The distinction between altruistic and deontological guilt feelings: insights from psychopathology

Francesco Mancini, Guyonne Rogier, and Amelia GangemF

1 Introduction

In a review of the literature about feelings of guilt, Carni et al. (2013) distinguish three main approaches: intrapsychic, interpersonal, and integrated.

The intrapsychic approach is well expressed by Freud, who assumes that guilt is the manifestation of the intervention of the Superego, which sanctions impulses, desires, and actions that violate internalized norms. Hence, guilt would express an intrapsychic conflict. In line with Kugler and Jones, “Guilt can be defined as the dysphoric feeling associated with the recognition of having violated a moral or social standard of personal relevance (1992: 218)”.

Fromm (1985) claimed that the fear of being guilty is the fear of having outraged an authority, albeit an unreal, internalized one, and that guilt is a kind of power that authority wields over people. To alleviate their guilt, individuals who feel guilty are particularly disposed to do everything they can to get the authority’s approval (Carni et al., 2013).

The psychoanalytic approach describes guilt, and the psychological distress that characterizes it, as not necessarily related to others. From this theoretical perspective, all the actions of people who experience guilt are aimed at diminishing their own discomfort, regardless of whether there is any actual damage repair. Thus, we can feel guilty and act to alleviate our guilt but not necessarily another’s suffering.

(Carni et al., 2013: 6)

Consequently, all feelings of guilt, even the survivor’s guilt, would translate into internal conflict, where transgression of a moral norm is not at all evident.

On the other hand, the interpersonal approach (Baumeister et al., 1994; Hoffman, 1982, 1998) shifted the attention from people’s internal states to the relational effects of their actions/omissions. This approach attributes feelings of guilt to the assumption of having harmed or failed to help another person, with the feeling of guilt being crucially affected by the affection and empathy that unite the ‘guilty’ to the ‘victim’ (Kubany and Watson, 2003). Individuals feel guilty not towards an internalized authority but another person, particularly if they are tied to the other by affection or, at least, by a common belonging. It is worth noting that the interpersonal approach also suggests a monistic conception of feelings of guilt, including those guilt feelings in which it seems that the good of another person is not involved (Carni et al., 2013).

Prinz and Nichols (2010) argued for an integrated approach, which describes the psychological guilt-related state as follows: “Someone I am concerned about has been harmed and I have responsibility for what I have done or failed to do”. This schema includes two components: the perceived transgression of an internalized moral norm that defines responsibility and the idea of not having preserved the other’s well-being. According to the monistic thesis of Prinz and Nichols (2010), any kind of guilt would therefore derive from these two ingredients, often mixed: having transgressed an internalized moral norm and having caused damage to a victim.

These three approaches share the idea that guilt is a single emotional state. However, two psychopathological disorders, obsessive-compulsive disorder (OCD) and major depression disorder (MDD), suggest the usefulness of distinguishing between two types of guilt: deontological guilt and altruistic guilt.

2 Obsessive-compulsive disorder

Obsessions are recurring and persistent thoughts or images, experienced in OCD as intrusive and undesirable and as the cause of marked anxiety or discomfort.

Roberto is obsessed by the doubt that he has not turned off the gas tap properly. This doubt implies strong anxiety linked to the fear that, if a gas leak occurred, there would be an explosion that could destroy the entire building where his apartment is located and kill a certain number of people. However, his main fear is that, if such an event occurred, it would be the result of his carelessness. To prevent this dramatic event, he checks the gas tap repeatedly and for a long time, often compulsively, in an attempt to eliminate any potential risk.

Claudio is obsessed by intruding thoughts of blasphemy that raise the doubt that he has intentionally offended God. To solve this problem, he engages in gruelling ruminations and mental compulsions, such as repeating the phrase ‘I love God’ several times.

Luigi is obsessed with order and symmetry. Before leaving the house, he must tidy up the objects placed on his desk. If he doesn’t, he gets an intense feeling that things aren’t as they should be and, more importantly, he deduces the likelihood of two negative consequences. The first is magical and superstitious by nature: ‘If my objects are not ordered as they should be, something important to me will go wrong, and if something goes wrong, it will be my fault’. What could go wrong is likely to be an accident involving Luigi’s wife. The second is subtler: ‘if my objects are not right, then I am not right as a person’, the whole self is imperfect in a moral sense.

Finally, Antonia is obsessed with the idea of being contaminated by her own and other people’s excrement. This possibility does not arouse a fear related to health, but an unbearable feeling of disgust. To shake off this feeling, she engages in compulsive washing rituals.

Thoughts with the same obsession content are usually observed among the normal population (Berry and Laskey, 2012). Similarly, patients try to solve the problem aroused by obsessions the same way as everyone else’s. For example, anyone might be afraid of leaving the gas tap open and, therefore, checks it. The difference lies in the importance attributed to obsessions and the severity/rigidity of the standard used to evaluate the results of the problem-solving process. What makes these possibilities so serious for obsessive patients? What are they really worried about?

