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  • The Reflective Doc

Shifting the Variables of Guilt

Throughout my training in psychiatry, I've been surrounded by truly remarkable peers. This field of medicine often attracts those with a background in the arts: writers, painters, performers, drawn perhaps to the creativity of psychotherapy, or the mystery of the human brain, capable of inventing worlds.

Me? I’ve always liked math. There is something so satisfying about bringing together numbers and symbols to reach a clear answer, an absolute solution that people across cultures would agree is correct. When 2+2=4, my brain is happy. This is also why I love puzzles, finding the right piece among a field of similar shapes, placing it into its one perfect position. So satisfying.

Psychiatry and psychology can be much more ambiguous, with solutions elusive at times, and the brain downright opaque. Our clinical interviews, by necessity, prioritize open-ended questions and subjective assessments of symptom degree. So if 2+2 = someone’s experience, impacted by adverse childhood experiences (ACE’s), genetic contributions, and environmental influences, the answers aren’t so distinct, in our own culture and certainly beyond.

My search for a clear understanding of the human condition is endlessly motivating, but sometimes feels overwhelming. Recently, while trying to understand the complex emotion of guilt, an equation popped into my head:

Guilt = Expectation --- Reality

In other words, guilt increases in strength the further our reality departs from what we believe should happen. If we have decided a “good mother” is one who can engage fully with her children, while also cooking a 5-course meal and making time for exercise, then our guilt rises the further our true activities depart from this ideal.

In considering how we can apply this equation, there are two key variables. I would like them to have straightforward influences, but of course, nothing is truly as simple as 2+2=4. Let’s begin with expectations. These are clearly shaped by broad forces of societal pressure, including social media displays of unrealistic life balance, generational shifts in the expectations of a woman’s “role,” and interpersonal agreements between partners, influenced by the relationship role models from our childhood.

To this already overwhelming pressure, then, we add our individual attempts to optimize, improve, and reach perfection. We often internalize the responsibility for our partners, children, and other loved ones beyond our ability to control their choices and outcomes.

If expectations are incredibly high, therefore, this equation clearly shows why the amount of guilt expressed by the many amazing women in my life is reaching epic proportions. Reality has no chance against the flawless performance expected by women today. Now that we have so many choices, many believe an inability to “have it all” must be a personal failing. So much of my time with women in session is challenging their self-defeating expectations in favor of self-compassion and choices that truly align with their goals and values.

Another variable that can be adjusted is reality. I’m not talking about escapism via virtual goggles, or even some healthy denial. I try to help women look at their lives with new eyes. What are they already doing that is amazing? What is currently true?

Recently, I compared their impressions of reality to the process of taring the small scale I use in my kitchen for precise baking measurements. After placing a small bowl on the scale, I push the tare button to reset the scale at zero before adding flour or other dry ingredients. The weight of the bowl is magically zero. Often, women use this same process to negate the positive things they are doing in their own lives. These accomplishments disappear to zero as they focus on what they have not done, potential they have not met.

For example, during the height of the pandemic, when many kids were “home-schooling” and women were adjusting to a massive, once-in-a-lifetime cultural shift, many felt guilty for being less productive at work, or noticing a messier house, less healthy food choices, or decreased exercise.

What they magically removed, however, was their incredible flexibility as they were responding to confusing recommendations, protecting their families from a novel and dangerous virus, adjusting to online communication for all things, and getting through each day in the absence of their usual support and social interactions. These adaptations must also be included in the reality variable.

I recognize that a simple formula for lowering guilt involves some wishful thinking, but I also believe in our ability to change our emotions by shifting our attention. If we can remember all of the hard work, ingenuity and love we squeeze into each day, and continue to challenge unrealistic and damaging expectations, perhaps we can relinquish some of our painful guilt. Think of the room this would leave for other, more rewarding, emotions.

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