Shame

Developmental, Cultural, and Clinical Realms

Salman Akhtar

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9781782202547
• eBook ISBN: 9780429919084
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book offers ten distinguished analysts' insights on shame from various perspectives, which include its developmental substrate, vicissitudes during adolescence, and manifestations in the course of aging and infirmity. It seeks to advance clinicians' empathy and therapeutic skills in this realm.

Part I
Developmental Realm

Chapter One
Shame in childhood

Ann Smolen

Shame is an affect that has been largely ignored and misunderstood within the psychoanalytic literature. Psychoanalytic scholars have emphasized the affect of guilt, which represents internal conflict between the ego and superego. Shame was understood as a reaction to disapproval from the environment and carried little consequence compared to its counterpoint of guilt (Morrison, 1983). Freud (1923b, 1924d) viewed the development of guilt as a by-product of oedipal struggles and superego retribution. He said very little about shame though he did propose (1930a) that it was a derivative of exposure to others through genital conspicuousness and vulnerability. In a later contribution, Freud (1933a) postulated that shame was a feminine characteristic and a defect in women.

Subsequent psychoanalytic scholars modified Freud’s views and stated that shame results from a conflict between the ego and the ego ideal (Piers & Singer, 1953). Shame is established when “a goal of the ego ideal is not attained, and therefore is the result of failure” (Morrison, 1983, p. 296). Shame encapsulates the whole self and is a narcissistic response to not living up to the goals of the ego ideal. H. B. Lewis (1971) states that the defense against shame is to hide or run away. The paradox here is when one feels shame, the impulse is to run or cover up, but this creates the danger that one will be abandoned (Levin, 1967; Piers & Singer, 1953). The ego ideal denotes internalization of values, morals, and the idealized object, therefore when the goals of the ego ideal fall short the individual’s identity comes into question and narcissistic vulnerabilities are exposed (Levin, 1967). When there is a defect in the sense of self, “the resultant shame carries with it a decrease in narcissistic self-esteem” (Morrison, 1983, p. 299). When an individual experiences the loss of an idealized self-image, she experiences shame. According to Severino, McNutt, & Feder (1987),

Shame is closely related to anxiety about the loss of the love of the object that can be associated with each developmental stage. It can be associated with the experience of the self as greedy, dependent, and in need of mother, the self as not in control or unable to perform, the self as genitally deficient, the self as humiliated and mortified by Oedipal defeat, and the self as bad in relationship to superego expectations. (p. 94)

Erik Erikson (1950) created his developmental stages and spoke about the stage that he titled: Autonomy vs. Shame and Doubt. He recognized that shame and guilt were interwoven and inadequately understood. Erikson stated: “Shame is an emotion insufficiently studied, because in our civilization it is so early and easily absorbed by guilt” (p. 252). He connected shame to the anal stage of development when the toddler’s task is to develop autonomy without being inundated by feelings of shame or self-doubt. In order to achieve this, the child must first have acquired a secure sense of trust. Without trust, the young child internalizes a sense of self as bad or defective. For Erikson (1963), shame accompanies exposure of an inner sense of inadequacy or self as defective.

Defective sense of self

Freud (1923b) stated that the ego “is first and foremost a body ego” (p. 27). In order to begin to understand the concept of a defective sense of self that then leads to the affect of shame, we must first understand the preverbal, pre-oedipal stage of development when the image of one’s body and self are idealized (Severino, McNutt, & Feder, 1987). When a person has the sense of her self as defective, shame is often the affect that is experienced, and with this comes a lowering of self-esteem and a sense of being flawed (Morrison, 1983). These individuals often experience a “distorted, vague, and incomplete body image [that] exerts its pathological influence on ego development” (Blos, 1960, p. 427). When a child experiences her self as defective it becomes a narcissistic injury and is “symbolically equated with badness, and becomes intermingled with disintegration anxiety, [and] castration anxiety” (Yanof, 1986, p. 578). Freud pointed out the significance of the mother-child relationship in helping the child to not feel defective. Freud wrote (1933) that Emperor Wilhelm II’s narcissistic vulnerabilities were not about his physical defect (i.e., his withered arm), but were a result of his mother’s withdrawal of her love because she could not bear his physical defect. When a person feels that their whole sense of self is defective, there is often a feeling of hopelessness that she will never be good enough or lovable. The “… sense of defect is experienced concretely, as a fact, which is emotionally deeply etched. At the same time the sense of defect is usually vague, poorly defined, not easily verbalized as to what is wrong” (Coen, 1986, p. 54). Coen understands the sense of self as defective as a compromise formation that attempts to resolve the conflict between the ego and the superego or ego ideal. Young children who see themselves as damaged often exhibit learning differences and memory disturbances (Yanof, 1986).