Obsessions have a common denominator, the fear of being guilty. Claudio fears being guilty of disrespect towards God, Roberto fears the responsibility for having caused a gas explosion, Luigi is obsessed, ultimately, with the superstitious fear of not preventing an accident involving his wife. Obsessive patients tend to be prone to guilt, a sense of responsibility, and a fear of guilt to a greater extent than individuals extracted from the normal and clinical populations (Chiang et al., 2016; D’Olimpio et al., 2013; Mancini and Gangemi, 2011). Nakame et al. (2012) reported, in obsessive patients exposed to feared stimuli, a neural activation similar to that observed in anyone feeling guilty.

The reduction of responsibility, and therefore of the possibility of being guilty both experimentally and therapeutically, reduces obsessive symptoms, while induction of a sense of responsibility and the fear of not being worthy of one’s responsibility (i.e., induction of guilt) arouses controlling obsessive behaviour in non-clinical subjects. The same induction among obsessive patients, even patients with obsessions and compulsions related to the fear of contamination, activates controlling behaviour with higher obsessive characteristics than that observed in non-clinical subjects (for a summary of the studies, see Mancini, 2018).

Antonia’s case is different. For her, being contaminated with substances such as excrement causes disgust, but not guilt or fear of guilt. Again, the literature supports the role of disgust in OCD. Bhikram et al. (2017) concluded from their review that “Recent research has identified the important role of disgust in obsessive-compulsive disorder (OCD) symptomatology. Exaggerated and inappropriate disgust reactions can drive some of the symptoms of OCD and, in some cases, can even outshine feelings of anxiety” (304).

Often, obsessive patients have symptoms related to both guilt and disgust and, even more frequently, they switch from one type of symptom to another during the course of the disorder.

Consequently, two questions emerge from clinical and empirical observations.

What kind of guilt is feared by obsessive individuals? It is usually assumed that to feel guilty, it is necessary to believe that you have deliberately acted or failed to act, causing harm or suffering to a victim, and that you have transgressed an internalized moral norm (Castelfranchi, 1994; Prinz and Nichols, 2010). Conversely, among patients with OCD, it is noted that they fear faults that do not harm anyone (for example, having blasphemous thoughts), being more concerned about the risk of having to blame themselves rather than the consequences for others. Roberto, for example, does not worry about the gas tap if the responsibility is not his, such as when he is not the last to leave the house. Luigi is not concerned about his wife having an accident for reasons beyond his responsibility. Thus, the sense of guilt feared by obsessives does not seem to be linked to the fate of the victim, but rather to the risk of having to blame themselves for not having done everything they could have done to fulfil their responsibilities.

With regard to OCD, therefore, two questions have arisen for the psychology of emotions. Is it possible to feel guilty only for the transgression of an internalized moral norm and not for the eventual harm to others? What is the relationship between guilt and disgust?

3 Major Depressive Disorder (MDD)

MDD is characterized by low mood (intense sadness) and a loss of interest in normal daily activities.

Martha is a 28-year-old woman who reports suffering from several depressive symptoms (e.g., fatigue, insomnia, anhedonia, chronic sadness, and guilt). She describes a very intimate and satisfying relationship with her mother, which has grown even stronger since her father died eight years ago. She describes herself as very caring and helpful towards her mother, a figure whom Martha perceives as emotionally vulnerable. On the contrary, she reports negative feelings about her sister, whom she considers irresponsible and a source of emotional distress for her mother. Thus, Martha reports the belief that she is the last chance to make her mother happy.

The depression started after Martha failed a university exam twice. Martha felt very guilty for failing because, in her opinion, this seriously undermined her goal of making her mother satisfied and happy. The depressive reaction was aggravated and maintained due to a vicious circle that exacerbated her feelings of guilt. Martha considered her depressive symptoms, in particular her loss of motivation and her propensity to cry and complain, as a further failure of her goal of making her mother happy. She feels more and more a burden to her mother and not a source of satisfaction.

It has recently been argued that at least one form of depression can be better defined as a disorder characterized by ‘concern for others’ rather than ‘concern for self’ (O’Connor et al., 2012). According to O’Connor et al. (2012), our understanding of depressive symptomatology' thus appears to have suffered from a bias that overestimated the importance of motivation for self-centeredness and neglected the other set of motivational drives directed to others, including caring, altruism, and protection of the group. Recently, a growing body of empirical evidence has disproved these hypotheses, underlying the central role played by altruistic concerns in depression.

MDD suggests the hypothesis that it is possible to feel guilty, in a way that we could define as altruistic, resulting not from the transgression of a moral norm but the perceived failure of one’s altruistic goals.

There thus emerges a question regarding the psychology' of emotions, mirroring the question posed by OCD. Is it possible to have a sense of guilt essentially due to the failure of altruistic goals and not to the transgression of moral norms?

The view we advance in this chapter is that there are two essentially different types of guilt. For one, deontological guilt, awareness of having transgressed an internalized moral norm is necessary, but not the assumption of having harmed a victim. For the other, altruistic guilt, the conviction of having harmed a victim is necessary, but not the assumption of having transgressed an internalized moral norm. In most daily experiences of guilt, the two emotions coexist. Indeed, most moral norms are about respecting the good of the other. For example, six of the Ten Commandments concern the well-being of and respect for other people. However, in some cases, such as in the symptomatic domain of obsessive or depressed patients, only one form of guilt may emerge or assume a dominant role.

