Sunday, May 10, 2009

Depression and the Shackles of Shame


There is no blood test for depression, no x-ray nor sonagram.  Depression is the label that is given to a constellation of symptoms.  There are theories about the cause of the symptoms.  But the diagnosis is more like tea leaves. 


Depression Diagnostic Criteria 

· Lasting sad, anxious, or empty mood
· Loss of interest or pleasure in activities once enjoyed, including sex

· Feelings of hopelessness or pessimism
· Feelings of guilt, worthlessness, or helplessness
· Decreased energy, a feeling of fatigue or of being “slowed down”
· Difficulty concentrating, remembering, making decisions
· Restlessness or irritability
· Sleeping too much, or can’t sleep
· Change in appetite and/or unintended weight loss or gain
· Chronic pain or other persistent bodily symptoms without physical cause
· Thoughts of death or suicide, or suicide attempts
.


If you have five of the above, including one of the first two, for more than two weeks, and without appropriate reason (like, your mother died) then that's depression. You've got the Grim at the bottom of your teacup. 

Guilt

I have done enough intake interviews that I recognize the differential diagnostic tree when it's coming at me. I used to get nervous when they asked about guilt. No, I don't actually feel guilt, except appropriate guilt for recent misbehavior, not the horrible self-judgment for imagined offenses. I don't feel guilty for my depression. I am not the offender but the offended.

Shame

No, what I feel about my depression, and events that are related, is shame.  And what I really feel shame about is feeling shame.

We don't do shame in this country.  I have heard there are guilt cultures and shame cultures, and that the United States is a guilt culture.  Places like Japan and Iran are shame cultures.  "You should be ashamed of yourself" -- people aren't supposed to say that here, because shame is bad, and making people feel ashamed is bad.

Yes, it is bad. I know, because I do feel shame, and it's not pretty.  I know it's not logical.  "You shouldn't feel ashamed" -- that's something else people say.  So I do something that I shouldn't, feel ashamed, which is why I am ashamed of my shame.

Research On Shame In Depression

And I get nervous when my shame is at risk of being discovered, like in an intake interview. I get nervous, but I needn't.  They never ask.  They don't ask, because it is not part of the diagnostic criteria for depression.  It's over in another branch of the tree that we aren't exploring.

So I was curious to discover a study about shame, guilt and childhood psychological mistreatment that says:

1) Shame and guilt together are positively associated with depression.
2) Guilt without shame is not positively correlated with depression.
3) There are other studies that indicate shame is associated with poor psychological functioning, but guilt isn't.

Huh?  Then why is guilt one of the diagnostic criteria? And why isn't shame?

Actually, I am glad that it isn't, because I don't want to talk about it.

Which brings me to another article about shame, reporting a review of the literature by A. Hook and B. Andrews, which includes:

1) Shame is associated with the onset and course of depression, especially recurrent and chronic depression.
2) Shame is a major reason why clients withhold information in therapy(nearly 75% of the time).
3) Withholding information, especially about symptoms, is associated with poorer outcomes in therapy.

All of which seems perfectly obvious.  What is not obvious is why shame is not one of the symptoms of depression.  Actually, I am glad that it isn't, because I don't want to talk about it.
photo in public domain and modified
reformatted 11/27/10

3 comments:

  1. Hello,

    Shame is the hallmark of how I feel, not guilt, just shame. I am ashamed of the opportunity I enjoyed to get a college education, but could not fulfill the promise of that degree by holding down a job. I am ashamed of the marriage I could not hold together because I could not maintain the middle class standards it required. I am ashamed that although I managed to give birth to and nurture three neurologically normal children, who have successfully been launched into young adulthood, that I cannot enjoy this time with them due to my financially reduced circumstances.

    I am ashamed that although I enjoy an above average intelligence that I have not found a way to make a contribution to my generation (or the next) that will withstand the vicissitudes of time.

    And finally, for all the above reasons, I am ashamed to be seen in public.

    From the heart of a recluse.

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  2. I know it's three years since you posted this, so this might no longer be of interest... Then again it might be... This morning i had the intuition that my depression might be connected to my tendency toward shame. So, i searched for that and stumbled on an interesting article by Thomas Scheff: Shame and Community. He, too, talks about the cultural connection that bonds shame & depression. One of the commentators also links in a self-critical personality, which is nurtured (to everybody's detriment) by our culture.

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  3. After many years of suffering under the weight of guilt and shame, I released myself from those emotions. I feel regret for actions that I do not wish to repeat and remorse for actions that require an apology on my part. Otherwise, no guilt and no shame. Short of committing abuse, no one need feel guilt or shame...

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