Yes, Shame has an offspring. I believe it is called secrecy. People hide their feelings, their illnesses and their family secrets because they feel ashamed. Owning diseases like mental illness and dementia are difficult, as people feel ashamed to have them, and become secretive about them. Why is it shameful to own up to mental illness or dementia I wonder, to openly declare you have it as one would with a broken leg.I researching this topic, I have found some information I believe to be relevant, that helps us to understand the significance of shame and the secrecy that comes from it. With dementia, the shame, stigma and myths still heavily shrouding the disease, cause many to be secretive about having been diagnosed with it. In fact, this shame and stigma prevents many from talking to their doctors or families about the symptoms they have, as they fear the diagnosis and the shameful feelings it can bring. So often I am asked, I think ‘so and so’ might have dementia, do you think I should say something, or do you think this would offend them?, followed by, I’d better not get involved, they might not want anyone to know about it. Why would the thought of having dementia be so offensive unless it is the shame and stigma and secrecy still surrounding it?

I was involved in suicide grief for many years, and saw that many felt ashamed of their loved one’s suicide, and were therefore secretive about it. Many simply didn’t want others to know their loved one had died by their own hand. In a conference on suicide prevention in Ireland in 2011, it this quote in an article in The Irish Examiner (Feb 16, 2011), “Suicide, shrouded in shame and secrecy, is one of the greatest causes of misery in Ireland. The devastation caused to families is unbelievable…“.  I highlight not the devastation to families of this act, but the feelings of shame and secrecy, which inhibit healing healthy healing as it denies families authentic support. In an article titled Anonymity vs. Secrecy: Do You Know the Difference?, on the site Residence X11, an alcohol and chemical dependence treatment centre for women, All across America, healthy people in recovery are replacing shame and secrecy with personal gratitude and a growing willingness to talk openly about their personal recovery. Putting a face and voice on recovery not only does not violate AA’s Traditions but, for many, it actually enhances personal recovery. After all, the bright side of addiction is recovery and that is the message we all need to send and hear! Whether it is alcoholism, suicide, or other things such as mental illness and dementia, it is clear shame has a lot to answer for.

According to Marc Miller PhD, in his article Shame and Psychotherapy, which talks about the negative impact of feelings of shame, he says shame manifests itself in many physical ways, for example hiding our eyes, lowering gaze, blushing, forcing ourselves to smile or appear happy, or becoming agitated or restless. Other responses might include irritation, excessive defensiveness, embellishment and exaggeration or denial. Because the effect of shame often interferes with our ability to think, we may also experience confusion, be at a loss for words, or have a completely blank mind. Shame is often experienced as the inner, critical voice that judges whatever we do as wrong, inferior, or worthless. Often this inner critical voice is repeating what was said to us by our parents, relatives, teachers and peers. We may have been told that we were naughty, selfish, ugly, stupid, etc. We may have been ostracized by peers at school, humiliated by teachers, treated with contempt by our parents. Ironically, shame may be caused by others expecting too much of us, evoking criticism when our performance is less than perfect. Some authority figures, especially parents may never seem satisfied with one’s efforts or performance, and are critical no matter what. Unfortunately, these criticisms become internalised, so that it is our own inner critical voice that is dishing out the shaming messages, such as: You idiot, you shouldn’t have done that?, Can’t you do anything right?, or  You should be ashamed of yourself, and so on.

Marc also sites Helen B. Lewis, a pioneer psychotherapist in recognising the importance of shame, argued that shame represents an entire family of emotions, which includes: humiliation, embarrassment, feelings of low self-esteem, belittlement, and stigmatisation. Shame is often a central in experiences of being:

He goes on to say one source of shame is associated with the expression of certain emotions. In many families, as well as in many cultures, expression of such feelings as anger, fear, sadness or vulnerability, may be met with shaming reproaches, such as Pull yourself together, Don’t be a baby, Stop crying or I’ll give you something to cry about, or You don’t have anything to be afraid of. Pride is also a feeling that is often met with shameful condemnations, such as Who do you think you are, Mr. Smartypants?, or You’re getting too big for your boots. Often these shaming rebukes are internalised, so that when we get in touch with any of these shameful feelings we will automatically feel shame, and try to control or hide the feelings, or even apologize for them. These inner voices of shame can do significant damage to our self-esteem. As they become self criticisms, e.g. we are stupid, selfish, arrogant, a show-off, a smartass,  etc., they become, in varying degrees, how we see ourselves. For many, the inner critical judge continuously provides a negative evaluation of what we are doing. As mentioned before, the inner critic may make it impossible for one to feel like you can do anything right.

Also cited in his article, Silvia Tomkins (in Nathanson, 1992) says: If distress is the effect of suffering, shame is the effect of indignity, transgression and of alienation. Though terror speaks to life and death and distress makes of the world a vale of tears, yet shame strikes deepest into the heart of man…. shame is felt as inner torment, a sickness of the soul….the humiliated one feels himself naked, defeated, alienated, lacking in dignity and worth.

Note: I have cited or paraphrased much of Marc’s article, as it confirms my feelings about shame, and he has said it so well, rather than just add the hyperlink for you to visit. I think it is very valuable in understanding shame and secrecy, associated with dementia.