4 The altruistic guilt

To feel altruistic guilt, it is necessary to believe that you have failed to pursue an altruistic goal because of your own act or omission, whether real, planned, or desired. It must also be assumed that the conditions to act differently actually existed.

There are three defining elements of an altruistic goal. First of all, the content: the most obvious is linked to the good of the other. Another, less obvious content, which however appears evident in the case of sentimental relationships, is the desire to stand by another person in difficulty, even if that closeness is not useful or reassuring for the other (Parisi, 1977). A second element is that a goal, to be fully altruistic, must be pursued through sacrifice, that is, by putting the other’s benefit before one’s own. Common sense intuition indicates that an action is even more altruistic when it involves a cost to the actor, while it is not considered particularly altruistic to give the other something that is cost-free. The third element of an altruistic goal is that the good of the other and standing by him must be pursued in a disinterested way and not for one’s own advantage.

Now, we would like to clarify one important misunderstanding that arises from the affirmation that being altruistic is in itself a moral norm. From this perspective, when one pursues the good of another, one respects the duty to be altruistic. To clarify this misunderstanding, we should start from an important premise: the psychological significance of an action depends on its subjective goal and not on its objective results. Thus, “helping because you care is different, psychologically speaking, front helping because you think it is what morality demands” (Prinz and Nichols, 2010: 113). Therefore, it is possible to pursue the good of another for at least two reasons. In the first place, to pursue an altruistic goal, that is, because one holds the good of the other as important in and of itself. Second, because of a sense of duty driven by the goal of respecting internalized moral norms, such as ‘be charitable’. Thus, the statement ‘be altruistic out of moral duty’ is an oxymoron. One cannot be altruistic out of respect for one’s moral duty, but certainly one can also pursue the good of the other out of moral duty.

Between these two ways of pursuing the good of another, out of altruism or out of a sense of moral duty, there is a great psychological difference. For example, let’s imagine the case of a mother who realizes she doesn’t love her children and feels guilty about it. In this case, her guilt would not be for the suffering of her children, which perhaps is even non-existent, but for her own inconsistency with the intuitive moral norm according to which a mother must love her children, otherwise, she violates the laws of nature.

The difference between other-directed behaviours motivated by altruism and those motivated by moral duty appears evident with a change of perspective. A few years ago, one of the authors clinically observed a young patient suffering from an acute depressive episode. A few months earlier, some days after her mother’s death, while she was sorting out her mother’s documents, she had found her mother’s diary, written during the patient’s childhood. In the diary, the mother often wrote about how little affection she felt for her children, how much she felt they were a burden, and how much she cared for them out of a sense of duty. This discovery surprised the patient, who had always had a completely different representation of her mother and her relationship with her children.

An intriguing question is whether altruistic goals, not instrumental to one’s own advantage, actually exist, or whether, on the contrary, the good of the other is pursued only because of certain benefits to oneself. The answer lies in a long series of subtle experiments conducted by Batson, summarized in a chapter by Stich et al. (2010), and in other studies summarized by Warneken and Toma-sello (2009): altruistic goals really exist. Human beings can pursue the good of another without any kind of personal advantage, even if there is no relationship with the other and even if the other is anonymous (i.e., a non-specific individual). People help others with a view to a truly altruistic goal, and not to reduce their discomfort induced by observing the difficulties of others, nor because they are afraid of being punished if they do not help, nor to avoid the pain associated with the sense of guilt they would experience if they did not help, nor in view of gratification, experienced as a positive sensation, which can derive from others or oneself (e.g., pride in having helped another), nor for the desire to feel the inner echo of the other’s relief on being helped to overcome a source of suffering. Indeed, individuals care for each other, even though they know they will have no information on the effect of their help on the well-being of those they have helped (Stich et al., 2010). Furthermore, Tomasello’s studies, summarized in Warneken and Tomasello (2009) and Tomasello (2016), found altruistic behaviours in very young children, around 2 years of age. According to the authors, this would suggest that the altruistic predisposition is innate and not a consequence of child rearing.

In support of the innate origin of altruism, some studies show monkeys and rats letting themselves starve if they associate eating to the suffering of another individual (Bekoff and Pierce, 2010). Thus, it seems that strictly (i.e., final) altruistic goals, pursued at a personal and likely innate cost, do indeed exist. This supports the idea that there is a possibility of feeling altruistic guilt.

It should be noted that altruistic guilt can arise from the failure of one of two altruistic goals. The first is closeness to the victim, which includes not only physical closeness to the victim but also the sharing of the respective ill-luck or misfortune or, where this is not possible, the participation in the suffering of the other. For example, if a good friend of mine is mourning the death of a parent, I am motivated to go to the funeral and show my emotional closeness and compassion for the friend’s suffering, and therefore, for example, I may feel guilty if the evening after the funeral I go dancing. The second altruistic goal is, conversely, sharing one’s joys with the other. I may feel selfish, and guilty about my selfishness, if I don’t let my friends share in my joy, for example, in my wedding.

