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Lactation Information and Discussion <[log in to unmask]>
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Tue, 7 Aug 2001 16:54:58 -0700
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I might be able to answer part of the question that was posted on the last lactnet:   

"I understand what people are getting at when they say: Guilt is used to get people to change other types of behavior."  Yeah, but where is the data
to support that this is effective in terms of getting people to change their behavior?  While it reinforces feelings of self-righteousness, there isn't much evidence that it works."

Twenty years ago, during my studies towards a degree in nursing, I took a course on "health teaching". One of the lectures in that course was on the use of guilt as a teaching tool in health education. Again that was twenty years ago and I don't remember everything, but what I do remember, is that we learned that guilt is considered a very important teaching tool in health education, when the learner has the potential to make changes after receiving the information. 

Psychological literature, especially psychoanalytic models, provides some insight into what I learned as a nursing student. Here is a very simplistic way of looking at the emotion of guilt as precursor for change.

There are different ways of looking at guilt, but in general, it is important to note that guilt is considered a healthy and normal emotion that enriches growth and development when it is resolved appropriately. 

Guilt stems when one feels that one has not met one's self imposed goals and has therefore, caused harm to oneself or others. Accordingly, guilt is not caused by another but is caused by the inner self who sets the goals for appropriate behavior. Issues that cause guilt, must touch one's self created goals and have relevance for the person,  otherwise, no guilt feelings will arise.

Therefore, parents who feel guilty about thinking about not breastfeeding in the future or did not breastfeed, are those for whom this information has relevance. Their internal goals might be, "I am responsible for my child's welfare, I must make sure that I do not harm my child, I am a good person if I give my child the best, it is up to me to make sure that my child is healthy, etc. etc.
Receiving information about the risks of not breastfeeding touches those internal scripts and therefore, might cause change. 

Change occurs as a result of the resolution of the guilty feelings. A healthy resolution of guilt results when one is able to make reparations for the perceived harm that one has caused.  When one believes that one has done damage, one needs to be provided with the opportunity to correct the damage.  Remember it is the person who feels guilt who perceives that damage has been done. This is an internal, not externally caused, feeling. 

This might mean for example, that the ethical obligation to provide accurate evidence based information might touch some parents' internal scripts such as "I am responsible for child, I must not harm my child' etc. As a result some expectant or new parents might feel that by not breastfeeding, they are harming their sense of self as parents. They might repair the "bad feelings" that arise by meeting their own self created goals through nursing.  

Comparatively, a mother might re-lactate, or nurse her next child, a grandmother who did not nurse might provide support for her daughter and nursing grandchildren and a nurse who did not nurse her own children might be able to repair her perceptions of harm by helping others. 
In fact, a colleague of mine, who did not nurse her own now grown children, stated that her work as a breastfeeding advocate, helps her feel better about herself as a mother. She is now openly able to discuss her sense of regret about not breastfeeding and has found an outlet that seems to meet her needs to repair the damage.     

 Reparative processes are facilitated when families are able to see the good parts of themselves, while they simultaneously internalize information  that is initially frustrating.The growth process is enriched in a supportive environment that contains the family as they attempt to make changes. The ability to successfully repair damage enhances one's ability to feel good about oneself and to continue functioning in a comfortable manner.

On the other hand, appropriate function is interfered with when one is overwhelmed by the sense of guilt and can not find successful ways of fixing the situation. In this case, when one can not reach the desired goal, one might experience contempt for those, who they belief have been successful at attaining one's self imposed goals. This explains the behavior of some of those who  adamantly dispute the significance of  breastfeeding and seem to despise those who nurse. 

Guilt is not an issue for all families who receive information that does not comply with their world view. These are the families whose internal scripts are not touched by the realities of not breastfeeding. Guilt is not part of their emotional experience in regards to breastfeeding and will not reinforce growth. 

Hence, guilt is an important emotion with the potential to enrich human development. Guilt arises when one does not meet one's own self imposed goals. Attempts to fix damage caused by not meeting one's goals leads to enhanced behaviors. The resolution of a healthy guilt process enables people to grow and develop.

Keren Epstein-Gilboa MEd,BScN,RN,LCCE,IBCLC
PhD (Candidate), Human Development/family,social relations
psychotherapist

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