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When Shame Turns Malignant

As mentioned yesterday, this week, I am attending a Scientific Symposium called “Recovery From Addiction“, organised as part of the Alberta Family Wellness Initiative of the Norlien Foundation.

One of the most fascinating and thought-provoking presentations yesterday, was a talk by Garrett O’Connor, Medical Director of the Professional Recovery Program at the Betty Ford Center, one of the leading US addiction treatment hospitals, on the topic of shame.

As Garrett pointed out, shame is not only a taboo topic but also leads to isolation, guilt, denial, secrets, silence, hidings and cover-ups – all issues related to addictions (and often obesity, I may add).

It seems that the phenomenon of shame is deeply ingrained in our biology and probably evolved to keep our reptilian brains in check.

Garrett described shame as, “A sudden decrease in self-esteem, an uncomfortable nanosecond in which we are revealed to ourselves as being something less than we wanted to believe“.

The emotions associated with shame can result in shyness, embarrassment, humiliation, alienation, or even mortification (shame can kill). Shame is the affect of inferiority, failure, mediocracy, inadequacy, dependency, unworthiness, abandonment, and expulsion.

There is a wide range of experiences that can result in shame, including witnessing or experiencing physical, mental or sexual abuse, witnessing domestic violence, mental illness, substance abuse, or criminality in the family, parental separation or divorce.

“Healthy” shame protects and motivates the self in a positive direction by deeply disturbing our sense of self or who we think we are.

In contrast “malignant” shame attacks and wounds the self, slices through the ego, and can express itself by rage and self-loathing. Often, malignant shame manifests itself as fear and terror of being judged negatively, or found wanting by a person or institution with real or imagined power and authority over you. It may lead people to evolve a false persona to conceal the “worthless person” hidden behind the mask of shame. In many cases malignant shame turns to despair – blocks feelings and connectedness.

Garrett spoke about how shame can cascade down through generations as it runs in families or even, as in the case of historical shame, can affect entire populations or societies.

When both personal and cultural shame come together, things can really go wrong. One example of malignant shame, discussed by Garrett, was the collective shame experienced by Germany after losng WW 1, which led to subsequent embracement of the Third Reich with projection of the shame into Jews, thereby making it appear “legitimate” to exterminate them in the holocaust. Clearly, the Nazis lacked “healthy” shame, which may well have have prevented these atrocities.

In North America, alcohol and other measures were used to induce malignant shame in the native populations resulting in much of the problems that these populations still face today (poverty, alcoholism, addiction, obesity, etc.).

Referring to his own experience with alcoholism, Garrett described how 25 years of shame, fear, remorse, despair, humiliation and dehumanisation were compounded by recognition of his own moral and spiritual bankruptcy with intermittent bouts of suicidal ideation.

I could not help but wonder, how often malignant shame plays a role in weight management. Many of my patients have experienced deep shame – shame about experiences or circumstances in their lives, but also shame about their failure to conquer their weight. For patients who chose bariatric surgery, shame can even come from appearing to have taken the “easy way out”.

Unfortunately, there is no easy way to deal with malignant shame. It appears, that as with addictions, the 12-steps approach may be the most effective.

Perhaps, as often, the first step on the path to healing is to simply acknowledge and accept shame as part of the problem. Anyone practicing in bariatric medicine or surgery should be sensitive to shame and learn to address this issue in a sensitive and constructive manner.

Banff, Alberta


  1. Hi Arya,
    Question: did you ear some research about causal link whit addiction-shame-social status? Lot of literature about how shameful it is to be “poor” in capitalism society…[it a degree of matter because we are always poorer when we compared our income whit someone else lol ]

    And some time direction is not clear…..
    Is it
    Poor Income =>big shame =>more addiction

    OR income orientated (inducing) which addiction =>shame =>more addiction => less money …

    One of “the classic” reference about that in sociology of deviance is definitely Howard S. Becker whit is book: Outsider (1985).
    Thanks, Nathalie

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  2. One of the issues implied via shame in addition to all you mentioned is the quality of experiencing one’s self as undeserving as a result of having been shamed. I think the links to overweight and obesity will be complex as each person’s reaction to shame will have been uniquely constellated via their familial, social, academic and other contexts -in other words, shame is profoundly relational in nature. As such I believe it needs to be addressed by exploring the multitude of ways it has been established, articulating what those are and that those are often first steps to dismantling what you are referring to as malignant shame. This could happen via a psychotherapy or psychoanalysis process or as you note by a 12-step program. Whatever it is, my belief is it takes a long, complex time to build shame and it takes a long, careful time to break it down and disempower it.

