Forgiveness : a correlational study between the spirit of forgiveness and physical health in senior citizens

212 Pages·2002·5.7 MB·English

by  Connery, Thomas J

FORGIVENESS:ACORRELATIONALSTUDYBETWEENTHESPIRITOF
FORGIVENESSANDPHYSICALHEALTHINSENIORCITIZENS
"'531
1
THOMASJ.CONNERY
ADISSERTATIONPRESENTEDTOTHEGRADUATESCHOOL
OFTHEUNIVERSITYOFFLORIDAINPARTIALFULFILLMENT
OFTHEREQUIREMENTSFORTHEDEGREEOF
DOCTOROFPHILOSOPHY
UNIVERSITYOFFLORIDA
2002 • -^^
ACKNOWLEDGMENTS
Ihavebeenblessedtoreceivetheguidanceandhelpfromsomanyindividials.
Firstandforemostismychairperson,Dr.MaryHoward-Hamilton,who,despitea
relocationtoIndiana,hasguidedanddirectedmewithloveandpatience.Iamindebted
tomycommitteemembers.Dr.SilviaEchevarria-Doan,Dr.JamesArcher,andDr.David
Miller,forgivingmetheirtimeandexpertise.Iamindebtedalsotomydearfriendswho
wantedthedegreealmostasmuchasIdid:GertandMarciaKing;TheresaHand;Dr.
AnthonyandPatCardinale,whopainstakinglyrecorded,typed,andorganizedmywork;
KathleenNonnenmacher,whoencouragedmeandspentcountlesshoursinthelibrary
assistingme;andJong-hyoPark,whoseexpertiseinstatisticswasaGod-send.Iam
gratefiiltoDr.RobertEnright,whoinitiallyputmeonthistrackofforgiveness,forhis
encouragement.IthankDr.SidSarinopolous,whomIconstantlyconsultedforadvice,
direction,andclarification;Iremainindebtedtohimandthankhimforhispatience.I
alsothankDr.JerryGoldberg,who,thoughastranger,willinglyofferedinsightand
clarification;MaryJaneSchaer,whodidanexcellentjobpreparingmywork;andCandy
Spires,whowasmosthelpfulinkeepingmyclassesstraight.Iwanttoexpressmy
gratitudetomymomanddadwho,thoughtheymaynothavehadtheopportunityto
furthertheireducation,encouragedmetobethebestthatIcanbe.
Finally,thisisdedicatedtoHelenSmorto,whowascalledhometoheavenandis
unabletorejoicewithme.Imissher,andIthankher.
TABLEOFCONTENTS
ACKNOWLEDGMENTS
ii
ABSTRACT vi
CHAPTERS
1 INTRODUCTION 1
TSthaeteRmoelnetooffFtohregiPvreonbelsesm 71
DefinitionofTerm g
ThePurposeoftheStudy 9
Hypotheses 9
SignificanceoftheStudy 10
2 REVIEWOFLITERATURE 11
WhyNowForgiveness? 14
WhatIsInterpersonalForgiveness? 16
PhilosophicalPerspectivesofForgiveness 24
TheUnforgivable 26
ThePossibilityofForgiveness 28
ConflictingViewofForgiveness 33
TheParametersofForgiveness 34
WhatForgivenessIsNot 37
DefinitionofForgiveness 45
WhatIsForgiveness? 46
FoundationalDefinition 51
ChallengeofForgiveness 57
THhoewPDroocePsesopolfeFoFrogrigviivneg 6612
AngerandForgiveness 71
TThheeMFoordgeilveonfesFsorMgoidveenlessBasedonKohlberg'sTheoryofMoralDevelopment...77g4
UWnocrokvering gg57
Outcome gg
TheRoleofEmpathy 89
HowDoesOneKnowWhenForgivenessHasTakenPlace? 92
WhatAretheBenefitsinForgiving 93
Hostility,Anger,andPhysicalHealth 99
TheRoleofAnger 105
HThoeowreFtoircgailveCnleasismsMiOgnhtthIenfPlhuyesniccealHeHaelatlhthEnhancingPotentialofForgiveness..111028
APosTshiebolreetPihcyaslioFlroagmiceawloMrekchanisms 112127
3 METHODOLOGY 126
Overview 126
Definitions 127
Participants 128
Procedure 12g
PsychologicalVariableInstnunents 129
DescriptiveStatisticsfortheNormativeSamples 132
