Shame: The Quintessential Emotion

Jan 12 2001 11:51:00

Holly VanScoy, Ph.D.

drkoop.com Medical Correspondent

It's the quintessential human emotion, says New Brunswick, N.J., psychologist

Michael Lewis, Ph.D., in his writings. All extravagant behaviors are

reactions to it, says Philadelphia psychiatrist Donald I. Nathanson, M.D.

It's the root of dysfunctions in families, says Montpelier, Vt.-based Jane

Middelton-Moz, author of "Shame & Guilt: Masters of Disguise."

After decades of obscurity -- spent, Middelton-Moz says, confused with and

overshadowed by guilt -- shame is increasingly recognized as a powerful,

painful and potentially dangerous emotion -- especially for those who don't

understand its origins or know how to manage it.

A Complex Response

According to Alen J. Salerian, M.D., psychiatrist and medical director of the

Washington, D.C., Psychiatric Center Outpatient Clinic, shame is a complex

emotional response that all humans acquire during early development. "It's a

normal feeling about ourselves and our behavior," he said, "not necessarily a

symptom of an illness or pathology. In many situations, it's abnormal if we

don't experience it."

Embarrassment and shyness, for example, are two forms of shame that seldom

cause trouble -- unless they're extreme or long lasting. And humility,

another of the forms shame can take, is generally considered socially

desirable.

But there's mounting evidence that problems occur when shame or humiliation

becomes an integral part of a person's self-image or sense of self-worth.

Over the past two decades, psychologists, psychiatrists and other mental

health professionals have reported that abnormal styles of handling shame

play an important role in social phobias, eating disorders, domestic

violence, substance abuse, road rage, schoolyard and workplace rampages,

sexual offenses and a host of other personal and social problems.

The Importance of Feeling Adequate

Marilyn J. Sorensen, Ph.D., author of "Breaking the Chain of Low Self-Esteem"

and clinical psychologist in Portland, Ore., explains how such disorders

originate.

"Early in life, individuals develop an internalized view of themselves as

adequate or inadequate within the world," she said. "Children who are

continually criticized, severely punished, neglected, abandoned, or in other

ways abused or mistreated get the message that they do not 'fit' in the world

-- that they are inadequate, inferior or unworthy."

These feelings of inferiority are the genesis of low self-esteem, Sorenson

says.

"Individuals with low self-esteem become overly sensitive and fearful in many

situations," she said. "They are afraid they won't know the rules or that

they've blundered, misspoken or acted in ways others might consider

inappropriate. Or they might perceive that others reject or are critical of

them."

Once low self-esteem is formed, the person becomes hypersensitive -- they

experience "self-esteem attacks" that take the form of embarrassment or

shame, Sorenson adds.

"Unlike guilt -- which is the feeling of doing something wrong," she said,

"shame is the feeling of being something wrong. When a person experiences

shame, they feel 'there is something basically wrong with me.'"

Middelton-Moz says this is a common emotional response in adult children of

alcoholic parents, as well as those who grew up with depressed parents,

abuse, religious fanaticism, war, cultural oppression, or adult or sibling

death. All of these experiences cause an individual to feel vulnerable,

helpless and shamed.

A Deep, Unproductive Well

Aaron Kipnis, Ph.D., author of "Angry Young Men: How Parents, Teachers and

Counselors Can Help Bad Boys Become Good Men" and a clinical psychologist in

private practice in Santa Barbara, Calif., agrees. He says that shame's

effects are more damaging than those of guilt.

"Guilt is positive," he said. "It's a response of psychologically healthy

individuals who realize they have done something wrong. It helps them act

more positively, more responsibly, often to correct what they've done."

But shame is not productive, Kipnis says. "Shame tends to direct individuals

into destructive behaviors. When we focus on what we did wrong, we can

correct it; but when we're convinced that we are wrong as a result of shame,

our whole sense of self is eroded."

That's why guilt doesn't produce the anger, rage or other irrational

behaviors shame does, Kipnis adds. "Many violent behaviors lead back to a

deep well of shame," he said.

He's Shamed, She's Shamed

Do men and women respond similarly when shamed?

"It has been common in shame-based conditions to say that men 'act out' and

women 'act in,'" Kipnis said.

In his book, "Shame: The Exposed Self," Lewis says that not only do women

feel more shame than men, they tend to express it differently. Typically,

females have dealt with shame through introversion and self-hate while males

have been more likely to exhibit extreme anger and violence.

