Forgiveness as therapeutic strategy

at 30.12.2021
Psychosomatic medicine and the virtues

When we talk about disease causes, we usually think about external factors like viruses, bacteria, microbes, poor diet, etc. However, our emotions and spiritual state are crucial for our health, often playing a critical role, as studies in psychosomatics and neuroscience are increasingly confirming. The immune system can fight microbes and viruses, but affects, emotions, and motivations attack us from within, where we should have a different type of defense. There, we fight with ourselves, and as long as we haven't developed a spiritual "immune system," we will end up sabotaging ourselves, allowing negative emotions to overwhelm us mentally and, as a result, physically.
These intuitions and discoveries have resulted in a remarkable development of psychosomatic medicine in recent decades, which studies the relationship between the appearance of diseases at the somatic level and their origins at the mental and mental levels. This therapeutic approach appears to be the oldest and most natural, based on the premise that proper emotional and interpersonal relationship management significantly impacts health.
In this sense, our relation to those who have hurt us is a critical factor in our health, through resentment and hostility or, on the contrary, through forgiveness and understanding. Of course, forgiveness is not easy, and it cannot be "executed" automatically, but adopting it as a way of life can have numerous benefits for both the forgiver and the forgiven. This statement does not come from a moral treatise, but scientific evidence supports it from multiple studies.
Speaking of the significant effects of forgiveness, Robert A. Emmons, Professor of Psychology at the University of California, well-known for his studies on the medical consequences of gratitude and forgiveness, says that forgiveness has the power to bring the person "out of a state of fragmentation in a state of integration, which extends beyond the state of happiness, health and well-being, to a deeper sense of coherence, integrity and inner unification" [1].

The somatic reaction to forgiveness
Forgiveness, defined as a cognitive, emotional, and behavioral response to interpersonal conflict, has been linked to a healthy state of mind and body [2]. When measured in various ways, the ability to forgive indicates, first and foremost, a low negative affect (which is defined as experiencing life in a negative way, with a tendency to manifest negatively in daily interpersonal relationships). As a result, people with low negative affect are less likely to experience anxiety and depression. In addition, due to not being dominated by stress and depression, they are less likely to engage in harmful habits such as alcohol, cigarettes, and drugs, which are frequently attempting to alleviate frustrations, resentment, and unresolved suffering within. A study [3] conducted by a team of American and Dutch researchers discovered, among other things, that the willingness to forgive is associated with less medication per day and less alcohol consumption per week. Studies show that forgiveness is associated with routine, decreasing hematocrit and white blood cell counts [4]. It is critical to understand that increased hematocrit is commonly associated with lung, cardiovascular, and certain types of tumors, as well as certain bone marrow disorders.
Thus, numerous scientific studies confirm that the willingness to forgive is inversely proportional to the predisposition for anger and hostility as dominant psychological traits, implying fewer angry emotions and less internalization of resentment, both of which fill our minds with negative cognitions. In this regard, Lawler et al. [5] discovered that memory retention and the frequent evocation of traumatic experiences in which we were betrayed and injured and did not resolve internally are associated, for example, with greater cardiovascular reactivity, as measured by diastolic and average blood pressure. Witvliet et al. [6], on the other hand, discovered that willingness to forgive is associated with lower levels of facial electromyography (EMG), skin electrical conductance, heart rate, and blood pressure, all of which indicate a low level of stress. As a result, we can expect better health to the extent that forgiveness cancels out these negative emotional states or at least lessens.
Another advantage of being able to forgive is that it improves social skills. There is no need for scientific studies to understand the importance of forgiveness in developing and maintaining harmonious social relationships. Harmonious social relationships, in turn, are critical for our emotional balance [7], which is directly proportional to our physical health. As a result, forgiveness can affect our physiology by significantly reducing negative emotions such as anger and depression and relieving stress.

