Philosophy, Psychiatry, & Psychology

This delightful and provocative vignette has many interesting clinical facets, and I thank Dr. Bailey for his candid introspection. For me, this essay calls attention to an asymmetry in our culture, in which women tend to feel more comfortable than men in expressing anxieties about our unpredictable and often dangerous world. Women's fears, however, often are dismissed or minimized, revealing an overall social discomfort with expressed anxiety, and a sense that anxiety itself is, somehow, feminine. When I read Dr. Bailey's essay, I am struck that two self-aware men need the metaphors of war and heroism to address their own anxieties.

The vignette builds around a soldier, Colin, who presents with guilt about having been deployed to Iraq, but not engaging in combat. Guilt is a moral sentiment, a feeling that one ought to have acted otherwise in a given situation. It is a self-imposed sanction for a moral failure. In mental health care, we use the term ‘inappropriate guilt’ to describe a clinical symptom commonly associated with depression. Clinicians understand inappropriate guilt as a manifestation of the self-criticism and low self-esteem often associated with depressive disorders. In Colin's case, it did fit with a constellation of symptoms that suggested depression. Dr. Bailey's essay explores the psychodynamics of Colin's guilt, and possible responses to it.

As I understand the situation, Colin sees himself as having a moral obligation to exceed his contractual obligation to the military. In the terminology of ethics, he imposes upon himself a duty to be supererogatory, that is, a duty to go beyond the call of duty, which some moral philosophers have considered oxymoronic. For Colin to feel guilty about not engaging in combat, he must have understood a moral obligation to participate in combat that goes beyond his obligation to follow orders. It seems to me that soldiers have a nonmoral, contractual obligation to train, deploy, follow orders, and if circumstances so dictate, fight. But if the circumstances do not lead to combat (Nagel might call this good moral luck), it does not seem to me that a soldier has failed either a contractual or a moral obligation by not being sent into battle. Supererogation aside, to my mind, Colin's guilt is inappropriate: he is holding himself to an unreasonable moral standard, according to which he is required not only to do what the military demands, but also to sacrifice or suffer from the experience in some meaningful way.

Although the notion of inappropriate guilt fits with the description of Colin's depression, it occurs to me that the word ‘guilt’ may be too strong here. Perhaps what Dr. Bailey is seeing is better characterized as ‘inappropriate regret’ that Colin missed “his last, best chance to be a hero.” ‘Regret’ is the sentiment that one could have (rather than should have) acted otherwise, perhaps to a better eventual end. Dr. Bailey agrees that Colin's guilt is inappropriate, that no one is ever required [End Page 233] to be a hero. But he seems to share, and even encourage, what I am calling Colin's ‘inappropriate regret,’ which suggests that if Colin had engaged in combat, he would not experience feelings of helplessness or insecurity in our uncertain world. What fascinates me is that Dr. Bailey accepts this premise, and even reflects on his own fears about self-protection in his own urban setting.

Rather than challenging it, Dr. Bailey clearly shares Colin's concern that he may not be able to respond adequately should a real threat arise. Both therapist and patient seem to want reassurance that they can keep themselves and their families safe when danger strikes. But this is not a matter of achieving or going beyond the call of duty. Rather, it is an expression of familiar and diffuse anxiety that is unrelated to wartime. In the essay, heroism seems to serve as a metaphor, a filter that makes the expression of anxiety more palatable to both the patient and the therapist. I am fascinated that these two sensitive and introspective interlocutors need to filter their anxieties through...