Shame does more than make us blush

When you make a mistake, do you question your behavior, or do you begin to see yourself as entirely inadequate and worthless? This distinction plays an important role in determining when shame becomes harmful. Being reprimanded or humiliated in front of others can cause a single mistake to become, in a person's own eyes, a flaw that defines their entire identity.

A guest editorial titled “The harming power of shame”, published in The British Journal of Psychiatry and co-authored by Dr. Agustin Ibanez of Istanbul Medipol University, examines both the constructive and harmful forms of shame in light of existing scientific research. While shame can encourage people to take responsibility in supportive environments, it can have very different consequences when used as a means of humiliation or pressure.

One of the article's key contributions is its examination of the effects of shame on the brain and body alongside the social and institutional conditions in which it occurs. This comprehensive approach emphasizes that addressing harmful shame requires not only individual support but also changes in healthcare, education, and workplace environments.

THE DIFFERENCE BETWEEN "I DID SOMETHING WRONG" AND "THERE IS SOMETHING WRONG WITH ME"
The article places particular emphasis on the distinction between shame and guilt. Guilt is generally directed toward a person's behavior. When individuals believe they have done something wrong, they may be motivated to correct their actions or repair the harm they have caused. Shame, however, involves a negative evaluation of the entire self. Instead of focusing on a particular mistake, individuals may begin to see themselves as bad, flawed, or worthless.

For this reason, guilt can encourage people to make amends, whereas shame is more closely associated with the desire to hide or withdraw from others. The emotion can be triggered not only by actual criticism but also by the anticipation of being criticized or humiliated.

Nevertheless, the authors point out that not every experience of shame is unhealthy. When experienced at a manageable level in a supportive environment, shame can help individuals take responsibility for their behavior and cooperate with others. What becomes harmful is shame that is excessive, persistent, and leads individuals to regard themselves as fundamentally worthless.

SHAME CAN INCREASE HEART RATE AND TRIGGER THE BODY'S ALARM RESPONSE 
Shame is not experienced solely through thoughts. The article explains that several brain regions involved in how individuals perceive themselves and interpret others' evaluations become active during experiences of shame.

Physical responses are also significant. Shame can increase heart rate and blood pressure. Intense or prolonged experiences of shame may also be associated with reactions such as freezing and emotional numbness.

The article further notes that shame is associated with elevated levels of cortisol, a hormone involved in the body's stress response. Symptoms such as nausea and a tightening sensation in the stomach are also discussed as physical manifestations of this emotion.

Persistent shame may additionally contribute to inflammatory processes in the body and disruptions in metabolic functioning.

FEELINGS OF WORTHLESSNESS CAN DEEPEN LONELINESS 
Not everyone is equally sensitive to shame. An individual's temperament, early relationships, life experiences, and cultural environment can influence how this emotion is experienced. Childhood experiences such as abuse, neglect, bullying, or emotional invalidation may contribute to the development of a lasting sense of worthlessness.

These effects do not always manifest as silence or withdrawal. The article also associates shame with coping responses such as outbursts of anger, risky behaviors, and perfectionism.

The relationship between shame and mental health difficulties is bidirectional. Shame may contribute to the development of psychological problems, while experiencing these problems may itself generate feelings of shame. High levels of shame have been linked to conditions including social anxiety, depression, substance use problems, eating disorders, and post-traumatic stress disorder.

The article also discusses the experiences of people living with dementia, a condition involving impairments in memory and other cognitive abilities that interfere with daily life. Social stigma can cause both individuals with dementia and their families to experience shame and become reluctant to discuss the condition. Concealing the illness and withdrawing from social relationships may, in turn, increase loneliness.

SHAME-BASED TEACHING CAN LEAD TO MISTAKES BEING CONCEALED 
One of the areas examined in the article is the use of shame in healthcare and educational settings. The authors note that shame-based teaching practices can still be encountered in medical education and doctoral training.

One example describes a young physician who is harshly reprimanded in front of the team for a minor mistake. Following the incident, the physician becomes quieter, begins to question their own decisions, and avoids asking questions. This example illustrates how humiliation can undermine learning and professional confidence.

In institutions where blame and humiliation become established practices, the consequences may extend beyond individual experiences. Mistakes may be concealed, while trust, open communication, and creativity can suffer. Reluctance to seek help and burnout are also identified as problems associated with such environments.

Rigid hierarchies and being evaluated in front of others can intensify feelings of shame. In contrast, supportive supervisors, private feedback, and systems focused on learning from mistakes can help reduce these effects.

THE SOLUTION: RECOGNAZING SHAME AND CREATING SAFE ENVIRONMENTS 
The approach proposed in the article does not seek to eliminate shame entirely. Instead, the aim is to reduce its harmful forms and help individuals make sense of their experiences.

The first step is recognizing and naming an emotion that is often kept hidden. Being able to discuss difficult experiences within safe relationships and developing self-compassion, the ability to treat oneself with understanding during times of difficulty, are identified as important parts of this process. Supportive approaches must also take individuals' cultural and social circumstances into account.

At the institutional level, however, individual awareness alone is not considered sufficient. The authors recommend replacing practices based on punishment and humiliation with a culture that promotes fairness, transparency, and learning. They emphasize the importance of strengthening psychological safety, creating environments in which people can ask questions and share difficulties without fear of humiliation.

The article calls for changes across healthcare, education, and management practices to create environments where people can take responsibility for their actions while also being able to learn without being humiliated.