“I don’t know when shame came to live in my house,” observed a woman in her early fifties, “but once it did, it moved from room to room until it had taken over the whole house.”
Although she did not say this in so many words, the implication was that once shame “had taken over her whole house,” there was no place for her to live. If we live in our minds, as surely we do, although not only there, then she was psychicly a homeless person, rendered so by her shame. Notice, too, that her shame is dynamic. It moves from room to room. It takes over. It grows and thrives at her expense. It is a very dangerous parasitic life form. Remember, too, that houses often stand for selves. These are often every bit as ramshackle as old homes, every bit as difficult to maintain.
Where might shame come from? How does it enter our homes, ourselves?
One place to start is with the name, itself, “shame.” The Oxford English Dictionary traces one speculative origin of the word “shame” back through a pre-Teutonic “skem” which in turn connects to “hame”, “A covering, esp. a natural covering, integument; skin, membrane, slough (of a serpent). It also quotes Darwin, in Emotions XII 321, “Under a keen sense of shame, there is a strong desire for concealment.” I am not learned enough to know if there is a word for shame in every language, but I can venture that most have such a word and if some do not, then the underlying cultures would be very interesting for the study of shame just because of their lack. So, at the very outset, we connect shame and the surface of skin, even sloughed snake skin, and concealment, all this without any reference to Eden.
The capacity to develop the sense of shame must be inborn, with the requisite physiological and neuro-physiological apparatus available to support this. Of course, some are constitutionally more prone to shame than others. Shame is often thought of as an affect that becomes prominent in the second year of life and plays an important part in the culturally appropriate molding of a young child’s behavior and internal sense of himself. But shaming and the response to shaming have their roots, too, in interactions of the first year of life. The threat that comes with shaming is a loss of love, a loss of connection, something that can be as drastic as ostracism. This threat can be internalized, too, making shame an important cultural tool in shaping personality. Seneca understood this when he said, “Shame may restrain what law does not prohibit.”
For those in the primate line, the loss of love, the loss of connection can be fatal. So the threat of shaming can be nothing less than a death threat. This can be conveyed absolutely quietly and habitually in the intimate flow of human relationships,
quite without any explicit labeling. without words. It can be conveyed without anyone noticing or knowing that they have noticed. Young children are fabulously plastic and fabulously vulnerable because achieving some sort of at least quasi-satisfactory fit with their primary caretakers is the central existential imperative of their budding lives. Their lives depend on catching hold of the essential and holding on once they have caught hold. This holds both physically and emotionally.
Blushing – shame’s characteristic mark on the skin surface, fainting, particular postures and muscular tones that convey both wishing to get out of the body to find a way to be anywhere else but here and hopelessness about succeeding, all are marks of shame. The experience of shame features a heightened parasympathetic tone. Hence the
vasodilatation of blushing, the tendency to reduced blood supply to the brain and so to fainting of the vaso-vagal type. Shame, if it is extreme enough, can kill immediately and suddenly as well as in the long term, as we see in our suicidal patients. It is fascinating to observe that depression produces shame, but also that severe shame, especially shame based character, may be an independent risk factor for suicide. Of course, shame can produce depression, too. Certainly, alcohol and drugs are used not just to mitigate depression, but also to try to tone shame down. We should remember, too, that shamelessness can be a mask that shame wears. Just as some are too mad to be mad, others may be too shamed to be shamed.
The central neurophysiology of shame is clearly a topic of great importance, about which we are just beginning to get glimpses. But clearly the brain activity involved in varieties of shame goes well beyond, “This brain area lights up and this brain area lights up and so does this one on functional magnetic resonance scans of persons reading shame evoking narratives.” Shame has vital connections with personal history and narrative, personal identity and social and cultural identity, Nor is it clear that shame experiences will be identically orchestrated in different persons, in men as in women, in Inuit as in Italians. There may be central final common pathways for shame in the brain, but they may be complex and not quite so utterly common as neuroscience investigators sometimes posit.
