Correspondence: Mental health care in South Africa

Shame has been an insufficiently studied emotion in psycho-analytic literature until recently, mainly because it tended to be ‘absorbed’ under the concept of guilt. Now it is recognized as a powerful affect of pregenital origin, linked with narcissism and the ego ideal. Shame can be a motivation for achievements and social adaptation, it can protect an individual's integrity and can be a modulator of interpersonal relatedness; it can also function as a defence or initiate psychopathological states, such as depression, self-alienation, identity confusion or acting out. In adolescence shame is a ubiquitous phenomenon, as this developmental stage consists of all the parameters that can trigger feelings of shame. The emotional regression connected with the emergence of primitive impulses, conflicts and defences; the grandiose phantasies and the increased narcissism; the preoccupation with bodily functions and body image; the tendency to idealization and the need for social acceptance constitute the matrix within which shame and shame-derived feelings can develop. Shame is discussed as it is experienced by young patients and often by the therapist. Shame in the countertransference and during supervision is also considered. Stress is put on the importance of taking shame into account as a fundamental factor in psychotherapy with adolescents, particularly in relation to the establishment of the therapeutic relationship, understanding and interpretations. The thesis is illustrated with clinical vignettes.     

On shame,countertransference, and analytic style

Some analysands experience a restricted space in the analytic situation with special counter-transferential consequences. The author discusses how shame is involved in these situations, and projected on to the analyst. This leads to an important choice of direction for the analyst regarding counter-transference acting out or conditions for a real analytic situation. Shame plays a special rôle in these choices of direction. The author illustrates the problem with a clinical vignette and shows how integration of shame is accomplished clinically, and continues with a discussion of the connections between the analyst's analytic style, his own communicative style as a defense against shame and the analytic styles of different analytic “schools”. A discussion of Liberman's concept, of “asymmetrical dialogue” and its connection with countertransference acting out and analytic styles, forms a conclusion to the paper.     

Scham und Schuld – Sein und Tun

Shame and guilt are affective experiential dimensions regulating the different forms of being and behaving in a social context. Constructive or even pathologic feelings of guilt are to be distinguished from real guilt. Shame refers to the judgment of ?So-sein” even if being often manifests itself in action. Shame is generated by the ideal ego. Guilt and feelings of guilt are dimensions of acting, real guilt requires the recognition of guilt, guilt is generated by the superego (conscience). The implications of familiar as well as extreme traumatisation for shame and feelings of guilt are discussed. The most frequent wish for a therapy nowadays that offers perspectives of changes by action can be considered as a defence against processing of the being in psychoanalytical therapy.     

Development and Preliminary Validation of a New Measure to Assess Shame: The Shame Inventory

Research on the emotion of shame has increased significantly in recent years. However, there remains a need for more psychometrically sound measures of shame, including measures of shame in response to specific, idiographic experiences. The Shame Inventory was developed in order to assess both global feelings of shame as well as shame in response to specific life events or personal characteristics. Two studies were conducted to determine the preliminary psychometric properties of the Shame Inventory. Across both studies, results indicate that the inventory has high internal consistency, test-retest reliability, construct validity, and predictive validity. The Shame Inventory holds promise as a new measure designed to assess both global feelings of shame as well as specific shame-eliciting cues.     

A case study of embarrassment

The psychoanalytic references to embarrassment are reviewed. Embarrassment, in the literature, is seen largely as an affect involving exhibitionistic and scopophilic conflicts and defenses against these. A case in which embarrassment was prominent is discussed. Embarrassment in the patient was an ego response which implied an external object for its manifestation. It involved exhibitionistic and scopophilic conflicts and projective defenses, but also operated in ego-gratifying and adaptive ways. Her embarrassment was understood through the analysis of an initial embarrassing dream of nakedness and other dreams and associated material as the defensive out-grouth of repeated exposures to the primal scene. Embarrassment was a resistance to remembering in the analysis, and the primal-scene experiences were partially reconstructed. The analytic situation was, in many ways, a symbolic re-creation of the primal scene, including the patient's response of embarrassment. The development of embarrassment in the patient's childhood was furthered and confirmed by its being an identification with the attitudes of both parents. Finally, some reflections on embarrassment and shame in its various forms are set forth.     

