Guilt, Shame and Moral Injury
“Why are you drinking? - the little prince asked.
- In order to forget - replied the drunkard.
- To forget what? - inquired the little prince, who was already feeling sorry for him.
- To forget that I am ashamed - the drunkard confessed, hanging his head.
- Ashamed of what? - asked the little prince who wanted to help him.
- Ashamed of drinking! - concluded the drunkard, withdrawing into total silence.
“The Little Prince” by Antoine de Saint-Exupery
Guilt, Shame, and Moral Injury
Just about everyone on this planet will experience guilt, remorse, regret, or shame at some point in their lives. Although these are technically different psychological states with subtle (sometimes very subtle) nuances between, they all share the common characteristic of feeling bad about oneself or what someone has done, especially when it relates to other people. They are social emotions. Psychologists believe that these emotions help us stay connected to each other by encouraging us to apologize, make amends, and repair the damage relationships.
Guilt or Remorse are typically short term issues associated with an identifiable, specific action. Usually, it can be coped with by apologizing and making amends. It’s considered healthy and normal part of being human.
A person experiences Shame when it is perceived as an identity fault. Like this is something wrong with them as a person. It is much more ingrained and very often socially reenforced by others. Sometimes, this can a healthy emotion. It is stronger then guilt and thus encourages the person to make more efforts in repairing the fault of character or identity.
Unfortunately, both guilt and shame can be weaponized by others and society in general to attempt to control a person’s behavior. This is one of the core components of how cult leaders and abusive partners control others. Since guilt and shame are painful emotions and we never want to experience them, they can be used as a kind of negative reinforcement. When a therapist works with individuals in these situations, it is very helpful to challenge the core assumption that guilt or shame necessarily means they did something wrong. In other words, just because a person feels guilt or shame, that does not mean they did anything that violates their conscience or personal values. It is a conditioned emotion. Meaning that it is taught to us, we are not strictly born feeling this way about certain actions.
Regret: Strictly speaking regret is not about violating morality, it is about making a mistake and wishing that mistake hadn’t happened. In other words, a person can feel regret knowing they did nothing against their conscience or values.
Moral Injury: Moral Injury is the most severe emotional and psychological response to perceived faults or moral failings. It includes all the above: guilt, shame, regret, etc. and it has an intense psychological reaction to reminders or associations with the wrong(s) committed. I’ve seen weeping, wailing, shaking, anger, and panic all in the mere mention of the moral failure in question. All these can be a normal response to a severe violation of one’s values or conscience but usually lessens over time as a person learns to forgive themselves and attempts to repair any damage caused. But for the one who is suffering for moral injury, this reaction doesn’t lessen. Instead of learning to forgive themselves, the person learns to hide from themselves and what they did. The best way to think of this is like a kind of post traumatic stress disorder (PTSD) with the trauma being the action or inaction of the person instead of something that actually happened to them. It more or less is so painful that the person avoids reminders of it at all cost.
-veterans who had killed people during war time.
-perpetrators of sexual assault or physical violence
-those who experience deviant sexual attractions
-continued and prolonged acting out in addiction
-injuring or harming one’s child
These are all examples that I have encountered in my work as a therapist and they are some of the most challenging situations from a therapists’ perspective. The challenge is in helping the person not hide from what they did or didn’t do so that they learn to accept it.
So What To Do About It
Like most aspects of healing or recovering from something, it requires a series of stages.
Learn acceptance that the event happened. That is part of one’s history and cannot be ignored.
Learn to show self-compassion even if one believes that they don’t deserve it. Teaching that compassion and care are gifts that are “free without conditions.” One can show compassion to others without them deserving or earning it. If compassion or care have to be “earned” then it is not compassion at all but an exchange of goods. Often, I will encourage a person to practice showing compassion to strangers or loved ones they don’t particularly like through small concrete acts of kindness.
Next we learn that forgiveness does not have conditions tied to it. Like compassion, if we forgive someone we are not expecting them to earn it. I like using the metaphor of forgiving someone of a debt (say $20). When we forgive that debt, we are not asking them to repay us in a different way. That is an exchange, not forgiveness. Again, we will practice this by encouraging the person to find someone that has wronged them and show unconditional forgiveness.
Lastly, we learn how to apply that to themselves. Acknowledging that it is not earned and that is the point. This usually results in a desire to try to do some good in the world related to their “sin” or moral violation.
Lastly
When the process is laid out like this, it can make it seem seamless and smooth but the reality is that it often feels like a roller-coaster with lots of emotions. But this is the general process. Notice, that the making amends comes from a place of self-forgiveness. If a person has not accepted the event, and has made steps to forgive themselves, then making amends will backfire and lead to more shame. I’ve noticed, for example that addicts can often move too quickly through the process. In attempt to feel relief sooner from the shame they try too hard to make amends through promises, impossible commitments, gifts, compliments, etc. Unbeknownst to the addict, these are often attempts to earn forgiveness or reconciliation. Since, forgiveness can’t be earned from others, yet alone from themselves, the results are often resentment, anger, and backsliding into the addiction. I encourage any struggling with moral injury to first work towards acceptance of the wrongs committed and forgiving themselves before attempting to make amends.