We report here two examples:

I suffered from severe symptoms and was hospitalized. During this time, I shared a room with another person and we became friends. After three days, the doctor told me that I was fine and that I could go home. While I was packing my bags, my friend walked into the room. He was demoralized: the doctor told him he had cancer. Even today, I can’t shake off the idea that I was going back to my life and he, instead, was going through a terrible experience. I felt guilty for not sharing his bad luck.

(Castelfranchi, 1994: 69)

In this example, as in the following one, the sense of guilt arises from the failure of one of the two altruistic objectives, namely that of proximity to the victim, which includes not only physical proximity to the victim but also the sharing of the respective luck and misfortune, or, when this is impossible, of compassion for the pain of the other.

I was on call in my hospital service when they called me from another service where my grandmother was hospitalized. A few minutes after I arrived, I realized my grandmother was in a coma and was about to die. I decided to return to my service to inform a patient that I could not speak to him that day. When I went back to my grandmother, I realized that in the meantime she died. Days later, I still feel guilty for not being near her and holding her hand while she was dying.

This is an example (from F.M.) of altruistic guilt due to affection, where guilt is aroused by not having been close to the victim. In both of these examples, the guilt stemmed from the failure of altruistic goals, particularly the goal of being close to the victim and sharing and participating in their pain. The transgression of a moral norm does not appear to be involved. Both protagonists wanted to stay close to the victim, not out of their sense of duty but out of their friendship and attachment, that is, for emotional and altruistic reasons.

The disposition to act out of altruistic guilt appears to be oriented in three directions: avoiding other altruistic faults, taking care of another’s good by placing it before one’s own, or maintaining a psychological closeness with the victim and, therefore, participating in the victim’s suffering. This last case may then manifest itself as survivor guilt or guilt over getting better, even where one’s good fortune is reduced. For example, someone might, without being aware of it, systematically block his efforts to achieve a goal because, if he were successful, the distance between him and, for example, a less fortunate sibling, would increase (Weiss, 1993). Therefore, systematic proneness to avoiding success, characteristic of those who feel altruistic guilt (Weiss and Sampson, 1986), does not appear to be motivated by a desire for atonement or the levelling of inequity (Castelfranchi, 1994; Mancini, 1997) but rather by the desire not to create further distance from the victim.

The facial expressions related to guilt are not known. Consequently, neither are those related to altruistic guilt. Verbal expressions, internal and external, refer to the victim, to his/her pain, his/her misfortune, and also to one’s actions and omissions. For instance, in a study conducted by Basile and Mancini (2011), altruistic guilt was usefully elicited by sentences like the following: “How could I have left her alone?!”, “She was suffering so much and I did nothing to help her!”, “I left her alone with her difficulty”, “I would have been able to help her and instead I didn’t do anything”. In brief, altruistic guilt also entails a distressing sense of pity for the victim, a proneness to saying “I’m sorry”, to focusing attention on the suffering victim, a compassionate attitude towards the suffering other, and, finally, a proneness to relieving the victim’s pain through personal sacrifices (Basile and Mancini, 2011).

5 The deontological guilt

Deontological guilt, as opposed to altruistic guilt, arises from the thought of having violated an internalized moral norm, and includes the feeling of being unworthy. Sometimes, one can find another or oneself guilty, even if no one has been harmed, not even oneself. Let’s look at an example.

Julie and Mark are brother and sister. They travel together in France during the summer holidays. One night, they are alone in a cabin near the beach. They decide it would be interesting and fun to try having sex. At least, it would be a new experience for both of them. Julie is already on birth control pills, but Mark uses condoms too, just to be safe. They both enjoyed the experience but decide never to do it again. They will regard this night as a special secret that will bring them even closer to each other.

(Haidt, 2001: 814)

This story has been told to thousands of individuals around the world, belonging to different cultures and religions, and most of them have found the incest between Julie and Mark to be morally blameworthy. Most people share this judgement even though the story makes it very clear that both are adults and consenting; both are mentally competent, that there is no risk of procreation; that there is no risk of psychological damage nor damage to their social image. The intuition that this behaviour is reprehensible is strong, as is the idea that everyone would feel guilty if they were the protagonists of the story. Let’s imagine another example. A man had just graduated from medical school and just started being on call at a clinic. One evening, being on call, he found a patient in a coma due to final-stage intestinal cancer. Even in this state of unconsciousness, the patient complained of pain. The service manager told him to administer a strong dose of morphine, which would reduce the pain and speed up death. He was about to inject the morphine, but a thought came to his mind: “Who am I to decide this person’s life and death? Who gives me the authority to take this action and replace God?” He then removed the needle; otherwise, he would have felt too guilty. In this example, the moral obstacle that stopped the young doctor also involved unnecessary pain for the poor patient. Therefore, feelings of guilt can exist independently of the well-being of others.

The feeling of deontological guilt is based on the conviction of having transgressed an internalized moral norm. In other words, the individual has the goal of respecting the norm and this is an ultimate goal. Both conditions are necessary but not sufficient. To feel ethical guilt, other conditions must also be met. One must believe that he could have acted differently, that is, that he was free from constrictions and was not obliged to act as he did. We can also feel guilty for intentions, desires, or dispositions to act, even if they are not put into action. For example, one might feel guilty, and morally unworthy, for having paedophiliac desires, even if they are not pursued, but on condition of assuming that one did not do everything in his power to free himself of those desires.

