They are able to see the world so much more intricately than the rest of us in ways that most people will never be unable to understand. That sets them apart and makes their lives hell.
Madness string 98176
At that point you can't even call it karma. It's just damnation. It doesn't matter how hard you try to change or reform, or how much you grow. You always need to be ready to pay any price for any past mistake as many times as it's asked.