The Mental Illness Construct: Does it Reduce Shame and Guilt?

Some people find that their actions are violating certain societal norms and feel guilty and ashamed about this. When they try to stop doing these actions, they may find they can’t just stop, and thus they end up feeling even more guilty and ashamed.

Some parents, when they see their offspring act in ways that violate certain societal norms, find that they feel guilty and embarrassed. These parents believe that they are to blame for the actions of their children, and they also feel ashamed because they believe others believe they are “bad” parents.

shame and guilt 2

Shame and Guilt 4The idea that certain actions that violate societal norms are mental illnesses like any other illnesses is attractive to many people because they believe it helps to reduce this guilt and shame. To understand this a little better, let’s take a look at a quick parable:

The Parable of Rachel

Mom-and-Son-TalkingRachel, the mother of five-year old Jonathan, recently went through a very sad divorce. Now, at Jonathan’s parent-teacher conference, his Kindergarten teacher expresses some serious concerns. “Your son is very hyperactive and he has a great deal of difficulty paying attention. Have you considered taking him to a doctor? He may have ADHD.”

Upon leaving the meeting, Rachel begins to cry. “I feel so ashamed,” she thinks to herself. “It’s all my fault. I shouldn’t have been so critical of Ron (her former husband). That’s why he left me for a younger woman. Jonathan has been so upset since Ron left, and he blames me for the breakup. And it is all my fault! I’m a rotten mother.”

Later, Rachel takes Jonathan to a doctor who, after asking a few questions, states that he has diagnosed Jonathan as having ADHD and prescribes Ritalin.

“I’m so ashamed,” cries Rachel.

guilt and shame 1“There is no need to blame yourself,” the doctor explains. “ADHD isn’t caused by bad mothering. It is an illness very much like diabetes. Just like insulin is a drug that treats diabetes, the drug I’m prescribing for your son’s ADHD will treat his medical condition.”

As Rachel leaves the doctor’s office she feels a little less to blame. angry manBut when she tells her father what the doctor has said, he grumbles and says that the doctor is full of crap. “Jonathan is angry and upset because of the divorce and not having his father with him any more. Anyone can see that!”

“You think you know better than a doctor!” cries Rachel.

Her father waves his hand in disgust, but says nothing more. Rachel interprets his silence as meaning that she won the argument, but her father is not at all convinced.

Later, Rachel discusses what has been happening with her closest friend, Lora. “I felt so ashamed about how Jonathan has been acting at school, but the doctor explained that I’m not to blame, that Jonathan has ADHD, which is an illness.”

child taking pill“Well, Rachel, I certainly don’t think you are to blame, but I don’t think Jonathan has an illness. I’m sorry to hear you are thinking about putting him on one of those ADHD drugs; they have a whole bunch of side effects.”

“If it’s not an illness, then I am to blame!” Tears start to roll down Rachel’s face. “I shouldn’t have criticized Ron so much. I should have been a better wife!”

responsibility1“You did your best, Rachel. I think it makes sense that you take some responsibility for what has happened, but blaming yourself isn’t being fair, nor is it helpful. When people blame themselves a lot of the time they think they deserve some type of punishment. In my opinion, a better way to take responsibility for what went wrong is to accept the strong emotional experiences that go along with taking responsibility, accept that you played at least a part in what went wrong, and then set yourself on becoming determined to take steps to improve. The genuine sad, heartfelt feelings that come with taking responsibility leads us to do a search for making improvements.”

Does The “Mental Illness” Construct Help To Reduce Shame and Guilt

Shame and guiltIn the above parable, a doctor tries to reduce the shame and guilt that a mother is feeling about her son’s behavior by framing the behavior as an illness. Although this initially appears to help, she runs into some people who refuse to go along with this anti-shame/mental illness notion. Let’s explore this notion a little more thoroughly with the help of some of the writings of psychologist and philosopher, William James.

William James’s Letter to his brother, Henry James

william James QuoteIn an earlier post, I discussed William James’s bout with a depression that many might refer to as a type of “mental illness.” There, we found that he came to believe he succeeded in overcoming his struggle with the help of his own will and effort, although he also recognized that as he went through the experience he received a great deal of support with the “will and effort” thinking from reading certain poets and philosophers.

