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opinion | Elissa Ely

The correct amount of guilt

The young man cornered last April in a backyard motorboat, now facing murder charges, has vanished from public view. His lawyers surface from time to time to demand more rights for him. He continues to deny his guilt.

But a woman who confessed to committing the Marathon bombing soon after it occurred lives in a group home a few towns from our clinic. She was nowhere near downtown Boston last April, but it makes no difference. She believes she did it.

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I also know someone who admitted to causing the events of 9/11. And, though it was a more distant catastrophe, I’ve met the person who says she engineered the Challenger explosion. She comes to the clinic every two months.

These patients don’t have the luck of benign hallucinations or grandiose delusions. They’re overcome with guilt for crimes they couldn’t have committed. It may be the worst part of their illness: mercilessly blaming themselves for what they haven’t done.

At the same time, it’s hard not to notice that blamelessness has become a first-rank response in the rest of the world. We take less and less responsibility for what we have done. Bombings and bridge jams jump to mind, but there’s no rock that can’t cover some righteously denied extortion or affair. No one wants to avoid the serving of justice. It’s just that someone else is at fault.

Many years ago, I had a supervisor in training. My job was to present a therapy session as honestly as possible. His was to shed enough illumination on what had just occurred to guide me through another unlit appointment.

I had just made a patient feel badly for not showing up — had chided him, to tell the truth. It was most unprofessional and I felt awful. My job was to relieve guilt, not induce it.

My supervisor listened. I remember he paused. Then he shrugged.

“A little guilt’s not such a bad thing,’’ he said.

I felt forgiven and lucky, the pardoned Thanksgiving turkey. A little guilt’s not a bad thing. I think of those words often. But I wish my psychotic patients blamed themselves less, and the rest of us blamed ourselves more.

Elissa Ely is a psychiatrist.
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