Lewis found the major causes of shame in women are feelings of

unattractiveness or perceived failures in personal relationships. In

contrast, he reported, the leading cause of shame in men is feelings of

sexual inadequacy.

In a 1997 article in the Electronic Journal of Sociology, Thomas J. Scheff,

Ph.D., professor emeritus at the University of California-Santa Barbara, and

Suzanne M. Retzinger, family relations mediator in the Superior Court of

Ventura, Calif., provide an explanation for the difference in how men and

women manage the shame associated with sexuality -- described as "quite

prevalent" in modern society.

Scheff and Retzinger found that women typically experience shame-shame

feedback loops, while males experience shame-anger feedback loops. In

shame-shame loops, individuals are ashamed of being ashamed, which makes them

more ashamed of being ashamed, which leads to more shame, and so on. This

circular process often results in withdrawal or depression.

In shame-anger loops, individuals are angry that they are ashamed, and

ashamed that they are angry, and so on. This creates another emotional loop

that feeds on itself and often culminates in antisocial acts.

"Shame about sexuality helps to explain the direction sexuality often takes

with women: lack of sexual interest, withdrawal, passivity or late-blooming

interest," Scheff and Retzinger say in the journal article. "But the same

shame leads men in a different direction -- to boldness, anger and

aggression. When a man feels ashamed of his sexuality and rejected by or

inadequate with women and does not acknowledge these feelings even to

himself, a likely outcome is sexual assault."

Nathanson uses an even broader stroke in characterizing the potential effects

of shame: "There's no record of a violent action other than as a reaction to

shame or humiliation," he said.

Compass of Shame: Pointing a Way to Treatment and Recovery

Nathanson, author of "The Many Faces of Shame" and "Shame and Pride: Affect,

Sex, and the Birth of the Self," has focused much of his attention on how to

help both patients and their therapists deal with the emotion more

effectively. After extensive study, he concluded nearly two decades ago that

psychoanalytic therapy had treated almost everything but shame-based

conditions -- despite mounting evidence that not only was shame a prominent

feature of many psychological disorders, but that many treatment approaches

often created or exacerbated painful shame reactions.

"Conventional psychoanalysis had viewed silence as anxiety, which was

interpreted as resistance to treatment," he said. "But, more often, silence

in therapy is actually a sign that the patient is ashamed to say what he's

thinking. The therapist's silence only makes the shame worse, it doesn't make

it go away."

Nathanson devised the Compass of Shame to provide a framework for better

understanding of the dynamics of shame and humiliation, as well as for

supporting more effective approaches to shame-based responses in treatment

situations. In this compass, each of the four cardinal directions is

represented by a reaction to an experience during which a shame trigger has

occurred, a physiological affect has been experienced and a cognitive

response has taken place.

"Imagine the points with 'Withdrawal' at the north pole, 'Attack Self' due

east, 'Avoidance' at the south pole and 'Attack Other' due west," he said.

"Each of these is a library in which individuals store a huge number of

scripts they use to respond to experiences of being shamed. These scripts are

activated by the sequence of events that involves the trigger, the

physiological affect and the cognitive response."

This means there is not a single entity that can be called "shame," but four

separate entities, four patterns of response in reaction to life events, he

says.

Nathanson adds that making patients aware that feelings of shame are a normal

part of the treatment process is an important first step toward resolving the

core psychological problems at all four points of the compass.

Medications for Shame

Nathanson, Salerian and other therapists agree the role of biology is

increasingly evident in the development of shame. Low levels of serotonin,

for example, are believed to contribute to an innate vulnerability to feeling

shamed or humiliated.

Both experts say the class of medications known as selective serotonin

reuptake inhibitors, or SSRIs, including Prozac, Zoloft, Luvox and Paxil,

have been effective in shame treatment.

But not all authorities agree on the appropriateness of prescribing SSRIs or

other drugs. Middelton-Moz, for instance, says that biology is unlikely to

hold the key to the cause or the cure of shame. "Medications send yet another

message that the individual is helpless; that they are not the one making the

change," she said. "The hope that we can achieve a better self through

chemistry is inevitably a false one in shame-based conditions."

Holly VanScoy, Ph.D., is an experienced medical writer, researcher and

statistician. She holds a doctorate in social research and human development,

and writes on topics such as child development, mental health, arthritis and

other immune system disorders from her office in Austin, Texas.

drkoop.com

Date Published: Jan 12 2001 11:45:14

Date Reviewed: Jan 12 2001 16:48:37