Health Column: Shame and guilt: What are they good for?

These two concepts seem to go together and be the same, but there may be important distinctions. Shame is a frequent topic of discussion in therapy situations because, as a feeling, it can diminish self-esteem and dull relationships. Shame can generate defensiveness and mistrust. Since shame is one of the more secretive emotions, it can do a good job of staying below conscious awareness and leave the individual with unexpressed anger, sadness and remorse. Shame refers to who we are; guilt is more about what we do.

These distinctions may be important, because shame can represent our personal reflections about the kind of person we believe we are - including our flaws, our acts and our thoughts. Shameful remorse can be a healthy repentance for shortcomings and lost opportunities, but shame also can be undeserved baggage.

For example, individuals who have been exploited or abused often feel deep shame and humiliation. For these people, shame may have been internalized as a feeling that they brought abuse upon themselves or somehow deserve it. Shameful body image is a common experience - we may be ashamed of our size, looks, sexuality, or body function, and we can develop a deep dread of ridicule or rejection. This abject devaluation of oneself affects daily life because the individual may assume he or she is unable or unworthy. We may begin to react to the world as if it expects the worst of us and that we have little merit. Helpless rages can take over and taint parts of life that should be a source of joy.

A close relative to shame is guilt, but it is associated with actions taken or avoided. It’s a feeling that comes when we feel we have done something wrong. It can follow shame if we react in response to falling short of our expectations of ourselves. Guilt often is undeserved if we believe we are failures, and it also may be moral feedback if we behave outside of cultural values or expectations.

Healthy guilt actually can help a person live successfully with himself or herself, with others and with the world. Guilt is a signal to evaluate one’s actions. It’s a valid response when we live or act in discord with strongly held values. It also is capable of becoming unhealthy and obsessive. Unhealthy guilt fosters an illusory feeling of control over our feelings or disastrous events in our lives. It freezes a person from growing. Unrealistic regret keeps one in the past rather than in the present, where it strangles joy and hope.

However, instead of angry defensiveness or a chronic unpleasant mood, conquering undeserved guilt and shame can foster self-acceptance. Getting to the key issues and anxieties may mean having a professional therapist provide non-judgmental witness and support. In the safety of a therapeutic setting, it’s possible to find release from crippling fears of failure or defect. As always, authentic living and a sense of integrity and esteem come from being able to feel and react genuinely in the present, while honoring what has brought us to the moment.

Barbara Bolin is a therapist with Blount Memorial Hospital’s EASE: Elder Assessment Service, an offering that provides assistance, assessment, treatment, support and referral sources to individuals age 55 and older along with their families.

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