Dr. Jennifer Reid
Maria* looked down at her lap as she said, “If only I had appreciated our time together more.”
“What do you imagine would have been different?” I asked.
“I guess I wouldn’t feel so awful now. I’d know that I had done everything possible.”
The most adaptive type of guilt occurs when we believe we’ve done something wrong. It’s uncomfortable, which urges us to make amends, perhaps through apology or another action. However, the guilt that often emerges in times of loss is typically the maladaptive kind, a broadly generalized sense of not doing “enough.” When I ask individuals what they believe they’ve done wrong, they may answer, “I don’t know, but I just feel like I let everyone down.”
Maria’s guilt in the face of loss is something I’ve heard so many times in my psychiatry practice. Whether it’s the ache of noticing time moving forward, such as children leaving home or an unexpected career change, or the overwhelming pain of losing a loved one, guilt is often one of the most prominent emotions.
Maria had recently lost her mother to cancer following a fairly rapid decline and frequent gatherings at her seaside home. After her death, Maria was overwhelmed by everything she wished she would have done differently when her mother was alive. “I should have asked her about her life. I should have found a way to lessen her pain. I should have done so much more.” Family and friends tried to reassure her that she had been a wonderful daughter, but she just couldn’t accept this.
I’ve found that this intense guilt often accompanies significant losses in our lives, shifting our attention away from the difficult awareness of grief. Why? Because guilt, for all of its discomfort and self-criticism, does provide something we so badly want during times of loss: a sense of control. After all, guilt tells us we’re the problem, so we should be able to solve it. This is a very different message from grief, which tells us “You’ve lost something important, and you couldn’t prevent it.”
However, distracting from grief with guilt can be costly for several reasons. First, you cannot process your true grief when you don’t allow it into your awareness. Instead, it lingers, showing up suddenly to knock you off course. Guilt also adds demoralizing self-criticism to the already present pain of loss, which can worsen your mood and sleep, as well as interfere with your interest in connecting with others, something that may help to ease your grief. Finally, when you believe you’ve failed at something, even if it’s far outside of your control (i.e. “I couldn’t keep this loss from happening.”) this can rob you of the confidence and agency you need to move forward.
The first step to uncovering the feelings underneath your guilt is learning to recognize the source of your guilty thoughts. To do this, you can use the Guilt Equation:
Guilt = Expectations – Perceived Reality
In other words, guilt lives in the space between what you expect of yourself and how well you believe you’re meeting these expectations. Maria could readily describe what a good daughter should be doing: taking away her mother’s anxiety, helping her sleep, protecting her from discomfort, but, unfortunately, she was unable to do these things, because they were out of her control. However, because she held these unreachable expectations, guilt was the inevitable result.
I taught her to apply the Guilt Equation with these simple questions.
- What am I expecting of myself here, and is that fair?
- What contributions could I be overlooking?
With encouragement, Maria used these questions to explore the unreasonable expectations she was holding in her role as a daughter. She began to forgive herself for her inability to save her mother, and instead could see all of the ways she showed up in her mother’s final days, sometimes just sitting and holding her hand at the bedside. Underneath the guilt was a deep and powerful grief, which she was able to share in session, expressing surprise that she felt better after shedding tears, rather than exhausted or overwhelmed.
If you find yourself struggling with guilt during a time of change or grief, you may find some relief in exploring the expectations you’re carrying, as well as the ways you have already been showing up in that role. You may also benefit from self-compassion, which involves three components: treating yourself with kindness, bringing mindful awareness to what you’re currently experiencing, and seeing yourself as part of a broader community. Here are some example statements to evoke self-compassion:
“Even if this is a desired transition, it’s understandable to feel sadness and to grieve aspects of my life I enjoyed before the change.”
“I wish I could protect myself and others from pain, but it’s human to feel this way. All I can do is keep trying to connect with those I love.
“This loss hurts because I was brave enough to care about someone deeply, and it was worth it. I didn’t do anything wrong.”
You can use another simple but helpful self-compassion exercise when you notice a guilty or self-critical thought, such as “I didn’t do enough because I’m a bad daughter.” Instead of letting this “rough draft” thought remain, you can rewrite it from a different perspective, asking yourself “What would I say to a close friend in this position?” Perhaps, “You clearly loved your mother so much. I saw how hard you worked to be there for her when she was sick.” It’s remarkable how much kinder you might sound when you’re speaking to someone else.
Remember, our lives are rich when we connect with others, when we love and are loved. With these gifts, however, comes a vulnerability to loss. No amount of guilt or denial will protect us fully from the reality that our lives progress through constant change. In the face of life’s impermanence, and the losses that occur, allowing a passage through grief is difficult but deeply meaningful journey.
*Names and identifying details have been changed to protect individuals’ privacy.
Dr. Jennifer Reid is a Columbia and UCLA-trained psychiatrist and award-winning educator on the clinical faculty at the University of Pennsylvania, with a private practice focused on women’s mental health. She is the author of Guilt Free: Reclaiming Your Life from Unreasonable Expectations, featured in the New York Times and selected as a ‘must-read’ by the Next Big Idea Book Club. She is also the host of A Mind of Her Own, a podcast bringing together clinicians, researchers, and writers for honest, science-informed conversations about the minds and lives of women. She grew up in rural North Dakota in a family of physicians, nurses and teachers, and now lives in New Jersey with her husband and two sons.
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