AngerExpressionandAngerControl 132
STAXI-2ScalesandSubscales 133
The27-ltemVersionoftheCookandMedleyHostilityScale 133
PhysicalHealthStatus I35
Health-RiskVariables 136
Study 137
4 RESULTS 13g
DescriptiveData 13g
Results J3g
5 DISCUSSION 15]
ResearchImplications I55
PracticalImplications I55
Limitations 15g
FutureResearch 15g
APPENDICES
A VOLUNTEERINVITATIONLETTERANDCHURCHBULLETINNOTICE.,161
B INFORMEDCONSENT 163
C BASICINFORMATIONQUESTIONNAIRE 164
D ACTIVITIESANDHABITSQUESTIONNAIRE 166
'
REFERENCES 168
BIOGRAPHICALSKETCH 202
t'1•
AbstractofDissertationPresentedtotheGraduateSchool
oftheUniversityofFloridainPartialFulfillmentofthe
RequirementsfortheDegreeofDoctorofPhilosophy
FORGIVENESS:ACORRELATIONALSTUDYBETWEENTHESPIRITOF
FORGIVENESSANDPHYSICALHEALTHINSENIORCITIZENS
By
ThomasJ.Connery
Chair:MaryHoward-Hamilton
MajorDepartment:CounselorEducation
Clientswhoseekcounselingareoftenmotivatedbythedesiretomovebeyondor
overcomepasthurtsandinjustices.Thoughthedesiremaybethere,theskilltodosois
lacking.Ascounselors,wefacilitatetheprocessbyourknowledgeandexpertise.One
strategytorecoverfrompastinjusticesisforgiveness.Forgivenesscanbethecatalystfor
healingandregainingone'speaceofmind.Clientsarereluctanttochooseforgivenessfor
itcarriesthestigmaofdefeat.Knowingthatforgivenessisconnectedtoimproved
outcomesmaybetheappealtoselectforgiveness.
Thisstudyinvolved203seniorcitizens,maleandfemale,whoseagesranged
from65to82. Sixty-sixpercentwerebetween65and75,47%rangedfrom76to79
and22%were80andolder.ThevolunteerswereprimarilyfromaCentralFlorida
CatholicChurch.Thefollowinginstrumentsweregiventoeachparticipant:Enright
ForgivenessInventory,TheAngerExpressionScale,The27-ItemVersionoftheCook
andMedleyHostilityScale,andthePhysicalHealthStatusandHealth-RiskVariables.
SeparatecorrelationanalyseswereperformedfortheEFIandangerandEFIand
hostility,EFIAngerandhostilityandpredictorvariablesandphysicalhealthmeasiu'es.
Multipleregressionanalyseswereperformedwithpredictorvariablesandphysical
health.Unlikepreviousresearch,theseresultsdidnotshowanysignificantcorrelation
betweenforgivenessandphysicalhealth.
INCTHRAOPDTUECTRI1ON
StatementoftheProblem
Health-relatedqualityoflifeorthecapabilitytofunctioninthephysical,
psychosocialandsociologicaldomainofhealthisofgrowinginterestinthefieldofaging
(Badger,2001).Today,thereare78millionAmericanbabyboomers—personsbetween
—
ages35and53 comprisingnearlyone-thirdofthetotalU.S.population.Accordingto
psychologistandentrepreneurDenDychtwald(1999),the20'"centuryhadbeeninthe
domainoftheyoung,butthe21"centurywillbelongtothe"new-old."Two-thirdsofall
thepeoplewhohaveeverlivedpastage65intheentirehistoryoftheworldarepresently
alivetoday.Hepredictsthatthispopulation,theagingbabyboomers,willcravevigor,
vitality,andlifeextension.Theironyofpastmedicalsuccesses,hebelieves,isthatthey
haveproducedlegionsoflong-livedelderswhowrestlewiththeveryproblemsthatthe
Americanhealthcaresystemisill-equippedtohandle,suchasheartdisease,cancer,
arthritis,osteoporosis,andAlzheimer's.
