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Forgiveness: The Fountain of Youth?

written by Kathi Norman 22 May 2018

Dr. Kathi Norman, MAPP '17, is a physician assistant, international speaker, and founder of Positive Medicine. Her passion is the marriage of medicine and positive health including both sustaining the well-being of health-care providers and developing optimism and other positive health traits in her patients. Kathi has studied healthcare law, global medicine and healthcare administration completing her doctorate in medical science. Website. LinkedIn Profile. Kathi's articles for Positive Psychology News are here.

“Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” The World Health Organization (WHO)

Forgiveness is sorely misunderstood and complex.

Forgiveness is a process of replacing the negative thoughts, emotions, and behaviors one might hold toward the transgressor with more positive, prosocial responses while still holding the transgressor accountable.

Forgiveness, according to Gandhi
Click to read words.

Forgiveness is not a pardon or excuse. It does not mean forgetting, denying, or condoning. One does not need to reconcile or have a relationship with the transgressor. Forgiveness is not for the transgressor; it is for the transgressed.

Unforgiveness involves the nurturing of anger, hostility, resentment, and fear.

The practice of forgiveness has been found to improve health outcomes because it helps to reduce physiological responses to stress. Other factors that affect the forgiveness-health connection are the presence of social support, relationship quality, and religious inferences. Let’s review the research that explores the effects of forgiveness on the autonomic nervous system, cardiovascular disease, the immune system, chronic pain, autoimmune disorders, anxiety and depression, HIV, and longevity.

This article is about why to forgive, not how to forgive. For ideas about ways to forgive, consult articles on that topic on this site.

Stress Hormones and Immune Function

Impact of chronic flight or flight

Have you ever felt your heart pound, muscles tense and your breath rapid when experiencing a stressful event? Then you have experienced the “fight or flight” reaction. While the stress response is critical in running from a predator, it becomes pathogenic when sustained. Many westernized diseases occur or are worsened by the condition of toxic unremitting stress over time.

Stress is unavoidable. How we manage this state makes a difference in physical health and psychological well-being. Stress changes one’s physiology, behaviors, and genetics. Chronic unremitting stress is lethal like a gun or knife. Left unchecked, stress may even begin to change one’s genetic components that leads to pathology at the same time the disease becomes irreversible and inheritable by one’s offspring.

Chronic activation of the stress response is maladaptive because it increases the risk for certain diseases by suppressing functions such as tissue repair, sleep, bone strength maintenance, and immunity. Sustained levels of cortisol can cause the hippocampus (the part of the brain responsible for integration of memory) to shrink. Accurately perceiving stressors and sources of coping is important to reduce this physiological response, and individual differences in temperament and personality are factors in understanding the stress response in humans.

Forgiveness has been found, when practiced, to calm down the stress response. The consequence of being forgiving is that one experiences less stress, depression, anxiety, and hostility as well as more satisfaction with life.

Anxiety and Depression

Forgiveness therapy helps to reduce anger, anxiety, and depression. Anxiety disorders are the most prevalent mental disorders in the United States. As many as one half of those diagnosed with depression have an associated diagnosis of anxiety. Rumination, or repetitive unhealthy contemplation, is linked to depression, anxiety, mixed anxiety/depression disorders, behavior disorders, and substance abuse. Rumination has been found to keep the transgressed in the loop of unforgiveness. For those who achieve forgiveness, restorative hope and self-esteem improve anxiety and depression.


Chronic pain and fibromyalgia

Forgiveness is currently being assessed with growing interest as an essential tool in coping with chronic pain. Current research in forgiveness therapy involved with chronic pain involves affective, behavioral, motivational, and cognitive components. With interpersonal and social stressors having a unique and powerful contribution to chronic pain, forgiveness has been found to be a useful and productive response.

If fibromyalgia (FM) symptoms could be associated with anger, resentment, and stress related to childhood abuse and neglect, then reducing anger and stress and forgiving a perpetrator might result in diminishing the influence on the neurophysiological process of FM. Forgiveness practice in women with FM and childhood abuse or neglect improved overall FM health and decreased anger.

