Guilt: The Concept and Facets Seen in Clinical Practice

The English word “guilt” is related to the German word “Geld” (money), which is reflected by the fact that guilt can be understood as expressing a striving to “repair,” or to recompense someone for something. To understand guilt, let’s look at the definition of guilt; guilt is defined as “a cognitive or an emotional experience that occurs when a person realizes or believes accurately or not that he or she has compromised his or her own standards of conduct or has violated a moral standard and bears significant responsibility for that violation.”^[1]

In psychology, guilt has been related to various other factors such as shame, crime, sexuality, committing a mistake, and some organizational factors. Guilt is a complex psychobiological construct. The aim of this editorial was to dissect the construct of guilt to trace the various types of guilt that a clinician may encounter as a symptom in psychopathology, as a cause of psychopathology, and the types of guilt that one may need to resolve through psychotherapy. The concept of guilt across the literature is not universal and varies from culture to culture. It is ironic how some authors believe that guilt is a cause of psychological distress, whereas others feel that guilt is protective against a psychological breakdown. We look at the various forms of guilt and their origins with insights into this diverse yet vexing construct.^[2]

PSYCHODYNAMIC FORMULATIONS

The psychology of guilt has its initial origins from the seminal work of Sigmund Freud. In Freud’s view, the moral sense of guilt is the expression of the tension between the ego and the superego. The superego regulates the actions of the ego in the form of a “conscience” and consequently imposes a sense of guilt and need for self-punishment on the individual. He adds the influence of parents, society, and consequences. In his viewpoint, the fear of being punished, and not the intrinsic breakup of our system of values, is what determines guilt. According to Freud, fear is equivalent to guilt. At a later stage, Erik Erikson, following a life cycle approach, improvised on Freud’s work giving us eight stages of human development, in which he stated guilt is the outcome of a stage of life that occurs between the ages of 3 and 5 years, a stage he named “Initiative versus Guilt.” Children should be allowed to show leadership and be allowed to express their natural tendencies for any initiative. If they are excessively limited, the opposite of initiative will occur, i.e., guilt, which is the opposite of playfulness. When these children turn into adults, they cannot express themselves, and when they try, it causes them to feel guilt and shame. Fritz Perls, revising certain aspects of Freud’s work, identifies guilt as a breakup or violation of rules that we have adopted internally as our standard. The feeling is that of self-punishment or a vindictive attitude toward oneself. Carl Jung, in his explanations of guilt, says that guilt is just a surface emotion. To feel guilty is one aspect and to understand guilt is another aspect. He says that guilt is one of the numerous essential things that may move us into living better lives than we do.^[3]

PHILOSOPHICAL STANDPOINT

Many psychologists, having attempted to study guilt, mentioned that guilt may be a factor that manipulates somebody into doing something he may not want to. Guilt has its implication in certain practices and certain forms of life; moreover, the moral practices of life. There have been two kinds of guilt mentioned in philosophy: one is moral guilt and the other is immoral or nonmoral. Guilt is the by-product of one’s capacity for moral feelings, and to comprehend those moral feelings, one must have possession of language. Further, guilt is the result of disobeying the allegiance to a governing authority. In contrast to this, the concept of nonmoral guilt suggests that sometimes one might not have done anything wrong and is aware of the same, but might still experience guilt due to various reasons like a wish for someone’s misfortune and guilt felt over historical wrongs committed by one’s community or a nation.^[4]

COGNITIVE THEORY OF GUILT

From a cognitive point of view, guilt is an emotion that people experience because they are convinced they have caused harm. In cognitive theory, thoughts lead to the development of emotions. There are four stages of guilt defined by Hoffman. In infancy, as a child does not have a separate sense of identity, and thus, the presence of guilt is not theoretically possible, but may be seen. In early childhood, as a child develops a sense of personal identity, but may not understand someone else’s sense of identity, guilt remains superficial (physical) where emotions are not considered. Further, in middle childhood, one develops an awareness of emotions. Here, intense emotions can make one overtly guilty for doing or not doing things. Finally, in adolescence, one develops a sense of how one’s personal doings cause harm not only to other individuals but also to a community or group. Guilt, here, operates on both personal and general levels. Shame and guilt have often been discussed together with regard to their similarities, differences, and possible interconnectedness. Some psychologists claim that guilt is a moral shame. Pain, tension, and arousal have been presented as common attributes to guilt and shame. Both these constructs induce dysphoric feelings which involve negative self-evaluations. Guilt is a healthier affect as it promotes a sense of personal responsibility and sensitivity to others. The boundaries between the two are still fuzzy and blurred.^[5]

TYPES OF GUILT THAT MAY BE SEEN CLINICALLY AND IN PSYCHOTHERAPY

Classification of guilt as adapted from Tilghman-Osborne et al.^[1]