The breadth and boundaries of a self‐psychological immersion in shame a one‐and‐a‐half‐person perspective

Shame colors other feelings and perceptions about the self. From reflections about his own personal experiences and observations regarding a particular manic‐depressive patient, the author discusses the evolution of his current clinical and theoretical understanding of shame. The framework of analytic self psychology is offered as a particularly useful perspective from which to consider shame, with its emphasis on the concept of selfobject to account both for shame's development (through selfobject misattunement and unresponsive‐ness) and for its amelioration (through empathic mirroring, idealization, and twinning). A developmental sequence for shame is advanced reflecting limitations in selfobject responsiveness, and problems are noted in the ability of current self psychology theory to fully account for the alleviation of shame. The self plays its part in the construction of those selfobjects needed to ease shame, representing the “one‐and‐a‐half‐person psychology”; of the paper's subtitle. Finally, the important role of countertransference shame is considered through a clinical example of therapist disclosure of his own shame to his patient, utilized in order to repair an interrupted kinship selfobject transference.     

A New Measure of the Expression of Shame: The Shame Code

While shame is essential for adaptive functioning, experiencing shame more often or intensely than others is strongly associated with psychopathology. To date, no measure of the behavioral expression of shame exists, despite the great potential for use in research and clinical settings. The present study aimed to assess the Shame Code, a new behavioral coding system of the expression of shame. Participants included 149 youth between the ages of 12 and 17 (50?% female, M?=?14.5). Shame was elicited with a spontaneous speech task. Participants’ overall Shame Code scores were correlated only with a state measure of shame, however, structural equation modeling results showed that Shame Code variables combined differentially to assess state and trait shame scores. A two-factor model was the best fit to the data. The first factor, Fidget, consisted of Hiding, Fidget (positively loaded), Nervous Positive, and Stillness (negatively loaded). The second factor, Freeze, was comprised of Stillness, Facial Tension, and Silence (positively loaded). The Fidget factor was associated with higher Trait Shame and the Freeze factor was associated with higher State Shame but lower Trait Shame. Therefore, the Shame Code not only effectively captured the behavioral manifestations of shame, but Shame Code variables also differentially predicted state and trait shame.     

Shame,Publicity, and Self‐Esteem

Shame is a puzzling emotion. On the one hand, to feel ashamed is to feel badly about oneself; but on the other hand, it also seems to be a response to the way the subject is perceived by other people. So whose standards is the subject worried about falling short of, his own or those of an audience? I begin by arguing that it is the audience's standards that matter, and then present a theory of shame according to which shame is a response to the subject's perception that he is not thought of in the way he intrinsically values himself for being thought of by someone else. Then I go on to suggest some refinements to this basic view. First, the subject of shame is primarily concerned about his audience's attitudes toward him, not what they believe about him. And second, there may be one particular attitude which he values himself for inspiring. There is no very perspicuous term for this attitude, so I call it ‘proto‐respect’ – the attitude a social animal directs toward those it regards as valuable allies or bad enemies.     

Empathy, Shame, Guilt, and Narratives of Interpersonal Conflicts: Guilt-Prone People Are Better at Perspective Taking

Both guilt and empathic perspective taking have been linked to prosocial, relationship-enhancing effects. Study 1 found that shame was linked to personal distress, whereas guilt was linked to perspective taking. In Studies 2 and 3, subjects were asked to describe a recent experience of interpersonal conflict, once from their own perspective, and once from the perspective of the other person. Guilt-prone people and guilt-dominated stories were linked to better perspective taking (measured by changes between the two versions of the story) than others. Shame had no effect. Guilt improved relationship outcomes but shame harmed them. Path analysis suggested that trait guilt-proneness leads to perspective taking, which leads to actual guilt feelings, which produces beneficial relationship outcomes. Guilt feelings may mediate the relationship-enhancing effects of empathy.     

The detection of shame in group psychotherapy: uncovering the hidden emotion

Shame, recently so extensively investigated in the individual and family therapy literature, has remained curiously underexplored in the group literature since Alonso and Rutan's noteworthy article on the subject in 1988. Shame is frequently bypassed because, as a result of its hidden nature, its presence is often not detected. This article strives to insure that shame does not go unaddressed. We catalogue and discuss six defenses that may suggest the subterranean workings of shame: (1) focusing on themes that stress similarities among members, (2) generating feelings of scorn and disdain, (3) avoiding here-and-now material, (4) inducing guilt, (5) transference reactions, and (6) preserving the illusion of the leader's infallibility. The best antidote for shame's neglect is a heightened readiness to detect it. Such detection is important because shame plays some role in many of our patients' complaints.     

