Body Shame

Conceptualisation, Research and Treatment

Paul Gilbert, Jeremy Miles, Paul Gilbert, Jeremy Miles

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317822318
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Physical appearance plays a powerful role in social relationships. Those who feel shame regarding the way they look, and who think others view their appearance negatively, can therefore be vulnerable to impoverished social relationships and a range of psychological difficulties. However, there are a few books which look specifically at the many permutations of body shame and their differing treatments.
In this book, researchers and therapists from a wide range of different disciplines and areas explore the role of shame in various physical and psychological disorders, and provide practical advice on management and treatment. Chapters are organised to address issues of conceptualisation, assessment and treatment, on topics such as:
* definitional controversies
* possible biopsychosocial and evolutionary origins of body shame
* effects on adjustment to maturation and aging process
* specific forms of disfigurement
* the role of body shame in depression, eating disorders and body dysmorphic disorder.
Body Shame gives the reader insight into the nature and mechanisms of shame, how it can focus on the body, how it can underlie a variety of psychological difficulties, and how to intervene to help resolve it. This book will be invaluable for practitioners from different disciplines working with people who have problems centred on their physical appearance and/or functions, and clinicians working with various mental health problems.

Part I
Introduction

Chapter 1
Body shame

A biopsychosocial conceptualisation and overview, with treatment implications

Paul Gilbert

Introduction

Shame has recently received increasing theory and research attention, as both a personal experience (to feel ashamed: Tangney & Fischer, 1995; Gilbert & Andrews, 1998) and an interpersonal process, via acts of stigmatising and shaming (Crisp, 2001; Jacoby, 1994). The experience of shame can be focused on many characteristics of the self, such as feeling ashamed of emotions (e.g., one’s anxiety, anger or sexual feelings); behaviours (e.g., things one has done in the past); perceived personality traits (e.g., laziness or carelessness) or even states of mind (e.g., mental illness). When people experience their physical bodies as in some way unattractive, undesirable and a source of a ‘shamed self’ they are at risk of psychological distress and disorders (Thompson & Kent, 2001). Such experiences are sometimes referred to as body image disturbances (e.g., Carr, Chapter 4, this volume; Cash & Grant, 1996). However, the concept of ‘body shame’ directs attention to negative experiences of both appearance and functions of the body, which can involve various sensory modalities (e.g., smell, and touch as well as vision or image, Ekströmer, Chapter 9, this volume). Moreover, by focusing on shame we can distinguish stigma, internal and external shame, and humiliation, and consider body shame in the context of developing self-awareness competencies that unfold in social and cultural contexts. Hence, this book brings together authors from different backgrounds to address the nature of ‘body shame’, and its relationship to psychopathology and treatment. As ‘body shame’ is a relatively new concept that can link different literatures, the opening sections of this chapter offer an overview of current approaches to shame. We note the complexity of our self-conscious emotions and their relationship to primary emotions. An evolutionary and biopsychosocial framework is outlined that offers the possibility of integrating physiological, psychological and socio-cultural processes and interactions. In the latter sections the relationship of shame to psychopathology is explored with a consideration of some key elements in psychological interventions.

The nature of shame

Emotions such as rage/anger, fear/anxiety, sadness/despair and joy/happiness are often considered as primary or basic emotions (Panskepp, 1998) and are the main components of our negative and positive affect systems (Clark, 2000). We share these emotions with many other animals, they can be elicited by simple threats and losses, and we know something of their evolutionary history (Nesse, 1998) and neurophysiology (Panskepp, 1998). Emotions such as shame, embarrassment, pride and guilt are sometimes referred to as secondary, higher-order or self-conscious emotions (Lewis, 1995; Tangney, 1995). These emotions are less shared (if at all) with other animals, are relatively new on the evolutionary stage and we know much less about their neurophysiology (although see Schore, 2001). Self-conscious emotions develop later than primary emotions and are dependent on various, unfolding competencies (Lewis, 1992; Tangney & Fischer, 1995; Zahn-Waxler, 2000). These competencies begin to unfold from around two years of age and include: an ability to recognise self as an object for others, theory of mind (able to make judgements about what others are thinking), awareness of the contingencies for approval and disapproval, and competencies for role-taking and understanding social rules. It is these self-conscious competencies that blend with primary emotions that give rise to self-conscious emotions of shame, pride and guilt. Thus, a threat to the self as a social agent (e.g., shame) can recruit negative primary emotions (e.g., anxiety, anger, disgust) and reduce positive emotions in various ways. Hence, as we will note below, some people will respond to a threat to the self (e.g., criticism or rejection) with anger while others will show more anxiety and submissive behaviour. In other words, self-conscious emotions operate through, and are shaped by, our competencies for a sense/construction of self as a social agent.