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  3. Dr. Sharma, this subject is so timely in weight management. Many of my patients express shame saying things like, “I feel gross that I can’t control myself” or “I hate by body”. I have seen exercise help tremendously. It boost self efficacy and when adhered to, it can be one tool along with cognitive reprogramming that works.

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  4. This is an area where psychotherapy can certainly help. An ongoing relationship where the therapist doesn’t validate the shame but acknowledges the feelings that are associated with it can be tremendously therapeutic.
    I have been in the place of feeling “gross” — even to the point of concern that I would be perceived as disgusting to my MD and his/her staff. Doctors that make a point of treating their larger patients with kindness, acceptance and touch can also provide healing. Even saying an earnest “It’s nice to see you” can go a long way.

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  5. As an obese woman (who’s been overweight my entire life), I can say with total certainty that shame is the DOMINANT emotion I feel on a daily basis. Shame gets programmed into overweight individuals via bullying, taunting, judgment and social ostracism (ie, direct human interaction), and via the indirect messages in all our forms of entertainment (movies like “Shallow Hal”, the “Fat Monica” episodes of “Friends”, and the billions of other occasions on which obese bodies are used as sources of disgust, repulsion, lower status and mockery). We all know that already, yes. I think what’s horrible, though, is that even for those of us who should be “smart enough” and “empowered enough” to get past that shame — even when we know, cognitively, that shame, like guilt, is a useless emotion — we can’t. I know I can’t! I’ll speak for myself, here: the sense of being an utterly unworthy human being is so strong, and the FEAR of the continuous, relentless judgment and hatred I’ll continue to incur is so strong, that I find myself backing away from many life situations — for example, I HATE eating in public…I hate going ANYplace in summer, because it means either showing more of my body, or covering up my body and being horribly uncomfortable…I LOATHE having to see doctors and specialists, for fear of how they’ll react to my weight, and have had experiences of putting off necessary doctor appointments for as long as humanly possible to avoid the shame I’ll be made to feel…and, while I love working out at the gym, going there means getting past the hurdle of knowing that I’ll probably be laughed at, snickered at, stared at, sneered at (several weeks ago, a pack of boys on the sidewalk outside the gym window saw me on the treadmill, started laughing uproariously and snapping photos of me with their cell phones). Furthermore, when one is living with this much shame around one’s body, it means that there is no “room” for any other self-esteem lowering events. For example, on top of being obese, I am now losing my hair — and the potentiality of being BALD on TOP OF being fat is, I’ve got to tell you, so alarming and devastating that all I can imagine is locking the door to my apartment and never going outside again.

    Now, if I’m an extremely extroverted, outspoken, active and impassioned person (er, I am) and I feel this vulnerable and this inclined to retreat from life, think of how much more vulnerable other overweight people are who AREN’T bold, outgoing loudmouths.

    My point is, many many fat people get caught in a vicious cycle created by the effects of lifelong shame, ostracism and bullying. If our efforts to be active, social, healthy individuals entitled just like everyone else to be out in public living full, happy, colorful lives are thwarted by the public’s response to our bodies (the laughing young men photographing this fat lady walking on the treadmill, for example), we are NOT going to continue to do the activities that might elicit that response. And if we retreat from the world, and from life…stay home, where there are no mocking voices, no sneering people, no doctors to admonish us, no salespeople staring as we search for clothes….then we increase our isolation, and very likely, our weight. We get more ashamed. The next time we try to participate in life, the reaction to our bodies is even WORSE. We retreat, eat more, grow more ashamed. Repeat, repeat, repeat.

    This is no way to live. This is horrible.
    Something has to change.

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