Shame conflicts and tragedy in The Scarlet Letter

Nathaniel Hawthorne's The Scarlet Letter has much to teach psychoanalysts and psychotherapists. Perhaps no other American novel lends itself so well to an exploration in depth of the dynamics, conflicts, and defenses characteristic of shame. While most commentators on The Scarlet Letter have assumed Hester Prynne's pain to be shame-based, and the Reverend Dimmesdale's to be guilt-based, a rather different interpretation is proposed namely, that both are afflicted with shame, but that Dimmesdale's is more unbearable than Hester's because more conflictual, less representable, and less easily used protectively. Dimmesdale's shame is at once deeper and more toxic. What "deeper" and "more toxic" mean in the context of shame conflicts (including conflicts to which feelings of shame give rise) is explored.     

Hidden shame

Shame dynamics, after decades of neglect, reappeared in psychoanalytic thinking with increasing prevalence in the last thirty years. Shame that is hidden is an aspect of complex clinical phenomenology that is particularly likely to be missed and hidden further by partial psychoanalytic explanations that drive shame more and more from view. Shame is often hidden theoretically by formulations limiting conflict to conflict between drives or impulses and something opposing them. By contrast, the incompatible idea model propounded by Freud in Studies on Hysteria emphasizes awareness incompatible with the dictates of conscience, and hence is broader in scope and closer to actual experience. Although shame and guilt arise developmentally earlier than does a true sense of morality, these emotions and their unconscious variants become entwined with the individual's sense of morality as development proceeds. The dynamics of shame and guilt are considerably more complex than their phenomenology as overt emotions. Shame emphasizes weakness, vulnerability, and the likelihood of rejection--so much so that its acknowledgment often generates more shame. Guilt, however, since it is action- and power-oriented, often obscures shame and so defends against it.     

Maternal Guilt and Shame: Relationship to Postnatal Depression and Attitudes towards Help-Seeking

Existing literature indicates that women can experience feelings of shame and guilt in relation to motherhood. This study investigated whether maternal feelings of shame and guilt were associated with postnatal depressive symptoms and attitudes towards help-seeking. A cross-sectional, correlational design was employed. Shame and guilt were measured as both dispositional factors and contextual factors i.e. in relation to motherhood (event-related shame and guilt). A UK community sample of 183 mothers with an infant between 4?weeks and 1?year of age completed a series of online questionnaires. The results indicated that shame proneness significantly predicted postnatal depressive symptoms once demographics and social support had been accounted for. Furthermore, shame proneness significantly predicted less positive attitudes towards help-seeking. Guilt proneness was not a significant predictor of postnatal depressive symptoms or attitudes towards help-seeking. These findings highlight the potential negative consequences of maternal feelings of shame in the postnatal period.     

No Place to Hide: When Shame Causes Proselfs to Cooperate

Shame is considered a social emotion with action tendencies that elicit socially beneficial behavior. Yet, unlike other social emotions, prior experimental studies do not indicate that incidental shame boosts prosocial behavior. Based on the affect as information theory, we hypothesize that incidental feelings of shame can increase cooperation, but only for self-interested individuals, and only in a context where shame is relevant with regards to its action tendency. To test this hypothesis, cooperation levels are compared between a simultaneous prisoner's dilemma (where “defect” may result from multiple motives) and a sequential prisoner's dilemma (where “second player defect” is the result of intentional greediness). As hypothesized, shame positively affected proselfs in a sequential prisoner's dilemma. Hence ashamed proselfs become inclined to cooperate when they believe they have no way to hide their greediness, and not necessarily because they want to make up for earlier wrong-doing.     

