Saturday, January 25, 2014

Shame 2.0: The Dissertation

I was talking to my husband the other day about the role of shame in the PTSD response, and I thought it might be a good time to revisit the topic in the ol' blog.

"Shame" has always been sort of a tricky thing for me to parse, especially relative to other similar, overlapping tricky things, like guilt and anxiety.

With which I am also familiar. Hence, I would imagine, much of the difficulty.

As you may recall, I wrote about shame here before, way back in 2011, when I first discussed the theory that PTSD may be, to some degree at least, a shame disorder.

More about that in a minute (because whoa-- did I find some interesting stuff about that).

To quote myself, back then I... um... quoted Dr. Oz:
Dr. Oz says that shame stifles emotion.

I can see how that is true-- instead of feeling what you're feeling, you feel shame for feeling it. The shame swallows or eclipses the anger or the pride or the contentment or whatever it was that you were feeling before the shame spiral pulled you under. It also makes you distance yourself from others, stifling intimacy and preventing you from connecting with others.
Hmmmm. Yeah... no. 

I mean, yes, good, those are some things that shame does to us. But I still wasn't explaining-- to you or to myself-- what shame is, much less how to differentiate that particular monkey from all the other monkeys in my zoo (ooh, what a good metaphor! I'm a walking monkey house, me!).

But I needed a better definition than that, because I needed to get to the bottom of something my husband and I were talking about: the different types of PTSD responses, and the role shame plays in them. 

In some people, it's easy to see. 

Take me, for example.

My husband brought it up because he said he'd been thinking about something I'd said to him recently: that I was slowly realizing how much of my time and energy is spent simply trying to appear normal to others while all of this chaos is going on below the surface.

My brand of PTSD could be called "The Art of Getting By." I bet most people who suffer from it could call it that.

He thought that maybe shame drove a lot of that impulse-- shame over my internal struggles, shame over my perceived inadequacy, shame over my anxiety, shame over whatever.

Sure, I said. That makes sense. Although...

Whenever I try to apply a general statement about PTSD/PTSR to myself, I try also to apply it to the grizzled Vietnam vet ducking at car backfires and screaming at the sky. What I mean by that is that I try to see how he and I could be experiencing similar neurological malfunctions.

Doing that has been a good gut-check for how I figure out what is true and what is not about what's going on in my brain. It's also been what has made me feel increasingly connected to the plight of our veterans with PTSD and the quality and extent of their care.

Anyway, I had trouble with the shame thing. I've felt a great kinship with the hypothetical veteran in the past-- the theory that we are both stuck in a stage of the fight-or-flight response makes perfect sense, and our resulting behavior does as well. 

But it's much harder to see the link with shame.

So I looked it up again, just now, and found something really simple and clear on, one of those websites I might otherwise have skipped, thinking it would have been too generic to have anything useful.


The article first differentiates shame from guilt:
Shame is often considered a "self-conscious emotion" and... occurs when a person evaluates or judges themselves in a negative light. For example, a person might experience shame if they view themselves as worthless, weak, bad, or useless.
Guilt, on the other hand, occurs when people evaluate a behavior or an action as negative. For example, if you borrow money from someone and then fail to pay them back, you might experience guilt because you did something that can be perceived as wrong or inconsiderate. However, if you judge yourself as a bad person because you failed to pay the person back, you would likely experience shame.
Then it tells you why the difference is important:
It is important to distinguish between shame and guilt because they influence our behavior in different ways. Guilt can motivate us to make amends, apologize, or correct a behavior. Doing such things will help alleviate guilt and may increase the extent to which we feel positive about ourselves. In this way, guilt can be a helpful emotion.
Shame, on the other hand, is rarely useful. With shame, people may be more likely to engage in self-punishment (such as through deliberate self-harm) or isolate oneself from others. This is going to do little to alleviate the shame in the long-term and can even intensify the shame. 
And then... the clincher (emphasis mine): 
Why might shame lead to PTSD? The experience of shame following a traumatic event may lead to the use of unhealthy coping strategies, such as alcohol use, avoidance, or self-destructive behaviors. These unhealthy coping strategies can interfere with the processing of emotions associated with the traumatic event, contributing to the development or intensification of PTSD symptoms.
In addition, if people experience shame due to judgments that they are weak or worthless, they may feel more stigma about having experienced a traumatic event. This stigma could then prevent someone from seeking out the appropriate care.  
Coping strategies. Shame is about coping strategies. 


In case you missed it, that was the light bulb turning on, right there.

So there's the link. In fact, there's the whole damn ball of wax, because without an unhealthy coping strategy, you don't have any PTSD to deal with.

And without that... you and I? We're not having this here conversation, folks.




There it is, then. 

