Put to shame

Mental Health Nursing,  Sep 2006  by Jones, Alun

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Helping professional service providers to become more aware of situations which provoke feelings of shame in service users and their families, may bring benefits to all concerned. More thoughtful service planning and professional preparation might be possible, bringing beneficial changes to the organisation of health services.

Shame is socially and culturally influenced. It is an adaptive emotion, concerned with reducing threats to a group's cohesiveness and so it has survival value. Even so, under some circumstances, shame can prove psychologically overwhelming and damaging to a person's wellbeing. The experience of shame is typically powerful and unpleasant. Shame has the potential to spoil identity for generations yet to come. Recovery from mental illness might therefore be negatively influenced by feelings of shame and have far reaching effects on individuals and their families. There might also be increased financial costs to health services, in that mental health problems are worsened by shame-fuelled ruminations. Consequently, a moral imperative for health professionals is to better understand how health provision might invoke shame responses in different situations.

Health professionals may also feel shame, in part because of affiliations with stigmatised groups. Yet in an early paper, Lazare (1987) indicated that all medical encounters have potential to arouse shame in both service users and professionals. Illness can imply failing, and health service use typically requires the scrutiny of another and personal exposure. Consequently, there are possibilities to arouse feelings of shame. Lazare (1987) suggested that in response to shame, individuals might withhold information, hide away, complain or take legal action against the providers of health services. The author also believed that health professionals might experience shame too because of real or imagined shortfalls in their work. This can result in professionals counter-shaming others as a corresponding psychological defence.

For these reasons, it seems sensible that all health professionals recognise and examine prejudices and identify values and moral principles influencing the course of their work. The values of those who make up organisations and provide services can differ considerably from those who deliver care or who use services.

Variations in values between professional groups and service users could lead to reduced quality in service provision and contribute to feelings of distress in those looking to mental health services for help. Being aware of the potential to invoke shame could help all involved with service provision and uptake to identify common ground and shared values while respecting differences.

Reference

Lazare A (1987) Shame and humiliation in the medical encounter. Archives of Internal Medicine 147(9): 1653-8.

Alun Jones is a member of the Mental Health Nursing editorial board and lecturer at the University of Manchester

Copyright Community Psychiatric Nurses Association Sep 2006
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