It makes no sense to talk about shame without talking about pride, because they are inextricably linked, two sides of the affective regulation of self-regard. Shame becomes prominent just in the phase of life where elation, too, comes to the fore. The toddler can go so high and go also so low, as most parents will have observed. In “The Antithetical Sense of Primal Words,” Freud made the point that Egyptian hieroglyphics paired opposites, being unable to express one without reference to the other, so that “strong” would be “strong-weak” and “weak” would be “weak-strong”. Priority, here, is determined simply by order, which of the paired opposite comes first. Humility, a very advanced personality disposition based on a realistic appreciation of our place in the universe, is the best defense against humiliation. We might as well say “Pride goeth before a shame” as the common, “Pride goeth before a fall.”
“What do you regard as most humane?” asks Nietzsche, who responds, “To spare someone shame.” “What makes the pain we feel from shame and jealousy so cutting is that vanity can give us no assistance in bearing them,” remarks the devastating La Rochefoucauld, who had, in the seventeenth century, a preternaturally well formed appreciation of the vicissitudes of narcissism. Shame operates within the defensive perimeter of vanity. It wounds under the armor. The surfaces on which it works are as near to us as our very skin
Let us go back to the woman with whose words we began, “I don’t know when shame came to live in my house…” She was the oldest daughter in a very large family, one that kept her mother so busy that she, the tractable eldest daughter, was readily enlisted in the role of helper. Her mother, too, was a helper, someone who took pride in keeping her own needs in the background while ministering to the needs of others. Beatrice was not unloved by her mother. In fact, in many ways, she was specially cherished as a child who suited her mother well, occasioning very little trouble and even making some difficult situations better. Beatrice took pride in her mother’s pride in her. Her mother’s pleasure and pride in her were the rewards for her renunciation.
The price was the downgrading of her own needs, putting them second to the needs of others to a very pronounced degree. Now this character constellation was not simply imposed by her mother, but rather composed by Beatrice within the emotional ecology of her family in her early years. Her own pride played a part in it. It is surely not irrelevant that she came from a pedigree of women in whom anxiety was very pronounced and prominent. Anxiety can reinforce inhibition and the avoidance of confrontation. In a subtle way embedded in the quiet flow of seconds, minutes, hours, days and months, Beatrice turned against her own needs. They seemed to her to be problematic, inner promptings that could only interfere with her being who she wanted to be. They seemed to her shameful signs of weakness and neediness. So they readily came to be allied with inner feelings of shame, even of degradation. It was as if, in some ways, she shut herself up in an attic or a closet built of planks of shame.
Within herself, she erected barriers against even noticing her needs, let alone being in any way assertive in practical ways in everyday living in getting them met. In fact, she did not wish to meet them, to make any acquaintance with them that would help her to include them in her strategies for living. She was proud, too, of this virtual suppression of her own needs, regarding it, much as her mother had, as an important achievement. As part of the complex dynamics behind these developments, her mother’s intolerance of aggression, in her girls as in herself, played its role, too. There were domains of Beatrice’s self that were positively seething with resentment and rage, but about which she knew very little. She had been forced to choose between a cherished connection with her mother and a vital connection with important parts of herself. This can be a terrible choice, especially when no malice is involved.
Shortly after I met Beatrice, she described her modus operandi as follows, “I just look around the room to see where the need is and then I set about trying to meet that need.”
“What about your own needs?” I asked her.
There was silence, even a stunned silence. No reply was forthcoming. A few sessions later Beatrice told me that what had stunned her was that it was an obvious question that I had asked her, but yet she had never thought about it. Even though it was an obvious question, in her internal mental world, the question did not exist. The consideration of her own needs was absent as a practical guide to daily action. This was a matter of character, of those automatic silent processes within ourselves that are not well enough known to be called into question and ultimately modified.
