Forgive and be well?

Close your eyes and think of someone who has hurt you. The offense may be profound or small but deeply painful, a single arrow to your heart or a thousand wounding slights. The perpetrator may be a stranger -- the guy who caused your accident, the gang-banger who took your child. More likely, it will be someone close and trusted. The sister who killed herself. The parent who lashed out, the spouse mired in addiction, an unfaithful lover.

Maybe it’s the boss who’s a tyrant, the business partner who’s an idiot, the trickster who seduced you. It might even be yourself.

Let all the anger, hurt and resentment you feel for that wrongdoer bubble to the surface. Seethe, shout, savor it. Feel your heart pounding, your blood boiling, your stomach churning and your thoughts racing in dark directions.

OK, stop. Now, forgive your offender. Don’t just shed the bitterness and drop the recrimination, but empathize with his plight, wish him well and move on -- whether he’s sorry or not.

University of Wisconsin psychologist Robert D. Enright, the guru of what many are calling a new science of forgiveness, calls this final step “making a gesture of goodness” to a wrongdoer. It’s the culmination of a process that, he insists, “you’ve got to be able to see through to the end.”

But why, exactly, would you do that? For the good of your soul? To hold the family or business together, to make the world a better place?

A growing corps of researchers thinks they have it. Forgiveness -- a virtue embraced by almost every religious tradition as a balm for the soul -- may be medicine for the body, they suggest. In less than a decade, those preaching and studying forgiveness have amassed an impressive slate of findings on its possible health benefits.

They have shown that “forgiveness interventions” -- often just a couple of short sessions in which the wounded are guided toward positive feelings for an offender -- can improve cardiovascular function, diminish chronic pain, relieve depression and boost quality of life among the very ill.

An AIDS patient who has forgiven the person presumed to have transmitted the virus is more likely to care for him or herself and less likely to engage in unprotected sex. Those more inclined to pardon the transgressions of others have been found to have lower blood pressure, fewer depressive symptoms and, once they hit late middle age, better overall mental and physical health than those who do not forgive easily.

Collectively, researchers say, these findings suggest that failure to forgive may, over a lifetime, boost a person’s risk for heart disease, mental illness and other ills -- and, conversely, that forgiving others may improve health. Like proper nutrition and exercise, forgiveness appears to be a behavior that a patient can learn, exercise and repeat as needed to prevent disease and preserve health.

“Who would have thunk it -- that something locked away in religious culture could be turned into a secular training program,” says psychologist Fred Luskin, director of Stanford University’s Forgiveness Projects and a leading researcher in the field who teaches groups -- many of them bound together in the workplace -- to forgive offenses large and small. “It’s a skill that can be taught.”

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Health-forgiveness link

Psychologist Loren Toussaint of Luther University in Decorah, Iowa, and colleagues were the first to establish a long-term link between people’s health and their propensity to forgive.

Their national survey, published in the Journal of Adult Development in 2001, found forgiveness rare enough: Only 52% of Americans said they had forgiven others for hurtful acts. But willingness of young respondents to forgive showed no link to health; that propensity began to make a difference as respondents approached middle age. The survey found that those 45 and older who forgave others were more likely to report having better overall mental and physical health than those who did not.

Everett Worthington, a professor of psychology at Commonwealth Virginia University and a leading researcher on the links between forgiveness and health, has put many a study subject through the paces of pardoning and measured the resulting physiological effect.

Worthington is a believer, both in the goodness of forgiveness and its power to influence health and wellness. The first part of that conviction springs from his Christian upbringing, he says. But he insists the latter has been forged by studies that rigorously test whether forgiveness -- including the replacement of hostility and negative feelings with “compassion, empathy or love” for the offender -- can blunt or reverse the physiological stress of chronic anger.

“We are limited in what we can conclude,” Worthington acknowledges. As a means of diffusing stress and its negative health effects, finding a way out of anger and resentment clearly yields benefits, he says. But it’s not so clear that developing good feelings for your transgressor -- the standard many of those conducting forgiveness research embrace -- will enhance health. “It’s a lot easier to document the reduction in bad effects than to document the increase in good effects,” he says.

