The Elephant in the Therapist’s Office
Trauma, The Limits of Forgiveness, and Religious Primacy
Forgiveness is fashionable. Major health resources for the layman, such as the Mayo Clinic, Harvard Medical School, and Johns Hopkins Medical School, have recommend forgiveness over the last twenty years as a means to heal over time and maintain a better constitution. Four- or five-step guides with similar justifications for forgiveness are published widely over the web. They usually offer the following guidance: The aggrieved party is urged to look into herself, remember the event, then empathize. She should understand that forgiveness is a form of altruism that she can give to someone who has wronged her. She should commit to forgiving an act now and carry that into the future. In all cases, the forgiveness process is unilateral. Health websites claim that this process is salubrious, but the research they draw upon doesn’t demonstrate its benefits for a broad population.
A unilateral forgiveness model is problematic for trauma victims. Stimuli specific to each person can cause involuntary reactions in the brain that result in maladaptive behaviors. An individual can’t untangle them through a simple will to forgive; moreover, an attempt to forgive may even be counterproductive in that it could bring back old conflicts involuntarily. Despite the complicated physiological and psychological nature of trauma that results from repeated abuse or neglect, the Mayo Clinic, Harvard Medical School, and Johns Hopkins Medical School oversimplify and market their methods as being applicable to any situation.
Why are these top-flight medical institutions missing the obvious connections between emotions, memory, and brain function that can be found in any PubMed article? My research indicates that their urgency in tone and oversimplification for managing negative emotions has roots in spirituality. Compare secular sites, large and small, to Christian sites that focus on forgiveness, and the language is remarkably similar. Christian forgiveness, usually oversimplified on these websites, focuses in its internet iteration on introspection and emulation of the divine, which can only be fulfilled by modeling one’s heart and mind, as well as actions, on the behavior and teachings of Christ (See Matthew 6:14–15, for example). Secular sites don’t ask for emulation of the divine, but they do rework this language of forgiveness in a way that leaves in a spiritual element requiring some level of introspection and personal sacrifice leading to renewal.
These religious and secular requirements put great demands on people who have suffered trauma because of the difficulties of tamping down emotions that surface at incongruous times or stay present in the background. Even more problematic, secular institutions that borrow from the Christian model not only ignore the variety of contexts that are inappropriate for forgiveness; they also assume that the theological model for their recommendations is recognized and accepted by their audience. It’s okay to borrow from religion for medical purposes. Psychotherapy borrows mindfulness from Buddhist monks all the time, but psychotherapy also discloses the origins of the practice. In contrast, institutions who promote medical forgiveness falsely present the technique as purely secular science even though it is inextricably connected to a particular theology.
Theology has no business in medicine unless it is fully disclosed. The application of a particular religious tradition should be transparent to the patient should there be personal conflicts. It is difficult, however, to have a conversation about this problem, because the elephant in the room is an explosive one.
In a 2022 LinkedIn thread discussing a February 2022 Psychology Today article, “Why Forgiveness Isn’t Required in Trauma Recovery,” many posts pushed back with statements that one “must” forgive. Others declared that forgiveness is necessary. For every person who explained why forgiveness was harmful for PTSD and complex PTSD clients, there was another who dismissed the relevance of the diagnosis to the application of this brand of forgiveness. In the end, it was a heated argument not over clinical psychology and the science behind it, but rather over moral virtue. Forgiveness was not a prescription, but rather an imperative for many of the thread participants.
The elephant in the room, of course, was that there was a religion behind this moral virtue. I don’t want this essay to be mistaken for anti-Christian sentiment. This essay isn’t about theology, and my aim is not to evaluate the Christian model of forgiveness per se. My concern here is simply the politics of religion in the context of medicine. The only reason why the LinkedIn discussion didn’t boil over into aggressive speech was because no one declared their religious affiliation or attempted to proselytize. Behind the “musts” and “needs,” nevertheless, was an assertion of religious primacy.
We need an open discussion about the role that religion plays in psychotherapy, as well as about the boundaries between religion and science in medicine. We can only address these topics by being transparent about the traditions we apply to mental health care, and why we choose one over another. This is a difficult conversation to have because it raises uncomfortable questions about the extent to which a particular class of patients are being sacrificed for the sake of religious assertion. In order to ensure that the right treatment goes to the right patient, however, this conversation needs to be had.
