Shame is one of the 9 primary emotions (technically, they are called, affects, which are the innate biological part of emotions). When we experience shame, we say to ourselves, “I am bad.” In contrast, when we feel guilty, we say, “I did a bad thing.”
Donald Nathanson, MD is a psychiatrist who is an expert on shame. He discovered that people react to feeling shame in 4 possible ways. They can be plotted out as if they were points on a compass, representing the 4 cardinal positions (North, South, East, West).
Response 1: Attack Self. In this case you believe that your shame is valid, and you are angry at yourself as a result. You criticize yourself and may even feel contempt. You may deal with your shame by subordinating yourself to others. As a result, you may do what others want you to do even if it is not in your best interests. You can lose your sense of autonomy.
Response 2: Attack Other. You project your sense of being bad by blaming others. You may put others down to make you feel better about yourself. In the worst case you may physically abuse someone else. Obviously, attacking others to reduce your shame is damaging to your relationships and does not directly address the shame.
Response 3: Avoidance. You think and act in ways that allow you to avoid feeling the shame. You may do this by distracting yourself by engaging in more sex, eating just for pleasure, or using alcohol or drugs (especially stimulants) to mask shame. Using substances in this way prevents you from dealing with your underlying shame. Alternatively, you may do things that increase pride in yourself such as being more charitable, learning a challenging new skill, etc.
Response 4: Withdrawl. As is the case with Attack Self, you accept that your shame is valid so you withdraw from situations to avoid shame. You may turn down invitations from others, turn to solitary activities, and cut off friendships. Although withdrawal may lesson a sense of shame (“People can tell that I am bad so I will stay away”), cutting yourself off from support is an unhealthy response to shame.
If you struggle with shame, you may find it helpful to figure out which of the four responses you are using to deal with it. It may be that you use more than one of these defenses. None of them are optimal responses, and they may make your life worse.
Seeing a therapist is a good idea if you are unsure if you are dealing with shame, depression or other psychological states. Therapy is also useful to figure out which defenses you are using and how to modify your responses in a healthier way.
Peter M. Hartmann, MD
Family Medicine & Psychiatry
Health and Culture 