“Suppose,” another patient in his fifties said, “that I’m really very different than who I thought I was, even so different as to be a stranger to myself. That’s not bad. It’s interesting. It’s something new.”
This kind of statement is a very positive prognostic sign, for it means that the patient has had glimmers, that he is more or less prepared internally to go abut changing his own view of himself. If we think about it, every really phase of growth demnds of us that we tolerate, even welcome, not being quite who we thought we were.
There is a useful clinical adage that guilt brings material into therapy, while shame keeps it out. The patient often needs a lot of help in getting to what he or she regards as shameful. We have to process non-verbal cues, often very subtle ones and follow our intuition in order to arrive near enough to the domain of the patient’s shame to help the patient construct a means of egress for that which shames him or her.
If we follow a model akin to Sullivan’s tripartite division of the self into good me, bad me and not me, we can say that guilt guards the surface that separates good me from bad me, while shame guards the surface that demarcates good me and bad me from not me. I am not using “not me” in a precisely Sullivanian sense. It may even be the case that for a “not me” element to enter into the more settled realms it has to pass first through “the bad me” space. The outcast may be stigmatized before it is allowed to change its status and to enter into communication and commerce with what has not been forced to live in the inner wilderness. “Bad me” leads a much richer inner social existence than does “not me.”
The ‘not me” regularly has a life of its own, often a secret life that is hidden away in a corner of a person’s living. Consider the young woman who eats next to nothing during the day, next to nothing when she is eating in the company of others, yet almost every night binges on ice cream all by herself in her kitchen. She devours it so fast that often she gets a headache. Who is this one who eats the ice cream like this? What is her experience of this devouring? Is it a fearful satisfaction? Is she alone psychically as she does this, or are there internal others who are with her?
Is there a dramatic script that attends this cloistered eating? Is this script repeated over and over as in a dream, but only one enacted waking? Is this some sort of a fugue, a dissociated state or is it a self-state perhaps kin to fugue or dissociation but not quite there? It is usually much easier to discover the existence of secret life elements than it is to find ways to help a patient explore them, because shameful as the existence of these secret elements are, the shame that attaches to the specifics, to the operational psychic facts, is even more intense. The specifics are where the connections to personal history and memory are located.
We can, perhaps, think of shame as capable of becoming a mechanism of self-imposed ostracism designed to protect against real and imagined ostracism at the hands of others along the lines of “Do unto yourself before others can do unto you.” This dictum could go by the name of the leaden rule and certainly partakes of identification with the aggressor. Ostracism as the ancient Greeks practiced it required no special accusation, no trial and admitted of no defense. The analogy to shame which also often has this non-specific feature can be framed in a persuasive way. One of the things about shame that is maddening is that there is no such thing as due process in the world of shame. Shame spreads along associative networks so that, from small beginnings, possibly insignificant ones, shame can come to cover significant psychic territory, even to have an imperial aspect.
By the time a patient can describe his or her shame to a therapist – “I’ve never told anyone else about this” – a large part of the treatment has already been achieved. The unspeakable has become speakable in the specific context of a different kind of relationship. There may be years, even decades of treatment and struggle ahead, but the essential acts of initiation of treatment have taken place, mediated not so much just by words, but also by attitude, therapeutic stance that conveys respectful steadiness and readiness to hear what can be sensed before there are words attached. Beginning work with a severely shamed person is a test of psychotherapeutic art and intuition. I am not sure, in fact, that our science has very much more to offer here than an awareness that this is a place where the mysteries of human meetings rule and a disciplined use of intuition is essential.
Self-disclosure can be an important part of establishing a communicative channel with a seriously shamed patient. At one point, I took care of a seriously suicidal characterologically very disturbed young inpatient, who came from a closed military family whose style of communication was not to communicate at all, at least not in words. This patient had had previous treatment where she did not seriously engage but remained in her special way above it all and below it all. Her mother had been profoundly depressed during much of her growing up. One of the things that struck me in Raita’s history was that she had never spent two successive years in the same school. She was always on the move, always the outsider and learned very quickly that any ties she made where going to be temporary, undone almost just as soon as they were achieved.