1. Developmental guilt: This indicates guilt that may be seen at different developmental levels during human growth. Guilt has been seen in infants, toddlers, and children as well as adolescents. The emotion of guilt develops as early as the age of 2–3 years, and by the age of 8 years, the child develops a strong self of mutual respect for the self and others, thereby forming a strong sense of morality^[6]
2. Moral transgression guilt: This is a form of guilt that develops when a person feels that he has not obeyed or transgressed the basic rules of morality that make up human nature. This is commonly felt by most people in everyday life in their interactions and feelings for others^[7]
3. Social transgression guilt: This is a form of guilt that one experiences when he does not adhere to social and societal norms and rules laid down in a particular society. To be defined as social transgression, the individual experiencing guilt must believe that his actions have caused harm or affected his society, family, or institution at large. Hurting a group of people that love him leads to this form of guilt^[8]
4. Self-focus guilt: This is a form of guilt that comes up as a result of self-evaluation and a loss of self-identity or self-esteem. This is defined as the guilt of self-reproach or negative self-regard^[9]
5. Not self guilt: This is a form of guilt where the guilt is the result of other factors, and the focus is not on the self. Here, guilt does not involve experiencing negative self-regard or loss of self-esteem and self-identity^[9]
6. Nonpublic/private guilt: Here, guilt is defined with reference to the lack of a real or imagined audience. Guilt is a private experience that does not involve other people or what they might think. Guilt is a feeling without any need for an audience^[10]
7. Public/open guilt: Guilt development, here, includes reference to the existence of a real or imagined audience. Central to this aspect of guilt is a concern with other people or what other people might think. An example of this is evident in a component of guilt, in which people see themselves through the eyes of those that hate them^[10]
8. Behavior/activity-related guilt: This is a form of guilt when the definition focuses on behavior, activity, actions, or inaction (i.e., failure to act when action is called for). This component of guilt is often discussed as an act of commission or omission^[1]
9. Adaptive guilt: This is a form of guilt that helps the individual learn and grow and might lead to further enhancement of his personality, where he learns from his mistakes and tries not to carry out such mistakes or errors in the future^[11]
10. Maladaptive guilt: Here, guilt is a negative construct that leads to problematic outcomes. Maladaptive guilt involves processes that reduce motivation to engage in constructive behaviors. It leads to psychopathology like depression and other psychiatric disorders in the long run if not corrected^[11]
11. Remorseful guilt: Here, guilt involves the compulsion to apologize or confess. Here, the experience of guilt is marked by remorse and sorrow. Apologies and acceptance of those apologies may serve as a means for absolution of guilt^[11]
12. Reparation guilt: Reparation refers to a need or motivation to repair, fix, or make amends for what has been done wrong. Experiencing this component of guilt involves a drive to undo damages^[12]
13. Personality-trait-like guilt: The idea that guilt is trait like refers to a conceptualization in which guilt is expressly dispositional, chronic, and ingrained in the character. Such definitions state that it occurs across many situations or is enduring over time. May be seen in chronic depression, depressive personality, and dysthymia^[13]
14. Specific/transient guilt: This refers to the experience of guilt pertaining to certain situations or periods of time. It is described as a transient phenomenon that does not necessarily generalize across situations
15. Painful guilt: This constitutes an uncomfortable, even viscerally disturbing condition. Guilt is regarded as a “painful emotion” that may be damaging and may cause physical and psychological harm^[14]
16. Responsibility guilt: This is central to guilt when the definition involves the perception of ownership or culpability. This sense of responsibility need not be plausible to others. Implausible responsibility is evident when young children feel responsible for their parent’s divorce^[13]
17. Specific guilt: The definition involves a specific kind of guilt. Subtypes refer to certain events, emotions, or personality characteristics. The examples of such subtypes are hostility guilt, sexual guilt, survivor guilt, masturbation guilt, separation guilt, and omnipotent guilt^[14–16]
18. Old age guilt/end-of-life guilt: Here, guilt comes up for the first time in old age when the person feels that he has committed wrong all his life and wants to make amends before he dies to absolve himself of his wrongdoings, so that his family and children do not suffer after his death^[17]
19. Menstrual guilt: Normal phenomenon in adolescence where young girls who experience the menstrual cycle for the first time may experience a sense of shame or guilt due to a lack of psychological support and knowledge of the physiology and processes involved^[18]
20. Collective guilt: This is a phenomenon where an entire group of people or a religious community may feel guilty for the wrongdoing of one person from their community as in case of a bombing attack or terrorist attack by some individuals^[19]
21. Religious guilt: Seen as guilt in some people that may develop due to nonadherence to religious norms or when a priest or religious figure makes them experience guilt for what they have done as during confession in Christians or during a religious discourse that they might attend^[20]
22. Therapeutic guilt: This is a form of guilt where guilt may be induced into an individual during correction or psychotherapy, so that he may feel responsible for his actions and take corrective measures for the same^[21]
23. Therapist guilt: Guilt experienced by the psychotherapist when the patient commits wrong despite therapy or tries to attempt suicide during a course of psychotherapy. This is a concept where the therapist feels that he or she may have failed to give adequate therapy to the client or have not understood the client well.^[22]

Guilt is a complex construct that, at its core, has both affective and cognitive components. Guilt involves moral transgressions (real or imagined), in which people believe that their action (or inaction) contributed to negative outcomes. A sense of responsibility and painful feelings of remorse are part of the guilt experience; however, whether or not atonement or reparations follow guilt is a separate question. Other personality characteristics and various circumstantial factors likely moderate the degree to which guilt actually leads to atonement or reparation. These variants are not universal and should not be built into the definition or measurement of guilt. Guilt is a collection of thoughts and feelings that occurs in response to a specific circumstance for reasons that likely have both trait-like and state-like characteristics.^[23] The various components of guilt must be understood further in cultural and psychological norms. There is a need for further research to elucidate the key cognitive and emotional components of guilt and to try and decipher how guilt-ridden patients may differ from their nonguilt-ridden counterparts. Guilt has been there in human nature from the time human beings have been existed. There is a need for philosophers, moralists, psychologists, developmental biologists, and psychiatrists to come together on one platform and further explore the concept of guilt in its entirety.