Illness Guilt, Inadequacy Guilt and Rehabilitation Therapy

Illness has historically4 been associated with moral guilt and punishment for moral wrongdoing and such association still exists in the contemporary mind.4,8,11 Rehabilitation and somatopsychological literature discuss the effects of this factor on the reactions of the rehabilitation patient. Wright11 identifies this “emotional syllogism by which the cause of disability becomes associated with evil …” However, another related “emotional syllogism,” the association of inadequacy feelings with guilt feelings, is hardly discussed in the literature and when discussed appears to be only vaguely and incompletely understood.

That the severely ill or physically handicapped person suffers from considerable feelings of inadequacy is obvious. That inadequacy feelings are associated with guilt, and may generate guilt feelings does not appear to be adequately understood. Frances Alexander3 has noted that inferiority feelings and guilt feelings are associated and tend to reinforce each other. Beatrice Wright11 indicates that, “At least under certain conditions, the shame of inferiority at being below standard is tainted with the shame of guilt at violating an ethical code.” In our conceptual framework the “shame” or “guilt” arising out of felt inadequacy associated with inferiority in physical, mental or psychological dimensions is the more basic guilt which