During my last supervision session with my clinical supervisor (which is recommended for all practicing therapists/counsellors to have), she asked me to think about how I address shame in session with clients and we could discuss it next time (unless I have more pressing topics I need to talk about). Interestingly, just a few days later I stumbled upon an article about shame, and then a podcast. Both around shame and illness. Shame is a natural human emotion that we all experience. Myself included. I’m trying to remember if I felt shame around my chronic pain/illness and if I did, I would say it was near the beginning of my healing journey, which almost feels like a distant memory. Yet, I think it’s really important for us to talk about shame because it is one of (if not the) most uncomfortable emotions to experience.
Shame, like all of our emotions is important. We wouldn’t have evolved all of these emotions if they weren’t useful in some way. If we go back to that caveman mind metaphor I’ve written about before, shame helped to keep us alive. As cave people, if we got kicked out of the clan, we would die because there would be less protection. So shame helps keep us in check with the expectations of those (clan members) around us so that we don’t get “kicked out.” The problem with that is, we will probably physically survive if we do get “kicked out” in 2022. It also, maybe even more importantly at this point in our history, lets us know when we’ve done something that contradicts our values (those qualities of action that determine how we treat ourselves, others and the world). When we don’t follow our values, we often experience shame.
Shame and chronic pain can often coexist. Many people with chronic pain experience higher levels of shame than in the general population (Boring et al., 2021). Part of the reason this happens is because chronic pain, especially if the cause isn’t quite yet known, is often invalidated – by family, friends, and healthcare professionals (especially medical doctors). When our pain is constantly invalidated by others, we are more likely to question the severity of our pain, hide our pain, and disregard our pain and other feelings. The more we do this, the more internalized shame develops. There are several problems with this:
- shame can lead to depression – there is a huge correlation between depression and chronic pain as they can amplify each other. If shame leads to depression then…
- pain not only increases but can also stick around longer – yes chronic pain means it’s sticking around, but to what intensity, to what end? and does it have to be that bad all the time?
- it can also change our beliefs about ourselves – this can lead to increased substance use and other behavioural problems that just increase shame and pain
- shame also causes stress, and we know from research by people like Gabor Mate and Bessel van der Kolk, this can cause physical symptoms such as chronic pain, as well as a myriad of other illnesses
How do we deal with shame? I mean, I’m always going to say that therapy/counselling (they’re interchangeable terms) is a good route to go because many therapists can help you talk through and give you skills to deal with these feelings. Brene Brown, who has done a ton of research on shame, has said that empathy is the best cure for it. Empathy is our ability to share in the feelings of others. Based on the definition of empathy, we need that support from others. What can we do for ourselves though? Kristin Neff, who has done a ton of research on self-compassion, has unsurprisingly found that self-compassion is an effective antidote to shame. As a clinical counsellor I am able to offer empathy to my clients, while not hiding away from shame when it comes up in session, which is generally effective. And then I teach my clients to be more self-compassionate so that they can deal with those feelings when they come up when they are alone. Try any of these self-compassion practices from my Youtube channel.
I hope this helps bring you an understanding of the natural experience of shame you may be feeling with your chronic illness. Keep making the most of it.