Not a great blood pressure reading

Blood Pressure

Forgiveness can produce valuable effects directly by reducing the allostatic load (the amount of energy for recovery of wear and tear on the body) associated with betrayal and conflict, and indirectly through lowering perceived stress. Lower blood pressure and high blood pressure recovery were found to be associated with higher levels of forgiveness.

Sustained stress over long periods can cause damage to the heart and blood vessels through the elevation of blood pressure. If unforgiveness is prolonged, wear and tear to the heart and blood vessels can lead to permanent damage and disability. Loss of vision, kidney failure, and heart failure are downstream results of chronic untreated hypertension.

Coronary Artery Disease

Coronary Artery Disease and Vascular Resistance

Perfusion, or the distribution of blood to the heart muscle, is reduced when recalling anger. This increases the risk of coronary heart disease with the likelihood of a poorer prognosis for those with heart disease. Failure to forgive unconditionally has an influence on one’s mortality. One possible antidote to attenuate the cardiotoxic effects of anger is through cultivating forgiveness. Forgiveness has been found to be associated with lower total cholesterol and higher HDL-to-LDL ratios, both indicators of cardiac health.


HIV/AIDS is a communicable disease that affects the autoimmune system, compromising health and many aspects of life for the person afflicted. HIV research aims at improving quality of life and managing chronic illness. The practice of forgiveness may be one way to improve quality of life in HIV positive persons. Research and theory on psychoneuroimmunology and HIV suggests that biological, psychological, and behavioral aspects interact in complex ways to influence quantifiable disease progression. HIV research demonstrates that a slower rate of disease progression, measured as preserved CD 4 count (a type of white blood cell that moves through the blood to find and destroy bacteria, viruses, and other invading germs) and lower viral load (the measurement of amount of virus in a system) in those with a positive view of God as benevolent and forgiving.

Self-administered Salve


Personal differences, daily frustrations, hurts, and injustices we experience throughout our lives can impose deep wounds in our bodies and minds. Forgiveness can serve as a powerful, self-administered salve. If one does not forgive, it is like handing the transgressor the skeleton key to the door of one’s life. Forgiveness might not prevent the pain of the past, but it can reduce suffering in the future. ?


Norman, K. (2017). Forgiveness: How it manifests in our health, well-being and longevity. MAPP capstone, University of Pennsylvania.

Friedberg, J. P., Suchday, S., & Shelov, D. V. (2007). The impact of forgiveness on cardiovascular reactivity and recovery. International Journal of Psychophysiology, 65, 87-94.

Greening, S. G., & Mitchell, D. G. (2015, September 10). A network of amygdala connections predict individual differences in trait anxiety. Human Brain Mapping, 36, 4819-4830. https://doi.org/10.1002/hbm.22952

Ironson, G., Stuetzle, R., Ironson, D., Balbin, E., Kremer, H., George, A., … Fletcher, M. A. (2011). View of God as benevolent and forgiving or punishing and judgement predicts HIV disease progression. Journal of Behavioral Medicine, 34, 414-425. http://dx.doi.org/10.1007/s10865-011-9314-z

Lee, Y., & Enright, R. D. (2014). A forgiveness intervention for women with fibromyalgia who were abused in childhood: A pilot study. Spirituality in Clinical Practice, 3, 203-217. https://doi.org/10.1037/scp0000025

Martin, L. A., Vosvick, M., & Riggs, S. A. (2011). Attachment, forgiveness, and physical health quality of life in HIV + adults. AIDS Care, 24, 1333-1340. https://doi.org/10.1080/09540121.2011.648598

May, R. W., Sanchez-Gonzalez, M. A., Hawkins, K. A., Batchelor, W. B., & Fincham, F. D. (2014). Effect of anger and trait forgiveness on cardiovascular risk in young adult females. The American Journal of Cardiology, 114, 47-52. http://dx.doi.org/10.1016/j.amjcard.2014.04.007

McCullough, M. E., Orsulak, P., Brandon, A., & Akers, L. (2007). Rumination, fear, and cortisol: An in vivo study of interpersonal transgressions. Health Psychology, 26, 126-132. https://doi.org/10.1037/0278-6133.26.1.126

Offenbacher, M., Dezutter, J., Vallejo, M. A., & Toussaint, L. L. (2015). The role of forgiveness in chronic pain and fibromyalgia. In L. L. Toussaint, E. L. Worthington, Jr, & D. R. Williams (Eds.), Forgiveness and Health: Scientific Evidence and Theories Relating Forgiveness to Better Health (pp. 123-138). New York, NY: Springer Science.