I will demonstrate in the case of “Jane,” how this young girl developed a sense of her whole self as defective. Because of this sense of self as defective, she experienced overwhelming shame that was a reflection of feeling like a failure. Jane was unable to live up to her ego ideal and developed narcissistic defenses that covered up a sense of worthlessness. She attempted over and over to conceal her unacceptable self to no avail.

A detailed illustration from child analysis

Jane

Jane was nine years old when she began her analysis. Her mother’s analyst had referred Jane to me because she was paralyzed with a multitude of fears. Jane was afraid of dogs, cats, and bugs. She refused to walk past a house if she knew a dog lived there. She could not go into a movie theater or a museum. She was afraid to go to another child’s home for a play date and could not sleep away from her mother. In fact, she could not go to bed without her mother sitting by her side every night. Jane insisted that her mother sit with her or lay down with her far into the night. She would cry and have tantrums if mother did not adhere to these desires. Jane was fearful of seeing “mean faces” in the hallway and worried about “bad men” entering the home in the night to kill her and her family. She did not trust the burglar alarm and would not allow her parents to activate it, fearful that it would go off and scare her. This nighttime behavior caused friction within the marriage as the father was inpatient and angry that Jane was exhibiting “ridiculous” fears and causing such trouble. Most difficult of all, Jane’s separation anxiety had culminated into a school phobia. She was very good at fooling her mother with fake illness. Jane refused to go to school many mornings and had tantrums and crying episodes where her mother would give in and allow her to stay home. Jane developed a vomit phobia and refused to go to school because she was afraid that she or another child might vomit. In addition, Jane was not doing well in school and had difficulty completing homework and other school-type work even though she was gifted and in the gifted program in her school. Jane was tested for learning difficulties and was diagnosed with a learning disability.

Jane’s early history

Mother described Jane’s first three months of life as torture. Jane was a colicky infant, screaming for hours, unable to be comforted. Jane experienced episodes of apnea and was monitored for several weeks. Her mother watched over her, never leaving her, to make sure she was breathing, worried she would die from SIDS. After these difficult, anxiety-filled first three months, Jane seemed to settle and developed normally. Her mother described her as a sweet baby who captivated everyone by her toothy smiles and belly laughs. She accomplished her developmental milestones early, walking by ten months and speaking in sentences by eighteen months.

When Jane was three, everything seemed to get derailed. Her speech, which had been advanced, deteriorated. She garbled her words and became difficult to understand. Toilet training had become a battleground. She was bladder trained for both day and nighttime by three years of age but continued to wear a diaper for bowels. She became extremely constipated. Her bowel movements were painful and she refused to use the bathroom. Her mother stated that she became “afraid” of the bathroom. This problem persisted and when Jane was six years old her mother attempted desperate measures to help her child use the toilet. She gave her enemas, put a TV in the bathroom, and sat with her for hours, reading to her while Jane sat on the toilet. Jane was given fiber pills at night and there were angry interactions between mother and daughter over bowel movements. Jane’s undiagnosed and untreated encopresis became a social problem. Jane’s mother had her wear a large sanitary napkin to catch the leakage. This continued until one year before Jane began her analysis. This condition dictated changes in family life; for example, trips caused constipation so the family did not go away. She also refused summer camp and other social situations where other children would become aware of her problem. Through the fourth grade she isolated herself from peers and remained very close with her mother.

When Jane was seven years old she became morose and obsessed about death after being read Charlotte’s Web (White, 1952). Her mother described her as being obsessed with death. She refused to allow her parents to bring flowers into the home because they would die and it made her too sad. She spoke obsessively about two deceased grandmothers (one died before she was born, the other when she was two) and worried that her parents would die and that she too would die.

