Sunday, April 28, 2013

Guilt and self condemnation

I often work with patients who have endured some sort of trauma and who have blamed themselves for these events.  In most cases, it would be obvious to any outside observer that my patient is not at fault for what happened.  In fact, many of my patients have been told on multiple occasions and by many people that they are not to blame.  Still, they continue to blame and then condemn themselves.  The most common example of this is sexual assault.  Patients often blame themselves for not screaming louder, fighting harder, or somehow resisting more vehemently.  Or they insist that they "should have known" the person was a rapist and stayed away from him. 

Then there are the patients I encounter whose actions did play some sort of role in the outcome of their traumatic experiences.  I have never had a case like this that was completely cut and dry, i.e., the patient's actions were the direct cause of a negative outcome.  Keep in mind that most of my patients are military service members.  So an example of this type of situation might be as follows: A patient is in charge of some team or unit of service members.  He plans some sort of mission or decides upon a particular course of action, which his team or unit then implements.  Someone in the team/unit gets hurt or killed during the mission.  The patient blames himself because he planned the mission and selected the people who participated in it.  Of course, the patient did not plant the bomb or fire the gun that killed his teammate.  Still, he feels responsible.

Self blame inevitably causes suffering.  A person's thoughts are often consumed by their traumatic experience/experiences.  They replay the event in their minds over and over again in an effort to identify what they could have done differently that would have led to a different outcome.  They initially condemn their actions but over time end up condemning themselves.  Often they begin to hate themselves.  As self-loathing grows, they withdraw socially and isolate themselves from others.  They frequently become depressed.

Self-blame also keeps a person stuck.  When a person blames himself for some traumatic event, everything about the event becomes frozen in time.  The person's memories of and feelings associated with the experience are stored in their mind and body in their original form.  When the person attempts to process the event he ends up condemning himself.  It doesn't take long before he decides to stop trying to process the event.  He tries to bury the emotions and memories.  This is, of course, impossible.  At some point, the emotions and memories rise to the surface (e.g., when the person sees something that reminds him of the event), as intense and as vivid as they were on the day the traumatic event occurred.  Most people respond by redoubling their efforts to suppress the thoughts and emotions, which may work in the short term but will eventually fail.  And thus a self-defeating cycle emerges.

If self-blame has such obvious negative consequences then why do it?  While the costs of self-blame are many, it also provides a certain benefit; it enables a person to maintain a sense of control.  If I accept that something bad happened that was completely beyond my ability to prevent or control then I must accept that something terrible could happen again at any minute and there is nothing I can do about it.  This is, of course, technically true.  It is, however, quite scary.  How do we live in a world where we cannot keep ourselves safe? 

If, however, something terrible happens and I blame myself for it then I can prevent the bad thing from happening again by changing my behavior in some way.  In other words, if it's my fault then I can fix it (or keep it from happening again).  I am in control.  Blaming myself allows me to maintain the illusion that I have control over my environment and that I can prevent bad things from happening to me (and am therefore able to keep myself safe). 

In future posts I will talk about ways to move past self blame...

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