Separation of Sheep from the Goats

Shame and Blame in Obesity, Diabetes, and Addiction

The headline brought a cringe: “Can shame be useful?” Writing in the New York Times, psychiatrist Sally Satel and psychologist Scott Lilienfeld say that:

The experience of shame – the feeling that one has failed to live up to one’s own standards – can play a positive role in recovery from addiction, as well as from other kinds of destructive habits.

The cringe comes because shame and blame are such destructive and ever-present fixtures in the landscape for people living with obesity. Way too many people, including healthcare professionals, walk around with the false notion that obesity is simply the result of destructive habits and dispensing a little shame might just fix it. They don’t need more encouragement.

For an up-to-date reflection on the problems that bias, stigma, blame, and blame bring for people living with obesity and diabetes, the new issue of Diabetes Care has a helpful review by Rebecca Puhl and colleagues. They write:

Provision of training and education about the complex causes of obesity, implementation of respectful language when discussing body weight with patients, and concerted efforts to challenge negative weight-based stereotypes in the clinical care setting can all help to shift the medical culture from one that often shames and stigmatizes patients because of their weight to one that supports and empowers patients with obesity and diabetes in their efforts to improve their health.

So how can we reconcile the perspective on shame offered up in the Times commentary? To do so, two distinctions matter greatly. One is that authors of that commentary are reflecting entirely upon intrinsic shame that people with addictions feel themselves — in no way do they suggest that the imposition of shame is therapeutic. Second, they identify the important distinction between shame that might prompt constructive change and shame that enforces a sense of hopelessness.

Certainly, shame is a genuine, intense emotion that must be acknowledged to avoid its potentially corrosive effects. It is not a therapeutic tool.

Click here for the commentary by Satel and Lilienfeld. Click here for the review by Puhl et al.

Separation of Sheep from the Goats, c. 6th century mosaic, Basilica of Sant’Apollinare, Nuovo, Ravenna, Italy. Image © Fr Lawrence Lew, O.P. / flickr

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January 25, 2016

2 Responses to “Shame and Blame in Obesity, Diabetes, and Addiction”

  1. January 28, 2016 at 4:26 pm, Allen Browne said:

    Yup, the title is scary. The details are some better. But I like “It is not a therapeutic tool”. Succinct and to the point.

    • January 28, 2016 at 4:29 pm, Ted said:

      It’s a concept that lives in the flawed thinking of many policy makers, sad to say, Allen. Thanks for speaking up.