Forgiveness and Self-Forgiveness in Healthcare

The Covid-19 pandemic has wreaked havoc in the lives of people across the world. During my ten years as the director of a Pastoral Care program at a cancer hospital in Philadelphia, I came to realize that there is also a spiritual epidemic that depletes the physical and mental health of both patients and providers: unforgiveness.

Before serving in the cancer hospital, I had undergone 8 years of formal theological education. To my dismay, I found that my training had not prepared me to help my ill and dying patients find emotional peace. Clergy, regardless of religious tradition, encourage their devotees to forgive. The hard part, of course, is doing it. With the help and support of experts in theology, psychology and psychoneuroimmunology, our team constructed a fogiveness therapy program that our patients, caregivers, nurses and physicians have found to be life-giving.

In this article, I will explain the difference between anger and hatred, provide a few examples of forgiveness therapy in practice, and share my hopes for how forgiveness therapy may facilitate healing for healthcare workers during this pandemic.

Hatred as a Co-Morbidity

Hatred is the core emotion of unforgiveness. Left untreated, it can destroy marriages, families, and societies as well as our health. Directed inward, it can destroy a life and/or a career.

My team’s research suggests that forgiveness, on the other hand, goes hand-in-hand with hope.

Our team devised a forgiveness protocol based upon the results of our peer-reviewed research. Self-assessed Likert scale questionnaires were given to a group of cancer patients, caregivers and nurses in order to determine their attitudes about forgiveness. Here’s what we learned: 66% of the people we surveyed described themselves as currently having forgiveness-related issues in their lives. 33% of them described themselves as having strong to severe forgiveness issues.

Unforgiveness was not unique to cancer patients. However, we found that the cancer patients felt more strongly motivated to seek and, hopefully, find the forgiveness they longed for. Almost everyone struggles with forgiving themselves or others. Most know that they should put their past in their past, and they suspect that their inability to do so impacts their quality of life. But few know how to do so.

Targeted Therapy: Anger, Hatred, Forgiveness and Justice

There are no universally accepted definitions for the words “anger” and “hatred.” College students of mine searched 60 different dictionaries within various disciplines and found numerous nuances in the definitions. We concluded that anger is the feeling we feel when we lose power or control over something or someone. We get angry at ourselves and/or others when we can’t make/force someone to do something we want them to do (or stop doing).

Hatred, on the other hand, is associated with harm. To hate someone is to desire harm to befall them; directly through our own actions, or indirectly through the actions of others. There is a significant difference between the emotion of anger and hatred. For example, we can be angry at a child and not hate them.

Unforgiveness involves the retention of hatred toward self or others. Forgiveness therapy attempts to neutralize the toxicity of hatred, while leaving the reasonably healthy aspects of anger in place. Anger, at its best, provides motivation to right wrongs and seek justice. Forgiveness should not inhibit a person’s desire to seek justice, but it should diminish their desire to harm themselves or others.

How does forgiveness therapy work in practice?

Example 1: A professional dispute.

Imagine a dispute where you feel professionally sabotaged or undermined by a colleague. You are upset and seek advice from a trusted friend bearing religious credentials who, in turn, encourages you to forgive them and move on. Following that, you and I have a conversation:

Me: Do you desire harm, professional or otherwise, to befall the perpetrator?

You: No. I don’t want to harm them.

Me: Then it’s NOT a forgiveness issue. It’s an anger issue. You are angry and would like to see them held accountable for the unethical behavior. Forgiveness does not mean that you ignore the wrongful behavior. In fact, you should be angry. You have a right to be angry and your desire to hold them accountable for the unethical behavior is a good thing and to be encouraged.

Anger, at its best, motivates us to want to right wrongs. Your anger at the perpetrator is justified and you should try to find a way to positively resolve the feelings. A private conversation yielding an apology might go a long way to heal this wound.

Example 2: A Painful Lawsuit.

Imagine being sued for malpractice based upon a false, slanderous and libelous accusation. Rightfully, you are sad and furious. Without question, few things are more painful than being falsely accused and being treated unfairly by both lawyers and the judicial process. As if dealing with the overwhelming emotional strains of a lawsuit wasn’t enough, you have continued to provide the highest level of care to your patients. But here is the question for you as well as your administrators: What institutional support was offered to you and those like you? Probably none. Our conversation might have gone something like this:

Me: Do you hate your accuser? Would you like to see them harmed?

You: Absolutely.

Me: How would you harm them?

You: I’d like to sue them for everything they’ve got, if not punch them in the face if I could.

Me: Understandable. But here’s what I hope for you. I hope that someday, not now but someday, you’ll be able to reach a point where you are able to look at your accuser with emotional indifference; not necessarily positive, but not negatively either.

I once counseled a woman who went through a horrible divorce. She hated her ex-husband with a perfect hatred. The hatred’s damage was two-fold: it ruined the quality of her life and also ruined her relationship with her two kids (who still loved their dad.) Eventually, she was able to forgive her ex-husband to the point where he and his new wife were invited to the kids’ birthday parties. Forgiveness allowed her hatred to dissipate along with the added benefit of connecting again with her children. She no longer loved him, but she no longer hated him either. She reached a state of peaceful indifference.

I want all of the people I counsel to hold open the possibility that one day, down the road, they might feel very differently about all they are going through. In the mean time, here’s my advice: Do no harm.

I can’t promise anyone that things will get better. But offering a vision of a new and better future, based upon evidenced-based research and years of providing forgiveness interventions, is reasonable. Sometimes all we need is a little hope to be able to continue.

Forgiveness Therapy in Healthcare*

Beyond creating a “blame free” culture, designed to increase self-reporting, physicians are left with few resources to help reduce levels of anguish and frustration when being falsely accused. However, errors do sometimes occur and unintentional harm does befall patients. At such times, physicians find themselves under attack from the outside as well as within. Triaging their emotions is critical for optimum patient care….and self-care.

Learning to find forgiveness of self and others is not a cure-all, but it is, for some, a foundation for finding peace with God, with yourself and others. In my 10 years of providing pastoral care to cancer patients, I found that leaving this life in peace was patients’ highest spiritual priority. We all would do well to learn how to forgive before we find ourselves nearing the end of life.

The world needs you.

Your patients need you. Your colleagues need you. Your family and friends need you. You’ve spent countless years honing your skills to make the world a better place. Adding the ability to forgive will benefit everyone, especially you.

The ability to forgive comes with practice. Knowing its health benefits creates an entirely different conversation, which I am very glad to have begun with you.