Guilt and shame as an enigma in mothers who suffer from eating difficulties : A hermeneutical study

PhD thesis in Health, medicine and welfareSearching for new understanding about the enigma of guilt and shame in mothers suffering from ED led to a focus on the power of motherhood and the mothers’ ability to suffer in silence. The desire to be a good mother and not transfer problems to the next generation seemed to intensify the sense of guilt and shame, as well as the will to keep the suffering associated with the mental health problem a secret. This was interpreted and understood as follows: Suffering from mental health problems in secret was found to intensify feelings of guilt and shame. Responsibility (guilt) and self-judgement (shame) have a powerful emotional and cognitive influence on important qualities of a woman’s daily life and can lead to both strength and vulnerability. Implications for mental health nurses are suggested. The conditions described in this study may cause mothers with ED to avoid seeking help. It is therefore necessary for the health services to offer mothers suffering from ED an environment in which they can articulate their problems. Improvement may be facilitated by means of emotional, cognitive and behavioural knowledge. By understanding the characteristics of a mother suffering from ED, mental health nurses will be able to identify such mothers. The knowledge that guilt and shame prevent mothers from verbalising their vulnerabilities will place mental health nurses in a better position to provide an environment for iv articulation. This approach may help such mothers to make health promoting choices rather than searching for strategies to hide their problems under a veil of secrecy. Guilt and shame need to be focused upon and allowed space for articulation in the dialogue in order to help these women to express important everyday issues and problems in daily life when suffering from concealed health problems. More research is needed on interventions that help to reveal guilt and shame and encourage the participants to open up and talk about the problems related to ED in the therapeutic situation. Further research should also focus on how to cope with motherhood in the context of ED as well as on how guilt and shame should be re-articulated so as to become understandable and thus be interpreted in ways that are recognisable to sufferers. The findings from this study concerning guilt and shame can be transferred to other areas related to persons suffering from mental health problems or to mothers with ED in the area of preand postnatal care and district health care