Shame is a key emotion in human experience, shaping perceptions of oneself and others, serving as a cornerstone for sense of self and attachment with others, central to core aspects of basic behavior and decision-making. To paraphrase, there is nothing to be ashamed of except shame itself — as a “self-conscious” emotion, shame can amplify itself without any external influences, spinning out of control in a vortex of self-abnegation. On the other hand, shame can also be a powerful source of strength and wisdom, when approached with equanimity, proper support and preparation, and the intention to inspect one’s own experience with patience, cautiously yet comprehensively.
If shame is so difficult, why is it bad to be shameless?
The social context is very important when approaching shame: Folks who feel hampered by shame often have learned to be ashamed of themselves because of developmental experiences of actually being shamed by others, often family members, teachers, peers, and other close contacts. Some folks may temperamentally be predisposed to have a shameful sense of self, in which case even with a pretty good developmental experience, there may still be issues.
At its core, shame is about wanting to belong to the group, to be accepted as a good person into the community of those closest to us, and on the other hand encountering whatever feelings arise in considering being cast out of the group into the darkness and unknown. Shame can also serve as an important corrective, putting stability of the community over the needs of the individual by preserving behavioral norms required for survival. Nowadays, shame can be more about perceived survival, however, rather than actual survival, leading to shame going haywire. Hiding vulnerabilities, real and perceived, may even be necessary for survival in an evolutionary sense, especially as disease may have been seen as evil, with an innate but distorted understanding of the risks of contagion.
Shame represents the boundary between self and other as it is organized around basic physical safety, for evolutionary reasons as being exiled would often mean death, especially for the young and ill-equipped. As basic survival is less of an issue for people in well-resourced societies, shame has become more about rejection and social exclusion, though it packs a powerful wallop and remains more threatening especially when developmental trauma is present.
When we have strong uncomfortable and threatening feelings we can’t digest, and there is no one else around to help us make sense of and deal with them, people can rely on a self-protective approach called “experiential avoidance”. Rather than actively coping with feelings we are afraid we will be overwhelmed by, and which maybe we imagine could destroy us physically or psychically, we may turn to suppression or inhibition of feelings (and memories), avoiding experience in order to regulate emotions. To address difficult experience without avoidance is easier than it sounds for people who take difficult experiences as a threat, and requires working on more basic “skills” first — such as self-efficacy, cognitive flexibility, being able to cultivate rational optimism — and pragmatic arrangements in social support and setting aside enough time and mental space to do the work, and so on.
Shame and chronic illness
Chronic illness presents particular challenges. A particular area where shame is thought to be critical is in how sense of self and social relations are shaped by chronic illness. Chronic illness can be a focus of bullying and teasing for young people especially, just as any differences can be singled out and targeted. People, especially when we are younger, want to and need to fit in. We often believe we must fit in, especially in groups with little diversity. Because of fear of being ostracized or singled out for attack or ridicule, we tend to hide things which stand out, though they can be powerful sources of strength and esteem later in life.
An important factor in determining how we seek help and receive offered help is fear of compassion. If we are in a good place with care giving and self-care, we can accept help from others without making us feel too bad. But, if we have higher fears of compassion, we will tend to view ourselves as pitiful, undeserving perhaps of help, and a weight dragging others down. Guilt and shame can play tag team with our emotions, driving us into a very bad place.
And the illness itself may get in the way, breathing difficulties making it hard to run around or do sports, or skin conditions leading to withdrawal, or blood sugar or other eating difficulties making it seem like too much of a burden to go out to eat. Chronic illness may get tangled up in one’s sense of self, and in some cases may affect mental and emotional functioning, making it harder to separate self from illness, even more so if we become defined socially by factors surrounding illness. Being resilient helps, but for various reasons can be hard to do. Chronic illness is good to study, because lessons learned here can be applied to to other challenges in life, in addition to helping live shamelessly with the illness itself.
Young adults coping with chronic illness
With a focus on the role of chronic illness in young adults, Trindade, Duarte, Ferreira, Coutinho and Pinto-Gouveia (2018) looked at the relationships among chronic illness, shame, fear of compassion, experiential avoidance, social relationships and physical health. They worked with 115 research volunteers drawn from a pool of university students in Portugal, averaging about 24 years old, mainly women (96 out of 115), who had a chronic illness for an average of 9 years. The most common illnesses included asthma, psoriasis, and Crohn’s disease, but included many others, and one third of participants had been hospitalized for their illness at some point. They analyzed the data looking for overall correlations, and conducted a more detailed analysis — ”Path Analysis” — to get a better understanding of causal relationships among the factors.
Participants completed four rating scales:
- The Chronic Illness-Related Shame Scale (CISS), asking participants to rate concerns about factors such as how much they worried people were criticizing them for their illness, how hard it was to talk with others about their illness, and related considerations;
- The Fears of Compassion Scale (FoC), with subscales looking at self-compassion, compassion for others, and compassion from others. Only the fears of compassion from others subscale was used in this study [though it would have been interested to see if self-compassion or compassion for others were significant factors, as we’d expect they might be);
- The Acceptance and Action Questionnaire, which assesses experiential avoidance as way of regulating emotions;
- and the World Health Organization Brief Quality of Life Assessment Scale, which covers subjective perceptions of physical health, environmental health, psychological health and social relationships. In this study, they used the items pertaining to psychological health and social relationships.
They found that illness-related shame strongly correlated with fear of compassion from others and experiential avoidance. Illness-related shame predicted poorer social relationships and psychological health. Fear of compassion from others and experiential avoidance correlated with each other, and correlated with lower quality of social relationships and psychological health. In the path analysis, they found that fear of receiving compassion others was the critical link between illness-related shame and social relationships, and experiential avoidance was the critical link between shame and psychological health. Experiential avoidance was also important to how illness-related shame led to lower quality of social relationships.
How to use shame
These are important findings, and they make a lot of sense. Having worked clinically with people with chronic illness, having chronic illness myself (thankfully mild so far), and having chronic illness present in my household growing up, I’m acutely aware of how big a problem it is when feelings of shame about chronic illness are not constructively addressed. In keeping with psychoanalytic understanding, this study identifies and spells out important the relationships among important factors connecting shame from chronic illness with negative outcomes on social relationships and psychological health. Engaging carefully and consistently with emotions, challenging as well as joyful, propels us forward.
Fears of compassion from others and experiential avoidance are main factors which underlie maladaptive and dysfunctional responses to stressors (such as shame), leading to problems in relationship with oneself, others and ways of viewing and acting in the world. We need a conceptual framework and the words to identify and alter these problematic responses more adaptively, transforming stuck responses to resilient responses from which we can enjoy more optimal development.
Naming experiential avoidance, interestingly, often decreases its negative impact — as avoidance is usually stronger when it is hidden. By squaring off with shame, and recognizing and fixing experiential avoidance and fears of compassion, we can not only move toward better social relationships and psychological wellbeing, but usually we’ll be able to make better use of medical care as well, alleviating the symptoms (physical and psychiatric, in some cases) which can feed into the psychological factors. Developing self-compassion is critical to this process.
This work is important for shame in general. We can address experiential avoidance and fears of compassion directly. We can do this on our own, and we can work together with trusted others, as well as therapists when appropriate, to get real traction with even long-standing problems. Identifying the causal targets and working on them planfully often gets things flowing.
Originally published at www.psychologytoday.com.