How forgiveness heals the body

I had just moved into a city where I knew only 6 people. It also was the beginning of the worst year of my life, as detailed in my previous post. I needed to build up my private practice, because the bank kept insisting that I pay my mortgage. A physician had referred a client to me, and Iris[i] was the very first client I had. She entered my office, a pleasant middle-aged woman, ordinary in every way. I pushed thoughts of my toxic business partner out of my mind and took a deep breath. I focused fully on what she was saying. “I have non-stop headaches” Iris told me. “I have lived in pain for two years straight.” I am a psychologist, not a physician, so I could not prescribe pain meds. But, I could learn what happened two years earlier, so I asked. “My brother and I got into a huge fight over my Dad’s inheritance.” He said some nasty things, and I am so angry at him.” Her lips tightened a bit, mirroring the tension in her head. We explored what happened, and I empathized with her. The second session was similar, but near the end of the session, she spontaneously admitted that she had thrown some slashing words at him as well.

When Iris came in for the third session, she filled in the scales of psychological distress as usual. There was a huge jump, far above the improvement seen in the average client. She put down the clipboard, and I remarked that she was reporting a lot of change. She smiled and said “yeah, my headache is completely gone. I am sleeping just fine now.” She continued “I felt better at the end of last session and realized that life is too short to carry such anger. I called my brother, and we talked things through. My head cleared completely, and I feel great.” We talked some more, and at the end, Iris commented, “I feel so good, I don’t know if I need another session.” I hesitated a split-second, but I knew that however empty my calendar was, it would be unethical to hold onto her as a client. “Well, if you need my services in the future, you know where to find me,” I said. She smiled, said thanks, and left my office. I never saw her again.

Which was the best possible outcome. Her choice to forgive her brother had a cascade of positive effects. Her mood improved substantially. Two years of headaches vanished, as Iris and her brother released their bitterness to each other. With the tension gone, her sleep improved. Iris was a textbook case of the role of bitterness and forgiveness in health.

It will not surprise you to learn that the deeper the transgression that the person has experienced, the worse they report that their physical health is.[ii] The psychological injuries of betrayal, rejection, or abuse result in problems throughout the body. On the flip side, if people are more able to forgive others, then they report having better physical health. Summaries of over 100 studies, with nearly 60,000 people in them, consistently found that those people who reported greater forgiveness reported better health. [iii] What is interesting is that the link between forgiveness and physical health was not affected by age, gender, race, education, or employment status. [iv] Whether you are a single white male who is finally starting college after years of underemployment, or an elderly married black woman with a MBA, practicing forgiveness is associated with better physical health.

Sharp-eyed readers may have noticed that I said there was an association. What if healthy people are happy, and therefore forgiving? Does being bitter actually cause poor health? One way to find out is to track people over time. When researchers followed a large sample of elderly Americans over three years, they found that if people were low in forgiveness, then their physical health declined over the span of three years. They ran the numbers to see if having poor physical health in the first place made people bitter years later, but this was not the case in multiple countries [v] [vi] Other studies found that being forgiving resulted in better emotional health later on [vii] [viii] [ix] but not better physical health. That may be because 90% of the people in the latter study were quite forgiving already.

The best way to determine if forgiveness improves physical health is to run a randomized trial. In a sophisticated study, veterans who did forgiveness therapy showed significantly better blood flow in the muscle of the heart, than those that did another type of psychotherapy.[x] This is such a fascinating result. I would have never guessed that letting go of bitterness, would allow blood to flow more smoothly through the muscle of the heart. Hanging on to anger blocks the movement of blood in the heart. One day in the future, science may unpack the biological processes that are going on. But the larger question of how doing the spiritual work of forgiveness changes the capillaries in the heart will be a mystery.