The impulse to action in deontological guilt appears to be directed in three directions: to constrain one’s self, by signalling a renewed willingness to submit and obey through confession, apology, and penance; to prevent other potential faults, including the search for justifications; to purify oneself, for example, through washing rituals (Lee and Schwarz, 2011; Zhong and Liljenquist, 2006). It is no coincidence that, in every religion, ritualistic body washing is used to free the conscience from sin. Baptism is a washing with which one purifies oneself from original sin, that is, from deontological guilt par excellence, from an act of pure disobedience to God, that is, hubris.

5.1 Psychological characteristics of internalized moral norms

But when we speak of moral norms regarding deontological guilt, what exactly are we referring to and how do such norms differ from conventional norms?

Moral norms are deontic norms and, as such, they limit the range of possible choices. Traditionally, moral norms are considered to be different from other ethical norms, such as the conventional norms of good manners or the rules of billiards, for four reasons related to the so-called moral signature (Haidt and Joseph, 2004). Moral norms are experienced as (1) universal and (2) unchangeable; (3) their transgression is usually considered more serious than the transgression of conventional norms; and, finally, (4) they regard the well-being of and respect for others.

Moral norms are considered universal, because they are valid for everyone. A norm ad or contra personam is not a moral norm. Moral norms are considered immutable. For example, paedophilia would be considered immoral, even if we observed it in a culture that admits it. The fact that they are considered universal and unchangeable leads to experiencing moral norms as if these were natural laws. Their transgression is considered more serious than the transgression of conventional norms and, finally, moral norms refer only to the well-being of others.

Conventional norms, on the contrary, are contingent, that is, dependent on the sociocultural environment. For example, burping while eating is reprehensible in our culture, but the Eskimos seem to see it as an adequate way for a guest to express his appreciation for the host’s food. Conventional norms are modifiable. For instance, the rules of billiards can be modified by an agreement between players. The transgression of conventional norms is not habitually considered serious. For instance, burping while eating may elicit criticism or hilarity but not a moral condemnation. Coherently with the Moral Signature, conventional norms are not related to the well-being of others. For instance, the norm “While eating, no elbows on the table”, defends the space of the other diners, but saying that it defends their well-being would be an exaggeration.

Yet, are Moral Standards universal? Some studies seem to dispute the idea that internalized moral norms are perceived as universal. For example, Kelly et al. (2007) have shown that an officer on an oil tanker who inflicts severe corporal punishment on a sailor who fell asleep while on watch is judged morally guilty, while that same officer would be held not guilty, or less guilty, if he were commanding a sailing ship in the 1600s, when such punishments were usual. However, these data do not sufficiently question the idea that moral norms are considered universal. It is pertinent to distinguish two types of sentences: it is one thing to say that, in the seventeenth century, it was right to administer severe corporal punishment while today it is not; it is quite another to affirm that the seventeenth-century officer was not morally guilty because he was convinced, sincerely trusting in the fairness of his decision, that it was consistent with the morals of his time. But this second judgement does not claim that the moral principles of this period were ‘right’. It is plausible that the answers given by the participants in Kelly’s study belonged to this second type. The first judgement would imply that the moral norm could be put into perspective, while the second would put the judgement on the officer into perspective, taking into consideration what seemed right to him, but not implying that the officer’s behaviour was inherently right.

It is probably more pertinent to reverse the question: who is authorized to change the rules and under what conditions? The appropriateness of this question is suggested by the comparison between two kinds of findings. From the studies by Kelly et al. (2007), it appears that the oil tanker officer described previously would have been found not guilty or less guilty if he had inflicted corporal punishment in carrying out his superior’s order. Milgram’s famous studies (e.g., 1974) confirm that authoritativeness, embodied in a scientist, can make harmfill behaviour morally permissible for others. This seems to suggest that a human authority can modify moral norms and, therefore, that moral and conventional norms are similar, at least in this respect. Conversely, other findings suggest that moral norms cannot be changed by human authority. For example, the studies by Turiel and Nucci (1978) and Nichols (2004) show that children do not recognize the authority, for example, of their teacher, to change moral norms (do not harm a friend), while they do recognize the teacher’s authority to change conventional norms (e.g., do not chew chewing gum in class). The conflicting nature of the data can probably be resolved by considering the relationship between the stature of the authority and the moral importance of the norm. The moral importance of a norm seems to depend on how much the transgression of the norm disturbs what appears to be the natural order. The stature of the authority is linked to how much the authority’s directive appears to be with the natural order, traditions, and God’s will.