There are, in fact, a number of different conceptualisations and debates on what actually constitutes a shame experience. For example, there is debate on whether shame can occur in babies, before the development of self-conscious competencies (Barrett, 1995; Gilbert, 1998a). Tangney (1995) argued that shame experiences are primarily ones of ‘emotion’, and although there are events that are more likely to elicit shame than others Tangney makes clear that shame comes from the self-relevant meanings given to the event rather than the type of event; a principle central to cognitive formulations of emotion.

The way self-conscious emotions, such as shame, blend primary emotions is complex and still not well understood. For example, shame commonly involves anxiety but is also different from it. For example, one patient related an incident where she had felt intense shame; her boyfriend telling her he had found out that she had had an abortion some years before, and was now unsure if he wanted to continue the relationship with ‘a person who could do that kind of thing’. She said, ‘I just felt this panic, and inner sense of deflation like something was going out of me. Everything in me just stopped and I couldn’t say anything. I wanted to die then – just not be there. I never want to feel like that again . . . This [her abortion] is going to haunt me for the rest of my life.’ Later, she acknowledged another set of thoughts and feelings about her boyfriend and disappointment in him; that he could not be more understanding and accepting – if he really loved her.

In some cultures (e.g., Japan) social anxiety and shame have always been closely linked (Takahashi, 1989). However, although Gilbert, Pehl and Allan, (1994) and Gilbert (1998a) argued that there is a huge overlap between the processes involved in shame and social anxiety, these two literatures have largely ignored each other, despite evidence for their current measures being very highly correlated (Gilbert, Pehl & Allan, 1994; Gilbert, 2000a). Using the aforementioned example we can also note the sense of dejection or deflation that people experiencing shame can speak of. Indeed, some believe that a sudden decrement in positive affect is central to shame (e.g., Nathanson, 1994).

Hence, one way to see shame is as a multifaceted experience that has various aspects and components. These include:

1. A social or external cognitive component: Shame affects are often elicited in social contexts and are associated with automatic thoughts that others see the self as inferior, bad, inadequate and flawed; that is, others are looking down on the self with a condemning or contemptuous view. This is linked to stigma consciousness and is explored in more detail below.
2. An internal self-evaluative component: For many theorists shame involves a global negative self-evaluation as bad, inadequate and flawed (Fischer & Tangney, 1995). Shame is thus commonly associated with negative automatic thoughts about the self. Indeed, many self-critical and self-attacking thoughts (e.g., I am useless, worthless, ugly, no good, a bad person, a failure) are in essence self-devaluations and internally shaming thoughts. This will be explored in more detail below.
3. An emotional component: The emotions and feelings recruited in shame are various but include anxiety, anger and disgust in the self and self-contempt. Some people talk of a type of inner deflation (as the lady above did) or dejection, although there is little research on this aspect. Tomkins (1981, 1987), Kaufman (1989) and Nathanson (1994) argued that shame is an affect associated with the interruption and sudden loss of positive affect. Although positive affect is inhibited or reduced in shame (Tangney, 1995), it is unclear if this can be seen as the basis of shame since most other negative affects (e.g., anxiety and sadness) also involve changes in positive affect (Gilbert, 1998a). Shame affect is often seen as the opposite of pride (Mascolo & Fischer, 1995); that is, shame is related to diminishment and loss, but has also been linked to dignity (Gilbert, 1998a) and in anthropological writings, to (dis)honour (Lindisfarne, 1998). Kaufman (1989) and Nathanson (1994) both develop Tomkins’ idea that shame often binds (or fuses with) other primary emotions such as anxiety, anger or disgust, giving different textures to how shame is experienced.
4. A behavioural component: Shame is often associated with specific defensive behaviours such as a strong urge to ‘not be seen,’ avoid exposure, to hide, and/or run away (Lewis, 1992; Tangney, 1995). Eye gaze is commonly averted and the individual may feel behaviourally inhibited. These responses have been linked to a rapid onset of submissive defensive behaviours (Gilbert & McGuire, 1998; Keltner & Harker, 1998). However, when anger is the emotion elicited in shaming encounters, the desire to retaliate or gain revenge against the one who is ‘exposing’ the self (as inferior, weak or bad) can be high, although may be inhibited or expressed (Retzinger, 1991). When there is a focus on the ‘other as bad’ for the shaming this has been referred to as humiliation. Again, we explore this in more detail below.
5. A physiological component: Shame is clearly related to a stress response although the exact nature of it is unclear. In some cases it may involve heightened parasympathetic activity (see Schore, 1994, 1998). As noted above, although we know something of the neurophysiology of primary emotions, such as anger, anxiety and disgust (Panskepp, 1998), we know much less about the neurophysiology of shame.