The parasympathetic nervous system and forgiveness
All of these bodily effects can be explained more broadly by how forgiveness affects the vegetative nervous system. The research discovered that the inability to forgive causes a reactivity of the sympathetic nervous system because the interaction with the person I did not forgive, memory and continuous evocation of traumas and offenses suffered, the persistence of resentment, hostility, and even the desire to revenge are perceived by the brain as a threat and a danger, as is stress [8]. The findings of Seybold et al. [9] and Thoresen et al. [10] show that a lack of forgiveness directly affects sympathetic reactivity, which is responsible for cardiovascular disease and many other health problems relevant in this regard. [11]
As it is known, the sympathetic nervous system involves an action such as "Fight or flight!" which, under normal conditions, helps us avoid the threat of danger by providing us with a surplus of energy to counteract it. However, this reaction causes the release of stress hormones such as cortisol and adrenaline, resulting in an increase in heart rate and blood pressure as well as a slowing or cessation of digestion as blood is directed from the internal organs to the limbs, preparing us for "fight or flight." Simultaneously, the rate of respiration increases to transport nutrients and oxygen to the cells more quickly, muscles tense, and blood vessels in the extremities contract. Furthermore, the sympathetic state suppresses all the functions required for survival, including all immune-related healing and recovery processes. On the other hand, the reduced immune activity allows viruses and bacteria to increase, contributing to dysbiosis or the overgrowth of harmful bacteria in the gut, the proliferation of unhealthy cells such as cancer cells, or the development of autoimmune conditions. As a result, it is natural that the sympathetic state does not last long because if it does, the body will self-destruct.
Because the processes of healing and maintaining health are triggered only when our body is in the opposite state, known as the parasympathetic state of the autonomic nervous system, i.e., "Rest, digest, and heal!", which should cover about 80% of the day, the activation of the sympathetic system should not take up more than 20% of the time of day. Almost every somatic disease and dysfunction stems from our inability to enter the parasympathetic state. As a result, the body's rhythms are slowed, allowing for relaxation and recovery from the stress we experienced. Genuine forgiveness mitigates the negative effects by removing the stress that caused the sympathetic system to hyperactivate and switching the body to the parasympathetic state, which is beneficial to our physical and mental health.

What exactly is "therapeutic forgiveness?"
As a result, forgiveness has beneficial medical effects, playing an essential role in developing harmonious interpersonal relationships, which are responsible for what we commonly refer to as "happiness" and "life fulfillment." But is a simple "Forgive me!" sufficient? According to L.G. Jones, "therapeutic forgiveness" is more than "a word, an action, or a feeling," but "a way of life that necessitates the cultivation of character in this sense through discipline, practice, and time" [12].
At the moment, there is no consensus on how to define forgiveness from a psychological and medical standpoint; instead, there is more consensus on what is not "therapeutic forgiveness" and how the inability to forgive manifests itself. Thus, "therapeutic" forgiveness is more than just apologizing, justifying, forgiving, or formally agreeing with someone. Of course, depending on the context, these intrapsychic processes are essential, but true forgiveness entails a complex interpersonal process that goes beyond common forgiveness experiences [13]. It is an internal process that can lead to the reduction, and even cancellation, of resentful emotions, motivations, behaviors, and cognitions. [14] [15]
Speaking of "therapeutic forgiveness," Dr. Everett L. Worthington Jr., a clinical psychologist and Professor of Psychology at the University of Virginia in the United States believes that there are two types of forgiveness: decisional forgiveness, which involves only the determination to control your behavior towards the person who has hurt you, and emotional forgiveness, which is much more comprehensive, encompassing a variety of aspects such as which changes cognition. This final type of forgiveness entails being able to empathize with the perspectives of others and understanding that people are complex personalities with both positive and negative traits [19].
Thus, "therapeutic forgiveness" is defined first by decreasing negative thoughts, feelings, and actions toward those who have hurt us and increasing positive emotions such as acceptance and compassion. As a defining psychological trait, forgiveness is a complex way of being in the world that includes two aspects: low levels of negative affect (i.e., lack of depression and stress) and a more profound sense of meaning and purpose in life, which determines an existential state of well-being, better interpersonal relationships, and better personal development, through self-acceptance, social integration, and personal autonomy.
Thus, the simple abandonment of the "natural" right to be angry or, moreover, to accumulate resentment when someone wronged us has so many benefits for our state of mind and body health that the ability to forgive. At the same time, a selfless gesture in and of itself is the most "interested" choice possible.
Ana Gheorghiu

[1] Emmons, R. A. (2000). Personality and forgiveness. In M. E. McCullough, K. I. Pargament, & C. E. Thoresen (Eds.), Forgiveness: Theory, research, and practice (pp. 156–178). New York: Guilford Press, p. 171.