The Pope has the right to modify the moral norm not to kill and command the Crusaders to exterminate infidels, if it is assumed that he is acting on behalf of God. On the other hand, the teacher is not recognized as having the authority to change the moral norm “Don’t pull your friend’s hair” but only to change the conventional norm, “Don’t chew gum in class”. Thus, the different modifiability of moral and conventional norms appears related to the authority recognized in those who change the norm and to the moral importance of the norm. Furthermore, the modifiability of a norm appears to be related to whether the transgression of the norm appears to be caused by the hubris or arrogance that leads human beings to assume their power and rebel against the given order - divine, human, or natural. In short, does the transgression show lack of respect for the norm Don’t play God/ Don’t tamper with nature?

Does the content of internalized moral norms only concern the good of others? In effect, many internalized moral norms do concern the good and the rights of others, for example, do not kill, do not steal, do not inflict useless pain. Others, however, though they too may be internalized, are not linked to our relationships with others (see Moral Foundation Theory - MFT - Haidt and Joseph, 2004; Graham and Haidt, 2012). For example, the first three of the Ten Commandments regulate, explicitly and exclusively, the relationship with the divinity, and not relationships with other people: (1) I am the Lord thy God, and thou shalt not have strange gods before me. (2) Thou shalt not take the name of the Lord thy God in vain. (3) Remember the Sabbath day, to keep it holy. Similarly, there are internalized moral norms that prohibit sexual behaviour that does not harm or violate anyone, such as coupling with animals, incest between consenting adults even without any risk of procreation, or masturbation.

6 Empirical evidence of the difference between altruistic and deontological guilt, and more generally between the two moralities

Various studies have demonstrated that altruistic guilt and deontological guilt are distinct from both behavioural and neurological points of view. An initial series of studies on moral choices was conducted by using the ‘trolley car dilemma’ (Foot, 1967). In its original form, the trolley dilemma asks participants to imagine that a trolley car is careening out of control on a track with five persons on it who, if the trolley continues on its course, will be run over and killed. Participants are then asked if they would pull an exchange lever, sending the trolley down another track where, however, there is another person who will certainly be hit and killed. This dilemma is especially interesting for the distinction between the two types of guilt. Indeed, it requires participants to choose between two incompatible options, which in light of what has been said so far can be defined as altruistic/humanitarian versus deontological. The altruistic/humanitarian option consists in moving the lever to cause the death of one person in order to save five, thus reducing as much as possible the overall suffering and harm. Nevertheless, moving the lever amounts to assuming responsibility for changing the course of events decided by fate, or for believers, by God. The deontological option consists in omitting to move the lever and allowing the five people to die, but not taking the responsibility to change the natural course of events and thus respecting the deontological principle Do Not Play God. According to Sunstein (2005), this principle is capable of explaining why, all things being equal, omission tends to be considered less grave than action. In line with these studies, Gangemi and Mancini (2013) have shown that the people who choose not to act tend to justify their choice on the Do Not Play God principle (for example, “Who am I to decide who lives and who dies’), while those who choose to act, appeal to the minimization of others’ pain and suffering, and thus to an altruistic/humanitarian principle (for example, “Better that only one person die rather than five”). Furthermore, the induction of deontological guilt implies a preference for not moving the lever, while the induction of altruistic guilt implies moving it (Mancini and Gangemi, 2015). A study by D’Olimpio and Mancini (2016) confirmed this finding, adding the evidence that a preference for emissive choices is ascribable to deontological guilt and not to shame. Another study highlighted that the deontological choice is more frequent if participants are asked to imagine being next to the exchange and to have nearby a figure who represents a moral authority, such as a judge or a police officer. The contrary happens when participants are asked to imagine themselves next to the lever and therefore close to the five people. The first situation plausibly induces respect for authority and therefore for the Do Not Play God principle, while the second activates empathy and, in turn, an altruistic/humanitarian impulse (Gangemi and Mancini, 2013).

Other researchers have found that respect for the moral norm “Do not tell lies” can even restrain the telling of white lies that would create a benefit for the deceived and small harm for the deceiver, and Pareto lies in which both the deceived and the deceiver would benefit. Respect for the moral norm, therefore, seems to be able to win out over the effect of the altruistic and cooperative disposition (Biziou-van-Pol et al., 2015).

Some findings seem to suggest that deontological guilt, but not altruistic guilt, reduces the moral authority that one recognizes in oneself. For example, the induction of deontological guilt reduces refusals of unjust offers in the three-person Ultimatum Game, unlike what happens with the induction of altruistic guilt (Mancini and Mancini, 2015). This suggests that induction of deontological guilt lessens the feeling of being entitled to make justice prevail.

Basile and Mancini (2011) activated the two senses of guilt separately by using as stimuli facial expressions of basic emotions (i.e., Ekman photos) accompanied by internal dialogue phrases typically associated with the two types of guilt feelings. For example, for deontological guilt, angry and contemptuous faces together with phrases such as “How could I have done that!”, while for altruistic guilt, sad faces with phrases such as “How could I have left her alone!”. Moreover, in a study using functional magnetic resonance imaging (fMRI) to identify the neural substrate of the two guilt feelings, Basile et al. (2011) found activation of the insula and the anterior cingulate cortex in the condition of deontological guilt and activation of medial prefrontal areas in the condition of altruistic guilt. These findings appear to be particularly interesting, not only because they demonstrate that the two guilt feelings can be “traced” to different cerebral circuits, but also for the specific areas involved. The medial prefrontal areas, which are activated by altruistic guilt, are normally activated by the theory of mind tasks and are associated with the representation of others’intentions (Blair, 1995; Shallice, 2001) and with the experience of empathy and compassion. Therefore, they are areas involved in the understanding of the mind of the victim (Moll et al., 2005). On the other hand, the insula, which is activated by deontological guilt, is associated with the experience of disgust and self-blame (Rozin et al., 2000).

