Daily insights on life in the face of uncertainty, by psychiatrist and habit change specialist Dr. Jud Brewer
Are you feeling stuck at home, unable to do anything but watch the current crisis from the sidelines? Maybe even feeling guilty or ashamed that there are doctors, nurses, and other first responders on the front lines of the battle while you’re safely at home? What you’re feeling is totally normal — and there are ways to keep from spiraling into negative emotions and recognize that we’re all doing our part.
Recently, my brother-in-law sent me a text of a Muppet dressed in a white coat with a stethoscope around his neck with the caption: “STAY HOME… unless you want to get intubated by a psychiatrist.” As my wife put it, this was funny and not funny at the same time.
We psychiatrists are much better at focusing on the mind than the body, so I’m doing my best to pitch in from home. I’ve switched my outpatient clinic to telemedicine, and I hold weekly office hours on YouTube live so that anyone can reach out with questions. I’m better at this type of stuff than I am at working in the ICU — I haven’t intubated a patient since I was a resident. And as I’m about to explain, feeling guilty about not being on the front lines isn’t going to help me or anyone else.
And yet, understandably, a lot of people are feeling shame and guilt for not doing more in these hard times. During my office hours, one person commented, “I feel guilty that I’m enjoying being home with my family and pets while people are dying, and others are fighting the disease in hospitals.” That same day, a student of mine asked how to work with feelings of guilt for staying home and not helping more. He described how he is used to being a helper and how helping makes him feel good — because, of course, when we lend a hand, it is rewarding.
Yet, my student went on to point out something more subtle. He had been mapping his own habit loops, where he’d identify triggers, behaviors, and rewards that drove unhealthy habits for him. When he traced his behavior, he noticed an underlying thought of “You could be doing more, so why aren’t you?” When he read about someone on the front lines, he noticed it would trigger the mental behavior of comparing himself to others or judging himself for not getting out there and helping. The result would be feelings of shame and guilt.
I’ve seen this happen to a lot of people. The best thing that 99% of us can do is to stay home. Yet, that can feel like doing nothing, because we see other people out there actively doing something. Yet, passively doing nothing, in this case, is actively doing something: You are taking the best action for our collective safety and health. My student also pointed out that the best thing to do — stay at home — is oddly uncomfortable. I think many of us can relate to this. The discomfort of feeling stuck or trapped inside can heighten the desire to be active in general, creating an even bigger contrast between staying put and helping outside of the home.
What’s going on here and how do we work with these feelings?
According to researchers, guilt is generally referred to as a “behavior-focused negative self-conscious emotion.” Basically, we feel guilty when we do something that feels wrong. Shame is a related emotion. Where guilt focuses on a behavior, “I did something wrong,” shame brings the focus to us. As a self-focused negative emotion, shame is related to the way we see ourselves, and how we believe others see us. “I am a bad person for doing X.” This is shame in a nutshell. Guilt and shame are like a one-two gut punch. We do something and feel guilty about it. Then we look in the mirror or imagine how people will perceive us, and feel ashamed for who we are.
As you can imagine, guilt and shame show up in our brains. The default mode network, a network of brain regions that gets activated when we think about ourselves in past situations, and worry about the future, also lights up when we feel shame. The default mode network is most consistently activated with self-referential thinking, and shame fits right in here — we think about ourselves in a negative way when we feel shame.
The best thing that 99% of us can do is to stay home. Yet, that can feel like doing nothing, because we see other people out there actively doing something.
My student, who was feeling guilty for not doing more, also described how he was getting stuck in what he called “shame spirals.” He would feel guilty, which would trigger self-judgmental thinking patterns, which would result in shame and more guilt. These spirals were loud and would take his thinking brain offline — making him unable to see the good things he was doing, like leading online meditation and support groups.
Interestingly, feelings of calm were also not a reprieve for my student. For him, being calm could trigger worry thought loops. He said, “I’m calm when the rest of the world is crazy. I shouldn’t be calm.” He mapped out his habit loop. Trigger: See everyone else nervous and anxious (remember social contagion?) Behavior: Beat himself up for not being anxious enough. Result: Feel like he should be doing more.
I think a lot of us can relate.
All of these emotions — guilt, shame, and worry — share a commonality: They can give us an uncomfortable, restless, wound-up feeling that gets us to act. They can also cause our thinking brains to go offline.
There was a study published in 2013 that showed that the default mode network negatively influences the task control network making us perform worse on cognitive tasks. Basically, shame makes it harder to do constructive things. Yikes.
So what might be a helpful response? In psychiatry there is a phrase, “don’t just do something, sit there.” That reminds us as therapists that when someone is struggling, we can actually make things worse by being triggered by our discomfort in favor of doing something. If we’re not careful, we might not notice that we’re doing something to make ourselves feel better rather than focusing on our patients. Paradoxically, the sitting there, the listening, and the being in the moment are often the best things we can do.
So see if you can turn that lens on yourself. Can you map out any habit loops of worry, guilt, or shame and determine if they’re making you uncomfortable and urging you into action? Name them so you can see them clearly. What’s the trigger? What’s the behavior? What’s the result? Oh, that’s guilt, you might notice. Oh, that’s worry. Oh, that’s shame.
Take a deep breath or two so that you can settle your nervous system and let your thinking brain come back online. Notice how these habit loops deplete your energy levels and feed unhealthy habits of self-judgment. Recognize any discomfort, see if you can allow it to be there, and remind yourself that staying home is doing something really important right now.
See if you can connect the experience of helping others with the experience of staying home. Notice how this feels.