[2] Thoresen, C. E., Luskin, F., and Harris, A. H. S. (1998). Science and forgiveness interventions: Reflections and recommendations. In Worthington, E. L. (Ed.), Dimensions of Forgiveness, Templeton Foundation, Philadelphia, pp. 163–192.


[4] Seybold, K. S., Hill, P. C., Neumann, J. K., and Chi, D. S. (2001). Physiological and psychological correlates of forgiveness. J. Psychol. Christianity 20: 250–259.

[5] Lawler, K. A., Younger, J. W., Piferi, R. L., Billington, E., Jobe, R., Edmondson, K., and Jones, W. H. (2003). A change of heart: Cardiovascular correlates of forgiveness in response to interpersonal conflict. J. Behav. Med. 26: 373–393.

[6] Witvliet, C. V. (2001). Forgiveness and health: Review and reflections on a matter of faith, feelings, and physiology. J. Psychol. Theol. 29: 212–224.

[7] Reis, H. T. (2001). Relationship experiences and emotional wellbeing. In Ryff, C. D., and Singer, B.H. (Eds.), Emotion, Social Relationships, and Health, Oxford University Press, Oxford, UK, pp. 57–85.

[8] Witvliet, C. V. (2001). Forgiveness and health: Review and reflections on a matter of faith, feelings, and physiology. J. Psychol.Theol. 29: 212–224.

[9] Seybold, K. S., Hill, P. C., Neumann, J. K., and Chi, D. S. (2001). Physiological and psychological correlates of forgiveness. J. Psychol. Christianity 20: 250–259.

[10] Thoresen, C. E., Harris, A. H. S., and Luskin, F. (2000). Forgiveness and health: An unanswered question. In McCullough, M. E., Pargament, K. I., and Thoresen, C. E. (Eds.), Forgiveness: Theory, Research, and Practice, Guilford Press, New York, pp. 254–280.

[11] Cacioppo, J. T., Berntson, G. G.,Malarkey, W. B., Kiecolt-Glaser, J. K., Sheridan, J. F., Poehlmann, K. M., Burleson, M. H., Ernst, J. M., Hawkley, L. C., and Glaser, R. (1998). Autonomic, neuroendocrine, and immune responses to psychological stress: The reactivity hypothesis. Ann. New York Acad. Sci. 840: 664–673. Light, K. C., Girdler, S. S., Sherwood, A., Bragdon, E. E., Brownley, K. A., West, S. G., and Hinderliter, A. L. (1999). High stress responsivity predicts later blood pressure only in combination with positive family history and high life stress. Hypertension 33: 1458–1464. Lovallo,W. R., and Gerin,W. (2003). Psychophysiological reactivity: Mechanisms and pathways to cardiovascular disease. Psychosom.Med. 65: 36–45.

[12] Jones, L. G. (1995). Embodying forgiveness: a theological analysis. Grand Rapids, MI: Eerdmans Publishing Company, pp. xii-xiii.

[13] Worthington, E. L. Jr. (Ed.). (2005a). Handbook of forgiveness. New York: Brunner-Routledge.

[14] Worthington, E. L. Jr. (2005b). More questions about forgiveness: Research agenda for 2005–2015. In E. L. Worthington Jr. (Ed.), Handbook of forgiveness (pp. 557–574). New York: Brunner-Routledge.

[15] Mullet, E., Neto, F., & Riviere, S. (2005). Personality and its effects on resentment, revenge, and forgiveness and on self-forgiveness. In E. L. Worthington Jr. (Ed.), Handbook of forgiveness (pp. 159–182). New York: Brunner-Routledge.

[16] Worthington, E. L. Jr. (2005b). More questions about forgiveness: Research agenda for 2005–2015. In E. L. Worthington Jr. (Ed.), Handbook of forgiveness (pp. 557–574). New York: Brunner-Routledge.

[17] Flanigan, B. (1998). Forgivers and the unforgiveable. In Enright, R. D., and North, J. (Eds.), Exploring Forgiveness, University of Wisconsin Press, Madison, WI, pp. 95–105.

[18] McCullough, M. E. (2000). Forgiveness as human strength: Theory, measurement, and links to well-being. J. Soc. Clin. Psychol.19: 43–55.

[19] Horwitz, L. (2005). The capacity to forgive: intrapsychic and developmental perspectives. Journal of the American Psychoanalytic Association, 53, 485–511.

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