The Eighth Emotion

Spider_October 2011
A spider in Rishikesh, India. Taken October 2011.

When it comes to causes of disease, you should most definitely fear viruses and carcinogens and mystery meat, but you should also fear fear itself (hypothetically, that is–please do not become ill from a panic attack on my account).

In Chinese medicine, it is understood that emotional stress can affect not only our mental health but our physical health as well, as mind and body are one. The classical literature of Chinese medicine mentions seven emotions that can cause disease if they become out of balance: fear, anger, joy, pensiveness, sadness, worry, and shock.1 However, there is one emotion not included in the traditional seven that is just as common and can be just as detrimental to our health. That emotion is guilt.

Chinese medicine practitioner and scholar Giovanni Maciocia writes that guilt can arise from breaking religious or social taboos or from doing something that one perceives as wrong.2  However, in some cases those who experience the wrongdoing of others feel guilty because anger, a natural reaction to having experienced interpersonal injustice, can turn inward and cause a feeling of guilt.2 This is the type of guilt that, in my clinical experience, poses one of the greatest challenges.

Flowers_September 2011
Flowers in New Delhi, India. Taken September 2011.

Guilt from unexpressed anger can be difficult to treat because it is actually developed, on a subconscious level, as a self-protective mechanism. Perhaps relationships that one values are at stake or hierarchies in place that one feels unable to challenge, perhaps both. Perhaps the person in the wrong didn’t intend to cause any harm. In any case, fear that expressing one’s anger may cause more harm than good, to oneself or others, makes taking justice into one’s own hands, against oneself, seem like the lesser of a few evils.

Guilt affects the Heart and the Kidneys.2 All emotions affect the Heart because its mental aspect is responsible for insight.3 The Heart is therefore the only organ that can recognize and “feel” emotions.3 It makes sense that guilt in particular would affect the Heart, however, because the Heart-mind is also responsible for our sense of self: in psychological terms, the ego consciousness.1 The mental aspect of the Kidneys, called the Zhì (pronounced “juh”), governs willpower, drive, and survival instinct.4 It is no wonder, then, that people in a chronic state of guilt due to repressed anger often tend toward depression, hopelessness, addiction, self-harm, and even suicidal thoughts.

Driftwood_May 2009
Driftwood on a beach in Nehalem State Park near Manzanita, OR. Taken May 2009.

These self-destructive thoughts and behaviors perpetuate the guilt, and can therefore prevent people from even seeking treatment in the first place. Talk therapy, and education about emotional stress as a cause of disease, can help people understand, on a conscious level, that they are not to blame, but the only way to help them shed the guilt so that they feel worthy is through mind-body therapies such as acupuncture that engage not only mind and body, but the conscious and subconscious divisions of the mind.

Finally, it is unlikely that people in this pickle will present with guilt as their chief complaint, or at all, because it is engrained in their subconscious mind as something they deserve. Examples of more likely presentations, in my clinical experience, include eating disorders, which could be seen as a betrayal of the self and ultimately affect the Heart; and low back pain unrelated to local injury, as the Kidneys are located in the low back.

So what do we treat, the low back pain or the guilt? Thankfully, in a medicine that recognizes physical-emotional as well as mental-emotional health, we can treat both simultaneously. Whatever modality we choose–acupuncture, bodywork, etc.–the principle behind their healing power is the same: simply giving positive attention to a body that becomes the victim of the guilt can help the person belonging to that body feel worthy of being, and, ideally, being well.


  1. Maciocia G. The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists. 2nd ed. Edinburgh: Churchill Livingstone/Elsevier; 2005.
  2. Maciocia G. The Practice of Chinese Medicine: The Treatment of Diseases with Acupuncture and Chinese Herbs. 2nd ed. Edinburgh: Churchill Livingstone/Elsevier; 2007.
  3. Maciocia G. The Psyche in Chinese Medicine: Treatment of Emotional and Mental Disharmonies with Acupuncture and Chinese Herbs. Edinburgh: Churchill Livingstone/Elsevier; 2009.
  4. Ni M. The Yellow Emperor’s Classic of Medicine: A New Translation of the Neijing Suwen with Commentary. Boulder, CO: Shambhala Publications; 1995.