Shortly after his recovery, James found that when he met other people who were struggling with their own bouts of depression, if he brought up the topic of will and effort it was not at all well received. James explains this type of reaction to his brother, Henry, in the following 1885 letter:

shame and guilt 8To suggest personal will and effort to one “all sicklied o’er” with the sense of weakness, of helpless failure, and of fear, is to suggest the most horrible of things to him. What he craves is to be consoled in his very impotence, to feel the Powers of the Universe recognize and secure him, all passive and failing as he is.

Why would one believe that framing one’s difficulties as an illness would lead to the Powers of the Universe providing some type of help? Perhaps it stems from a related experience.

Mother Taking Care of Sick Daughter --- Image by © Royalty-Free/Corbis

Anyone with even an ounce of maternal feeling is familiar with the altruistic emotions that spring up when a baby is stricken with an illness. Generalizing from such experiences might lead to the belief that an illness is especially worthy of altruism.

Although this may make sense to some, others just don’t buy the illness notion, and feel that it is an excuse to avoid responsibility. Thus, the “mental illness” construct comes with it some pluses and minuses.

AAFrom my discussions with people in Alcoholic Anonymous, it seems to me that many of its members found themselves in a state similar to what James describes in his letter. The program seems to provide them a way to stop blaming themselves by using the “I have a real sickness” idea. It also offers a sense that they could put themselves in the hands of a higher power, while, at the same time, they receive a great deal of support from peers who have managed to recover.

Group therapy session

I think the real active ingredients in the program are the reduction of blame that is experienced by becoming a member of a group that stops the blaming rhetoric while also providing peer support to its members to work toward their common goal. However, for people who have a religious background, perhaps the additions of the “real illness” and “higher power” ingredients do offer some added benefits, but they come with negative reactions from those who believe in taking responsibility for one’s actions. Some of those who believe in responsibility think mainly that certain actions are “deserving of punishment.” In my view, it is much better if we come to understand responsibility as a strong emotion that spurs us on to actively pursue better ways to deal with the present and the future.

Now, to further our thinking of these issues, let’s turn our attention to something else that James wrote on this topic.

James’s Talk to Teachers

In James’s book titled Talk to Teachers he tells us, “The teacher often is confronted in the school with an abnormal type of will, which we may call the ‘balky will.’  He then explains what he means by this: “Certain children, if they do not succeed in doing a thing immediately, remain completely inhibited in regard to it.”

Father yelling at son (8-10)

James then tells us that “Such children are usually treated as sinful, and are punished; or else the teacher pits his or her will against the child’s will, considering that the latter must be ‘broken.’

Clearly, James opposes this approach. “Such will breaking is always a scene with a great deal of nervous wear and tear on both sides, a bad state of feeling left behind it and the victory not always with the would-be will-breaker.”

In his next paragraph, which I quote in its entirety, the theory that pathology as a concept is used by James to protect individuals can be seen rather clearly.

When a situation of the kind is once fairly developed, and the child is all tense and excited inwardly, nineteen times out of twenty it is best for the teacher to apperceive the case as one of neural pathology rather than as one of moral culpability. So long as the inhibiting sense of impossibility remains in the child’s mind, he will continue unable to get beyond the obstacle. The aim of the teacher should then be to make him simply to forget. Drop the subject for the time, divert the mind to something else: then, leading the pupil back by some circuitous line of association, spring it on him again before he has time to recognize it, and as likely as not he will go over it now without any difficulty. horse-whispererIt is in no other way that we overcome balkiness in a horse: we divert his attention, do something to his nose or ear, lead him around in a circle, and thus get him over a place where flogging would only have made him more invincible.

Note that James doesn’t say that the child actually has a neural pathology, only that it would be helpful for the teacher to apperceive the child as having this condition. Neural ActivityBy apperceiving the case as neural pathology, what does James hope to gain? He does not explicitly say. The technique that he describes of dropping the subject, diverting the mind, then springing it on the pupil later, is stated plainly enough so that many individuals can employ it without first apperceiving the case as neural pathology. I have done so, myself, on numerous occasions.