Thesearethehealthrisksthatelderlyfaceastheyaregracedwithlongevity.A
severeproblem,oftenunmentioned,thatplaguesthesenioryearsisthestrugglewith
depression.Depressionisaseriousproblemamongpersonsaged65andolderandoften
ismissedinprimarycarepractice(Butler,Cohen,Lewis,Simmons-Clemmons,&
Sunderiand,1997).Thoughtheprevalenceofmajordepressionamongpeopleage65and
overincommunitysurveysstandsat15%,another15%sufferfromsomedegreeof
2
adjustmentdisorder,chronicdepression,andotherformsofminordepression(Diagnosis
andTreatment,1991).Prevalenceinnursinghomesis12%to22%formajordepression
disorderandover15%to30%forminordepression(AmericanPsychiatricAssociation,
1994).
Thisisnoteworthybecausedepressionislinkedwithphysicalhealthproblems
(Koenig,1999).Depression,alongwithanxiety,inmedicallyillseniorsbothincreases
themorbidityandmortalityandburdensnotonlytheindividualbutsocietywithhigher
healthcostsandutilization.Itisalsolinkedtoapoorerfunctionalstatusandoutcomes
forpatients(Kim,Braun,&Kunick,2001).Ormelandcolleagues(1998)notedthat
depressivesymptomscontributemoretofunctionaldisability,poorhealthperception,
andpoorwell-beingthanmostchronicmedicalconditions.Inpersonsaged65andolder,
theincidenceofdepressionincreaseswiththedegreeofphysicalhealthproblems.Higher
levelsofmortalityamongdepressedpatientsmayhaveasacontributorpsychological
stress,whichtriggerstheproductionofCortisolbytheadrenalglandsandthereby
adverselyaffectstheimmunesystem.Unfortunately70%to90%oflate-lifedepression
isundiagnosed(Koenig,1999).
Untreateddepressionamongolderpeoplecanbedeadly.Thesuiciderateinold
ageisthehighestofanyagegroup:67.6suicidesper100,000inpersonsage85and
older,fivetimesthenationalrateforallagesof12per100,000(Butler,1997).An
estimatedoneoutofsixpatientsseenbyaprimarycarephysicianissufferingfrom
depression.Inabout25%ofcasesofdepression,acontributingfactormaybechronic
physicalillnesssuchasheartdisease,stroke,cancer,lungdisease,arthritis,and
Parkinson'sdisease(Butler,1997).Depression,especiallyinolderadults,isprevalentbut
oftenunrecognizedinpatientswithothermedicaldisorders.Ifleftuntreated,comorbid
3
depressionmayleadtoaworseningofcertainmedicalconditionssuchascoronaryartery
disease(Evans,1997).
Depressedpatientssufferfromsymptomaticandfatalischemicheartdiseaseata
higherratethannondepressedpatients.Alterationsinsympatheticandparasympathetic
tonepossiblymakedepressedpatientsmorevulnerabletoventricularfibrillation.
Comorbiddepressionandcardiacdiseasearecommonlyencounteredbyanyclinician
treatingolderpatients.Furthermore,depressedpatientshavepooreroutcomesthan
nondepressedpatientswithsimilardegreesofheartdisease.Depressedpatientshavea
higherthanexpectedrateofsuddencardiovasculardeath.Patientswithdepression
developsymptomaticandfatalischemicheartdiseaseatahigherratewhencompared
withanondepressedgroup(Roose,Devanand,&Suthers,1999).
Depressioninolderpersonsisassociatedwithsignificantdecreaseinphysical
mobilityandincreaseindisabilityassociatedwithactivitiesofdailyliving.Depression
canadverselyaffectbiologicalprocessesthatmayenhancesusceptibilitytodiseaseor
causeneuromuscularfactionaldecline(Penninx&Leveille,1999).Peoplewhoare
depressedhavesignificantlygreatermortalityfollowingamyocardialinfarction(MI)and
aremorelikelytohaveareinfarction.Seniorcitizenssufferingfrommyocardial
infarctionoftenpresentwithrestlessagitationorconfusion.Congestiveheartfailurecan
produceanxiety,fatigue,orpoorconcentration.Hypertension,whichaffects40%ofthe
elderly,isoftentreatedwithmedicationthathasahighpotentialofcausingdepression
(Vickers,1988) Depressionputsenormousstressonaperson'spsychologicalsystem.
Serotoninlevelsaredecreasedinthebrainofanyonewhoisdepressed,fthasbeen
reportedthatserotoninlevelsinplateletcellsalsomightbedecreasedindepressed
people,makingplateletsmorecoagulableandincreasingtheriskofMI(Koenig,1999).