Shame: Secret Ally of Illness (cont.)

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.

When we feel bad about having failed or about having done something we think is wrong, we feel guilt or shame.

"Guilty people feel bad about their behavior. Shamed people feel bad about themselves," Tangney tells WebMD. "Guilt is a less overwhelming feeling. It is less self-esteem related, and doesn't affect our sense of who we are."

Guilt motivates a person to repair the damage done by bad behavior and to make positive changes in their lives. Shame works in the other direction. It makes us want to disappear.

"When people are ashamed, the defense mechanism is hiding," Joseph says. "We become like little kids who are ashamed and hide their faces in their mothers' aprons. It is hard to get past that."

As adults, we don't have our mothers' skirts to hide behind. But our reaction to shame often isn't any more mature.

"When people feel ashamed they are more likely to hide, deny, escape, and externalize blame," Tangney says. "When people feel guilt they are motivated to face the music. When people feel shame they want to duck the heat."

Tangney lists five ways shame can be destructive:

  • Lack of motivation to seek care.
  • Lack of empathy. Shame, Tangney says, is very self-involved. People feeling shame cut themselves off from other people.
  • Anger and aggression. Tangney says shame has a special link to anger. "In day-to-day life, when people are shamed and angry they tend to be motivated to get back at a person and get revenge," she says.
  • Psychological problems. Tangney says shame is associated with eating disorders, substance abuse, anxiety, depression, and other mental disorders.
  • Problematic moral behavior. Tangney's team tested fifth-grade students, and followed them until they were 18 years old. Shame-prone kids were prone to substance abuse, earlier sexual activity, less safe sexual activity, and involvement with the criminal justice system.

Because we tend to feel more shame about our bodies than about other aspects of ourselves, health issues are particularly likely to evoke shame. And no health issues evoke shame more than those involving sex, says Ilan Meyer, PhD, associate professor of clinical sociomedical sciences at Columbia University's Mailman School of Public Health.

"If people are embarrassed to talk about their sexuality, they are not going to be seeking out services, testing or counseling on the topic," Meyer tells WebMD. "People often don't seek treatment for an STD [sexually transmitted disease]. Or when they do, they lie or pretend it is something else. I know of someone with an STD who called the doctor and said he had a cold, and wanted antibiotics. Of course this would be the wrong drug for both conditions, but this is a case of a person acting out of shame, trying to manipulate the situation to get care."