“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 effect 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 effect 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.”