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Building on a recent paper by Lester (1997) on shame and suicide, a case is presented of a woman who made a serious attempt to kill herself, motivated in large part by shame. The therapeutic strategies employed are described, and the case brought to a successful resolution.
While suicide is clearly a multifaceted act, shame is one dynamic that has been recognized in both the clinical and secular literatures as contributing to many suicides (Lester, 1997). This paper briefly explicates the concept of shame, reviews its role in suicide, and presents a case that illustrates the role of shame and strategies for addressing shame with a suicidal individual.
Shame
Shame, like guilt, is a feeling we experience when we evaluate our actions or feelings and conclude that we have done wrong. However, whereas in guilt we judge our behavior to be wrong, and we are able to apologize and perhaps atone for our misdeeds, in shame we feel that our whole self is no good, inadequate or unworthy (Lewis, 1992). Piers and Singer (1971) explained this by the distinction between "I can't believe I did that" (guilt), and "I can't believe that I did that" (shame). If we experience shame, then our desire is to hide, to withdraw from the situation, "to fall through the floor" (Wellek, 1993). We fear facing those who know of our unworthiness, and we may, under some conditions, seek the ultimate withdrawal-suicide.
Lester (1997) noted that shame is sometimes viewed as a developmentally more primitive emotion than guilt. Erikson (1968) placed shame as a feeling experienced in his second stage of development (shame and doubt vs. autonomy) and guilt as a feeling experienced in the third stage of development (initiative vs. guilt).
Several scholars have suggested that shame may play a role in the psychodynamics of suicidal behavior. For example, Breed (1972) saw shame as one of the five basic components of a suicide syndrome: commitment to particular aspirations, failure, rigid thinking patterns, social isolation, and shame. The shame results from failure in a major social role and the anticipation of negative reactions from others. Breed estimated that about one third of the men and the women in his study of completed suicides in New Orleans experienced shame...