Randall, M. (2013). The physiology of stress: Cortisol and the hypothalamic-pituitary-adrenal axis. Dartmouth Undergraduate Journal of Science.

Reed, G. L., & Enright, R. D. (2006). The effects of forgiveness therapy on depression, anxiety, and post traumatic stress for women after spousal emotional abuse. Journal of Consulting and Clinical Psychology, 74, 920-929. https://doi.org/10.1037/0022-006X.74.5.920

Sapolsky, R. M. (2004). The physiology and pathophysiology of unhappiness. In E. L. Worthington Jr. (Ed.), Handbook of Forgiveness (pp. 273-303). New York, NY: Taylor & Francis Group.

Shapiro, J. (2005). Visual thinking strategies: A new role for art in medical education. Family Medicine, 37, 250-252.

Temoshok, L. R., & Wald, R. L. (2005). Forgiveness and health in persons living with HIV/AIDS. In E. L. Worthington, Jr (Ed.), Handbook of Forgiveness (pp. 335-348). New York, NY: Routledge.

Waltman, M. A., Rusell, D. C., Coyle, C. T., Enright, R. D., Holter, A. C., & Swoboda, C. M. (2008). The effects of a forgiveness intervention on patients with coronary artery disease. Psychology & Health, 24, 11-27. http://dx.doi.org/10.1080/08870440801975127

Photo Credit: Flickr via Compfight with Creative Commons licenses
Forgivess according to Gandhi courtesy of symphony of love
Chronic stress courtesy of Duncan Rawlinson – Duncan.co – @thelastminute
Pain collage courtesy of sbpoet
Blood pressure reading courtesy of stevendepolo
Heart disease courtesy of gandhiji40
Salve courtesy of Vaping360

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Stephen P. Gallagher 23 May 2018 - 2:16 pm

I love your conclusion. Great job.

“Personal differences, daily frustrations, hurts, and injustices we experience throughout our lives can impose deep wounds in our bodies and minds. Forgiveness can serve as a powerful, self-administered salve. If one does not forgive, it is like handing the transgressor the skeleton key to the door of one’s life. Forgiveness might not prevent the pain of the past, but it can reduce suffering in the future.”

I would love to share this with a couple thousand lawyer friends. SPG

Kathi 30 May 2018 - 6:41 am

Hi Stephen, There are many lawyers now implementing positive psychology in their practice and even teaching in law school. Let me know if you want connections for more information. You can find me on LinkedIn above.

Judy Krings 23 May 2018 - 2:42 pm

Thanks, Kathi, for a wonderful summary on why forgiveness may be the best gift we can give to ourselves. Letting go of all that does not serve us is a concept that has always resonated with me as well as my Positive Psychology coaching clients. Well said!

Elaine O’Brien 26 May 2018 - 11:36 pm

Thank you, Kathi, for advancing the science of forgiveness, positive health and medicine with your great PPND story. Happy to share your very imformative well written piece. Cheers! Elaine
PS It’s been a pleasure working with you and looking forward to our EPPC panel presentation in Budapest next month.

Linda Schiavone 28 May 2018 - 8:03 am

Kathi, I am so happy to see your article here and to read what you are so passionate about. Thank you for sharing the important work you do in the area of forgiveness. I miss our MAPP days together. Congratulations on starting your new journey – you will do great things for many people. With love, Linda

Kathi 30 May 2018 - 6:35 am

Hey Linda, Great to hear from you! My passion is definitely medicine and positive psychology. I think that was obvious during our year of MAPP together. So much love and admiration to you Linda

Lisa Buksbaum 30 May 2018 - 8:30 am

What a comprehensive article on this essential topic. Forgiveness so easy to forget how easy it is to do… for ourselves and to others. Kathi, your medical knowledge and positive psychology wisdom is a powerful salve. Thanks for sharing this article with us.


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