Kurt A. Walker

At the Crossroads

On the cusp of completing my first unit of CPE at Massachusetts General Hospital, I am struck by how many changes I have experienced. I’m sure that this is not particularly shocking to anyone who has experienced a unit of CPE. CPE is intended to facilitate an educational experience – at the crossroads of our pain and suffering and the pain and suffering of people in the hospital. It is there at the crossroads where the real work happened, internally and externally, for myself and the people I served. This is where the questions came up, in a place of empathy and compassion. One of those questions was for me: How does this person’s experience with guilt and shame intersect with my understanding of guilt? And what is the difference between shame and guilt?

As I began to listen to patients describe their feelings while experiencing their pain and suffering in the hospital, I heard various stories while keeping in mind my questions about shame and guilt. I found that, on occasion, a patient seems to be feeling guilt, when he\she is really experiencing ‘shame’, and vice versa. This has caused me to explore my own feelings of both guilt and shame. What is the difference? How do feelings of guilt and shame affect a person? What is the intended motivation of each?

I learned that guilt is an emotion that has the potential to resolve conflict between what is and what should be – either external to the self or internal. Guilt feels like a hand placed between the shoulder-blades. It has the intention of moving a person forward from the place where the guilt was experienced. It is a motivating factor in bringing closure to the experience and restoring the self to the other or to the greater community. Guilt says ‘I’ve done something wrong in my life and would like to repair it.’

Shame, on the other hand, is an emotion that creates an even greater sense of pain, internally to the self. Shame feels like a hand placed directly on the shoulders, restraining and holding a person down. It has the intention of paralyzing a person and of causing that person to be pushed further into the darkness of isolation; further ripping the self from the community. Shame says ‘I am wrong and I don’t deserve to be repaired.’

To be fully present with the patients, families, and staff, it is crucial for us to aid persons in moving from the darkness of isolation and self-loathing to the light of healing and community. When listening to a patient expressing guilt we are called to pay attention to the motivation that will help reframe a person’s experiences of pain and suffering, allowing them to heal the relationship with self and community.

In CPE I have experienced such healing for myself and in turn I have been able to be present with my patients in a new way. For this change I am grateful.

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