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Shame versus guilt in community responses to wrongdoing.

The views expressed are those of the author and are not necessarily those of Scientific American.

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Yesterday, on the Hastings Center Bioethics Forum, Carl Elliott pondered the question of why a petition asking the governor of Minnesota to investigate ethically problematic research at the University of Minnesota has gathered hundreds of signatures from scholars in bioethics, clinical research, medical humanities, and related disciplines — but only a handful of signatures from scholars and researchers at the University of Minnesota.

At the center of the research scandal is the death of Dan Markingson, who was a human subject in a clinical trial of psychiatric drugs. Detailed background on the case can be found here, and Judy Stone has blogged extensively about the ethical dimensions of the case.

Elliott writes:

Very few signers come from the University of Minnesota. In fact, only two people from the Center for Bioethics have signed: Leigh Turner and me. This is not because any faculty member outside the Department of Psychiatry actually defends the ethics of the study, at least as far as I can tell. What seems to bother people here is speaking out about it. Very few faculty members are willing to register their objections publicly.

Why not? Well, there are the obvious possibilities – fear, apathy, self-interest, and so on. At least one person has told me she is unwilling to sign because she doesn’t think the petition will succeed. But there may be a more interesting explanation that I’d like to explore. …

Why would faculty members remain silent about such an alarming sequence of events? One possible reason is simply because they do not feel as if the wrongdoing has anything to do with them. The University of Minnesota is a vast institution; the scandal took place in a single department; if anyone is to be blamed, it is the psychiatrists and the university administrators, not them. Simply being a faculty member at the university does not implicate them in the wrongdoing or give them any special obligation to fix it. In a phrase: no guilt, hence no responsibility.

My view is somewhat different. These events have made me deeply ashamed to be a part of the University of Minnesota, in the same way that I feel ashamed to be a Southerner when I see video clips of Strom Thurmond’s race-baiting speeches or photos of Alabama police dogs snapping at black civil rights marchers. I think that what our psychiatrists did to Dan Markingson was wrong in the deepest sense. It was exploitative, cruel, and corrupt. Almost as disgraceful are the actions university officials have taken to cover it up and protect the reputation of the university. The shame I feel comes from the fact that I have worked at the University of Minnesota for 15 years. I have even been a member of the IRB. For better or worse, my identity is bound up with the institution.

These two different reactions – shame versus guilt – differ in important ways. Shame is linked with honor; it is about losing the respect of others, and by virtue of that, losing your self-respect. And honor often involves collective identity. While we don’t usually feel guilty about the actions of other people, we often do feel ashamed if those actions reflect on our own identities. So, for example, you can feel ashamed at the actions of your parents, your fellow Lutherans, or your physician colleagues – even if you feel as if it would be unfair for anyone to blame you personally for their actions.

Shame, unlike guilt, involves the imagined gaze of other people. As Ruth Benedict writes: “Shame is a reaction to other people’s criticism. A man is shamed either by being openly ridiculed or by fantasying to himself that he has been made ridiculous. In either case it is a potent sanction. But it requires an audience or at least a man’s fantasy of an audience. Guilt does not.”

As Elliott notes, one way to avoid an audience — and thus to avoid shame — is to actively participate in, or tacitly endorse, a cover-up of the wrongdoing. I’m inclined to think, however, that taking steps to avoid shame by hiding the facts, or by allowing retaliation against people asking inconvenient questions, is itself a kind of wrongdoing — the kind of thing that incurs guilt, for which no audience is required.

As well, I think the scholars and researchers at the University of Minnesota who prefer not to take a stand on how their university responds to ethically problematic research, even if it is research in someone else’s lab, or someone else’s department, underestimate the size of the audience for their actions and for their inaction.

A hugely significant segment of this audience is their trainees. Their students and postdocs (and others involved in training relationships with them) are watching them, trying to draw lessons about how to be a grown-up scientist or scholar, a responsible member of a discipline, a responsible member of a university community, a responsible citizen of the world. The people they are training are looking to them to set a good example on how to respond to problems — by addressing them, learning from them, making things right, and doing better going forward, or by lying, covering up, and punishing people harmed by trying to recover costs from them (thus sending a message to others daring to point out how they have been harmed).

There are many fewer explicit conversations about such issues than one might hope in a scientist’s training. In the absence of explicit conversations, most of what trainees have to go on is how the people training them actually behave. And sometimes, a mentor’s silence speaks as loud as words.

Janet D. Stemwedel About the Author: Janet D. Stemwedel is an Associate Professor of Philosophy at San José State University. Her explorations of ethics, scientific knowledge-building, and how they are intertwined are informed by her misspent scientific youth as a physical chemist. Follow on Twitter @docfreeride.

The views expressed are those of the author and are not necessarily those of Scientific American.

