Wendy Lowe takes a look at a new edited collection on shame, and explores its relevance to the medical humanities.
In some ways, because Interdisciplinary Perspectives on Shame deals with a cultural tendency to hide shame away, this is a troubling book. It may be that one’s reception of it will depend on one’s own relationship with shame. That is, culturally, feelings of shame tend to be dismissed or transmuted into blame, attack or rejection of others who don’t fit preconceived ideas of how we should be. For example, a culture of shaming seems to have emerged during the COVID-19 pandemic, with people who are perceived not to be adhering to guidelines being blamed for new outbreaks, leading to stigmatisation and discrimination. Shame could be seen as a boundary experience (Ney, 2019) where our cherished beliefs about who we and others are come into contact with the world and perhaps require adjustment. Perhaps there is also a shared, although unacknowledged, cultural shame about the possibility of collective culpability regarding certain aspects of the pandemic: do we all feel we could have done better – especially when considering the disparities in prevalence and severity of outcomes from COVID-19 for people of different ethnic groups in the USA and UK (Bassett et al, 2020; PHE, 2020)?
Chapter One of Interdisciplinary Perspectives on Shame establishes shame as a universal concept, but this chapter can come across as abstract in its linguistic analysis. Chapter Two deals with the difficulties encountered by philosophers and psychologists seeking to identify shame’s ‘core’. The statement that all self-conscious experiences require a double perspective, involving self-distancing, reminded me of Arendt’s (1971) point about the silent witness waiting at home, expecting us to give an account of ourselves. We see ourselves and our lives through others’ eyes. However, the author states that any distortion is an attribute of the mirror; not the subject, which is a useful way of thinking about shame. That is, we see ourselves through the eyes of the social critic which diminishes our capacity to act. This perhaps may account for the feeling of imposter syndrome (LaDonna et al, 2018).
Epistemic shame features in Chapters Three and Four: this is the shame experienced when we do not know what to do or how to think about an intractable problem. Shame can motivate us to learn more, via acknowledgement of inadequacy; it is primary in our cognitive transformation of these intractable problems. That is, shame can be regarded as a learning experience. Shame is an affective tool that compels us to do better in situations where we come up against our own wall of knowledge and competency. That wall can be a lack of knowledge or it can be a psychosocial barrier that limits insight and so disrupts learning. There may be a tension between the cultural desire to dismiss or run away from gaps in knowledge and the desire to learn more; this experience of tension may compel us to deal with our own self-doubt. The potential to put shame to good use also depends how it is viewed by the community within which one is embedded.
Given that shame is associated with marginalisation and exclusion, the positive aspects of shame may be hard to reach. Likewise, physical and cultural barriers may work to exclude people, as explained in Chapter Five. But this does not mean to say that the shame is therefore on the excluded person; rather, it is (or ought to be) on the social world. This is a difficult notion because on the one hand the authors suggest that shame is an unconscious, embodied response to events in the material social world. That is, the origin of shame belongs to the social world. On the other hand, a person experiences shame as belonging to them, as an inherent failing that they have, due to the feeling of what happens to them; the event.
Part Two moves on to exploring norms, cultures and politics around the experience of shame. In Chapter Six, Daniel Herbert deconstructs the Christian influence on shame. He draws on Nietzsche’s challenge that we should live unashamedly, whilst at the same time eschewing shamelessness and shameless pity. Herbert promotes the idea of living on a knife-edge between potentially polarizing forces of shamelessness and shameless pity through awareness of the socioeconomic conditions that produce creativity. The knife-edge requires us to be critical of both shame and shamelessness when they threaten to undermine life-affirming attitudes, such as those offered by ancient Hellenic culture. Whilst, for Nietzsche, Hellenic culture produced great works of art and life-affirming luxuries and privilege, this achievement was gained at the expense of exploiting labour, including slavery. Thus shame attaches to an awareness of the hierarchical socioeconomic conditions which enable artistic culture.