This resonated a bit with me because I had grown up with a much less extreme version of this n my early years. I told her about how I had been a little boy in Paris and was taken by my school to admire the Winged Victory of Samothrace at the Louvre. All I could think of was that she had no arms. What kind of a victory was that, if you lost both your arms. I told Raita that I had never spoken this thought aloud, not to my parents, not to my teacher. In fact, I didn’t talk about it until I was quite grown up. I also told her about the cold rain that seemed to me never to stop falling in the gray Paris winter. I told her about still not being able to remember what happened at recess. I told her about how I was always confused about where Cleveland and my grandparents and the trees outside my window had gone. I told her about how everything seemed strange to me when we would come back to Cleveland.
I told her lots of things. It is my style to be much more open about myself personally than most psychotherapists are, but this is a topic I have dealt with in other places. The point here is not what I told her, but what she came to tell me. After a good many difficult and tumultuous months, Raita said to me one morning. “You know, Dr. Lewin. You are the first psychiatrist I ever thought was human.” She went on to tell me how she had always thought psychiatrists were perfect, with no difficulties or feelings and with nothing at all in common with her. So how could she possible communicate with them. I was stunned. I had treated Raita the way I did not because of any clear declarative conviction, but because I was feeling my way along, trying to make contact, often feeling like a total fool (without the capacity to invoke the concept of projective identification to help myself out). I did what I did because I couldn’t think of anything else to do. It may be true as Sullivan postulated that “we are all more simply human than otherwise” but patients who are deeply shamed do not necessarily recognize or experience the commonality. In order to work with these patients we have to come close but not too close, keep our distance but not too much distance, to establish the relational standing that is a principal requisite of therapy.
Feeling like an awkward ineffectual fool is often an important part of treating a seriously shamed person. You are dancing in the dark, chancing in the dark. This feeling like an awkward ineffectual fool is much too little talked about. For reasons of pedigree and personal predilection both, I am perhaps quite good at feeling this way. One way of thinking about this is in terms of shame contagion. As the shamed person feels small, insignificant, ineffectual, unable to make and sustain robust contact both within himself and with an outside person, so the therapist comes to doubt himself, to wonder about his efficacy, his acumen, his capacity for therapeutic engagement. Of course, the way of doubt is also a way of learning and eventually even a way of knowing. Sometimes sharing this kind of feeling openly with a patient is very helpful, because a community of doubt starts to be formed and starts to work against the presumption of shame. In other situations, the patient may respond bitterly along the lines of, “Somebody here is supposed to know something and it’s not me because I’m the patient, so you had damn well better shoulder the burden.” Of course, in this kind of indignation there is a noteworthy dependency appeal. To the extent to which we are not acquainted with the exquisite discomfort of our own shames, we will find communicative proximity to a seriously shamed person powerfully repellent with any substantive grasp of how the repulsion works on us and in us. Many patients are new affective curricula for their therapists. This is not an unusual experience, just a taxing one.
A gifted college student for whom shame and embarrassment were everywhere with a variety of prides, attending each approach he made to another person, each act of self-assessment that he undertook in his mind, told me one day that suicide bombers held absolutely no mystery for him. He proceeded to anatomize the psyche of a suicide bomber. First of all, he said, you had to be a huge problem to yourself, with no idea of a path forward, but rather with a tangle of misapprehensions and doubts about any possible steps to be taken. Second, you had to want desperately to do something big, something that would gain you renown. Buy becoming a suicide bomber, you could solve two problems at once. You could take yourself off your hands and you could win fame and be widely talked about. This fellow, who had a gentle and tender side as well, told me that from his point view the surprise was not that there were suicide bombers, but that there were so few.
