I have heard Dr. Newman speak on this topic as well. Dr. Newman seems to be 
famous (or infamous) for not messing around with words. He calls it like he 
sees it. Bravo to him, even if I don't always agree :-).

From Websters:

* Guilt: a feeling of culpability for offenses 
* Shame (noun): - a painful emotion caused by consciousness of guilt, 
shortcoming, or impropriety
Shame (verb): - to force by causing to feel guilty 
* Regret: sorrow aroused by circumstances beyond one's control or power to 
repair

We can't make someone feel guilty. We can make a client aware of her 
options and the possible outcomes. If she feels guilt, that is a natural 
consequence to doing something wrong. Her internal moral monitor is telling 
her something valuable. We use guilt all the time to influence people's 
decisions. Guilt has gotten a bad rap, in my opinion. Guilt is a healthy emotion 
that gives us an indication that we need to change something.

We can also shame a client, which I think is where the confusion comes in. 
Using shame is not an effective health education tool. 

I've heard it said that guilt is the emotion felt when you've done something 
wrong. Shame is when you internalize someone else's negative opinion about 
you or your actions. Regret is the emotion felt after the fact, when there's no 
chance of fixing it. 

There is a difference between telling a client that "feeding a baby artificial milk 
will increase the risk of certain poor health outcomes" VS something to the 
effect of "mothers who use formula don't care about their babies" (which 
would of course be a crappy thing to say to anyone). If we are giving out 
FACTS in order to allow the woman to make an informed decision, how is that 
mis-using guilt? If she is leaning towards using formula without a medical 
reason, she will likely feel guilty (IF she accepts our former statement to be 
true). If a woman uses formula because there is no better alternative, she is 
not going to feel guilty; she may feel regret.

Anyway, semantics are in important in this conversation, as the popular 
negative connotation of the word "guilt" may really imply another word entirely.

Hopes this makes sense.

Warm greetings,
Karen Wilson, RN IBCLC
Thornton, CO

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