James appears to feel that some individuals who are prone to apperceive the case as one of moral culpability are likely to use will-breaking and flogging. If, instead, they can apperceive the case as neural pathology, it would be easier to use the technique that leads to a good state of feeling.

Viewing someone as “sick” can elicit altruistic behavior for some people. Feelings of caring, as if for a child with an illness, are conjured up. Such a chain of reactions is more commensurate with James’s circuitous technique than the clashing-wills technique.

Here again, we are faced with the dilemma–whether it is wiser to use the “mental illness” construct to promote caring, which may short circuit the habit of blaming someone in the sense of seeking to punish someone, or is it wiser to promote notions of responsibility that leaves out the desire to punish, while constructively seeking to make personal improvements? Today, I leave this dilemma in the hands of my readers.


Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.

Depression As Illness: A Case Study
Research Update On ADHD Drug Treatments

About the Author

Jeffrey Rubin grew up in Brooklyn, received his PhD from the University of Minnesota and has taught conflict resolution there as well as at a psychiatric clinic, a correctional facility and a number of public schools. He has published articles on anger and conflict resolution and has authored three novels.


  1. This is something I struggle with. Let me share a few lines from my journal. How does one figure karma points? Does autism and other bi polar effect our karma? Does it mean we get away with more or are we just being more severely tested?

    • Hi Mary Annslavcheff,
      You raise some intriguing questions. I can’t really answer them in any definitive manner, but I do think that the concerns referred to as “mental illnesses” would be more aptly construed as mental health concerns.

  2. Absolutely, mental illness when applied to humanity in general, is a construct beyond good and evil. It is possible to pathologize all human behavior we dislike via the ever-evolving DSMV and switch to paradigms of treatment and wellness (rather than goodness) of the individual within the collective. No criminal judgment, no religious sin, just supporting each other in improving. Medicine and education for all would benefit all.

    • Hi Elena Krugman, I take heart in your way of thinking about these issues. It gives me hope that a new paradigm is rising.