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  1. 1. ultimobo 6:21 pm 04/25/2013

    interesting – tho’ I’ve typically found the differences between shame vs guilt to be not immediately obvious.

    in my readings of this subject, I’ve been interested to compare Japan – a shame-based society – with few laws, but where people avoid certain things because that might shame their family – with the US and Australia – where if no-one’s looking, people tend to be tempted to get away with something, so many laws describe harsh penalties in attempts to dissuade bad behaviour.

    Particularly interesting to me was to read of England as a shame-based society (stand in that queue – or else!) – so it was intriguing to me arriving back at an Australian airport to find a long line of people/trolleys for taxis angling away from me – I pushed my trolley to join at the closest point, a US guy said ‘people jump queues here?’ – I said ‘no because you came from over there, I came from over here’ – then an English lady remonstrated with me about respecting the queue

    After a tense few words, I joined the queue – net effect – no-one else said anything – my perspective – no-one else cared – I enjoy the fact that in my country people don’t care if you jump a queue, they figure you must be more keen than them, and that’s OK …

    Have a nice day.

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  2. 2. hammerbait 7:47 pm 04/25/2013

    i guess, by your example, it’s ok to push women and kids aside for, say, lifeboats, or food. it seems our
    “ethics” are determined by how desperate we feel, not how we actually are.

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  3. 3. syzygyygyzys 8:15 pm 04/25/2013

    Whether those at the University of Minnesota who won’t stand up and sign the petition feel shame, guilt or both, they seem to be without honor. I wonder if honor isn’t something not connected to shame or guilt. My personal view is that honor is doing what is right for its own sake without regard to the difficulty, the consequences, or if anyone else knows about it. Actions motivated by shame or guilt may have the same result, but that seems different from honor.

    Since I haven’t studied ethics, I don’t really feel qualified to comment here. But, after reading your post I wanted to respond. Work in this area is important.

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  4. 4. meegwich 8:31 am 04/26/2013

    The University of Minnesota has a long history and reputation for turning a blind eye on clinical trial misconduct. In the past on a few occasions it had enough sense of shame and awareness that it was wrong, and that they would take pains to make sure that there was at least some plausible deniability. That changed with the death of Dan Markingson. Not only have they denied any wrongdoing, they feel no shame in hiding behind legal immunity, and it’s as though they even take pride in it as a sign of their toughness.
    This is all because the Office of the General Counsel and Dean of the Medical School have created a culture of impunity within the University and specifically its psychiatry department. In the case of Dan Markingson, not only did the treating physician/principal investigator not suffer any consequences, the department chair was shielded from liability and even received verbal promotions from the Dean of the Medical School.
    But there is a price to be paid for this condoning of clinical trial misconduct and the creation of a culture of impunity where lower-level people such as the study coordinator are given carte blanche to violate the law in the conducting of clinical experiments on human subjects.
    Such a culture has certain legal consequences. Under the doctrine of command responsibility, when an organization such as the University of Minnesota involves itself in unethical and clinical trial misconduct and cover-up or fails to punish or discipline those who engaged in that conduct, criminal liability passes to the senior officers of University.
    The chair of the psychiatry department performs like a side-show carnival barker…but the University has failed to heed the consumer warning of buyer-beware.

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  5. 5. jgrosay 1:59 pm 04/27/2013

    Some ideas about this tragic event, from my experience in CTs: most grants for CTs are paid the same way, a fee for case validly enrolled, that is increased if the case is finally considered evaluable, and as a longer follow-up makes data more valuable, sometimes grants are increased according to how long the patient stayed in Trial, also because a longer followed case means also extra workload for the investigator. Is not uncommom, and I’d say it’s hard if not impossible avoiding this, doctors in CTs having received honoraria from one or several Pharmaceutical companies before being included in an individual trial as investigators. Doctors with the high numbers of patients required to screen a lot, to enroll just a few cases in the trial are not many, and those with the expertise to produce data of good quality, this doesn’t mean data favorable or biased to any experimental product, but just people who do well the job of screening, enrollment, follow up, and Case Report Forms completion, are not easy to find, and once somebody has been considered a good investigator, more trials are offered him/her. As those who participated in a CT are called later for presenting the Study Results in Congresses and Meetings, and also to publish data, it’s difficult finding someone known to have cases, and do the follow up well, who hasn’t been offered honoraria by the same company or other companies before. All this does not equal to faking data, and the issues of Ethics in enrolling cases in some specific areas of medicine, where the Autonomy of patient may be dubious or absent, are just the reason why for Institutional Review Boards, and Data Safety Monitoring Committees to exist, and taxpayers are also maintainig a body of Health Regulatory Authorities and Inspectors to watch for Clinical Trials being conducted in accordance of such basic things as the Helsinki Declaration, and the specific protocol of the Trial, that always needs an approval before starting screening patients. Rules can’t make all people good or saints, nor wise, and freedom, the actual possibility of doing things wrong, always exists, but this is human nature, not laws or Commandments.

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