Blaming yourself when bad things happen

I've talked before about the role of self-blame in maintaining depression.  As I've read more on this topic I discvoered that self-blame is not always associated with depression.  (I guess I don't really see those people who blame themselves but aren't depressed.  They don't tend to need therapy).  Based on personal experience, it seems like self-blame often provides people with a greater sense of control.  If I did something wrong that caused something bad to happen then all I have to do to keep it from happening again in the future is to change my own behavior.  For many of my patients, gaining this sense of control decreases anxiety but also causes a lot of guilt which, over time, leads to depression. 

According to the research literature, however, this type of self-blame should not lead to depression.  Peterson, Schwartz, and Seligman explain that attributing a negative event to one's own behavior increases perceived controllability (as I said before) and creates the sense that one's bad behavior was situation specific.  (In other words, a person sees his behavior in a given situation as a one time thing.  He doesn't see it as representative of a broader pattern of bad behavior or as a reflection of who he is as a person).  Peterson et al. call this phenomenon "behavioral self blame" and describe it as an "attributional defense mechanism...[that is] inconsistent with depression."

So what gives? Why do I see so many depressed patients who blame their bad behavior for causing significant negative events?  According to research, this sort of self-blame is a defense mechanism and should protect them from depression.  Why does this not seem to be happening?

I don't have a definitive answer but I do have some ideas...

One thing that stands out to me is how many of my self-blaming patients seem unable to forgive themselves for making mistakes.  Theoretically, attributing a negative event to their own behavior should boost their sense of control, leading to increased hopefulness about their ability to prevent similar events from taking place in the future.  And yet, I don't often see hopefulness.  Instead I see a tendency to dwell on perceived mistakes, which creates an overwhelming sense of guilt and self-doubt.  It's difficult to feel hopeful about the future when you're busy condemning yourself for mistakes you made in the past.  Part of "behavioral self blame" is "admitting I did something wrong."  For some, making a mistake is simply unacceptable.  In such cases, "behavioral self-blame" equates to perpertual self-condemnation; this inevitably leads to depression.

Or perhaps certain kinds of negative events are simply so terrible that normal rules don't apply.  The negative events experienced by the majority of my patients fall into one of two categories: 1. Combat-related incidents in which one or more people were seriously injured and/or killed and 2. Sexual assault.  Rape and violent death are more extreme than most other negative life events.  Perhaps the reactions people have to these experiences are therefore more complex. 

Another possiblity for some is their inability to identify what exactly they did wrong.  That is, they have the general sense that they did something to cause a negative event but despite replaying the event in their minds again and again they are unable to identify a specific behavior that would explain what happened.  They feel compelled to continue replaying the event in their minds in an effort to figure out exactly what they did wrong.  I imagine the people who do this are people who have a pre-existing tendency to blame themselves when things go wrong; the drive to blame oneself in the absence of any evidence seems to suggest this.

These are just theories...

Shame and depression

I mentioned before that I was recently tasked to lead a therapy group focused on sexual assault, trauma, and depression.  I did some background research to prepare.  One thing that stood out to me is how frequently shame was mentioned as a factor contributing to depression.  I mentioned this during the first group session.  It seemed to resonate strongly with the group members.  As they shared their experiences I spontaneously found myself talking about the "power of shame."  I hadn't intended to go this route but it felt right.  It ended up being a very powerful discussion.

In the ensuing days my thoughts repeatedly turned to the concept of shame.  It's not something I've ever spent a lot of time talking about with patients, although it does come up in sessions.  There are, however, certain treatment approaches to which the concept of shame is integral.  John Bradshaw (http://www.johnbradshaw.com/) is probably the shame guru,   if there is such a thing.  His book, "Healing the Shame that Binds You," is a New York Times best seller.  In it, Bradshaw points to "toxic shame" as the underlying cause of compulsions, addiction, co-dependencies, and the drive to super-achieve or underachieve."

Shame and guilt are often used interchangeably, which can sometimes cause confusion.  For my purposes, I've decided to distinguish guilt and shame as follows:

*Guilt is a bad feeling caused by the fact of having committed a specific offense.

*Shame focuses on the entire self.  It is a painful feeling arising from the judgment of oneself as dishonorable, disgraceful, disgusting, etc.

Thus, guilt is concerned with something specific a person has done.  The focus of shame is on the self as a whole.

Like most human emotions, shame can be healthy in small doses.  Shame can compel us to eliminate bad behavior and motivate us to act in ways consistent with our values.  Healthy shame fuels personal growth and so helps us to become better people. 

Too much shame is emotionally and psychologically toxic.  (Bradshaw talks extensively about this in his book).  There is significant overlap between the consequences of toxic shame and the symptoms of major depression.  Here are some of the ways toxic shame manifests itself:

*Causes you to feel exposed and vulnerable, creating a sense that "everyone knows" how disgusting you are.  This leads to a desire to hide, withdrawal, or otherwise escape from public view.

*Generates negative judgments about the self, which is seens as inferior, flawed, damaged, disgusting, worthless, etc.

*Creates a tendency to blame yourself when something goes wrong.

*Leads to a sense that you have a very limited amount of power to control what happens in your life.  This eventually leads to feelings of hopelessness and helplessness.

*Can create social anxiety due to fears that others will judge you as negatively as you judge yourself.

Essentially, chronic shame leads to self-loathing; self-loathing leads to depression.   I have come to believe that chronic, pervasive shame inevitably leads to depression.  After all, how could a person hate himself and not become depressed over time? 

