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Is Forgiveness a Public Health Issue?
Thursday August 16th 2018, 9:38 pm
Filed under: medicine and religion,public health,spirituality and mental health

By Tyler VanderWeele

It’s said that to err is human and to forgive is divine, but forgiveness may be a health-promoting behavior as well. Though often considered to be a very personal behavior, often linked with ethics or religion, a recent meta-analysis of 54 interventional studies on forgiveness suggests that this act has major health benefits as well. [4]

Forgiveness is sometimes defined as the victim’s choice reduce negative thoughts, emotions, and behaviors and replace these with positive thoughts, emotions, and behaviors toward the offender.[1-3]  It should be noted that forgiveness is distinct from condoning, justifying, or sanctioning the behavior of the wrongdoer, and it is not appropriate in situations of ongoing, sustained violence or abuse.

One example of community forgiveness comes from a 2016 incident in which a young, intoxicated man vandalized a mosque in Fort Smith, Arkansas. He subsequently realized the cruelty of his impulsive act, apologizing to the mosque community and asking for their forgiveness, which they freely gave. [8]. The members of the mosque community did not justify or excuse his actions but they made clear that they forgave him for and did not want to ruin his life. One member of the mosque wrote on social media, “we forgave you from the first time you apologized, don’t let that mistake bring you down  […] we don’t hold grudges against anybody!” The mosque members even asked for a more lenient sentence for the offender; though the case was eventually treated as a felony courts. However, sustained by the forgiveness of the community he had wronged, the former vandal gained a deeper awareness of the effects of his actions on others and become determined to never again commit such a heinous act. [8]

There is growing evidence that the choice to offer this kind of forgiveness can bring numerous benefits, both for the offender and for the victim. Forgiveness is linked to a number of health benefits: 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 evidence comes even from randomized trials of forgiveness interventions as well. A recent meta-analysis of 54 intervention studies suggested a sizable average effect of these interventions on increasing forgiveness itself [4] but these trials 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 might thus be seen as an issue of importance to public health.

Even in cases in which the offender does not repent, the victim’s personal choice to offer forgiveness may allow the victim to gain a measure of control over a painful event, and to move on from this trauma. In contrast to holding a grudge, which entwines the victim with the offender, offering forgiveness may allow the victim to free his/herself from entanglement with a wrongdoer.

One prominent intervention is Worthington’s REACH Model,[2] which offers a multi-step program for processing one’s feelings of being wronged and moving towards forgiveness. 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.


However, experts emphasize that care must be taken not to confuse forgiveness with a restored relationship. Forgiveness does not require victims to have ongoing contact with a person who may be dangerous or violent. Additionally, the health benefits of forgiveness do not apply to situations of prolonged, ongoing abuse such as intimate partner violence.

The spiritual undertones present in a discussion of forgiveness must also be addressed. Many world religions champion forgiveness as a personal practice as well as a quality of divinity. Forgiveness is a form of love towards another imperfect human being, and it also separates the person’s act from the person themselves, giving the wrongdoer space to change. Forgiveness allows the victim to retain choice and agency, but also respects the wrongdoer as a moral agent who has failed but may choose to be better in the future. In this way, forgiveness can promote love, compassion, acceptance, and harmony in human relations – worthy goals from the perspective of both public health officials and people of faith.



[1] Toussaint LL, Worthington EL, Williams DR, eds. Forgiveness and Health: Scientific Evidence and Theories Relating Forgiveness to Better Health. Dordrecht, The Netherlands: Springer; 2015.

[2] Worthington EL. Forgiveness and Reconciliation: Theory and Application. New York, NY: Taylor & Francis; 2006.

[3] Enright RD, Fitzgibbons RP. Helping Clients Forgive: An Empirical Guide for Resolving Anger and Restoring Hope. Washington, DC: American Psychological Association; 2000.

[4] Wade NG, Hoyt WT, Kidwell JE, Worthington EL. Efficacy of psychotherapeutic interventions to promote forgiveness: a meta-analysis. J Consult Clin Psychol. 2014;82(1):154–170.

[5] Harper Q, Worthington EL, Griffin BJ, et al. Efficacy of a workbook to promote forgiveness: a randomized controlled trial with university students. J Clin Psychol. 2014;70(12):1158–1169.

[6] Holmgren MR. Forgiveness and the intrinsic value of persons. Am Philos Q. 1993;30:341–352.

[7]Stump E. Love, by all accounts. Proc Addresses Am Philos Assoc. 2006;80:25–43.

[8] Tavernise S. The Two Americans. The New York Times. . Posted: 8/26/2017. Accessed: 8/11/2017.


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