建设性还是破坏性?羞愧的双路径模型

羞愧是一种典型的自我意识情绪, 在个体行为以及心理发展结果中发挥着重要作用。羞愧同时是一种中国传统文化中极为重要的道德情绪, 被认为是中国人自我反省的重要途径。但当前关于羞愧的导向性存在两个截然相反的观点:羞愧导向建设性还是破坏性?理论模型包括:其一, 羞愧导向破坏性, 相应的理论解释有社会威胁防御模型、羞愧调节模型等, 其二, 羞愧导向建设性, 相应的理论解释有进化心理学视角及功能主义视角等。这两种观点均得到大量实证研究的支持。为了合理解释这一分歧, 系统理解羞愧促发的行动机制, 本文提出羞愧的双路径结构模型, 突出社会自我威胁评估在其中的重要作用。未来研究需要开发出更客观全面的羞愧测量方法, 基于文化差异关注社会自我修复的影响因素, 理解不同文化背景社会对羞愧的诠释, 从而提出更具针对性的干预方法, 以促进个体羞愧可能的破坏性结果向建设性方向转化。     

“They suffer mainly from reminiscences”

Shame is a universal affect that everyone would like to avoid. Responses to trauma include profound experiences of shame, which re-emerge in the transference and can be recognized in reciprocal countertransference responses. Primitive defense mechanisms associated with borderline states such as projection, projective identification and splitting, are often encountered during the course of intensive psychotherapies involving traumatic shame. Attempts to avoid shame reactions may involve regressive reactions, even in non-borderline individuals. Shame avoidance may produce transference-countertransference enactments leading to a negative therapeutic reaction. Addressing shame-related issues may be difficult for both therapist and patient, but ultimately are essential for productive therapy and recovery from trauma.     

Self-compassion Improves Parental Well-being in Response to Challenging Parenting Events

Shame and guilt are common during the course of parenting and can reflect feelings of “bad self “and “bad behaviour” in relation to parenting events. Self-compassion is known to be beneficial for well-being by reducing negative emotions, yet there is little research examining whether self-compassion might reduce parental guilt and shame. The current study examined the effects of dispositional and induced self-compassion on guilt and shame in a sample of 167 parents (Mage = 37.23, SD = 6.73, 83.1% female) of children ≤12?years recruited online. After completing baseline measures, parents were randomly assigned to recall a guilt versus shame provoking parenting event, and randomly allocated to either a self-compassion prompt versus a control condition. Analyses confirmed that those who received the self-compassion prompt reported higher levels of self-compassion, and reduced feelings of guilt and shame compared to the control group. Effects did not differ as a function of the guilt versus shame instructions. Multivariate analyses revealed that, when controlling for dispositional self-compassion, and baseline guilt and shame, differences between conditions were maintained for post-manipulation guilt and shame. Findings extend our understanding of the role of self-compassion for improving well-being when dealing with the challenges of parenting.     

Interview with Jonathan Asser

In this interview, Jonathan Asser recounts how working in prisons with violent male inmates was the inspiration behind ‘Starred Up’, his acclaimed film about a young man who enters adult prison for the first time. The film offers an insight into the innovative Shame/Violence Intervention (SVI) that Asser pioneered whilst working as a group therapist at HMP Wandsworth. Asser’s approach included getting members of his groups to acknowledge the shame they felt before these feelings became unbearable and escalated into violence. Drawing on the ideas of American psychiatrist James Gilligan, Asser found he was able to work with the most violent and institutionalised prisoners by developing a technique that relied on a particular use of his counter-transference. Asser also talks about the personal experiences that led him into working therapeutically with this client group.     

Development of the Weight- and Body-Related Shame and Guilt scale (WEB-SG) in a nonclinical sample of obese individuals

In this article, we present the evaluation of the psychometric properties of a new self-report measure of Weight- and Body-Related Shame and Guilt (WEB-SG). The main purpose of the study was to measure shame and guilt feelings separately in obese individuals and investigate differing behavioral and emotional correlates of these emotions. Altogether, 331 obese participants completed the WEB-SG and other established self-report measures. A subset of the participants completed a 6-month follow-up. The WEB-SG proved to be internally consistent and temporally stable over a 6-month period. Regarding the factorial structure, a two-factor conceptualization was supported. The construct validity of the WEB-SG subscales was evidenced by a substantial overlap of common variance with related measures. The subscales Shame and Guilt showed differential correlation patterns to other scales. The WEB-SG is a brief, psychometrically sound measure for assessing body shame and guilt concerning weight control in obese individuals.