Another layer of torment: ‘COVID shame’

As if contracting COVID-19 weren’t stressful enough, add another layer of mental torment to the illness. It’s the guilt and shame someone feels if they become infected.

Northwestern Medicine mental health experts spoke to Northwestern Now about “COVID shame” and how patients can cope with it.

Worried about what others think?

“Several patients with COVID-19 have struggled with feeling excessive guilt as if they did something wrong, even if they followed all the recommendations to stay safe,” said Sheehan Fisher, a psychologist and assistant professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine. “They start to second guess themselves about their choices and decision making and worry about what others will think of them.

“The guilt adds extra suffering, even if they are asymptomatic. The guilt adds to their stress and anxiety.

“They also feel a level of social shame. The shame makes them want to avoid social interaction over the phone or even getting social support from friends, because they don’t want to be judged. Social support helps with the stress of dealing with having COVID. People want support, but feel they can’t talk to anyone, so that exacerbates the stress.”

‘I try to ground them in reality’

“I try to ground them in reality to focus on the fact that they know they followed the recommendations and didn’t do anything reckless,” Fisher said. “The guilt isn’t a sign of a true mistake made, but an emotional experience based on social pressure. I try to help them accept they can’t control how others think. Plus, their fears may be imaginary about how others are viewing or judging them.

“I try to encourage people to be kind to others because all of us are at risk, and all of us could make some choice that allows us to contract COVID, even if we engage in a conversative approach.”

Feel like you’re wearing a scarlet letter?

“Some of my patients feel guilty about just having a cough or sniffle because people look at them as if they are wearing a scarlet letter, before they are even tested,” said Dr. Crystal Clark, a psychiatrist and associate professor of psychiatry and behavioral sciences at Feinberg. “They may just have a routine cold, but that has come up in a lot of conversations personally and professionally.

“This shame has resulted in some people choosing not to get tested. They believe that they have been doing everything as they should and feel like, ‘I can’t have this.’ They avoid finding out, because if they do, it’s that guilt and shame that goes with that.

“If a person does test positive, there is a lot of rumination around ‘how did I get this, what did I do or what haven’t I done?’ They mentally rehearse everything they did to try to avoid getting this virus and feel they failed or were inept to protect themselves. They might not share with family or friends that have COVID because of that shame. They are hiding and not wanting to share.

“It can be very isolating and reduces the support that people need when they are going through any illness or stressful time. It leaves them with a lot of negative thoughts or ruminations which can result in increased anxiety and depression.”

It doesn’t mean you did the wrong things

“I remind them that we know this virus and the new the variants are highly infectious. And, although many are doing everything recommended by the FDA in being vaccinated and boosted and wearing masks, there is still a risk for catching this virus. Catching it doesn’t mean they didn’t do what they were supposed to do.

“Still get vaccinated, still mask — it might be the difference between life and death. If you are vaccinated and get boosted, you are less likely to have severe complications from this virus.

“If you have any respiratory symptoms, get tested. We still need everyone’s efforts in not spreading it. Let people know and quarantine until you are feeling better. That’s the only way we have of fighting this.”

For those who don’t have the virus, Clark said, “We have to do better at being less judgmental. We can’t assume someone who gets sick has been irresponsible.”