A psychologist’s perspective on guilt vs. regret

February 7th, 2011 § 24 comments

I’ve written previously about my decision to have my ovaries removed two years ago in order to (hopefully) decrease the likelihood that my breast cancer will recur (“The Impetus of Fear”). Though I tested negative for the BRCA-1 and BRCA-2 genes, my hormone receptor positive cancer feeds off of the hormones that my ovaries produced. To significantly reduce the amount of those hormones circulating in my body (as a pre-menopausal woman of 38) I decided to have a salpingo-oophorectomy (surgical removal of my Fallopian tubes and ovaries). I recovered from the surgery itself within two weeks; the effects of plummeting into menopause overnight have been longer-lasting and in some cases, quite devastating.

As I do with almost any issue in my life, I have repeatedly talked to my mother, Dr. Rita Bonchek, about the ramifications of my decision. This angst has led to many talks about the difference between regret and guilt. As a psychologist specializing in issues of grief, loss, death, and dying for twenty years, she always has a keen ability to separate out what appear to be muddled feelings. She often has ways of explaining complicated topics in easy-to-understand terms and using real-life examples to illustrate her points. She and I have collaborated here to present some thoughts on these two emotions. The ideas on the differences between guilt and regret are hers; I have pushed her to explain things as fully as possible and helped with some of the re-writing.

We hope that they will help you to think more clearly about actions in your life and the emotions you have about them. We look forward to hearing your comments and any follow-up questions you have. Because my mom is not on Twitter, if you have any questions for her, it’s best to put them in a comment below; I’ll post her answers for everyone to read, too. This is meant as an introduction to these two emotions, not a comprehensive analysis of them.

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People use the word “guilt” more often than is appropriate. Improperly using the word “guilt” can result in unnecessary emotional distress and harsh self-criticism. The word “guilt” refers to something you did, something which you feel you shouldn’t have done because it was morally or legally wrong. But what if the experience you feel guilty about was not something you caused or had control over? Then you would feel regret, not guilt.

Here is an actual situation: Ann1 was referred by her family doctor for grief counseling. She was unable to cope with her persistent feelings of guilt related to her husband’s death several months prior. Bob was diagnosed with a terminal illness and he was bed-ridden. He needed constant care and attention which was mainly provided for by his wife. Bob was hospitalized for three weeks prior to his death. Ann was with him throughout that time as well.

On the day of Bob’s death, his wife left the hospital room to use the bathroom. When she returned to the room, the nurse told her that Bob had died in her absence. Ann was overcome with feelings of what she termed “guilt” and punished herself for not having been with Bob at the time of his death. For months she could not function and was preoccupied with thinking how terrible she was in being absent when her husband died. She mentally punished herself for breaking the vow she had made to herself to be with him when he died. Instead of focusing on the 99% of the time she had cared for him while he was ill, she focused on the last minutes he lived.

Why shouldn’t Ann feel guilty? Because she did not do anything that caused her husband’s death; she was not there. If Ann had asked the nurse whether it was “safe” for her to leave for a few minutes and the nurse had cautioned her that Bob could die at any time, and then Ann chose to leave, then she could justly experience guilt because she ignored information indicating he could die during the time she was away. In this alternate scenario, Ann had the personal responsibility for making the decision to go, she had control of making the decision that resulted in her absence, and could therefore justly experience feelings of guilt. As a counselor, if someone is justifiably guilty for an action, I would advise them to make a confession, offer an apology, take responsbility, and — if possible– make reparations.

By disproportionately magnifying these few minutes to overshadow all of the months of care Ann had given Bob, the result was that she could not forgive herself. After discussing the difference between regret and guilt, Ann came to see that there was, in fact, nothing to forgive. She understood that she was only responsible for her own actions; Bob didn’t die because she left the room. By reframing the circumstances of Bob’s death, Ann was better able to properly grieve her loss and move on afterwards.