7 Deontological guilt and disgust

In general, starting from the observation that, in all religions, sins soil the conscience and washing purifies it, the scientific literature has suggested the existence of a strong relationship between guilt and disgust (Lee and Schwarz, 2011). For example, several studies have confirmed the relationship between the physical component of disgust, the contamination of moral evil, and the need to wash (Doron et al., 2012). In this regard, Zhong and Liljenquist (2006) have described the ‘Lady Macbeth’ effect, in which a threat to moral purity implies the need to wash and that physical washing provides relief from the consequences of immoral behaviour and reduces the threat to one’s moral image (Lee and Schwarz, 2011). However, several studies have not replicated this effect (e.g., Earp et al., 2014). The diversity of findings can be explained if it is considered that the Macbeth effect is solely due to the deontological component of guilt and not due to the altruistic one. In fact, in each of the studies cited, the two components, altruistic and deontological, were not controlled, but a general sense of guilt was induced. In fact, in a recent study, the induction of deontological but not altruistic guilt led to the ‘Lady Macbeth’ effect (D’Olimpio and Mancini, 2014). This study was replicated (Ottaviani et al., 2018) to confirm that the induction of deontological, but not altruistic, guilt provokes, in addition to thorough washing, the typical physiological activation observed by way of Heart Rate Variability.

These findings are supported by another study that used tDCS (transcranial direct current stimulation) (Ottaviani et al., 2018). Stimulating the insula cortex activates the parasympathetic nervous system in a way compatible with the activation of disgust, increases disposition to words related to cleaning, and induces the tendency to feel disgust. Above all, the subject himself judges transgressions of moral norms to be more serious when the insula cortex is activated compared to when it is not. In situations like, by way of example, “you see a politician use tax revenues to construct an addition to his own home”. Whereas activation of the insula cortex does not induce changes in altruistic judgements, such as “you see a boy set up a series of traps to kill stray cats in his neighbourhood”.

We have found additional evidence of a close relationship between ethical guilt and disgust. Both disgust and guilt reduce self-rank in the social cognitive chain of being (SCCB). The SCCB represents the propensity of human beings to organize their moral world along a vertical axis, with those deserving obedience and respect in a higher position, those who must give respect and obedience in a lower position, and those who deserve contempt in the lowest position (Brandt and Reyna, 2011). But there may be a specific relationship between deontological, but not altruistic, guilt and rank in the SCCB. Induction of deontological guilt reduces the rejection of unfair offers in the Ultimatum Game, in contrast with what occurs if altruistic guilt or shame is induced (Mancini and Mancini, 2015). This suggests that inducement of deontological guilt reduces the rank of those who identify with the SCCB and feel less empowered to enforce justice.

8 Deontological guilt and OCD

Some studies suggest that the guilt feared by the obsessive patient is predominantly deontological and that obsessive patients are more sensitive to ethics than nonobsessive subjects (for a review, see Gangemi and Mancini, 2017). Mancini and Gangemi (2015) found that ОС patients almost always solved the trolley dilemma with an omission, thus avoiding deontological guilt, while healthy controls and patients with anxiety disorders almost always solved the dilemma by shifting the lever, thus avoiding altruistic guilt. Franklin et al. (2009) studied moral choices using the trolley car dilemma, showing that in patients with ОС, preference for action was inversely related to the severity of their symptoms. Giacomantonio et al. (2019) documented that in a condition of uncertainty, individuals without a psychiatric diagnosis spent more time in obsessive checks when they experienced deontological rather than altruistic guilt. In two previously cited studies (D’Olimpio and Mancini, 2014; Ottaviani et al., 2018), the results showed that, in non-clinical participants, the induction of ethical guilt led to obsessive control and washing behaviours to a greater extent than the induction of altruistic guilt. In OC patients, the ‘Lady Macbeth’ effect is significantly higher than in non-OC participants (Reuven et al., 2013).

Several studies with functional magnetic resonance imaging (e.g., Mataix-Cols et al., 2005; Rauch et al., 1998) have shown that, during a symptom-inducing activity, OC patients show the same activation, i.e., similar areas of the brain (e.g., anterior cingulate cortex and insulae), as that shown by healthy individuals who experience deontological guilt (Basile et al., 2011). This overlap would suggest that patients may experience deontological guilt when provoking symptoms. These results are in line with those found in an fMRI study (Basile et al., 2013), in which the authors examined the brain responses of obsessive patients while processing deontological guilt and altruistic guilt stimuli. During deontological guilt processing, OC patients showed decreased activation in the anterior cingulate cortex, insula, and precuneus, compared with healthy controls. There were no differences between the two groups when processing altruistic cues for guilt, anger, or sadness. According to the neuro-efficiency hypothesis (Neubauer and Fink, 2009), this reduced activation would suggest the brain efficiency of patients, due to their frequent exposure to deontological guilt feelings (Carni et al., 2013).

