What is shame? The painful feeling of humiliation or distress that comes from the sense of being or doing a dishonorable, ridiculous, or immodest thing; the feeling that you are less than, unbefitting, or undesirable.
What causes shame of a mental dysfunction. History, culture, the disease model of mental healthcare, and mental health stigma (MHS).
Why you should not be ashamed. History is crude and inconsistent, culture is misinformed, the disease model is exploitive and archaic, and MHS is generated and sustained by prejudice, ignorance, and discrimination based on disinformation.
The most famous definition of shame is “feeling ridiculous, embarrassed, humiliated, chagrined, mortified, shy, reticent, painfully self-conscious, inferior, and inadequate.”[i] There are many aspects and degrees of shame; volumes have been written about shame’s types and complexities. Here is what some of the experts write. “Shame is painful, [ii] incapacitating,[iii] and uncontrollable.[iv] Shame makes you feel powerless,[v] inferior, and worthless.[vi] “To feel shame is to feel seen, acutely diminished.[vii]
Shame makes you want to escape, to become invisible. It elicits self-defensive reactions that can make you feel inadequate or become hostile and aggressive. Shame is inescapable, embracing every aspect of the human experience.[viii]
Shame is not all bad. Shame alerts you to wrongness. You have done something wrong (you are bad), someone has wronged you (they are bad), or you feel wrong (you are inadequate). Shame can be revealing, cathartic and motivational, promoting change, growth, and broadened self-awareness.
Right now, I am only concerned about the shame you feel because of your mental dysfunction. Everyone has some degree of psychological disturbance. It is a universal and undiscriminating condition; it infects during childhood rendering you unaccountable. So why do you feel shame? Because mental illness is historically denigrating and culturally feared and scorned – beliefs perpetuated by the disease model of mental health and reinforced by MHS claims that you are disgusting, distressing, frightening, and undesirable.
The disease model of mental health focuses on what is wrong with you. It labels you by your diagnosis, and you cease to be a person. You are then lumped in with others similarly diagnosed and labeled as schizophrenics, paranoiacs, depressive persons, persons with anxiety. You are then stereotyped by the most descriptive symptoms and characteristics of your dysfunction using terms utilized by the Diagnostic and Statistical Manual of Mental Disorders (e.g., incapable, deceitful, unempathetic, manipulative, irresponsible). Then and ignorant (misinformed) and prejudiced (fearful) society stigmatizes or brands you as personifications of that stereotype.
Labels, stereotypes, and stigma are inaccurate representations because of the “implied expectations of how people with mental health problems may behave.” [ix] You may share or resemble symptoms or characteristics of a dysfunction (who doesn’t), but the sum of the label and stereotype is not the sum of the person. You are not your dysfunction.
Mental Health Stigma is the hostile expression of the abject undesirability of a human being who has a mental illness. Stereotypes of mental illness “often include an exaggerated sense of dangerousness.” [i] (Ironically, the early asylums in Spain and Egypt were built to protect the mentally ill from the dangerous and violent members of society.)[ii] The stigma or branding does not need to be true or accurate; it just has to be believed. Its only purpose is to separate you from the rest of society, which assumes they are normal, and you are not.
What are the factors or attributes in MHS? Mental health stigma is formed facilitated by ignorance (misinformation), prejudice (fear), and discrimination (false superiority). Stigma supports and is supported by public opinion, media misrepresentation, the mental healthcare industry, and the disease model of mental health.
First of all, studies show that the aversion to mental illness is socially hard-wired. Society considers you dangerous, unpredictable, and socially undesirable. Society wants to distance themselves and isolate you because of their deep-rooted fear and realization of their own susceptibility.
The media stereotypes anyone with a dysfunction as an unpredictable, hysterical, and dangerous schizophrenic. Half of news stories on ‘mental’ illness allude to violence. A person with a mental illness is either a homicidal maniac, autistic, or a rebellious, hair-brained, free spirit.
Healthcare professionals are often undertrained and inflexible. You know how your disorder impacts your emotional wellbeing and quality of life far better than your doctor. Clinicians deal with 31 similar and comorbid disorders, over 400 schools of psychotherapy, multiple treatment programs, and an ever-increasing plethora of medications.
The mental healthcare community is drowning in pessimism. There is evidence to indicate the problem is endemic in the medical health community and universally systemic, which means that it impacts you personally, and the current model of healthcare is the culprit.
Clients report instances where staff members are rude or dismissive. Complaints include coercive measures, excessive wait-times, paternalistic or demeaning attitudes, one-size-fits-all treatment programs, medications with undesirable side-effects, and stigmatizing language.
