A Social-Emotional Theory of Depression

This paper outlines a theory of hidden shame as the cause of depression, and the rudiments of a treatment plan. It builds upon earlier studies of shame, especially the work of the psychoanalystpsychologist Helen Block Lewis. The theory concerns the cybernetics of emotion: recursive shame-based spirals may be the basic mechanism of both minor and clinical depression. Shame/fear, shame/shame, and shame/anger spirals are described. Hypothesis: depression results from a shame/shame spiral or when the anger in shame/anger spirals is directed inwards, recursively, with little or no limit. Limitless spirals may occur when shame is completely, rather than partially hidden. These ideas lead to a proposal for treatment of depression focused on social bonds and hidden emotions. In this connection, possible effects of anti-depressants on emotion are also discussed. James Gilligan (1997) served as a prison psychiatrist for many years. Based on his interviews with prisoners, he came to the conclusion that shame can be an awesomely powerful force: The degree of shame that a man needs to be experiencing in order to become homicidal is so intense and so painful that it threatens to overwhelm him and bring about the death of the self, cause him to lose his mind, his soul, or his sacred honor.” (112). Gilligan proposed that it is secret shame that has awesome power: "Shame is probably the most carefully guarded secret held by violent men... (112) This paper also proposes that secret shame is a powerful causal agent, as Gilligan did, but that it can also cause clinical depression. It will also take a step missing from Gilligan's study and most other work on shame by outlining a process through which shame might become an overwhelming force. The psychologist Gershen Kaufman is one of several writers who have argued that shame is a secret in our whole society: American society is a shame-based culture, but ...shame remains hidden. Since there is shame about shame, it remains under taboo. ....The taboo on shame is so strict ...that we behave as if shame does not exist (Kaufman 1989). Kaufman’s phrase “shame about shame” turns out to have a hidden importance, since it can be seen as implying the first step in a recursive sequence, as will be discussed below. A Study of How Shame Became Unspeakable and Invisible The idea that shame is kept secret in modern societies is supported by a monumental study by the sociologist Norbert Elias (1939, in German, 1978 in English). Over the last five hundreds of years of European history, Elias analyzed etiquette and education manuals in five different languages. There are two main themes; 1. As physical punishment decreased, shame became increasingly dominant as the main agent of social control. 2. As shame became more prevalent, it also became almost invisible because of taboo. The following excerpt gives the flavor of Elias’s study. It is from a nineteenth-century work (von Raumer 1857) that advises mothers how to answer the sexual questions their daughters ask: Children should be left for as long as possible in the belief that an angel brings babies..... If girls should later ask how children come into the world, they should be told that the good Lord gives the mother her child..."You do not need to know nor could you understand how God gives children." It is the mother's task to occupy her daughters' thoughts so incessantly with the good and beautiful that they are left no time to brood on such matters.... A mother . . . ought only once to say seriously: "It would not be good for you to know such a thing, and you should take care not to listen to anything said about it." A truly well brought-up girl will from then on feel shame at hearing things of this kind spoken of. (1978:180) Elias first interprets the repression of sexuality in terms of hidden shame: An aura of embarrassment...surrounds this sphere of life. Even among adults it is referred to officially only with caution and circumlocutions. And with children, particularly girls, such things are, as far as possible, not referred to at all. Von Raumer gives no reason why one ought not to speak of it with children. He could have said it is desirable to preserve the spiritual purity of girls for as long as possible. But even this reason is only another expression of how far the gradual submergence of these impulses in shame and embarrassment has advanced by this time. (1978:180) Elias raises a host of significant questions about this excerpt, concerning its motivation and its effects. His analysis goes to what may be a key causal chain in modern civilization: denial of shame and of the threatened social bonds that both cause and reflect that denial. Considered rationally, the problem confronting him [von Raumer] seems unsolved, and what he says appears contradictory. He does not explain how and when the young girl should be made to understand what is happening and will happen to her. The primary concern is the necessity of instilling "modesty" (i.e., feelings of shame, fear, embarrassment, and guilt) or, more precisely, behavior conforming to the social standard. And one feels how infinitely difficult it is for the educator himself to overcome the resistance of the shame and embarrassment which surround this sphere for him. (1978:181) Elias's study suggests a way of understanding the social transmission of taboo. The adult teacher, von Raumer, in this case, is not only ashamed of sex, he is ashamed of being ashamed. The nineteenth-century reader, in turn, probably reacted in a similar way: being ashamed, and being ashamed of being ashamed, and being ashamed of causing further shame in the daughter. Von Raumer's advice was part of a social system in which attempts at civilized delicacy resulted and continue to result in an endless chain reaction of hidden shame. Elias understood the significance of the denial of shame to mean that shame goes underground, leading to behavior that is outside of awareness: Neither rational motives nor practical reasons primarily determine this attitude, but rather the shame (scham) of adults themselves, which has become compulsive. It is the social prohibitions and resistances within themselves...that makes them keep silent. (1978:181; emphasis added) Like many other passages, this one implies not only to a taboo on shame, but the actual mechanisms by which it is transmitted and maintained. This study has been widely proclaimed as a masterpiece. However, those that praise and/or use it haven’t noticed that the central thesis concerns shame. There are many citations, but only a few mention shame, and they do only in passing. Elias seems to have noticed this, since he avoided using the s-word in a later study (1996) that also involves shame in its central thesis. Instead, he used the word humiliation, and only once. Neither word appears in the index. Perhaps he wasn’t surprised, since he had predicted the invisibility of shame in modern societies. A Novel Approach to Shame Elias’s study and the other approaches to secret shame raise a question: if shame is a secret for everyone, under what circumstances does it lead to depression? The work of Helen Block Lewis on shame and anger provides a first step toward answering this question. Lewis’s conception of shame and other closely related emotions (such as guilt) was and is still radically different than that of most other shame experts. Her working conception of shame grew out the results of a study (1971) of the transcripts of many psychotherapy sessions conducted by other therapists. Using a systematic method based on long lists of indicators words for the major emotions (Gottschalk and Gleser 1969) she located and analyzed emotion episodes in the transcripts. She found that shame/embarrassment was by far the most frequent, with more occurrences than all the other emotions combined. Lewis found that shame occurrences were not mentioned by patient or therapist. Other emotions, such as sadness or anger, were often referred to by either patient or therapist or both. But in the many instances of shame/embarrassment/humiliation, emotion names were never used, not even indirectly (see the discussion of indirection below). Lewis called these instances "unacknowledged shame." This finding supports, at the micro level, Elias’s findings at the macro level on the invisibility of shame in modern societies.