Feature Archive

Shame: Secret Ally of Illness

Experts tell WebMD how shame can have an impact on health.

By Daniel DeNoon
WebMD Feature

Reviewed By Brunilda Nazario

Think positive. Eat good foods. Be healthy. It's good advice. Sadly, it has a dark side.

"You can be healthy!" shout the covers of magazines and health books. The promise is that all it takes for good health is good exercise, good diet, and good hygiene.

But what does it mean if we aren't like those good people on the covers of health magazines? What if we aren't slim or young or fit? What if we're at risk of illness -- or actually ill?

We all have an ideal self we feel we should live up to, says psychologist Lawrence Josephs, PhD, a professor at Adelphi University. And we feel ashamed when we don't live up to this ideal.

"Everybody believes they should be healthy and fit and youthful and live to a ripe old age," Josephs tells WebMD. "But people do get weak and vulnerable and depend on others and need help. So that ideal of being a strong, healthy person who can do everything on their own, that is shattered. And people get shamed and don't want to admit they are ill."

Shame: A Major Health Issue

In the experience of shame, one's whole being seems diminished or lessened. The expression of shame is not just the desire to hide, or to hide my face, but the desire to disappear, not to be there. It is not even the wish, as people say, to sink through the floor, but rather the wish that the space occupied by me should be instantaneously empty. -- Bernard Williams, British philosopher

The effects of shame and stigma can be devastating to a person's health, experts tell WebMD. They're seen not only in people with life-altering medical problems but also in relatively healthy people with risk factors (such as a family history of cancer) for future illness.

Examples include:

  • AIDS patients not taking their lifesaving drugs.
  • People with diabetes becoming discouraged over difficulties with blood-sugar control.
  • Obese people ashamed to go out of doors and get the exercise they desperately need.
  • People with urinary incontinence afraid to leave their homes.
  • Unnecessary suffering in people with treatable mental illnesses.

Duke University researcher Laura Smart Richman, PhD, studies emotional influences on health.

"Shame is one reason why people don't seek care," Richman tells WebMD. "There tends to be this perspective that people should have a lot of control over their health -- even with an illness like cancer. We're told, 'You should think positive, you should eat the right foods.' So when people aren't healthy there is self-blame and the perception of societal blame."

Taking personal responsibility for one's life is a good thing. We all want to be independent and in control of our lives. But illness isn't something we fully control. That can be scary -- and shaming.

"People want to think, 'I am in control,' so if you have alcoholism, addiction, eating disorders, incontinence, whatever, there is shame in lack of self-control," Josephs says. "Shame can be dangerous if it keeps you from seeking help for anything serious. It is very upsetting to have a heart attack scare or a cancer scare. It is tempting to deny it -- because that is a big assault on our self-image."

This isn't merely a matter of vanity, or even of being a control freak. Shame is hardwired into our mental makeup, says psychiatrist Michelle E. Friedman, MD, director of pastoral counseling at Yeshivat Chovevei Torah rabbinical seminary and assistant clinical professor at Mount Sinai School of Medicine, New York.

"This is an issue and a struggle for every ill person," Friedman tells WebMD. "Shame comes from an ancient, primitive way of thinking. It is really powerful."

We feel guilty for what we do. We feel shame for what we are. A person feels guilt because he did something wrong. A person feels shame because he is something wrong. We may feel guilty because we lied to our mother. We may feel shame because we are not the person our mother wanted us to be. -- Lewis B. Smedes, U.S. psychologist

Why is shame such a problem? It has to do with the nature of this mixed emotion. Like its sister emotion, guilt, shame is what psychologists call a negative emotion.

Negative emotions such as sadness, anger, and fear -- alone or in any of their many combinations -- aren't bad in and of themselves. It's how we handle them that makes them harmful. In this regard, shame is particularly tricky. It strikes at the core of our being, says psychologist June Tangney, PhD, a professor at George Mason University in Fairfax, Va. Tangney is co-author of the book Shame and Guilt.