The ‘defective’ or disease emphasis has been the overriding psychiatric perspective for over a century. By the 1952 publication of the first DSM, the focus had drifted from pathology (the science of the causes and effects of your dysfunction) to pathography (the breakdown of your psychological shortfalls, categorizing them to facilitate diagnosis). Pathography focuses on a deficit, disease model of human behavior. Which disorder poses the most threat? What behaviors contribute to the disorder? Are you contagious? What sort of person has a mental illness? It is these attributions that form public opinion, stigma, and your self-beliefs and image.
The disease model and the DSM’s diagnostic system is under increasing scrutiny for its misdiagnosis, constant criteria revisions, symptom comorbidity, one-size-fits-all recovery programs, and general negativity. The Wellness Model of mental health focuses on your character strengths and virtues that generate the motivation, persistence, and perseverance to recover. A battle is not won by focusing on incompetence and weakness; it is won by knowing and utilizing your strengths and attributes. That is how you recover―with pride and self-reliance and determination―with the awareness of what you are capable.
Why you should not be ashamed
(History is crude and inconsistent, culture is misinformed, the disease model is exploitive and archaic, and MHS is generated and sustained by prejudice, ignorance, and discrimination based on disinformation.)
Recognizing that shame is a fundamental part of human nature allows you to confront it and realize, while others may attempt to shame you, it is up to you whether you chose to be shamed. No one can make you feel shame; it is entirely of your own volition. What is there to be ashamed of? Mental illness is universal and undiscriminating. Everyone is dysfunctional in one way or another. You are not responsible for being infected. You did not deal yourself the cards. You should only feel shame if your dysfunction negatively impacts your emotional wellbeing and quality of life, and you refuse to do something about it.
Why is your support essential? ReChanneling is dedicated to research and development of methods to alleviate symptoms of psychological dysfunction and discomfort. Our vision is to reshape the current pathographic emphasis on diagnoses over individual, which fosters a deficit, disease model of human behavior. Treatment programs must disavow ineffective, one-size-fits-all approaches and target the individual personality through communication, empathy, collaboration, and an integration of historically and clinically practical methods. All donations support scholarships for workshops and practicums.
i Goldberg C. (1991). Understanding shame. New Jersey/London: Jason Aronson.
ii Benda, J., Kadleĉík, P., Loskotová, M. (2018). Differences in self-compassion and shame in patients with anxiety disorders, patients with depressive disorders and healthy controls. Československá psychologie / ročník LXII (6), 520-541.
iii Keen, N., George, D., Scragg, P., Peters, E. (2017). The role of shame in people with a diagnosis of schizophrenia. British Journal of Clinical Psychology 56, 115–129 (2017). doi:10.1111/bjc.12125.
iv Camp, A.R. (2018). Pursuing Accountability for Perpetrators of Intimate Partner Violence: The Peril (and Utility?) of shame. Boston University Law Review, 98: 1677-1736.
v Vanderheiden, E., & Mayer, C.-H. (2017). An introduction to the value of shame―Exploring a health resource in cultural contexts. In E. Vanderheiden, C-H. Mayer (Eds.) The Value of Shame. Exploring a Health Resource in Cultural Contexts (pp, 1-42). New York City: Springer Publishing. doi:10.1007/978-3-319-53100-7
vi Murphy, S.A., & Kiffin-Petersen, S. (2017). The Exposed Self: A Multilevel Model of Shame and Ethical Behavior. Journal of Business Ethics, 141, 657–675 (2017). doi:10.1007/s10551-016-3185-8.
vii Miceli, M., & Castelfranchi, C. (2018). Reconsidering the Differences Between Shame and Guilt. Europe’s Journal of Psychology, 14(3), 710-733 (2018). doi:10.5964/ejop.v14i3.1564.
viii Okano, K. (1994). Shame and Social Phobia: A Transcultural Viewpoint. Bulletin of the Menninger Clinic, 58(3), .http://enlight.lib.ntu.edu.tw/FULLTEXT/JR-MDL/oka.htm
ix Huggett, C., Birtel, M.D., Awenat, Y.F., Fleming, P., Wilkes, S., Williams, S., Haddock, G. (2018). A qualitative study: experiences of stigma by people with mental health problems. Psychology and Psychotherapy: Theory, Research and Practice, 91, 380–397 (2018). doi:10.1111/papt.12167
x Pryor, J.B., Reeder, G.D., Monroe, A.E., Patel, A. (2009). Stigmas and Prosocial Behavior Are People Reluctant to Help Stigmatized Persons in S. Stürner, M. Snyder (Eds.) The Psychology of Prosocial Behavior, (pp.59-80). New York City: John Wiley and Sons. doi:10.1002/9781444307948.ch3
xi Stuart, H., & Arboleda-Flórez, J. (2012). A Public Health Perspective on the Stigmatization of Mental Illnesses. Public Health Reviews, 34: Epub ahead of print.