Anxiety and Guilt

by Paul Ballas, D.O. Health Professional

There are many sources of anxiety. One interesting psychodynamic source of anxiety is guilt. What is guilt? This is not an easy question to answer.

The concept of
is an elusive one. The best answer I have come across, and one that fits with what I have observed in my patients, is that guilt has something to do with the feeling of "needing to be punished." In other words, if I cheat on a test, and get away with it, I might still feel guilty. Why? Because on some level - even if unconsciously -- I feel I deserve some punishment. If I didn't feel it was wrong to cheat, and therefore not deserving of some sort of reprimand, I probably would not feel guilty. Interestingly, guilt has a cousin called shame. Shame can be understood as guilt plus public embarrassment. If I got caught, and was publicly exposed, I might also feel that thing called 'shame'.

The origins of guilt

Where does guilt come from? This question is of great interest to psychotherapists. The story begins in our youth. When we are young, we not only lack good judgment, but we lack moral decision making capacity. In other words we don't know right from wrong. In order to help children get past this period of their lives (and to help inculcate moral behavior in us), our parents and society must impose a system of rewards and punishments to get us to act in a moral way. Even if we can't understand right and wrong, we can understand reward and punishment, and we act accordingly. All cultures do this. Usually it works, until we become a little older and we no longer need to operate out of fear of reprimand on the one hand and approval on the other.

The problem of guilt

But what if this system of fear of disappointing on the one hand, and desire for approval on the other, lingers on past our youth? To some extent, this happens to all of us. But what happens if the vestiges of this reward/punishment system is not replaced by an independent sense of responsibility and moral duty. What if fear of desire for approval and fear of punishment continue to weigh heavily on our conscience as adults? Well...we end up with the potential for feeling guilty. Some would argue that there is nothing wrong with feeling guilty - after all, how would we know how to act correctly. Shouldn't we feel guilty if we choose not to walk an elderly lady across the street? (I would argue that we should do it out of a sense of duty, not out of guilt). The problem, of course, is with excessive guilt; with walking around constantly feeling inadequate or feeling that we have done something wrong. This leads ultimately to potentially significant anxiety.

I see many patients with anxiety. They are not all caused by excessive guilt. Nevertheless, along with uncertainty (discussed in our previous blog), excessive guilt or shame does seem to be one of the central concepts in understanding the psychodynamic underpinnings of anxiety. Please remember there are several effective treatments for anxiety, from psychodynamic and behavioral therapies to medication management in severe cases. If you feel your anxiety is debilitating, or is impinging on your functioning, please consult a mental health professional.

Paul Ballas, D.O.
Meet Our Writer
Paul Ballas, D.O.

Paul Ballas, D.O., wrote about mental health for HealthCentral. He is a member of the American Psychiatric Association and has been a presenter at the American Psychiatric Association and American Academy of Psychosomatic Medicine meetings.