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