Tuesday, January 7, 2014

Shame and depression

I mentioned before that I was recently tasked to lead a therapy group focused on sexual assault, trauma, and depression.  I did some background research to prepare.  One thing that stood out to me is how frequently shame was mentioned as a factor contributing to depression.  I mentioned this during the first group session.  It seemed to resonate strongly with the group members.  As they shared their experiences I spontaneously found myself talking about the "power of shame."  I hadn't intended to go this route but it felt right.  It ended up being a very powerful discussion.

In the ensuing days my thoughts repeatedly turned to the concept of shame.  It's not something I've ever spent a lot of time talking about with patients, although it does come up in sessions.  There are, however, certain treatment approaches to which the concept of shame is integral.  John Bradshaw (http://www.johnbradshaw.com/) is probably the shame guru,   if there is such a thing.  His book, "Healing the Shame that Binds You," is a New York Times best seller.  In it, Bradshaw points to "toxic shame" as the underlying cause of compulsions, addiction, co-dependencies, and the drive to super-achieve or underachieve."

Shame and guilt are often used interchangeably, which can sometimes cause confusion.  For my purposes, I've decided to distinguish guilt and shame as follows:

*Guilt is a bad feeling caused by the fact of having committed a specific offense.

*Shame focuses on the entire self.  It is a painful feeling arising from the judgment of oneself as dishonorable, disgraceful, disgusting, etc.

Thus, guilt is concerned with something specific a person has done.  The focus of shame is on the self as a whole.

Like most human emotions, shame can be healthy in small doses.  Shame can compel us to eliminate bad behavior and motivate us to act in ways consistent with our values.  Healthy shame fuels personal growth and so helps us to become better people. 

Too much shame is emotionally and psychologically toxic.  (Bradshaw talks extensively about this in his book).  There is significant overlap between the consequences of toxic shame and the symptoms of major depression.  Here are some of the ways toxic shame manifests itself:

*Causes you to feel exposed and vulnerable, creating a sense that "everyone knows" how disgusting you are.  This leads to a desire to hide, withdrawal, or otherwise escape from public view.

*Generates negative judgments about the self, which is seens as inferior, flawed, damaged, disgusting, worthless, etc.

*Creates a tendency to blame yourself when something goes wrong.

*Leads to a sense that you have a very limited amount of power to control what happens in your life.  This eventually leads to feelings of hopelessness and helplessness.

*Can create social anxiety due to fears that others will judge you as negatively as you judge yourself.

Essentially, chronic shame leads to self-loathing; self-loathing leads to depression.   I have come to believe that chronic, pervasive shame inevitably leads to depression.  After all, how could a person hate himself and not become depressed over time? 

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