Let’s talk about shame and anxiety

Trauma-informed approaches are so integral to how we operate as a service provider that we now see this as a common sense approach; after all, it was adopted in response to clear data showing that a significant number of people accessing mental health services had experienced physical or sexual abuse. However, trauma-informed approaches have only been implemented since the turn of the century, twenty years ago.

It has been a transformative journey for many of us to heal from the old-school mentality we grew up with that we are simply making choices between good and bad, and based on that choice, we are good or bad. We can all recall childhood memories of a teacher or parent telling us we were good or bad based on an action we may not have thought about very much, shaming us into believing that their label defines us and setting us on a course to live by these two opposites, in the hope of not feeling that most awful of emotions; shame.

That this mentality exists in formal institutions such as schools, hospitals, local authority services, and workplaces is inevitable. It is based on how the Western world understands human existence. A quote we have all heard is ‘I think therefore I am’ (Descartes, 1637!). This mentality frames how modern psychology, medicine, and education have been delivered to us. I read somewhere once that this makes us all ‘bobbleheads’, and the image stays with me because it helps me to understand some of our constant need to label ideas and people as right or wrong. Mainly, it helps me understand why I label myself good or bad throughout the day as I make decisions and take actions; if thinking and acting = good/bad, we are making decisions and viewing ourselves based on a shame narrative.

Because shame so powerfully influences our sense of identity and impacts our social wellbeing, it is often referred to as the ‘Master Emotion’ by psychologists and neuroscientists. An acute sense of shame is a feeling we will remember from a very young age: that flush of heat and sensation from your stomach up to your face, making you wish the ground would open up and swallow you! But for those who experience neglect and abuse, shame can be chronic rather than acute, a constant emotion that colours how the self and the world are perceived.

Although chronic shame is also characterised by some features as acute shame because it is painful and isolating, it is better defined as a continual fear and avoidance of shame. This causes hyper self-consciousness and emotional torment as people make decisions about their day-to-day life and long-term goals, making fear-based decisions to avoid being put to shame by any person, circumstance or outcome. This is a hyper-anxious state, and the impact on mental health, physical wellbeing and relationships is inevitable.

The ’shame compass’ tool can help identify shame-avoidance behaviours, which follow four common patterns: withdrawal, avoidance, attacking others and attacking self. Common defensive behaviours are varied but damage self and relationships: anger, aggression, hostility, violence, narcissism, depression, perfectionism, apathy, withdrawal, avoidance, and excessive deference.

In practical terms, people may miss appointments, avoid following prescribed pathways and seek to hide from professional and social settings, which expose them to being misunderstood, denied help or belittled. To counter negative feelings about the self and anger towards others because they pose the threat of rejection, people may seek to empower themselves or numb themselves. Thrill-seeking behaviours and substance dependence would serve these purposes.

For professionals, a shame lens has to be applied to our trauma-informed approaches to identify and understand the experience of those we work with. Still, we will have to begin recognising our own shame experiences. Otherwise, we may respond to residents and participants according to our internalised good versus bad understanding. We may then take authority in client-facing situations because we are seeking to avoid being shamed ourselves.

For all of us in the mental health and support sector, whether facilitating or accessing services, the practical work of following three steps of shame-sensitive practice can be empowering: acknowledge, avoid, and address. Addressing chronic shame and shame-proneness through practice based on compassion-focused can facilitate shame resilience through methods that help counter the self-critical inner voice developed in those sensitive to shame.

The compassion-focused approach encourages us to counter the inner critic with a kinder attitude towards ourselves, firstly by accepting how we feel and act each day, seeking to take a positive and forgiving view of ourselves, and then encouraging ourselves to make choices that will benefit us and others, rather than trying to bully ourselves into making choices based on any extreme understanding of what makes us ‘good’ or ‘bad’.

What is exciting about challenging the constant voice of criticism that tells us we are shameful or in danger of being put to shame is that we can start now. Practical methods that create new habits enable people to empower themselves daily and advance towards wellbeing. Practising talking to yourself kindly every day until it is a habit will eventually cause it to feel normal. That is shame resilience!

When combined with other therapies, shame-sensitive and compassion-focused therapies can counter the story of shame our minds and society tell us. Social Interest Group have been working through our ‘I Am More Than’ Project and Theory of Change to break the stigma and shaming narrative for women with complex needs and risks. SIG SafeGround team trained with the Forgiveness Project to recognise how shame impacts and how we can counter it.

Accessing external services without fear of judgement or blame is essential for all residents and participants in our services. We advocate for policy change to reflect non-shaming, non-authoritarian practice from all organisations and institutions tasked with supporting people with their health and wellbeing.