Invisibility of shame in mental health practice and medical education
Dr Radha BhatZoom
Shame is an unpleasant affect often mis-recognised and under-reported. In this paper I wish to explore and discuss phenomenology of shame conflicts emerging in the narratives during consultations for mental health difficulties with young people, their parents and in adults. I will also explore how shame feelings can manifest as a result of unhelpful teaching strategies in educational settings including medical education. Shame conflicts can originate in early parent child relationships and also as a result of group dynamics in the context of groups. Shame affect can be a response to impairments caused by the physical illness or mental health difficulties, or can be the underlying contributory factor. Shame affect can result in delay in seeking help, feeling marginalised, and difficulties in contributing and participating in group discussions.
I will discuss affect of shame by presenting case studies of young people and adults. I will also discuss some in depth interview material with colleagues about shame affect generated in educational settings. Shame becomes internalised when there are threats to one's self esteem arising from experience associated with difference of many kinds.