Forgiveness changes other physical problems. Women with fibromyalgia who had been abused in childhood by their parents were given this intervention. They had significantly better physical and psychological health at the end of the study than the control group, who received education about fibromyalgia.[xi] In a fascinating study, forgiveness even makes certain drugs work better. People who were high in forgivingness reported significantly more pain relief from acetaminophen than people low in forgivingness. The pill did nothing for them, as the bitter people had slightly more pain after swallowing pain relief medication for 3 weeks![xii]

What diverse results. Forgiveness improves blood flow in the heart muscle, reduces fibromyalgia, and even helps pain relief medication work better. This validates that people who are more forgiving have better physical health. This raises a very important question for you. Is there someone to whom you feel bitterness? I am sure that there are valid reasons for your anger to them, but carrying that anger is slowly damaging your body. I encourage you to make the choice to release that anger, so that you can live in far more freedom. If the hurt and anger is deep, then a religious leader or a therapist can be quite helpful in guiding you through the process. When I took the steps to forgive, I felt the poison release bit from bit in my cells. It was a long slow process, but I no longer felt I was losing years of my life by carrying the toxin of bitterness. It is very worthwhile for you to take the same steps.

[i] Not her real name. Details have been altered to maintain confidentiality.

[ii] Webster NJ, Ajrouch KJ, Antonucci TC. (2021). Towards positive aging: Links between forgiveness and health. OBM Geriat. 4(2):10.21926/obm.geriatr.2002118. doi: 10.21926/obm.geriatr.2002118. PMID: 34296188

[iii] Rasmussen KR, Stackhouse M, Boon SD, Comstock K, Ross R. (2019). Meta-analytic connections between forgiveness and health: The moderating effects of forgiveness-related distinctions. Psychol Health. May;34(5):515-534. doi: 10.1080/08870446.2018.1545906. PMID: 30632797

[iv] Lee YR, Enright RD. (2019). A meta-analysis of the association between forgiveness of others and physical health. Psychol Health. May;34(5):626-643. doi: 10.1080/08870446.2018.1554185. PMID: 30669877

[v] Seawell AH, Toussaint LL, Cheadle AC. (2014). Prospective associations between unforgiveness and physical health and positive mediating mechanisms in a nationally representative sample of older adults. Psychol Health. 29(4):375-89. doi: 10.1080/08870446.2013.856434. PMID: 24266673

[vi] Cook KV, Kurniati NMT, Suwartono C, Widyarini N, Worthington EL Jr, Cowden RG. (2022). Differential effects of decisional and emotional forgiveness on distress and well-being: A three-wave study of Indonesian adults. Front Psychol. Oct 6;13:918045. doi: 10.3389/fpsyg.2022.918045. PMID: 36275245

[vii] Cowden RG, Chen ZJ, Bechara AO, Worthington EL Jr. (2023). Associations of dispositional forgivingness with facets of well-being among Colombian adults: A longitudinal outcome-wide analysis. Int J Psychol. Apr;58(2):153-163. doi: 10.1002/ijop.12883. PMID: 36251713

[viii] Toussaint LL, Shields GS, Slavich GM. (2016). Forgiveness, stress, and health: A 5-week dynamic parallel process study. Ann Behav Med. Oct;50(5):727-735. doi: 10.1007/s12160-016-9796-6. PMID: 27068160

[ix] Long KNG, Worthington EL Jr, VanderWeele TJ, Chen Y. (2020). Forgiveness of others and subsequent health and well-being in mid-life: A longitudinal study on female nurses. BMC Psychol. Oct 1;8(1):104. doi: 10.1186/s40359-020-00470-w. PMID: 33004075

[x] Waltman, M. A., Russell, D. C., Coyle, C. T., Enright, R. D., Holter, A. C., & Swovoda, C. (2009). The

effects of a forgiveness intervention on patients with coronary artery disease. Psychology and

Health, 24, 11–27. doi:10.1080/08870440801975127 PMID: 20186637

[xi] Lee, Y.-R., & Enright, R. D. (2014). A forgiveness intervention for women with fibromyalgia who were abused in childhood: A pilot study. Spirituality in Clinical Practice, 1, 203–217. doi: 10.1037/scp0000025 PMID: 25914886

[xii] Slavich GM, Shields GS, Deal BD, Gregory A, Toussaint LL. (2019). Alleviating social pain: A double-blind, randomized, placebo-controlled trial of forgiveness and acetaminophen. Ann Behav Med. Nov 9;53(12):1045-1054. doi: 10.1093/abm/kaz015. PMID: 31050715