Guilt, and anxiety

The real problem with dependence is that it limits personal freedom. Of course, everyone is dependent on food, water, and other people no one can ever be completely self-sufficient. Dependencies become problems when they take up vast amounts ot time, money, and energy create guilt and anxiety and control one s life It is easy for people to ignore the extent to which dependencies control their liveS sometimes other people can see the problem more clearly. 

Although relatively few studies have focused on nurses or other professions, studies that do exist suggest that nurses also suffer similarly in the aftermath of errors. Not surprisingly they experience the same basic human responses of shame, guilt and anxiety about the consequences. In one study on medication error, nurses were more likely than doctors or pharmacists to report strong emotional responses to making an error and fear of disciplinary aaion or punishment (Wolf et ai, 2000 White et ai, 2008), which perhaps reflects the different disciplinary culture of nursing. 

I went to touch something," Mrs. Northway remarked sadly, "I wondered if it was contaminated." Fortunately, the levels of radiation found in the homes were low, and thorough physical examinations of McVey and Northway revealed no signs of internal radioactivity or serious injury. Although the health assessments were optimistic, they hardly relieved the guilt and anxiety that the two men felt. ... 

Emotional symptoms may include diminished ability to experience pleasure, loss of interest in usual activities, sadness, pessimistic outlook, crying spells, hopelessness, anxiety (present in almost 90% of depressed outpatients), feelings of guilt, and psychotic features (e.g., auditory hallucinations, delusions). 

You re too hard on everyone, yourself included. You nag. You criticize. You can t distinguish between that which is acceptable (your spouse) and that which is ideal (your spouse, if only he would shape up). You can be incredibly demanding — and incredibly disappointed when your demands aren t met. At times you act the part of the martyr who s compelled to put up with the inadequacies of others, but you also suffer from waves of guilt, inferiority, shyness, and anxiety. You worry about the air, the water, global warming, war, calories, the homeless person you passed on the street, the insensitive remark you re afraid you may have made, your investments, and your body. 

Most important— particularly with injury or fatality events—the investigator must never lose sight of the fact that these incidents involve real people, with real families and real friends. Incident investigation and analysis is not an intellectual exercise in which different investigators try to score points of one another or in which they show off their expertise. Incidents are about real people suffering from pain, grief, guilt, disability, and anxiety. 

He still watched that vacant chair but he saw only the day they discovered the loss of that money which had disappeared so mysteriously from the firm s safe. Suspicion rested upon that one true friend of his, the friend to whom he owed all he was, all he had. There was not sufficient evidence to prove that he was the thief, but in the minds of his employers there was no doubt as to his guilt. The supposed delinquent was dismissed and the cloud of suspicion rested upon him wherever he went thereafter. Only two people had known the truth, the man now sitting by the stove in the tenement house kitchen and the friend who had suffered in silence rather than betray him. They had never met again, and not long after the robbery, the man now sitting by the stove had heard of his friend s death the physicians said it was typhoid, but he knew better. Disappointment, anxiety, heartbreak, were the real causes of his friend s early taking off. 

The diagnosis of mania is made on the basis of clinical history plus a mental state examination. Key features of mania include elevated, expansive or irritable mood accompanied by hyperactivity, pressure of speech, flight of ideas, grandiosity, hyposomnia and distractibility. Such episodes may alternate with severe depression, hence the term "bipolar illness", which is clinically similar to that seen in patients with "unipolar depression". In such cases, the mood can range from sadness to profound melancholia with feelings of guilt, anxiety, apprehension and suicidal ideation accompanied by anhedonia (lack of interest in work, food, sex, etc.). 

The target symptoms of psychoneurosis that respond to doxepin include anxiety, tension, depression, somatic symptoms and concerns, insomnia, guilt, lack of energy, fear, apprehension, and worry. 

Other data arise as scores. These are frequently as a result of the need to provide a measure of some clinical condition such as depression or anxiety. The Hamilton Depression (HAM-D) scale and the Hamilton Anxiety (HAM-A) scale provide measures in these cases. These scales contain distinct items which are scored individually and then the total score is obtained as the sum of the individual scores. For the Hamilton Depression scale there are usually 17 items depressed mood, self-depreciation and guilt feelings, etc., each scored on a three-point scale or on a five-point scale. The five-point scales are typically scores 0 = absent, 1 = doubtful to mild, 2 = mild to moderate, 3 = moderate to severe and 4 = very severe while the three-point scales are typically 0 = absent, 1 = probable or mild and 3 = definite. 

In patients receiving antidepressants for acute major depression, the initial therapeutic response is often delayed by several weeks. Patients with severe anxiety or insomnia may benefit from the concurrent, time-limited use of a benzodiazepine or short-acting hypnotic (Chapter 3). A patient may initially experience a return of energy and motivation while still having feelings of hopelessness and excessive guilt. Such patients may be at an increased risk for suicide because a return of energy in an extremely dysphoric individual may provide the impetus and means for an act of self-destruction. 

Depressive and anxious symptoms are frequently associated with schizophrenia, but this does not necessarily mean that they fulfill the diagnostic criteria for a comorbid anxiety or affective disorder. Nevertheless, depressed mood, anxious mood, guilt, tension, irritability, and worry frequently accompany schizophrenia. These various symptoms are also prominent features of major depressive disorder, psychotic depression, bipolar disorder, schizoaffective disorder, organic dementias, and childhood... 

Viewing the relationship between culture and psychopathology within an evolutionary framework, Hammer and Zubin (1966) also suggest some possible culturally adaptive functions of schizophrenia. They point out that the characteristics of the mentally ill occur in most people, and symptoms such as anxiety, guilt, shame, and depression are often harnessed to socially useful purposes. Similarly, Bowers and Freedman (1966) and Ludwig (1966) emphasize the healing function of schizophrenic states and consider them a major avenue of new knowledge and creative experience. 

---