  3. I’m having trouble getting to the articles and topics I click on and corresponding post posts from others on the topics that I’m clicking on. I clicked on alcohol addiction and it sent me to The Mental Illness Construct, does it reduce shame and guilt. This was not on alcohol addiction nor is alcohol addiction a mental illness. It is a disease Lake diabetes and recognized by the medical community as a disease since it is Progressive chronic and fatal. ATD n even depression do not fall into the category of a disease that is by definition Progressive chronic and fatal without option that is what will happen if people don’t find recovery and most of them don’t. AA is the only program that not only exist but the only possible way Define recovery and live a happy sober life since alcohol addiction is the physical mental and spiritual disease. It’s always been the only thing that works the theory of one alcoholic helping another living by the 12 Steps going to meetings working the program in the suggestions they give you saves lives everyday. They exist solely 2 help people who want to find sobriety and Recovery. They have no religious Medical political or any other affiliation. I have got to say that shocked of here I have to say complete ignorance of this disease being that it’s a topic that you feel you can speak on but what you briefly wrote was the most bizarre and inaccurate information I’ve ever seen about AA and the basic philosophy of the program which is the 12 Steps meetings and some of the things I mentioned of following the suggestions of the program. it’s a fairly simple program , but definitely not easy and the large majority of Alcoholics die from the disease of alcoholism. That’s why people in treatment centers are always recovering alcoholics and if you’re going to counsel anybody on alcoholism you better make sure that they’re going to meetings because seeing a counselor and psychiatrist has never worked in the history of people suffering from this disease. Because it is a physical mental and spiritual disease it is also very baffling to both the person suffering and people that don’t have it. But just walking into those meetings taking suggestions and working the steps is the only chance alcoholics have her recovery . They used to just throw them away to an insane asylum because nobody knew what to do including the famous psychiatrist Dr.Jung who is written forward and the AA big book. Finding out that your an alcoholic, or admitting it which is where you’re at by the time your going to treatment centers or meetings isn’t a matter of guilt and then no guilt because we know we’re alcoholics. It’s a place you walk into where you know everybody not only understands you but is you. We have all felt done and lived the same thing and you feel that . we have all been in the same place and the only thing that can arrest this disease both in abstinence and Recovery in spiritual, physical and mental aspects is AA. 1 alcohol helping another to stay sober and the links that we will go to to help another alcoholic who want sobriety is beyond anything you can imagine because we know we are our only hope only an alcoholic can save an alcoholic . Your statement on people wanting to come in for the religious aspects is also quite a bit off since by the time anybody gets there they have no relationship with God because as I said and you should know it is a spiritual physical and mental disease. It’s actually a problem for most people because they don’t believe or have a God of their understanding or a higher power let alone a relationship with one that they are willing to turn their lives and wills over to. We just know that we will die if we don’t stick around and start following the suggestions not drinking and the first step is admitting you are powerless over alcohol and your life’is unmanageable. the second is coming to believe in a power greater than yourself then the 3rd is making a decision to turn your life and your will over to the care of the God of your understanding. And you have to depend and the God of your understanding because you are powerless over alcohol and it is a baffling cunning disease that is Progressive it is chronic and you will eventually die_ those are the two options. I cannot believe it actually shocked you’re in the medical profession to have made a statement inure paragraph on alcoholism that people go to AA initially for some sort of religious reason, and that AAA members would never judge another fellow alcoholic and think the other option you suggested was that it was because we were weak willed and we just weren’t taking enough responsibility for our lives_ we just weren’t trying hard enough to quit we didn’t understand we do not have the will to quit we are alcoholics that is what we would do which is why we turn our life and our will over to the God of our understanding. It is shocking and Despicable again that you are a counselor and a doctor and suggest that people are going religious reasons and then judging the other people because you’re delusional and thinking they even have one thought that these people didn’t do all that they could do as they did you end up in AA because you are at the point of not being able to live with drinking or without it. There is no responsibility in the fact that we are alcoholics it has nothing to do with self-will are not taking personal responsibility otherwise AA would not even exist. If we didn’t believe with our whole heart and soul that we are not able to stop drinking on our own and people have tried millions of other measures which have never worked and our willpower, as you alluded to, has nothing to do with it since the disease is stronger and it cannot be battled alone. Some people also go to counseling and are on antidepressants but certainly not everyone and those things are helpful, but they will not keep you sober. Sobriety is only 1 Part. Recovery is what you get in a AA, you can’t have recovery without sobriety and you won’t have sobriety without recovery at least not for long. Drinking is just a symptom of the disease as you know oh that’s right you don’t. Because it is spiritual physical and mental disease, the 12 steps, the meetings, your higher power and sponsor and following the suggestions from the big book and other AA members will lead us to recovery and as they say happy joyous and free. I’m struggling from a relapse and was looking for things online because I thought counseling would also be helpful and like I said was extremely shocked when I clicked on alcoholism and saw your one paragraph that sounded like the most ignorant person on the topic wrote it. Besides the medical community as a whole most people even college kids have a better understanding of what AA is about and that alcoholism is a disease. Not simply a mental illness although, like I said it is a disease that affects you mentally physically and spiritually . If I were you I wouldn’t make any more comments, write or speak on the subjects of alcoholism and AA -besides having completely incorrect information of what you’re talking about, you are embarrassing yourself you’re not helping anybody.

    • Hi Julie Koss,
      Much thanks for taking the time to give me a piece of your mind. I think it is enormously important for people to hear from those, like yourself, that have direct experience with the workings of AA. As I mentioned in my article, I do believe that AA has been very helpful for many.
      Wishing you well as you seek to find a healthy life path,

  4. I need to say something that i’m quite certain will ruffle some feathers. In my opinion, The human being is a marvelously perfect being. When nurtured and given proper sustenance, it operates beautifully in harmony with all that is good for oneself and others, and guilt is an important ingredient. It only becomes a negative when narcissists and masters at manipulation use another persons feelings of guilt to manipulate an end that only serves themselves. All while training themselves to feel no guilt, if they weren’t an already obvious sociopath! I realize that some won’t understand what I am referencing, but about 10% know exactly what I’ve opined here.

    • Hi Margaret Lurra,
      Thanks for sharing with us your perspective. Like you, I prefer that more of us have a keen sense of caring for others and the actions that we take are not just for our own selfish ends.

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