Mr. Guilt gets it wrong so much of the time, skipping over people who should feel its punishing pinch, and injecting its emotional pain into compassionate people who should be fully at peace with what they are doing or have done. The public pictures chaplains hearing confessions of sin that people feel guilty about. But patients and families under my care rarely have wrongdoing to reveal to me, such as skimping on care for a loved one in order to ultimately have more money for themselves, or confessing to assault, harassment or any other kind of crime from their past. Much more common is the guilt for things they should not feel any guilt about at all, and if anything, should be at peace with or even proud of.
I am thinking now of a patient Matilde, who has been so religious all of her life that “she almost became a nun,” a child of hers said. She is confined to bed. When I see her, she speaks Portuguese and she settles for my Spanish as a linguistic compromise. At each visit, she laments that she cannot get out of bed and go to Mass. I assure her that God is everywhere, including her room, and usually this does not console her. But one time I said it again and went into more detail, and to my consternation, she started to cry even more. “What did I do now?” I (guiltily) wondered to myself. Fortunately her sister was visiting and she could translate the amount of Portuguese the patient was saying that I did not understand—which I assure you was a substantial chunk. She translated, “I am crying from happiness, not distress, because you brought God to me.”
As moving as that was, assuaging guilt is the exception. Trying to do so might even let Mr. Guilt become even more entrenched. I have to remind myself that instead of talking a person out of guilt to let them talk about their guilt. This is really no different from how the helping professions should operate regarding any kinds of changes for the better they yearn for their clients to make. We have to ask questions that will unearth hidden angles. We have to refrain from giving them the distraction of resisting our suggestions of “Don’t feel guilty” instead of exploring what ghosts past and present are fueling it. Clients have to find the end of their guilt trips on their own, and all we can do is illuminate the obscure segments of the journey.
Sometimes I am lucky enough to see Mr. Guilt being let out at his last stop when a client talks with me about their guilt during a series of conversations. There was the case of a patient’s son, who I will call Samuel. His mother, who will get the name Jackie, was a patient of mine for around a year. I saw that when he visited her, she would needle him about this or that and make sarcastic jabs at whatever came to mind. When I spoke with Samuel about this after his visits, over time he built up a story of family relationships with plenty of twists and turns for guilt to ride along in. I was surprised first of all when he said his mother favored him over his other siblings, given all her hobbling negativity towards him. (If that is favoriting, I wonder what his siblings dealt with; i.e. “With friends like that, who needs enemies,” as the saying goes.) Over time Samuel talked about his sources of guilt, amply supplied not just from within, but from his siblings. The gist was that they accused him of not giving his mother enough care, the right care, enough money, enough visits, and so on. No praise and certainly no encouragement that I supplied about his compassion, his constant visits from far away, no lamentations over the hostile texts and emails from the sibs which he had showed me, served to derail his guilt. Of course guilt stalks a favorite child, so I knew this was part of the story, which we discussed. I suspect even Joseph felt ill at ease as much as he reveled in his coat of many colors. Still, covering that did not make any headway either.
I soon refrained from praising him and discussing favoritism and over time uncovered a clue that at least took guilt out of the driver’s seat: “When you feel guilty, this lets your sisters do their job for them. They don’t have to feel guilty about anything they do; they just lay it all on you and instead of them beating you up, you oblige and do all the work of beating yourself up for them.” For the first time regarding his guilt, Samuel said he felt “lighter.” A day later he emailed me that he was sleeping better. Ah, Mr. Guilt, I got you that time!!