This discussion explores the far-reaching consequences of betrayal of patients, both at the individual and at the social level. Considering the variety of betrayal’s Elise describes, there are many deep effects on patients, on the field, on institutions, on a sense of the ethics of the profession and public trust. Particularly interesting and important in Elise’s paper is the long-ranging effect on many treatments beyond the original dyad. I would argue that betrayal is among the most profoundly important and damaging situation psychoanalysts and psychoanalysis faces. This discussion notices Bleger’s theory of the setting to consider how deeply events outside a treatment but connected to institutions and communities can impact psychoanalytic work. Crises and betrayals in the field (large and small) deserve our most careful attention. In this discussion the role of shame in the context of betrayals and damage to patients is discussed.