In Chapter Nine, shame is posited as a master-emotion in contemporary neoliberal societies. Mikko Salmela reflects on the relationship between the social contract and public health. Healthcare professionals’ self-perception and practice are impacted by factors including the retraction of the welfare state, the downsizing of the public sector, economic deregulation, privatisation, and globalisation (with its colonial past). For example, health professionals may have an awareness of social and individual suffering, yet often feel unable to do anything about this. Worse, they may also feel that because they have not been able to improve conditions of suffering or have a positive impact on health inequities (whose worsening is highlighted by the COVID-19 pandemic), they are somehow complicit in perpetuating suffering. In this context, healthcare professionals have to deal with a potential loss of hero status (Zembylas, 2019). In fact, this loss of hero status has already been apparent in media releases which exhort General Practitioners to return to work, even though they never left it or their patients. These musings inspire the ability to be with shame more and to learn from it, rather than avoiding it, which is perhaps the more usual gut reaction.
For me as a healthcare professional, it would have been interesting to see more on how this work could be applied in the field of healthcare, since shame can play a significant role in this context. For example, some patients state that they feel a need to hide from healthcare providers (Adams et al, 2019). It will be intriguing to follow the new Wellcome Shame and Medicine project as it explores how patients and health professionals are tied together by unacknowledged shame (Lyons & Dolezal, 2017). It seems important to question how scientific, empirical models of care impact on the lived experience of shame through depersonalisation and dehumanisation.
Overall, Interdisciplinary Perspectives on Shame examines this complex affective state through a variety of disciplinary lenses. Examining its place in societies of the Global North, the book unpacks shame in the context of a colonialist, Christian history, and a neoliberal present. It is rare to explore a human affect such as shame in this context, and yet it must play an enormous part in colonialist strategies. Shame and exclusion of those considered ‘other’ to the white male colonialist norm are inherently intertwined and co-constitutive (Singleton, 2015). A consideration of the collective cultural shame attached to an awareness of hierarchical socioeconomic conditions is particularly timely for medical humanities. Artistic culture is linked with socioeconomic conditions; perhaps now, more than ever, we need to be aware of the conditions that make art and the humanities possible.
References
Adams J., Lowe W., Protheroe J., et al. 2019. Self-management of a musculoskeletal condition for people from harder to reach groups: a qualitative patient interview study. Disability Rehabilitation; 41(25):3034-3042, doi:10.1080/09638288.2018.1485182.
Arendt H. 1971. Thinking and moral considerations: a lecture. Social Research; 38(3):417-446.
Bassett MT., Chen JT., Krieger N. 2020. The unequal toll of COVID-19 mortality by age in the United States: Quantifying racial/ethnic disparities. HCPDS Working Paper; 19(3).
LaDonna KA., Ginsburg S., Watling C. 2018. “Rising to the Level of Your Incompetence”: What Physicians’ Self-Assessment of Their Performance Reveals About the Imposter Syndrome in Medicine. Academic Medicine; 93:763–768.
Lyons B., Dolezal L. 2017. Shame, stigma and medicine. Medical Humanities; 43:208–210, doi:10.1136/medhum-2017-011392.
Ney A. 2019. Metaphysics: an introduction. Routledge: London.
Public Health England (PHE). 2020. Beyond the data: Understanding the impact of COVID-19 on BAME groups. PHE publications gateway number: GW-1307.
Wellcome Trust. 2016. The shame and medicine project. http://www.shameandmedicineproject.com/.
Singleton J. 2015. Cultural Melancholy: Readings of Race, Impossible Mourning, and African American Ritual. University of Illinois Press.
Zembylas M. 2019. “Shame at being human” as a transformative political concept and praxis: Pedagogical possibilities. Feminism & Psychology; 29(2):303-321.
Interdisciplinary Perspectives on Shame: Methods, Theory, Norms, Cultures and Politics by Cecilea Mun was published in 2019 by Lexington Books.
Wendy Lowe is a Senior Lecturer in Medical Sociology and Medical Education and Module Lead for the Human Science Public Health module in Years 2 and 3 of the MBBS and GEP at Barts and The London School of Medicine and Dentistry. Her PhD explored how health professionals are educated.