So, shame is a complex set of feelings, cognitions and actions, tendencies whose exact complexion can vary from person to person. It is an experience that is self-focused however, dependent on the competencies to construct self as a social agent and thus is called a self-conscious emotion (Fischer & Tangney, 1995). Like other emotions (e.g., anxiety, anger or disgust) there may be fast, affect-based, limbic-centred processing systems that point to a complexity of the cognition–emotion interaction (Panskepp, 1998). Also, like other emotions, while some people seem able to tolerate shame feelings (at least to some degree) without acting out defensive behaviours (e.g., hiding or concealing), others find them intolerable and will go to great lengths to avoid both the situations eliciting them and the feelings themselves.

Competing to be attractive

One way of helping to explore the complexity of shame and highlight the reasons why shame should not be reduced to (say) social anxiety, even when it is one of its more common components, is to suggest that negative emotions are often reactions to threats. Different threats are associated with different emotions, for example, jealousy, sadness, anger and anxiety (Nesse, 1998). This leads to the question of what are the threats that our capacity for shame evolved to cope with? Scheff and Retzinger (see Retzinger 1991, 1998) have argued that shame is related to threats and disruptions to social bonds. Framed in a slightly different way, Gilbert (1997, 1998a) suggested that shame is an affective-defensive response to the threat of, or actual experience of, social rejection or devaluation (loss of status) because one is (or has become) unattractive as a social agent.

Conceptualised this way turns a spotlight on to questions of why humans are so sensitive to how ‘attractive’ (and not just physically) they are to others. This, in turn, is linked to questions of the distal processes that may have led to the evolution of self-conscious competencies (e.g., theory of mind). Part of the answer may be related to the evolution of behavioural strategies that function to enable animals to develop social roles and interactional patterns for example, to form sexual and alliance relationships (Gilbert & McGuire, 1998). For example, for many species, from fish to humans, a central social strategy (serving reproductive fitness) is to attract others (via various displays and signals) and engage them in certain types of roles and relationships. For sexual behaviour one can think of the various colourings, plumages, size and scent displays that are used to attract mates. For millions of years the power of attraction as a social strategy has shaped the evolution of minds and brains. Indeed, for millions of years humans have competed to be seen as attractive to others because those who were so regarded had better access to social resources (support from others, allies and sexual partners) that enhanced their fitness. Those regarded as unattractive and rejected, ostracised or ‘demoted’ will have suffered in the competition for such resources. Consequently, over millions of years various mental mechanisms may have evolved to track and attend to such threats and respond to them with various defensive behaviours (Gilbert, 1997, 2001a). As relationships became more central to a range of inclusive fitness outcomes, it can be suggested that one of the evolutionary pressures that gave rise to our various competencies that unfold from two years onwards (such as our ability to recognise self as an object for others, theory of mind, awareness of the contingencies for approval and disapproval, and competencies for role-taking and understanding social rules) was the importance of eliciting (manipulating) positive responses (care, support and acceptance) from others.

There is little doubt that from the cradle to the grave humans are highly dependent on the help and support they receive from others. Indeed, in many types of relationships (e.g., between infants and parents, friends and lovers), signals of acceptance and being valued are physiologically regulating and impact on stress hormones and various neurotransmitters that are linked to positive affect (Cacioppo et al., 2000; Schore, 1994, 2001). In order to participate and engage others in mutually beneficial social roles one must be included and valued (Baumeister & Leary, 1995). However, as Tooby and Cosmides (1996) suggest, engaging successfully in many forms of social relationship, such as eliciting parental investment, developing supportive peer relationships, and attracting desirable mates, there is an underlying competition. This is because investing in relationships is not cost free. Hence, people will invest their time and energy in those with whom they can form beneficial relationships; relationships that are in some way useful to their own interests, whereas associating with those who are seen as unattractive in some way can be detrimental to self-interests. Clearly, in general then, we want to be someone others will invest in rather than reject.

However, there are both cultural and evolutionary reasons to make selections between people and reject some in favour of others. For example, Kurzban and Leary (2001) suggest that stigmatisation ...

Table of contents

• Cover Page
• Half Title page
• Title page
• Copyright Page
• Contents
• Contributors
• Acknowledgements
• Preface
• Part I Introduction
• Part II Body shame and disfigurement
• Part III Body shame and psychological disorders
• Index