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The Yale Journal for Humanities in Medicine |
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Spirituality, Religious Wisdom, and the Care of the PatientGuilt in the Context of Illness: A Protestant Perspective Marilyn P. Mecham One of the great Protestant theologians, Reinhold Niebuhr, once wrote," . . . human beings cannot accept their limitations without a sense of guilt." Guilt is so pervasive that it is often hard to contemplate. In the words of humorist, Garrison Keilor, "Guilt is the gift that keeps on giving." There are two sides to guilt. Healthy guilt impacts our conscience by providing emotional feedback about the consequences of bad choices. Healthy guilt may increase our sense of responsibility, self-inquiry, and self-respect. On the other hand, unhealthy guilt, the guilt we are discussing in this presentation, is a burden. It can eat away at our mental well-being and slowly destroy our physical well-being. It may be as degenerative as a disease. Guilt paralyzes and limits people's ability to function and be productive. It is toxic to our peace of mind. A number of studies have focused on the relationship between guilt and wellness. A research team from Hull University found a correlation between high guilt ratings and low immunoglobulin levels. It is imperative for people to shed the burden of guilt as they cope with illness. A person struggling with a diagnosis of lung cancer may express guilt of having smoked for years, even after being warned by medical professionals, and begged not to by family and friends. The feeling of having brought this on is overwhelming. While the person may be able to accept the responsibility for his/her own condition, the burden of the emotional and financial suffering the family is now forced to deal with is devastating. Another person may have been told that the body, mind and spirit connection is so strong that by imagining the white blood cells enveloping the diseased cells, the cancer will disappear. An inappropriate and unhealthy feeling of guilt for not having prayed hard enough or willed strong enough can surface when healing does not occur. In each case, guilt overwhelms and is detrimental to the recovery process. Illnesses are affected by a combination of genetic, biological, environmental, behavioral, and psychosocial factors. Even the most optimistic, positive, giving, and loving people with excellent mental health fall victim to serious illness. While there is considerable data to support the positive impact that healthy attitudes and behaviors reduce the risk of illness, the biology of disease may be overwhelming. In responding to a patient's feelings of guilt the role of a medical professional parallels that of a spiritual leader. Both must be present in a nonjudgmental, caring way. Confession is good for the soul. Reflecting feelings and offering insight or even sharing similar circumstances can be helpful. Often the person is looking for validation, to be able to accept themselves for who they are in this time and place. They need to be challenged to stop living in the past and to start looking to the future, to see even that without a cure there are healthy ways to live with a disease. When physicians, nurses, and spiritual leaders work as a team to help a patient cope with immobilizing guilt, it is helpful to know what each is "bringing to the table." In the Protestant faith the 'ministry of presence' is a time for clergy and lay leaders to let the person know that he/she is accepted, loved for who he/she is, and assured that someone will be there for them. What is then offered is a 'spiritual presence.' People who are racked with guilt need to know of the Gift of Grace (undeserved mercy); that Jesus was sent for people who struggle. Confession is a necessary step toward accepting grace. In our tradition guilt and shame are placed on Jesus. He went to the cross to nail them there. Our belief is that He sacrificed His perfect life for our transgressions. God sets us free from the burden of guilt. There is forgiveness and atonement for sin through Jesus Christ and His sacrifice for us. Paul assured us of this in his letter to the Ephesians, "In Christ we have redemption through His blood, the forgiveness of sins, in accordance with the riches of God's grace." (Ephesians 1:7) In our tradition we give a great deal of emphasis to the forgiveness we receive in a tangible, physical and very meaningful way at the Lord's Supper. Coming to the table and accepting the bread and wine with the words, "The body of Christ given for you, the blood of Christ shed for you," helps us process wherein we remember the sacrifice Christ made and accept the assurance of forgiveness and the pardoning of sin. Our faith teaches that God can even take our failings and work them together into a tapestry of renewed living. God's unconditional love is ongoing. "His mercy endures forever." (Psalm 136:1) The Christian message of the resurrection brings the promise of New Life. It is a spiritual presence that medical professionals often call on as they struggle with their own feelings of guilt. Making a wrong diagnosis, feeling like there may have been something else that could have been done, not responding in time, may burden the physician with real or false guilt. Both can limit effectiveness. Dr. Mark Jones, Lexington, NE, stated, "It is my observation that medical professionals are not very good about sharing guilt or fear and are somewhat isolated. I think that there is a fine line between having too sensitive of a conscience and one that is too hardhearted. Over a period of time I have been able to develop the ability through journaling and meditation to hopefully deal with my failures honestly, but not to allow them to paralyze me at the same time. I try to spend some quiet time both morning and night reading scripture and just reviewing the events of the day, monitoring my emotions and trying to be honest with myself about things that were done that should not have been done, or sometimes things that were left undone or unsaid that should have been said." Dr. Jones' observation regarding medical professionals' unwillingness to acknowledge their own guilt feelings is understandable in today's litigious society. Many years ago my illness was misdiagnosed resulting in numerous complications. I will never forget being in my doctor's office days after being released from the hospital and having him sit before me, look me in the eyes, and say, "I feel so guilty . . ." Confession was good for both of our souls. Real healing began. Being able to open up through journaling or through conversations with clergy or mental health professionals, which are spiritually and legally confidential, can provide spiritual, emotional, and physical benefits. Protestant teaching (to use a well-worn phrase) is to "let go and let God." Some guilt weighs us down so heavily that we cannot just forget it. But with the help of the Holy Spirit and God's grace and unconditional love we are able to turn over our heaviest burdens for God to carry for us. Guilt is a burden too heavy to carry alone. Protestants look to the cross, the symbol of forgiveness, for blessed assurance as found in Isaiah 2:16, " . . . your guilt is taken away, and your sin forgiven." It is with that assurance that we can follow the advice of Ralph Waldo Emerson, "Finish every day and be done with it. You have done what you could. Some blunders and absurdities crept in-forget them as soon as you can. Tomorrow is a new day. You shall begin it well and serenely with too high a spirit to be encumbered with your old nonsense." Guilt: Introduction Published: February 5, 2005 |
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