Guilt and shame can complicate life during and after illness. Over the years of my cancer survivorship, I’ve strived to find healthy responses, efforts that began with exploring the similarities and differences between those two emotions.
Guilt is the feeling that arises when you believe you did something wrong that affected someone else--and you regret it. Guilt is normal, healthy, and adaptive when it prompts you to recognize an error in your ways and motivates you to repair the error when possible and take proper action from now on. For example, feeling guilty about ending up in the ER due to missing doses of medicines can motivate a patient to start using a pill minder and to taking medications faithfully thereafter.
Guilt that arises in the absence of any wrongdoing is common but maladaptive. For example, patients’ guilt about the expense of their illness is maladaptive. Having done nothing wrong, those patients have nothing to repair or change. Guilt adds stress, complicates relationships, and may lead patients to avoid reporting worrisome symptoms.
In contrast to guilt, shame is the feeling that arises when you believe you did something wrong that makes you a "bad" or "incompetent" person, or lesser in some other significant way. Shame is maladaptive because it erodes patients’ self-confidence and sense of agency. Patients’ shame about their changed body may motivate them to avoid others and/or avoid dealing with the losses--real or imagined.
Next: Healthy responses to guilt
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