Worthington’s own ability to forgive was put to the test in 1996, when his elderly mother was killed in her apartment by a crowbar-wielding intruder. Although a suspect was arrested and police said he initially confessed to the crime, irregularities in the handling of evidence resulted in the suspect being released. Nevertheless, Worthington says, he had run the full course of shock, anger and grief and was ready to forgive in less than a month after his mother’s death.

“I look back and I think, for me, what a mercy from God that I could spend eight years examining forgiveness before I had to deal with it. I had already thought through so many of these issues before I had to apply them.”

Efforts to put forgiveness to a rigorous scientific test have been funded largely by a pair of philanthropies long associated with research on faith, religion and science: the Michigan-based Fetzer Foundation and the John Templeton Foundation of Pennsylvania, which effectively created the field in 1997 with a pledge of $2 million for research on forgiveness. The leading thinkers on the subject, including Worthington, are clinical and academic psychologists whose devotion to the goal of forgiveness either springs from religious teachings or verges on the religious.

These origins raise discomfort and controversy among both scientists and those who help the physically and mentally wounded heal. For if forgiveness is first a virtue -- as it is in Christianity, Judaism, Islam and Buddhism -- it is an objective to be striven for irrespective of self-interest. If it is to be a means of enhancing health, treating illness or preventing disease, forgiveness must be abandoned as a virtue, tested with scrupulous neutrality and valued only inasmuch as it serves a patient’s needs.

For many scientists, the value of forgiveness in physical and mental health remains an intriguing prospect in the earliest stages of rigorous study -- but far from a prescription for maintaining health or treating illness. To many in mental health who fear that traumatized patients face pressure to forgive when doing so is premature or ill-advised, the new science of forgiveness is deeply worrisome.

“The whole Christian, 12-step mentality has permeated our culture, and the emphasis on forgiveness is part of that,” says Jeanne Safer, a New York psychoanalyst and author of “Must We Forgive?” “For many patients, forgiveness is a double-whammy: First someone screws you, and then it’s your fault you don’t want to embrace them in heaven. I’m not against forgiveness; I’m against compulsory forgiveness with no choice. And I’m against ‘forgiveness lite,’ which keeps you from feeling the intensity of the experience, from deeply grappling with what’s been done to you.”

Among victims of incest -- many of whom have turned blame inward or fear that forgiveness entails reconciliation with an abuser -- pressure to forgive can be extremely stressful, and sometimes impossible, says Linda Davis, the executive director of Survivors of Incest Anonymous. “I always tell ministers, ‘Don’t use the F-word.’ ”

“You have to get to a place of acceptance,” says Davis. “Forgiveness is a bonus. You don’t have to get there.”

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Self versus others

Scientific scrutiny has a way of upending pious notions, and the science of forgiveness is no exception. While much of the field’s early work has focused extensively on forgiveness of others, academic psychologists and clinicians are turning up evidence that forgiving oneself might have a more powerful effect on overall health and well-being.

Eruptions of anger at others have been shown, clearly, to increase the risk of heart arrhythmias, heart attacks and high blood pressure, says Dr. Douglas Russell, a Veterans Administration cardiologist who, in a 2003 study, found that the coronary function of patients who had suffered a heart attack improved after a 10-hour course in forgiveness. But when anger is turned inward, bottled up and directed at oneself, lack of forgiveness appears likely to have an ongoing, toxic health effect that may be even more corrosive to physical and mental health than anger directed outward.

“Sometimes people hurt us, and we move on, and it might fade,” says Toussaint, the psychologist. As he has refined that work with better definitions of forgiveness, however, Toussaint says he has been surprised to learn that those who hold onto self-blame may suffer more. “Forgiveness of self holds the more powerful punch,” says Toussaint. “The effects are dramatic.”

In work not yet published, Toussaint found that men who do not forgive themselves readily are seven times more likely to meet the full diagnostic criteria for clinical depression than men who do. Highly self-forgiving women are three times less likely to have the symptoms of clinical depression -- a risk factor for a host of ills -- than their sisters who are prone to regret and self-blame. Those more forgiving of themselves also get more sleep and are in better overall health, he has found.

