A heavy dose of guilt is a frequent companion to diabetes. For this week’s discussion, we were joined by Dr. Gary McClain, a therapist specializing in helping clients with the emotional impact of chronic illness, to chat with members of the diabetes community about coping with diabetes guilt. We were also joined by Chris “Clem” Clement, T1D and social media manager at Diabetic Connect, as our moderator.
Q. Do you ever feel guilt in relation to your diabetes? What situations are likely to cause these feelings?
A. Dr. Gary: I spend a lot of time talking to my clients about guilty feelings. Usually related to not being compliant. Actions aren’t the only cause of guilt. My clients tell me they also feel guilty when they think of ways to avoid being compliant. I have had clients tell me that just thinking about a Hershey bar can make them feel guilty in anticipation of cheating. Interaction with the doctor is a big source of guilt. Clients often talk about not being quite honest with their doctors. Some of my clients are so focused that just a minor slip-up on their diet will result in lots of guilty feelings and self-criticism.
Clem: Guilt has been a big part of my life with diabetes. Comes easy if we expect perfection. Find reachable, practical goals, and work up.
• I don’t feel guilt in relation to my diabetes, but I feel like I’m always judged, which is hard. You just kind of cope, though.
• Being a diabetes parent, I often feel guilt for an incorrect bolus or missed low glucose.
Q. Is guilt a motivator or deterrent for engaging in personal health improvement?
A. Dr. Gary: An unexpected spike can result in feeling guilty and confused. Something went wrong, but you thought you were doing everything right. I hear both sides from my clients. Just the desire to avoid feeling guilty can be a motivator to stay on the path. There’s a lot to be said for avoidance as a motivator. Humans are all about avoiding discomfort; avoidance can be used in a positive way. Guilt often comes with the sense you have let yourself down. So if you don’t want to do that, stay focused on your compliance, right? Guilt is a deterrent when it leads to the point of feeling like staying compliant is a lost cause: “I always end up here, why bother?” Guilt can also lead to feelings of helplessness, and that can, in turn, cause you to say why bother and just give up. I encourage clients to talk about guilt, move beyond it, focus on what’s possible. Break the cycle of defeat that begins with guilt.
Clem: Guilt is a motivator when it affects others directly, deterrent when I only see me affected and not ready to change.
• Guilt is a deterrent for me. I feel guilty, and then depressed, and then unmotivated.
• I try not to let guilt guide me. I’m much more motivated by physical feelings. If it makes me feel better, I continue to do it.
Q. Do guilty feelings motivate you to get back on track? If so, what do you tell yourself?
A. Dr. Gary: I encourage my clients to use self-talk to lift themselves out of the guilt. “Okay, so I messed up. Time to get back on the horse.” I think guilt can motivate you to want to prove something to yourself, that you can do this despite a slip-up. Being out of adherence may be the result of a self-care regimen that isn’t working for you. Don’t wallow in guilt. Look for a lesson. Adherence issues can be a good reason to sit down and talk to your doctor about your regimen. It may need to be tweaked.
Clem: When it’s time to get rid of guilt, self-accountability. If that isn’t enough, I think of a doctor as one to whom I’m accountable.
• I think there is healthy guilt, but not if it is overwhelming or takes over.
• It motivates me. I am very analytical. I acknowledge the guilt, analyze the reason for it, learn, and move on.
• When I feel sad about high blood sugars, I feel motivated to develop new exercise habits and re-evaluate my nutrition plan.
Q. Have you ever felt shamed by a healthcare provider (HCP)? How did you respond?
A. Dr. Gary: My clients often tell me stories about being shamed or scolded by their doctors. Talk about feeling guilty! Guilt is a tool doctors have learned to use to motivate their patients to do better. They know their patients want their approval. Unfortunately, doctors don’t always know how to also offer encouragement. Being constantly scolded and guilt tripped is demotivating. I also think that if patients are constantly made to feel guilty, chances are they will stop being forthcoming with their doctors. Clients talk about how they became defensive with their doctor and the discussion ended up not being very productive.
Clem: Being shamed by HCPs is a de-motivator. Encouraging self-care and to be part of the solution is not just [saying] be compliant or viewed as failing.
• I don’t think I’ve ever felt shamed by an HCP, but some of the wording said made me realize I had not been caring for myself well.
• Yes, and I responded poorly. I need help, not condescension.
Q. At times, members of our support system can be too involved. How have you dealt with an overbearing loved one?
A. Dr. Gary: Family members sure know how to pile on the guilt, don’t they? Sure, it’s done out of love and concern, but [it’s] not always very helpful. The need to pile on the guilt may be the result of your loved one feeling helpless, so to cope, they guilt trip you. Guilt tripping can feel so intense you start to wonder if your loved ones see you as one big diagnosis and not as a whole person. It can help to let your loved one know that you appreciate their concern, but that guilt tripping you is not helpful. Don’t respond to guilt tripping by asserting your control in a negative way—not being adherent.
Clem: I don’t like feeling shamed by people who know me. I default to “it isn’t that simple” and try to explain complexities of diabetes.
• I’ve made it very clear with particular family members that I will let them know how I’m doing, but I will likely ignore all advice.
• My husband is very involved and supportive. It makes my life so much easier!
Q. How has the way you process guilt changed over time?
A. Dr. Gary: Newly diagnosed clients often say they feel guilty all the time. Everything is new, they may feel they aren’t doing anything right. Over time, I think you learn what is a big issue and what is a small issue. You learn what merits guilty feelings and what doesn’t. I have to say that if there is a benefit of guilt and shame, it is to help us stay on the path. Let your conscience be your guide. It is all about perspective. As you gain the big picture of living with diabetes, I think you have a more balanced view. Having said that, I get concerned when I talk to clients who are feeling diabetes burnout. They have moved beyond guilt to giving up.
Clem: I like to think I’ve learned to tackle struggles before guilt starts. When it does start, I tell myself it doesn’t define my worth.
• Self-empowerment reduces guilt. The more you learn, the more you feel in control—even of your mistakes.
• I’m getting better at it! Going easier on myself and [recognizing] that my diabetes [self-care] isn’t perfect, but I’m doing my best.
• Burnout has the potential to happen more often than it should, but can be [managed] and even prevented with the right coping mechanisms.
Thank you to Dr. Gary, Clem, and members of the diabetes community who joined our discussion this week.