CareManagement
FR O M TH E E D I TOR -I N -CH I EF
OFFICIAL JOURNAL OF THE ACADEMY OF CERTIFIED CASE MANAGERS AND COMMISSION FOR CASE MANAGER CERTIFICATION
Working with Patients Who Experience Guilt and Shame
G
Editor-in-Chief/Executive Vice President Gary S. Wolfe
uilt and shame are part of life imagined harm to others. Guilt is the and are experienced by most greatest destroyer of emotional energy. people. Excessive guilt and It leaves you feeling immobilized in the shame can affect health, and thus present by something that has already guilt and shame are important issues for occurred. the case manager to understand in order Guilt and shame often go hand to deal with patients more effectively. in hand. We might feel guilty about Shame and guilt are commonly something we have done but ashamed confused. The difference between about how this reflects on who we are. shame and guilt is that guilt refers to a However, guilt and shame can also be behavior and shame refers to an identity. experienced independently. For example, Shame is defined as the painful feeling one may feel guilty about having passed or experience of believing we are flawed on an infection to someone else without and therefore feeling ashamed. unworthy of Shame and guilt are commonly confused. One might feel acceptance and ashamed about The difference between shame and guilt belonging. Shame our physical is that guilt refers to a behavior and is a protective appearance shame refers to an identity. emotion. It will without any sense shut down other of guilt. Guilt is emotions and disconnect you from those often overt and upfront, whereas shame around you. When our emotions are shut tends to hide itself and is thus often down, it shuts down our body and can harder to identify both for the person even trigger the nervous system to perceive feeling shame and for the person trying to a potential threat. This triggers a fight or help. Shame seems to have a closer link to flight response. When our sympathetic the body through our autonomic nervous nervous system is triggered, our bodies system (eg, blushing). are not able to heal. It is all about survival It is useful to establish the relative mode, which is not meant for long periods. contribution of guilt and shame to the Survival mode includes invalidating patient’s distress, bearing in mind that pain and engaging in unhealthy they may not be able to describe shame behaviors. Shame can be recognized by “I (patients often use the term “embarrassed” statements.” For example, “I’m not good when they are actually referring to enough.” “I’m not trying hard enough.” something much more uncomfortable than “I’m lazy.” I’m dumb.” Shame can be embarrassment). When exploring guilt, it is recognized by a physical reaction. Most important to determine whether the guilt people feel flush in their face and neck. is proportionate to what the patient has Some people sweat. Some people tuck done. If it is disproportionate, one can their heads, move their shoulders forward, begin to unravel the various factors in and bend forward slightly at the waist. the patient’s life that may be contributing Guilt is an emotion and refers to our to the feelings of guilt. This may take sense of having done something wrong, some time but can lead to a more realistic either in reality or in our imagination. appraisal of how responsible they are for It relates to real or imagined actions their feelings of guilt. or inactions that have caused real or continues on page 4 2 CareManagement April/May 2021
Gary S. Wolfe, rn, ccm Editorial Board
Barbara Aubry, rn, cpc, chcqm, faihcq Jennifer E. Voorlas, msg, cmc Adele Webb, rn, phd, aacrn, cpnap, faan Executive Editor
Catherine M. Mullahy, rn, bs, ccrn, ccm Contributing Editor
Elizabeth Hogue, Esq. Copy Editor
Esther Tazartes, MS Art Director and Webmaster
Laura D. Campbell Circulation Manager
Robin Lane Ventura Member Services Coordinator
Kathy Lynch Senior VP Finance & Administration
Jacqueline Abel Publisher, President
Howard Mason, rph, ms Vol. 27, No. 2, April/May 2021. CareManagement (ISSN #1531-037X) is published electronically six times a year, February, April, June, August, October, and December, and its contents are copyrighted by Academy of Certified Case Managers, 2740 SW Martin Downs Blvd. #330, Palm City, FL 34990; Tel: 203-454-1333; Fax: 203-547-7273. Subscription rates: $120 per year for ACCM members; $150 for institutions. Opinions expressed in articles are those of the authors and do not necessarily reflect the opinions of the editors or the publisher or the Academy of Certified Case Managers. One or two copies of articles for personal or internal use may be made at no charge. For copying beyond that number, contact Copyright Clearance Center, Inc. 222 Rosewood Dr., Danvers, MA 01923, Tel: 978-750-8400. CareManagement is indexed in the CINAHL® Database and Cumulative Index to Nursing & Allied Health Literature™ Print Index and in RNdex.™
© Academy of Certified Case Managers, Inc. 2021