It’s an effect that Toussaint has seen extensively -- with related health effects -- in combat veterans who come home unable to forgive themselves for what they did, or did not do, in battle. Other researchers have studied self-blame and forgiveness in cancer patients, those living with HIV/AIDS and victims of incest and abuse, many of whom blame themselves for their plight.

“The human mind is sometimes an instrument of misery. When you’ve done wrong to others and regret it, it bubbles up again and again,” says Toussaint. “There’s no escaping the perpetrator.”

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If forgiveness rings false

Findings as this, some say, could pose a problem for what Safer, the New York psychoanalyst, calls “the forgiveness lobby” -- the loose congregation of researchers, faith-based advocates and motivational gurus devoted to the promotion of forgiveness and its benefits.

These early pioneers of the forgiveness field have focused largely on an unselfish, altruistic version of forgiveness -- one that replaces ill will toward hurtful others with positive feelings. By contrast, while the health benefits of forgiving oneself for past mistakes or misdeeds may be considerable, there is arguably little altruism in it, says Safer. Does that, she wonders, make it a less appealing object of research or a less worthy goal for clinicians to foster?

And then there is the complex relationship, for many people, between forgiveness of others and self-blame.

Clinicians skeptical of forgiveness as a necessary endpoint of therapy say they are quick to recognize them: Many of those who are quickest to forgive others, often at the urging of a relative or clergy member, do so because they blame themselves for the bad things that have happened to them. Others forgive too quickly because they are unwilling to acknowledge their general feelings of shame and anger or simply because they feel unworthy of better treatment.

Safer calls this “fake forgiveness.” It allows victims to continue blaming themselves, she says. And it’s a dangerous side effect of what Safer sees as a bid to sell forgiveness as a panacea.

Lydia Temoshok, a clinical and social psychologist at University of Maryland’s Institute of Human Virology, has seen and studied plenty of chronic self-blamers only too willing to forgive others who have wronged them. In her study of patients infected with HIV, Temoshok knows these as “Type Cs.” They are not the hard-charging, angry Type A’s who are given to heart disease or the easy-rolling, deal-with-it Type Bs who tend to enjoy better health, but the ones who deny problems, suppress strong feelings and tend to stay in stressful situations longer, putting their health at greater long-term risk.

Emerging research suggests that a person’s Type C designation, says Temoshok, is a powerful predictor of HIV’s progression to AIDS, as well as the progression of melanoma -- a fact that strongly suggests that this mode of coping can wreak havoc on the immune system.

Temoshok says these are the patients in her lab whose mouths utter the words of forgiveness but whose central nervous systems tell the real story. They may believe their willingness to forgive with all their hearts, she says, but their hearts are working overtime to sustain the fiction. “They’re going to have the high physiological reactivity of a Type A without knowing,” says Temoshok, “which is why it’s so lethal, because you can’t do anything about it when Type Cs are pushing away a lot of that useful feedback.”

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Letting go of anger

Jeffrey R., a Maryland man whose father sexually molested him and three siblings as children, acknowledges that self-blame and denial after the abuse has exacted a terrible cost on his family. Two older brothers -- both of whom have refused to discuss their father’s actions -- have had seven heart attacks between them before the age of 60. One is a drug addict for whom a longtime stomach ailment now threatens to become deadly. Another lives alone, “eats unhealthy, lives unhealthy,” says Jeffrey, a member of Survivors After Incest who spoke on condition that his full name not be revealed.

“When you have this background, you become very skilled at pretending things are OK, just ignoring it,” says Jeffrey. Meanwhile, the guilt, shame and anger, he says, “are just consuming.”

After nine suicide attempts and decades of contending with crippling temper and suspicion toward others, Jeffrey says he’s not ready to forgive the father who did it, the mother who looked the other way or the aunts and uncles who, after the abuse came to light, refused to discuss it. His sister, who was raped by her father at 5, has embraced forgiveness, says Jeffrey, telling her brother God will judge their father. Jeffrey insists he’s let go of the anger and bitterness caused by his abuse, and it “has saved my life.”

But forgiveness on the same level as his sister’s? “I’m not really there yet,” he says.

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