It’s all about making choices


This is something I regularly teach my patients to live by when it comes to decision making, and they find with time that it works. I haven’t come upon a situation in which it has failed when there is a possible solution. Those who feel that it is impossible often find themselves in a quagmire which tells me that they have emotional work to do. It is an internal conflict that they cannot negotiate because it requires sacrificing something.

These emotions – shame, guilt, fear and anger –  represent reactions to an event, a previous decision or an outcome. They can cause immense pain – psychic and, believe or not,  immense physical pain as well. People respond to these emotions differently just as people respond to grief differently. People also experience these emotions in different areas of their body as well. An anxious person might have tense shoulders or butterflies in their stomach or sweat profusely. Turn that up a hundred notches and you have symptoms that mimic fibromyalgia, severe constipation, or dehydration respectively. All three can lead to extreme exhaustion because of the mental strain. It can lead to chronic depression or chronic anxiety or both.

Medications do not treat these emotions, only psychotherapy does. Many times, its one or all of these  conflicting emotions that are the root cause of what one is experiencing mentally and physically. Resolving these problems requires awareness of these emotions, what triggers them, and what sustains them while searching for patterns. People believe that they are suffering from some physical ailment and look for a physical cause when it’s really an emotional cause, which leads them down the wrong path of recovery. The emotional turmoil is the root cause and addressing these symptoms is what one needs to do.

These emotions are a part of a healthy emotional mind.  It’s not abnormal to feel guilt, shame, fear or anger. When one feels one of these emotions, it is meant to be a signal that something is wrong or  that something has gone awry. One uses the emotion as a red flag to stop and check oneself, to look around, to pay attention.  However in extreme situations, they can cause a great deal of damage especially if one allows these emotions to guide decision making.

Many times these patterns begin in early childhood. There are certain cultures that use guilt to drive another person’s behavior. “She guilted me into doing it.” These patterns are passed down from generation to generation sometimes. Guilt is used to control another’s action without explanation of what the proper reason is, i.e., concepts of charity and altruism take time and energy to explain and one can only understand these concepts once they have reached a specific developmental stage or maturity. It may take years to instill these concepts. Guilt yields immediate results and the easy way to control behavior. Overtime it leaves a residue which heavily tints future decisions without thinking it through as to whether or not you agree or even if it is something you really  want.  Guilt should be a normal emotion used to do a self check. Without the self check, guilt can be extremely damaging to the point of losing one’s identity because the decisions made by the person are ultimately imposed by another.

Shame is different from guilt. Shame is personal while guilt is public. A failure to meet your own standards of behavior; a dissatisfaction based on your own assessment of a decrease in stature leads to shame. Failing to meet the moral standards of others leads to guilt. Shame is ‘not doing your best’ while guilt is ‘harming another’. At an extreme, one might feel shame for believing that they are a burden to others to the point of hating themselves. There is no self love. Shame is a decrease in stature while pride is an increase in stature.

Again, in some cultures, shame is used to drive behavior.  Society sets the bar. What was thought to be taboo years ago is shrugged off now. My mother was shamed for being left handed and she shamed me for being left handed. She was forced to learn to write with her right hand but I was not. I’m actually sad that none of my children are left handed.  If one does not examine these types of decisions in the context of culture or more so if it’s the right thing for them, one is bound to repeat the cycle of shame.

Both shame and guilt leads unconsciously to self punishment. If one believes they have done something wrong or haven’t made the grade, they will set their life up to be punished on a regular basis. It might seem like a black cloud is always over them or that things never seem to go their way but it’s what we therapists call ‘self sabotage’.

By appearances, it seems that the world is against the person but it’s actually the person orchestrating the attack against himself or herself. When one is on the journey of healing, this pattern must be dismantled first and fore most because any effort for self improvement or healing will cycle back to punishment and failure. One needs to look for this pattern of behavior and chronic feelings of guilt or shame are clues for you to search for this pattern. It’s important to get a good therapist that understands these concepts and help you to work on changing how you respond to these emotions.

I will comment on fear and anger in the next post.
Peace of mind and health to you,

Achina Stein DO