As we continue to honor Mental Health Month, it’s a good time to talk about two challenging emotions: shame and guilt. Over the years, I have found a beneficial way to talk about these emotions for certain young patients who are struggling. Today I share a story from my clinic. 

Story from clinic

In the community clinics for the underserved where I work, we also hold special clinics at night for teenagers who are experiencing homelessness. 

I will never forget Tony (not his real name). He had arrived via a shuttle bus from a homeless shelter. He was 17, with a strong build and a soft voice. First, we talked about his medical concerns and then eventually started discussing his social situation. 

I asked him about his family. Tony said,  “I’m not talking with any of them.” 

“Did you grow up with two parents?”

“No, just my mom.”

“When was the last time you spoke with her?”

“I don’t know, like two years ago.”

“Do you want to say what happened? No problem if not.”

“She doesn't want to talk with me anymore.” 

Tony looked away, and then he slowly continued.

“I was in a gang, and we did some pretty messed up things.”

“That’s hard. From what I have been told, I know gang life can be really tough. “

“Yeah.”

“I know for some people joining a gang can come from wanting  a sense of more family.”

The room was silent.

Still looking away, Tony then said, “You know, doctor, my gang…um…when a person joins… the initiation is that a few of us have to beat up a… “ 

He paused, and I could see a tear in the corner of his eye.

“We have to beat up a friend.”

When he said this, the tears started falling.  I reflexively put my hand on his shoulder, and I felt a burning in my throat-holding back my own tears.

Then I asked, “And about your mom?”

“She hated that I was in the gang. Now I am not in it,  but she still doesn’t want to talk with me.”

I told him, “There are two emotions I want to talk about… if you’re ok with that?” 

Tony nodded. 

“One is called shame — of course, we all know the word. Shame is the feeling that we don’t deserve to be included. It’s an awful feeling, a deep-down feeling like we don’t deserve to belong. 

But the truth is most people who feel shame are experiencing unwarranted shame. The feeling is real…there’s no denying that, but it is unwarranted because people deserve to be included, to belong. 

Warranted shame, on the other hand, is rare. Warranted shame would be, for example,  the shame a person should feel if they were doing something truly horrific such as trafficking kids. 

Now the next emotion I want to mention is guilt. Guilt would look something like this: ‘I am a good person, but some of my actions have not aligned with what I wish I had done.’ What is great about healthy guilt is that we get to take actions to try and repair things we did.”

By now, Tony had moved closer to me on the little medical bench, and his eyes were meeting mine. 

I articulated my next words very slowly, “Tony, you are a good person. Your shame is unwarranted. You belong.”

I, too, was leaning in, and I remember a warm smile passing between us.

“Tony, what if you put flowers with a card on your mom’s porch? And, then, do that for many days in a row to say you are sorry? To show that you feel guilt and you want to repair things. 

Who knows what will happen, but I imagine that something good could happen.”

Tony shifted a bit in his chair, and then he started nodding and, with an upbeat tone, he said,

“Yeah, yeah, that’s a good idea.”

I remember feeling a bit sad saying goodbye after our visit because I knew there was a decent chance I would never see him again. Indeed that was the case. But after all these years I still think of him.  

Shame vs. Guilt 

June Tangney, Ph.D. has been studying shame for over 30 years, and she explains things this way:

"When people feel shame, they focus on the self. They often feel powerless, worthless, or exposed. Shame-prone people are more prone to anger and don't manage their anger constructively. 

When people feel guilt, they focus more on the behavior and less on the self.  Guilt is linked with empathy and motivation to try and repair a transgression.”

Research

Some years ago, Tangney and colleagues recruited several 10-year-old kids, gave them written scenarios, and asked them how they would most likely handle the situations. From their answers, they could gauge which kids were more “shame-prone” and which were more “guilt-prone.”

For example, the participant reads a scenario in which they are to imagine they’re in their school cafeteria and accidentally knock over someone's food tray. How do they think they would react? Would they run out of the room?  Raise their voice at the person whose trqy they knocked over? These are behaviors suggestive of shame-proneness. Or would they help the person pick up the food? Apologize? These behaviors are suggestive of guilt-proneness.

Then the researchers followed up with these same children when they were 18 and surveyed them about their lives. One important finding was that the ones who were more shame-prone at age 10 were significantly more likely to have used drugs, particularly hard drugs. In Screenagers Under The Influence, Tangney discusses the connection between shame-proneness and drug use.

One of my therapists

I must give thanks to one of my past therapists for being the one who taught me about shame and guilt in this particular way.  She said something I will never forget, “My main job is helping move people from unwarranted shame to warranted guilt.”  I love that.

Questions to get the conversation started:

1. What do you think the difference is between shame and guilt?
2. Do you think the idea of unwarranted shame is helpful (which is not to dismiss the feeling, but rather to really ask oneself if the feeling is in line with the situation? Aren’t we still worthy of belonging?
3. Do you think you are more shame-prone or guilt-prone? To answer this, think about situations where you did something that you regretted and how did you talk to yourself. And what did you do?