I do not think that I have heard a more astute discussion of suicide bombers. Shame can be such a private perdition, one that admits neither of fight or flight as a solution. It is too deep inside. It can make all roads inaccessible, even inconceivable. It can make a person a huge problem to himself or herself. Shame and humiliation can easily conduce, too, to violence. If shame cuts off communication, not only with others outside, but with the wiser selves or self states within, then the capacity to temper response is endangered with a retreat back towards the territory of the all-or nothing. This can be life threatening.
When I started working with her, Beatrice, the woman with whom I began this paper had no idea that she was angry. She was aware that she might be thought to have cause for anger, even multiple causes for anger. She was aware of how grieved she was, but the anger was something she could talk about, but not feel. Sadly, in the course of treatment, she made a series of suicide attempts, which not only I but her family saw as not being like her. These suicide attempts came at moments of inner impasse and they came on her swiftly, taking her sometimes by surprise, too. They were full of murderous anger, anger that she recognized herself but could not defend herself against, She has moved to another state to be closer to her family but her very survival remains in doubt.
The too shamed are too silent, so much so that their shame can easily escape the notice of those around them, especially if they have a compliant turn of character and the habit of pleasing others. We notice their shame often by noting that something is missing. It is the presence of an absence that catches our attention. It is a peculiarity of therapeutic attention to be listening always for what is not said in the midst of what is said. We generate imaginative pictures of those who come to speak to us and to be with us. Sometimes these imaginative figures are much more eloquent and much less inhibited than the actual person in front of us. The virtual person we have in our minds can clue us in to deeper actualities of the one who is with us.
Of course, we have to be careful, because if we are too confident of our own imagination and its productions, we may find ourselves trying to treat imaginary patients who do not exist. For shamed persons, this is an all too familiar form of violence. Only back and forth, only tinkering, only a series of humble approximations, only uncertainty can protect us from the grave danger of false invention of our patients. Theory can as easily support false invention as deep discernment,
We cannot afford to be too silent in the presence of the silence of the enormously shamed, but we must also be careful not to be intrusive. To remain silent is to abandon the too silent one to his or her shame. To be too intrusive is to run the risk of repeating assaults that may have played a large part in the generation of the silent shame in the first place. When we try to communicate with one who is too silent because too shamed, much of our speech is likely to need to be speech without words, non-verbal speech. Anyone who ever saw the recently deceased Marcel Marceau will have a vivid image of how much can be communicated without any words at all. In fact, I deem it quite likely that Marcel Marceau would have been able to deliver a more direct and feelingful version of this talk than I have been able to do. There is no way to overestimate how much we talk with our bodies and how much we hear of others from their postures and movements, With the current intensive investigation of mirror neurons we are learning much more about how all this might work at the neurophysiological level.
We notice a stray glance, a shy smile, a sudden access of alertness, a change in posture, a change in the rhythm of breathing and we respond, sometimes knowing what we do and sometimes below the level of awareness. This is a dance, a game, a preparation. When I was younger I had a great deal of trouble understanding how diplomats meeting in Geneva could spend years negotiating about what the shape of the table would be when, if they ever did, the substantive negotiations between the principals actually came to take place. Now, having worked for years with many kinds of patients who have had terrible trouble revealing themselves not just to me but to themselves, I think I understand the dilatory pace of international diplomacy only too well. The long silences we share with our patients, the long years of longing to hear what is being said by not being said more clearly avowed, are preparatory, having to do with trust building that is not only external but also internal to the patient. In these preparatory phases, which we live without any guarantee, a person like Beatrice may be putting her house in a very different kind of order. They are about a great deal that we and the patient are not in a position to specify, even after major communicative advances have been made. Silence and frustration are both important modes of hope in therapies of patients whose scope has been shrunk by shame and its inhibitions. Silence and frustration are nothing for us to be ashamed of in the treatment of these people.