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In Civilization and Its DiscontentsFreud (1930) wrote that it was his inention “… to represent the sense of guilt as the most important problem in the development of civilization and to show that the price we pay for our advance in civilization is the loss of happiness through the heightening of the sense of guilt.” There is no doubt that guilt is one of the most painful affects from which patients suffer. Consciously most of them express the hope of finding relief from it through analysis. Nevertheless, clinical experience often reveals an impressive determination on the part of some patients to cling to their feelings of guilt and to the fantasies which produce them. Such an attitude is evidence of an internal unconscious conflict in which the patient is obliged, for reasons of which he is unaware, to reject what he wants, namely reduction of guilt, just at the moment when it becomes possible to attain it. This, in effect, is a negative therapeutic reaction. As Freud (1923) pointed out in The Ego and the Id, guilt seems to be both a source and a manifestation of the negative therapeutic reaction.
My intention in this paper is to present some reflections on guilt as it is encountered clinically. In particular I wish to examine various fantasies which produce and sustain guilt and to call attention to some of the hidden narcissistic benefits which are also derived from these same fantasies. It is important to recognize these benefits as they make it difficult for patients to lessen their guilt and the painful feelings which it causes.