Mother reported that Jane did not like kindergarten. In first grade, she was unhappy because her teacher was too strict and the teacher would not allow the children to use the bathroom. Jane was afraid of this teacher. Second grade was a better year. She had a “sweet, loving teacher” but Jane’s separation anxiety became worse as she became concerned about dying. She began to complain of “funny feelings” in her chest and stayed home from school a lot. In third grade, Jane became nauseated all the time and was fearful that she would vomit. She developed a phobia about vomiting and was afraid to go to school because she might vomit on the other children. Her mother described this as a “fixation on vomit.” In third grade, she became “very clingy” and bedtime problems were exacerbated. Fourth grade was described as a very bad year. She had a “sarcastic, mean teacher” who made life difficult for Jane. A school phobia took hold and Jane spent many days sick at home.

Shameful secret

It was not until we were well into our second year when Jane’s parents told me the family secret: Jane’s mother had a degenerative hereditary disorder that, in time, would cause blindness. The mother was diagnosed with this disease when Jane was three years old. At this time, the parents left Jane and her sisters on several occasions for days at a time, to travel to another state where the mother received the devastating diagnosis. Jane’s early history began to make sense, as that was the time when Jane regressed in speech, and behaviors. The parents were adamant in not telling their children because they did not want them to worry about their mother’s health or their own future risk of developing the disease; however they did know that their mother was unable to drive at night and had difficulty seeing when dusk set in. Jane’s mother told me that, at that time, she was extremely depressed, and received short-term therapy. At this point, it seemed that the mother was operating mostly in denial while underneath she was furious and profoundly sad. I explained that I felt that children on some level knew everything that goes on in the family. Secrets are dangerous and now I held the secret too. It took several more years before Jane’s parents shared the secret with their four daughters.

Jane’s analysis

Jane, a tall thin child with dark, luminous, sunken eyes, seemed ill at ease in her body. She often tripped as she walked up my stairs, her arms awkwardly dangling. She rarely smiled, and seemed to be an extremely sensitive and serious young girl. She chatted incessantly while anxiously touching items with her hands, rarely making eye contact. In these early sessions, list making was her favorite activity. Jane would sit at the easel in my playroom as she carefully listed each subject that she wanted to cover that day, crossing each item off as we spoke. In addition, as she talked, she wrote every third or fourth word that she was saying. Sometimes she drew next to the list, though always erasing her artwork immediately. Jane exhibited an extensive and sophisticated vocabulary as she regaled me with elaborate fantastical stories.

Jane spoke of many friends, but in reality her friendships were fragile. Her list of topics always contained a retelling of painful interactions with other children. It seemed as if she often misinterpreted others’ intentions and missed important social cues. As I got to know her, I found her to have a milk-toast veneer underneath which she harbored intense anger and aggression. Her relationships with her three older sisters and her father were fraught with intense sexual excitement and aggression. Jane was quite efficacious in keeping her mother’s attention focused on her worries and phobias, causing intense jealousies and antagonistic feelings to surface among her siblings and father. Jane was especially angry with her father, but did not know why. She was often disrespectful toward him and rebuffed his attempts to be affectionate with her.

At times, Jane had difficulty differentiating between fantasy and reality. She became involved in fantasy play with a girlfriend where her imagination took over and her fantasies became real and frightening. For example, she believed she could teach herself how to fly and she believed she had a protecting goddess who would save her from evil. She would describe video games that she was able to watch as a friend played, but she was terrified that the evil characters and bad and scary things that took place within the game would actually happen. She was involved with Wicca and believed that she had special powers, claiming that when she showered, a beautiful goddess joined her as her protector.

My first impression was that she was a sweet girl who appeared young for her age. She held herself in a stiff way and she seemed nervous and anxious as I showed her my office layout. She began to relax as I explained how I work and she built a “Jane city” in my sand box. She was very verbal, telling me all about her city where there was much fear of fire and villains and war. She spoke of her girlfriend who only sees the bad parts of her. When I asked her what those bad parts are, she explained that she “worries too much.” I enjoyed her very much as she became very talkative and animated as she expressed fears of going off to middle school and worries about boys and being liked. In her subsequent early sessions, she was less nervous and spoke about her oldest sister who terrorized her. She began to speak of her nighttime fears and the faces she saw in the hallway.

