Shame: The Quintessential Emotion

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.

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