Forgiveness sounds so warm and fuzzy and facile. And religious: Forgive us our debts (or trespasses) as we forgive our debtors (or trespassers)…. Like a joyous sunflower turning its laughing seedy face toward the warmth and the light.

But wait. That sunflower looks decidedly sinister. Could there be a dark, prickly underbelly to forgiveness? Is forgiveness always a good thing?

These are questions I’ve been asking myself as well as ‘asking’ various experts through an extensive search of the academic literature related to forgiveness (mainly within the fields of philosophy, psychology, and counseling). These questions have led to more questions: Can you forgive someone or something like an institution–a hospital system for instance–for wrongdoing in the absence of an admission of guilt and a sincere apology? What constitutes a sincere apology? What constitutes sincere forgiveness versus a too-quick-to-give (or forced into) ‘cheap grace’ forgiveness? Do you have to forget to forgive? What is self-forgiveness and why is it important? What are the power dynamics, including gender dynamics, embedded in forgiveness? Who has the ‘right’ to forgive? Are there some instances of wrongdoing (like the atrocities of the Holocaust and of various genocides around the world, or like severe child abuse) that are of such great magnitude that they are unforgivable? Can there be reconciliation without forgiveness?

Forgiveness and its close relations of shame, guilt, righteous indignation, anger, revenge, restitution, reconciliation, and restorative justice are highly relevant to health care, to public/community health, and to all health care providers. There are the all too frequent medical errors leading to patient injuries and deaths. There are the ‘second victim’ casualties to health care providers involved in medical errors. There are the just and unjust cultures of hospitals, medical systems, and health regulatory boards. There are the U.S. Public Health Services’ infamous Tuskegee Syphilis Study and its lingering effects. There are worsening environmental justice issues, racism, gender-based violence, police brutality, and global health inequities.

Within health care provider education in the U.S. we now include course content and interprofessional mock trainings on ‘error disclosure.’ We try to identify and intervene with incompetent or ‘bad apple’ students. We have student counseling services for students struggling with emotional issues. We have (or rather we should have) faculty development trainings on how to provide clear, constructive student performance feedback in a supportive, non-shaming way. But we don’t really have a place for open discussion of forgiveness, shame, vulnerability, and uncertainty. We’re all about measuring and having students attain ‘competencies.’

The closest I ever come to teaching about forgiveness, vulnerability, and shame is when I touch on the concept and practice of cultural humility in my community health course (the best description of cultural humility is the short video Cultural Humility: People, Principles and Practice by Vivian Chavez). As social worker, therapist, and researcher Brene Brown points out, we can’t have constructive conversations about race, class, power, and privilege without addressing shame. If you haven’t already seen it, I encourage you to watch her 20 minute TED talk “Listening to Shame.” It reminds me of how much I love the profession of social work.

Out of the thirty or so scholarly books and articles I have read on the topic of forgiveness, here are the ones I found most helpful, provocative, and powerful:

• The Sunflower: On the Possibilities and Limits of Forgiveness, by Simon Wiesenthal (Shocken Books, 1976, 1997). The first part of this book is Wiesenthal telling the story of his experience as a Jewish prisoner in a Nazi concentration work camp in Poland. He was picked at random by a Nazi nurse to visit a young, dying SS officer who wanted to ‘confess his sins’ to a Jewish person and ask for forgiveness. Wiesenthal sat for hours by the patient’s beside listening to him–at one point he brushed a fly away from the patient’s bandaged head–but he stayed silent and did not forgive him. The episode bothers him and he asks people what they would have done in the same or similar situation. The remainder of the book is comprised of responses from various theologians (Jewish, Christian, Buddhist, and Muslim) and philosophers. This is a book that will haunt you long after you’ve finished reading it.
• Before Forgiving: Cautionary Views on Forgiveness in Psychotherapy, edited by Sharon Lamb and Jeffrie G. Murphy (Oxford University Press, 2002)–and especially Sharon Lamb’s chapter “The Good, the Bad, and the Ugly: Psychoanalytic and Cultural Perspectives on Forgiveness.” She writes about power dynamics and gender politics vis-a-vis forgiveness. “Gender conformity then is ‘met’ when a woman forgives her wrongdoer and lets go of resentment, even at the cost of self-respect.” (or safety as she add in the case of abuse and intimate-partner violence).
• “Shame, guilt, and the medical learner: ignored connections and why we should care,” by William Bynum and Jeffrey Goodies, Medical Education, 2014, 48:1045-1054.)
• For an amazingly rich sci-fi take on the topic of forgiveness, there is Ursula Le Guin’s book Four Ways to Forgiveness, the first part of which is titled “Betrayals.”
• In the realm of fiction, Naseem Rakha’s novel The Crying Tree (Broadway, 2009) is carefully researched and beautifully written. It’s a fictionalized account of the complicated grief process of the mother of a murdered teenage son who forgives and befriends her son’s murderer while he awaits his execution on death row. This novel is based on Rakha’s work as a journalist covering the death penalty in Oregon.