Though Ann did not experience guilt, she did have regret, a universal experience.  Regret refers to circumstances beyond one’s personal control. An unidentified author defined regret as “distress over a desire unfulfilled.” Regrets can pertain to decisions made concerning: education (not getting a degree), career (working at a job that offered good income but no personal satisfaction), marriage (married too young), raising children (being too permissive), medical decisions (sterilization), etc. These and other decisions can be considered mistakes.2

As an emotional response to a distressing experience, the sound of the word “guilt” is harsher and more of a self-reproach than the word “regret.” If you say, “I feel so guilty” you should make sure that the deed and circumstances surrounding it actually warrant your feeling of guilt rather than regret.

Dr. Rita Bonchek has a Ph.D. in educational psychology. She spent twenty years in private practice.

  1. names have been changed []
  2. Most often, individuals regret what they haven’t done moreso than what they have done. Often, people regret not taking chances moreso than regretting the chances they actually took. []

The Impetus of Fear

November 21st, 2010 § 0 comments

One of the most destructive emotions in my life is regret. Thankfully, I don’t have many decisions in my life that I would change if I had the chance. But there is one big medical one that I question daily: my decision to have my ovaries removed 18 months ago to put me into menopause and remove/significantly decrease some major hormones from being produced in my body.

In consultation with my oncologist, after chemotherapy was over I decided to take ovarian suppression injections. My period had come back within a few months of chemo ending even though I was in my late 30s. I was not going to have any more children. The tamoxifen I was taking had already started giving me ovarian cysts and I needed numerous ultrasounds to monitor them. Ovarian cancer was always in the back of my mind.

After one year of the injections (in which a thick needle is plunged under the skin of your belly and a small pellet of medication is placed which dissolves slowly over the course of one month) I decided I wasn’t going back; I couldn’t tolerate the questions every month with a menstrual cycle and hormone fluctuations. With my kind of breast cancer (estrogen and progesterone receptor positive), any remaning cancer cells in my body would be “fueled” by these hormones. I wanted to minimize them, and hopefully reduce my chance of cancer recurrence.

And so, after the year of injections I consulted with some surgeons. They felt that the ovary removal (oophorectomy) would be no harder on my body than the injections I’d already been taking. I had laparoscopic surgery in December of 2008 and felt good about the aggressive stance I was taking.

Then my world caved in. Within weeks of the surgery I was depressed. My hormones were bottoming out. Not just the estrogen and progesterone, but other ones the ovaries produce. I was plunged into menopause and all of its agony overnight. My hormone levels went not to the point of a menopausal woman (there are still some hormones present) but as my oncologist told me “of a prepubescent girl.”

I was depressed. I cried constantly. I was still getting over the surgery itself (not exactly the “walk in the park” that had been described to me) and had to miss the family Christmas vacation that year. Clarke and the 2 older kids went to Wyoming while I stayed with Tristan and tried to heal and regroup.

The joint pains started, the bone loss continued, the depression loomed. I had to watch my cholesterol numbers and must take osteoporosis medication after breaking ribs in a fall. I have sexual side effects that can’t be remedied with estrogen creams or pills. In the future I worry about the increased risks of dementia, heart disease and lung cancer without the protective benefits of estrogen.

But worse than any of them, the migraines began. I’d never had them before, but the overnight hormone drop brought them on fast and furious. Up to 15 a month.

It really is “always something.” Each decision is not isolated; everything I do to my body has ramifications and risks. I don’t know if I would have made the same decision if I knew what pain I was bringing on myself. All I know is that fear is a motivator. At the time all I could think about was the cancer. I felt that anything I could do to decrease the chance of my cancer recurring was worth it.

Some days I’m not so sure about that. I believe the doctors I consulted vastly underestimated the effect that this surgery can have. Perhaps as more women electively remove their ovaries if they test positive for the BRCA-1 and 2 genes we will learn more about the effect it has on our bodies (I have tested negative for both of those genes but it is a main reason women opt to have oophorectomies).

There’s no way to know if I made the right decision.

If my cancer stays in remission I will feel better about my decision. But as side effects mount and long-term health issues occur throughout my life because of this surgery and its repercussions, I can’t help but question if my fear may have pushed me too far.

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