Jane settled right into her analysis, attending her sessions with a sense of relief as she told me her stories and troubles with girlfriends and sisters and parents. She had a difficult time in her summer camp with many social problems, always feeling left out and isolated. The major themes in her stories were about growing up, separating from parents, and traveling toward death. In one particular session, Jane became agitated, left her list-making activity, and relocated to the floor of my playroom, sitting in a contorted position with the heel of one foot pressed against her anus. I wondered about this, which allowed Jane to tell me her encopresis story. Jane related how painful her bowel movements were and had always been, and how difficult it was in school to be worried about leaking and smelling. Her sisters teased her and her humiliation was so great she had to hide these feelings at all costs. In a proud and enthusiastic tone, she relayed the following: “One day I just figured it out. If I push my heel into my bottom, I can control my poops! I can either make myself poop by doing this, or stop the poop from coming, and best of all nobody knows what I am doing!” I told her that I thought she was a genius as she figured out how to control her body all on her own.

Jane’s school phobia improved and when she entered middle school, at eleven years old, she became obsessed with a boy and spoke incessantly about him at home. This caused discomfort in her parents. Jane complained bitterly to me: “My mom doesn’t want me to grow up and dad forbids me to have a boyfriend.” She exclaimed: “It is all I can think about.” I felt that she was exhausting herself from these overwhelming sexual feelings. It was in this session that she first spoke of her fear of menstruation and we began to try to understand this. Jane became very depressed weeks later when her crush, a boy who did not even know she existed, declared his love for another girl.

Jane was entering puberty and was terrified to menstruate. She wanted to shave her legs and armpits, and felt peer pressure to do so, but was unable to use the razor, afraid she would cut herself. Her mother shaved her. She began to speak of feeling very stupid. Other children in the gifted program questioned why she was there and her grades plummeted. Jane remained very depressed for several weeks, having difficulties completing homework, and experiencing social problems. It became apparent that the parents were experiencing significant problems in their relationship. Monthly parent meetings were difficult as each blamed the other and tattled on the other. Mother had the tendency to use her daughters to retaliate against her husband. Her daughters seemed all too eager to gang up on father with their mother. Father responded by withdrawing even further from his family and at times exploding in rage.

Jane’s obsession with Wicca became all-consuming. Jane explained to me that her goddess had become her best friend, someone she could depend on twenty-four hours a day. “I only see you four times a week for a short time. You aren’t available. I can trust my goddess with things that I can’t even trust you with.” I wondered with Jane why she needed to have someone available to her at all times, that in real life this is impossible. Nobody can have that. Not fathers, nor mothers, nor sisters, nor best friends, nor therapists can be there always for someone else. She replied: “But that’s too hard.” I agreed with her that it was very difficult and a painful part of growing up. I understood her dependence on this imaginary goddess (who became all too real) first as a replacement for her mother, who was trying very hard to separate from her daughter, and second as a replacement for me who also let her down. I think she became furious with me for helping her mother to leave her bedroom, and when I was not a sufficient replacement she needed to make up an imaginary goddess who was all-powerful. Jane was able to express anger toward me by telling me she needed to replace me with her goddess, and when she shared a fantasy where she threw water in my face and I threw her out my window. I think she was terrified that I would not be able to withstand her intense rage and murderous wishes. The fantasy life of children who perceive themselves as defective and who are filled with shame are often grandiose and unrealistic, and may interfere with reality testing and developing healthy object relations (Jacobson, 1959; Lussier, 1960; Niederland, 1965). Jane’s parents became alarmed with her Wicca involvement, which at first infuriated Jane, but also scared her. Slowly over many months she gradually lost interest in Wicca and was able to let go of her goddess.

When Jane was thirteen years old, she began to menstruate and refused ...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• CONTENTS
• ACKNOWLEDGMENTS
• ABOUT THE EDITOR AND CONTRIBUTORS
• INTRODUCTION
• PART I: DEVELOPMENTAL REALM
• PART II: CULTURAL REALM
• PART III: CLINICAL REALM
• REFERENCES
• INDEX