9 Altruistic guilt and major depression disorder

In 2013, Schreiter, Pijnenborg, and aan het Rot performed a systematic review to shed light on the controversial relationship between depression and empathy. Their meta-analysis showed that depression was related to the empathic stress component of affective empathy. Most other subsequent studies have brought consistent additional evidence showing an association between high levels of empathic stress and depressive symptoms (Ekinci and Ekinci, 2016; Gambin and Sharp, 2018; Guhn et al., 2020; Kim and Han. 2018; Tone and Tully, 2014).

Stimulating findings in neuroscience also illuminate the abnormal empathic profile of depressed individuals. Fujino et al. (2014), comparing the hemodynamic responses to the visual pain stimuli of others in depressed and healthy participants, highlighted a reduced activation of the left inferior frontal gyrus (which represents the evaluation component of others’ pain) and increased activation of the emotional correlates of these processes. Together with some convergent evidence gathered among the healthy population (Berna et al., 2010), this is in line with the hypothesis that depressed individuals experience intense and downregulated negative arousal in response to others’pain (i.e., empathic distress).

Furthermore, Pulcu et al. (2014) observed hypersensitivity in individuals with MDD of the subgenual septal cingulate cortex (sgACC) region in response to altruistic actions. This region was first identified as abnormal in depression (e.g., Greicius et al., 2007) but more recently has also been related to altruistic decisionmaking (e.g., Cutler and Campbell-Meiklejohn, 2019) and both empathic distress and altruistic guilt (Basile et al., 2011; Pulcu et al., 2014).

Strong evidence of abnormal empathic capacity among depressed individuals has led some authors to advance the hypothesis that this disorder could be better understood as a form of pathological altruism (O’Connor et al., 2012). The first real study to shed light on altruistic ecological behaviours related to depression was that of Fujiwara (2009). The results, checked for a large number of potential confounding demographic variables, showed that charitable support was able to predict the onset of MDD longitudinally.

Preliminary evidence from the field of developmental psychopathology has reported that an unusually early appearance of the theory of mind among girls predicts high levels of altruistic guilt in adolescence which, in turn, would predict the onset of depression (Rasco, 2004).

According to O’Connor, the fundamental determinant linking empathy dys-regulation and depression is pathological altruistic guilt, primarily in its survivor components. Survivor’s guilt is fundamentally interpersonal, focused on others and devoid of culpability. Another central feature of the pathological aspect of survivor’s guilt can be found in the pervasive nature of the underlying goals rigidly pursued by the individual and which, consequently, would inhibit the pursuit of other healthy life goals (O’Connor et al., 2012).

In support of these hypotheses, studies have reported a positive and significant association between the severity of depressive symptoms and survivor’s guilt. Furthermore, this result was found to be stable in all countries (Japan, Sweden, and Germany) and several ethnic groups living in the United States (O’Connor et al., 2007). Furthermore, depressed individuals have been shown to score higher in these subscales than healthy controls (O’Connor et al., 2002) and this result was replicated with a fully remitted MDD sample (Green et al., 2012). Additionally, Neelapaijit et al. (2017) reported higher beliefs related to omnipotent guilt and survivor’s guilt among depressed individuals compared to healthy subjects. Finally, correlates of depression such as pessimistic thinking have been found to correlate with survivors’guilt levels (Menaker, 1995). Recently, Gambin and Sharp (2018), in a study of depressed adolescent in-patients, partially replicated and extended these results. Specifically, they demonstrated that generalized (but not contextual) guilt mediated the path that led from affective empathy to depression.

10 Conclusions

The study of two psychopathological disorders, OCD and MDD, offers the opportunity to distinguish two types of guilt, deontological and altruistic, independent and unrelated. Deontological guilt arises from the transgression of internalized moral norms. Moreover, deontological transgressions are ultimately caused by Hybris, or the lack of respect for moral authority, which is usually identified by children in parents, by believers in divinities, and by non-believers in what appears to be the natural order. Altruistic guilt is experienced when one believes that one has acted inconsistently with one’s altruistic motives. Altruistic guilt is related to empathy and affection, and is experienced when the sufferer is close. Our proposal is similar to previous psychological approaches to guilt because it considers the presence of two elements necessary to guilt: harm to a victim and the transgression of an internalized moral norm. It differs from previous approaches because it posits the possibility of experiencing guilt even if only one of these two components is present, insofar as the two types of guilt are independent of each other. This approach eliminates the need to demonstrate that the basis of any internalized moral norm is an altruistic/humanitarian goal and that the basis of every altruistic act is the goal of respecting a moral norm.


1 An earlier version of the sections devoted to deontological guilt, altruistic guilt, and the proof of their differences has been published, in Italian, in the Giornale Italiano di Psicolo-gia: Mancini, F. and Gangemi, A. Sense di colpa deontologico e senso di colpa altruistico: una tesi dualista. Giornale italiano di psicologia, 3 September 2018, doi: 10.1421/92800.


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