prove to be effective, the potential for outreach and promotion of both forgiveness and mental health may be substantial and could have profound public health implications. Such workbooks could be disseminated very widely nationally and even internationally to promote forgiveness and thereby health.
MORALITY OF FORGIVENESS
Questions are sometimes raised about when forgiveness is morally appropriate. In considering this question, it is again important to keep in mind that forgiveness is generally distinguished from condoning, reconciling, forgetting, forbearing, justifying, not demanding justice, and excusing.2,3,6,7 One can desire the good of the other without excusing or forgetting the wrongful action and while still pursuing a just outcome.
For example, in 2016 a 20-year-old man, while drunk, vandalized a mosque in Fort Smith, Arkansas. He subsequently asked for and received mercy and forgiveness from the mosque members (nyti.ms/2xlglFn). His actions were not justified or excused, but the mosque members made clear that they forgave him and did not want to ruin his life. The mosque members even asked for a lenient sentence; the case was, however, treated as a felony and bigotry by the courts.
With these distinctions in mind, arguments have been put forward that, provided the victim does not deny the wrong that was done, its implications, and feelings about it, forgiveness—understood as the replacement of ill will by compassion and goodwill for the offender—can be appropriate; moreover, provided these conditions are met, forgiveness is always morally appropriate and can take place regardless of whether the wrongdoer repents or asks for forgiveness.6 Forgiveness is, again, different from reconciliation.
In many theological and moral understandings of character and social relationships, forgiveness is also considered a good in and of itself. It is a form of love toward the other.7 Provided denial of the wrongdoing is avoided, forgiveness allows retaining self-respect but also respects the wrongdoer as a moral agent who has failed; the perpetrator’s perspective, even if confused, is acknowledged without the victim necessarily having responsibility for changing it. Forgiveness can free the victim from the past, does not make the victim dependent on the wrongdoer, and promotes love, compassion, acceptance, and harmony in human relations. Such seems to have been the case in the Fort Smith community with the mosque vandalism incident.
Such genuine forgiveness, it is argued, respects morality because it acknowledges a wrong, it separates the “sin” and the “sinner,” and it gives the wrongdoer space to change.6 Care must of course be taken, however, not to confuse forgiveness with a restored relationship; this could be particularly problematic in contexts in which this would facilitate the dynamics of prolonged intimate partner violence.7 In other settings, however, forgiveness may be appropriate and desired but difficult to achieve, and in these cases the forgiveness interventions may be of benefit.
IMPLICATIONS
To not address forgiveness is to leave many people trapped in resentment, in negative feelings, and in rumination on the past. The evidence strongly suggests that forgiveness promotes health, in the sense of wholeness of mind and better mental health. In addition, in many theological and moral understandings, forgiveness also promotes health in the broader sense of wholeness of the person: in growth of character, in spiritual well-being, and in restoration, when appropriate, of relationships.
The evidence suggests that forgiveness can be facilitated at the individual, couple, or group level by various forgiveness interventions.2–5 These could be used with greater frequency. Large-scale randomized trials to definitively establish the efficacy of forgiveness workbook interventions might be especially valuable because of the potential for the easy dissemination and outreach of such workbook interventions. Thought could also be given to whether it is possible, or when or how it might be appropriate, to cultivate forgiveness on national and international scales. Forgiveness promotes health and wholeness; it is important to public health.
REFERENCES
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