Description 

Shame and guilt are deeply personal experiences that are influenced by physical appearance (gender, height, weight, skin color, etc), ethnoracial identity, caste systems, and prevailing systems of oppression against those who identify as Other. Over the last decade, there has been an acceleration in the  appreciation of the clinical relevance and importance of addressing social determinants of mental health in clinical care.  Although shame and guilt  are ubiquitous emotions that occur along a spectrum, they are often misunderstood by both clinician and patient. Shame refers to a spectrum of painful affects - embarrassment, humiliation, and loss of face - that accompany the feeling of being ridiculed, excluded, or rejected. Guilt is the emotion that occurs when one feels they have violated standards of conduct; shame is experienced as a personal sense of “missing the mark” while guilt is usually accompanied with the intrapsychic expectation of punishment.  Defensive responses to shame and guilt are undermining our ability to incorporate social determinants of mental health in didactics, clinical care, and supervision. Some argue that the US history of colonization and enslavement and enduring systemic racism have resulted in loss of moral authority by whites. This loss impacts Blacks and whites differently. Whites may experience shame about their implicit biases and their ancestors’ overt racism. Blacks Indigenous, and People of Color (BIPOC) may experience shame because of internalized racism and ongoing public reminders that their communities are disproportionately treated as second class citizens. It is not inherent poor self-regard that these communities experience; shame is a response to the public treatment, exclusion, and humiliation that corresponds to their subjugated role in a caste system that inherently values whiteness. Some members of BIPOC communities may even feel ashamed of their racialized identity. Shame and guilt are inextricably linked to our moral character and our relationship with those we confer moral authority. Those with strong intact superegoes are more susceptible to shame and guilt. Low level responses to shame include denial, withdrawal, defiance, arrogance and projection onto others. High level adaptive responses include introspection, empathy, altruism and realistic self-appraisals that can motivate action. Iit has been argued that moral injury has resulted in Black Rage, a mental construct that reflects a healthy adaptation to the trauma of exclusion and oppression. If psychiatrists are to make progress on centering the role and impact of social determinants of mental health in their work, the first step will be personal examination of their own defensive responses to shame and guilt in response to awareness of systemic racism and the resultant social determinants of mental health.

Format 

Recorded webinar.

This content was recorded during the APA 2023 Annual Meeting.

Learning Objectives 

1. Identify patients’ adaptive and maladaptive responses to shame and guilt.
2. Articulate how clinicians’ maladaptive defenses to shame and guilt undermine organized medicine’s efforts to center social determinants of mental health Objective
3. Apply strategies to incorporate social determinants of mental health in didactics and clinical care

Target Audience 

Medical Students, Residents/Fellows, Psychiatrists, non-psychiatrist Physicians

Estimate Time to Complete 

Estimated Duration: 1 hour
Program Start Date: May 1, 2025
Program End Date: May 1, 2028

How to Earn Credit 

Participants who wish to earn AMA PRA Category 1 Credit™ may do so after completing all sections of the course including the evaluation. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians) or certificate of participation (non-physicians) showing the completion date and hours earned. 

Continuing Education Credit  

In support of improving patient care, the American Psychiatric Association is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 

The APA designates this live activity for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Faculty and Planner Disclosures 

The American Psychiatric Association adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Medical Education. Any individuals in a position to control the content of a CME activity — including faculty, planners, reviewers or others — are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity. 

Instructors 

• Constance Dunlap, MD

Planners  

• Vishal Madaan, MD, Chief of Education and Deputy Medical Director at the American Psychiatric Association.

Accessibility for Participants with Disabilities 

The American Psychiatric Association is committed to ensuring accessibility of its website to people with disabilities. Please contact the American Psychiatric Association at 202-559-3900, if you require assistance seven (7) business days prior to the start of a live webinar. 

Technical Requirements 

This internet-based CME activity is best experienced using any of the following: 

• The latest and 2nd latest public versions of Google Chrome, Mozilla Firefox, or Safari 
• Internet Explorer 11+ 

This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Acrobat Reader, Microsoft PowerPoint, and Windows Media Player. 

Optimal System Configuration: 

• Browser: Google Chrome (latest and 2nd latest version), Safari (latest and 2nd latest version), Internet Explorer 11.0+, Firefox (latest and 2nd latest version), or Microsoft Edge (latest and 2nd latest version) 
• Operating System: Windows versions 8.1+, Mac OS X 10.5 (Leopard) +, Android (latest and 2nd latest version), or iOS/iPad OS (latest and 2nd latest version) 
• Internet Connection: 1 Mbps or higher 

Minimum Requirements: 

• Windows PC: Windows 8.1 or higher; 1 GB (for 32-bit)/2 GB (for 64-bit) or higher RAM; Microsoft DirectX 9 graphics device with WDDM driver; audio playback with speakers for programs with video content 
• Macintosh: Mac OS X 10.5 or higher with latest updates installed; Intel, PowerPC G5, or PowerPC G4 (867MHz or faster) processor; 512 MB or higher RAM; audio playback with speakers for programs with video content 

For assistance: Contact educme@psych.org for questions about this activity | Contact learningcenter@psych.org for technical assistance