Shame, as the conductor of the affective orchestra in humans, is a powerful, elusive and tricky emotion that can protect or destroy the organism – depending on the circumstances. Often referred to as the pathological affect of abandonment, indignity, alienation and failure, the healthy function of shame, which is to protect and motivate the self to move in a positive direction by deeply disturbing it, goes largely unrecognized. This protection, however, comes with a high premium in pain and suffering for alcoholics and other addicts who, because of their frequently shameful lifestyles and bio-psycho-social-spiritual make-up, tend to exist in a more or less chronic state of permanent and immutable malignant shame.
Shame must be differentiated from guilt, although both affects often work in concert with each other. Guilt is about action and behavior, while shame is about identity and self. Guilt involves a violation of an external rule or standard that can be redressed by restitution or an apology. Shame, on the other hand, slices uninvited through the ego boundary to inflict a deep wound on the self that is experienced as an “inner torment” or a sickness of the soul. Shame patrols the boundary between our public and private lives.
Malignant shame, the core affect of addiction, can be treacherous, dangerous and even lethal to the addict as well as to family members and others when it is expressed as rage, fear, anxiety or despair. Paradoxically, healthy shame, which motivates the alcoholic or addict not to drink or use drugs, kicks in at the moment when the addict hits bottom, and continues to function as the healing force that energizes the hard, but joyous, work of authentic suffering, surrender, forgiveness and service to others that is so essential to the attainment of stable and sustained sobriety. Shame can be paired with hope as well as with despair.
Fundamentally, the healing approach for the disease of addiction is based on caring rather than curing (Kurtz.). Shame-based, traumatized addicts need care, while at the same time they must be held accountable for whatever physical, emotional or spiritual damage they may have caused through their frequently anti-social behavior.
Although the treatment of shame-based disorders can be considered from a number of different perspectives, the 12-Step approach, which has been shown to meet all scientific criteria for psychotherapy, is a highly effective shame reduction modality for alcoholics and other addicts in that it challenges and modifies the narcissistic self-centeredness of the addict in an environment of spiritually-protected public exposure. Thus unencumbered by selfish narcissism, and newly liberated from the prison of malignant shame, the alcoholic or drug addict can maintain sobriety by being of service to other suffering alcoholics and drug addicts so that they too may achieve sobriety.
by Garrett O’Connor, M.D.- Betty Ford Institute