Did I just figure this whole thing out? I did, didn't I. Ha ha. <cracks knuckles, leans back, places hands casually behind head>

Hi. Sherlock here. Have we met?

So, before I go, one more (sort of really big) thing about PTSD-as-shame-disorder. You'd think it would be talked about more openly, considering all the evidence there is for it. 

And there is a great deal of widely-understood evidence. I am hardly the first to make this connection. There's enough that the US military (and many others, I reckon), includes shame-proneness as a variable when looking for candidates for special forces teams and other such intense, high-stress military positions. 

In fact, speaking of the military, I saw an article recently that talked about the newly-emerging issue of women returning from combat positions, and their higher-than-average propensity to suffer from PTSD. I was hoping to see the connection made there.

It wasn't. Shame wasn't mentioned at all.

I think it should have been. Now more than ever, I think it's THE key element to understanding not only how to unlock the mystery of PTSD, but how to properly care for our returning veterans of both genders.

And before I get off this topic, consider this: this article discusses the commonly-held theories not only that women experience more shame than men, but also that men and women tend to express their shame differently: "women 'act in' ... through introversion and self-hate.... [while] men 'act out'... [through] extreme anger and violence."

As that first article states, female veterans are TWICE as likely as their male counterparts to commit suicide. (Acting in: check.)

And as all of these articles state, our veterans are very likely, and getting more likely by the day, to commit suicide.

And as we hear with alarming frequency on the news, sometimes they (as far as my research shows, exclusively men) don't-- or don't only- kill themselves. (Acting out: check.)

And yes, I'm conflating expressions of shame here with expressions of PTSD and/or expressions of clinical depression or whatever other neurological misfires have piled on in any given individual case... but it seems to me that there is useful information here. 

That the roots of these behaviors can be traced to something as simple and malleable as a coping strategy.

That this stuff can be, to some extent-- and maybe to a very great extent indeed--anticipated and mitigated.

Or at the very least, addressed properly, directly, with care and compassion, and without judgement or stigma when the men and women who risk their lives for our country return home, so that they don't end up sacrificing more than they-- and those who love them-- bargained for.


  1. This is really intriguing. We don't specifically look at PTSR at BCNW but we do look at shame and its relationship to, and differentiation from, guilt.

    And yep - we describe it in exactly the same way. The difference between "I did a bad thing." and "I'm a bad person."

    We would typically say that the dart of guilt lands in our soul (in the classical sense of mind+will+emotion) and is therefore reachable through talking therapy and an appeal to reason. Where guilt's sting lands in the spirit - a dial rarely moved by knowledge, wisdom or understanding. Pascal says that "the heart(spirit) has reasons that Reason knows not of."

    Fascinating stuff Kate...I mean Serlock!

  2. Kate,

    First, I had no idea you had a blog--it was good ol' Cryptopur there who clued me in over on his blog. So if for no other reason, his blog is good.

    Second, I had not idea that you went through any of this, and I'm amazed, heartbroken, impressed, inspired, chastened, and a whole bunch of other emotions. I don't even begin to pretend to know what you've gone through and are going through and will go through, but you are phenomenal for having survived and continuing to strive for wholeness and peace. My prayers will certainly be with you.

    Third, I had no idea that you were such a wonderful writer. Not only is your story touching, but your voice in telling it is awesome.

    So, in summary: there are many things I do not know. I'm glad I know a few more of them now. And that thing about you being awesome.

  3. The book I'm currently reading just dealt with the concept of shame and how debilitating it can be. In a nutshell, it states that shame convinces us not to keep doing the work that matters. That may mean stop writing because someone doesn't like your work (or to not write in the first place because someone might not like your work) or it may mean someone with PTSD doesn't seek the care they need.

    It just made me think how fucked up it is that we have this extremely powerful part of our brain, designed over millions of years, to keep us from creating a new "safety zone", where we truly are safe and able to grow and thrive, by establishing a "comfort zone" that really isn't very comfortable at all.

    I've counted at least three times today where my thoughts and emotions reverted back into this comfort zone and had to consciously tell myself that this isn't a safe place to be. The scary part is that my initial reaction to these feelings of shame is some action that's obviously not ideal. It's nuts!! In one instance the reaction I had (and one I followed through on) was to do nothing. In what universe does that make sense?

    You said, "without an unhealthy coping experience you don't have any PTSD to deal with" and I'd even go ahead and say that it's not just PTSD, it's any harmful, lizard-brain driven response that keeps us from being the best representatives of ourselves. You take away those unhealthy coping experiences and what do you get? You get someone doing what they need to do to kick shame square in balls and get down to doing the work that matters. You have someone taking the action steps to confront their shame and finding ways to connect in a real human way with the people they care about more than anything.

    Great post Kate!