Part of moving past self-blame is asking the right questions

It is relatively common for people who have had some sort of traumatic experience to blame themselves for the event, even when it is clear they did not cause it.  Some of these individuals readily acknowledge that they did not cause the event to occur; still, they hold themselves responsible for not preventing it.  This is especially true when they can look back on the event and identify things they could have done differently that would have led to a better outcome.

Self-blame creates a lot of emotional suffering.  This leads me to conclude that people do not choose self blame; in fact, many people attempt to convince themselves of their innocence.  Barring that, they might try to avoid thinking about the event at all.  Paradoxically, they find that no matter how hard they try not to think about the event they seem to think about it all the time.  In turn, these unwanted thoughts remind them of their guilt.  In this way, self-blame begins to consume more and more of their lives.

So how do you help someone overcome self-blame?  It is not enough to tell them that they've done nothing wrong; they've probably heard this a million times already.  There is very little anyone can say to convince them of their innocence; this is a conclusion they must reach on their own.  As a therapist, I try to operate from the assumption that the patient has the answers; my job is to ask the right questions.

So what kind of things might I ask about?

What happened? It's important for me to have at least a basic understanding of what took place.  For one thing, it helps to distinguish between appropriate and inappropriate guilt.  There is always a possibility that the patient did in fact commit some act of wrongdoing.  In such cases, the task is for the patient to learn to forgive himself.  Either way, I need to know the basic facts in order to help the patient put the event in its appropriate context.  If relevant, I sometimes ask patients to draw a little diagram so I can get an idea of the environment where the event took place and of where the patient was positioned in relation to other people.  (You'd be surprised by how helpful this can be.  Sometimes a diagram makes it immediately apparent that, for example, based on the patient's position in relation to others there was no way he could have caused, prevented, or otherwise intervened in the event). 

If you went before a jury, would they find you guilty and convict you of causing the event?  What specifically would they convict you of?  This helps people to think about guilt from a different perspective by adopting the mindset of a hypotehtical jury member who has been instructed to consider only the facts.

Are you the only one to blame for the event?  Or are there others who bear some responsibility?  I often have patients make a "responsibility pie chart."  I ask them to identify all of the people (or other entities) who played some role in causing the event and to assign a percentage of total blame to each one.  (Remember, the total has to add up to 100%).  Ultimately, most patients end up assigning themselves somehwere around 20 to 25% of the total "blame."  I then ask: "Are you treating yourself like you're 25% responsible?  Or are you treating yourself like you're 100% responsible?"

Do other people share the belief that you are to blame?  If not, who do they blame?  How did they reach this conclusion?  What evidence did they use?  Is this the same evidence you use? 

If a friend or relative had a similar experience, would you blame them?  If not, why?  Are you holding yourself to a different standard? 

These are just a few of an endless number of possible questions...

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...

Guilt and shame

I've always thought of guilt and shame as two sides of the same coin.  In theory, when you do something wrong you feel guilty; when people find out about it, you feel ashamed.  Thus, one can feel guilty about something he's done even when no one else knows about it; he only feels ashamed, however, once his actions are discovered and his guilt is brought to light. 

In my mind, shame was a mixture of embarrassment and guilt brought about by having one's misdeeds made public.  I saw guilt, on the other hand, as a moral compass of sorts, one that alerts you when you've strayed too far off course.  Apparently, though, I've had it all wrong.  It turns out that people who study this type of thing think about guilt and shame quite differently.  To feel guilty is to condemn specific actions, i.e., you feel guilty about something you've done.  When, in contrast, a person feels shame he condemns himself.  In other words, I feel guilty about what I've done; I feel ashamed of who I am.

I have no problem with this perspective; it makes a certain amount of sense.  Who am I to argue with the experts?  Moving on...

Guilt is often uncomfortable and unpleasant but it also serves an important social function in that in promotes cooperation and adherence to group norms.  (Consider this: the inability to experience guilt and remorse is a characteristic of most psychopaths).  Studies show that guilt tends to motivate conciliatory behaviors and efforts at restitution.  Because it serves as an impetus for corrective action when social norms are violated, guilt facilitates the restoraction of peace and cooperation, thus enabling individuals to live and work together in communities.

Shame, on the other hand, yields very little in the way of benefits (at least according to the experts).  Whereas guilt often motivates reparative actions, shame tends to induce behaviors that are self destructive.  With guilt, the focus is on one's actions and their consequences to other people.  Shame, however, is a self-focused emotion characterized by a a sense of unworthiness and self-directed contempt.  Shame is associated with negative attributions towards oneself and is frequently accompanied by low self-esteem. 

Over time, shame leads to self loathing.  Pause for a moment: have you ever known someone who hated himself?  Think about what this person was like...

Probably very sensitive to any negative feedback.  People who carry a lot of shame tend to be very defensive.  You see, the job of the human "ego" (or sense of self, subconscious, identity, self concept, or whatever you want to call it) is to protect itself and to maintain its integrity.  Shame leads to self loathing; this poses a serious threat to the "ego."  The "ego" of someone who hates himself is under constant attack from the inside; an attack from the outside would be crippling.  So it builds up a network of defenses to protect it.  Thus the shame filled individual blames others for his mistakes and refuses to accept responsibility for his actions. We think he's just being an asshole.  The truth is, his fragile ego cannot withstand the blow of acknowledging he did something wrong; he can't even admit it to himself.  And obviously if a person can't admit he did something wrong, he certainly can't come to forgive himself...

Which is what I plan to talk about next week - self-forgiveness.