Shame and how our bodies betray us

How shame can shape daily life

When I started having sex consensually to try and erase my rape, I was ill-equipped. No one had ever talked to me about sex, about how my body works, or what I should do to be safe.

I didn’t know how to use condoms and I was too afraid to ask. I didn’t know what sex was supposed to feel like and I didn’t dare voice this thought, so I had no idea that the sharp pain I felt each time was abnormal. I spent ten years thinking pain was an inherent and non-negotiable part of sex for women.

Everyday shame is also why, the first time I got a urinary tract infection (UTI), I ended up in hospital, curled over myself, confused and scared. I waited in A&E for seven hours. When I got treated it was very straightforward: I was given antibiotics and the infection cleared within hours.

I had never heard about UTIs. The knowledge that women can contract them if we don’t urinate after sex was completely unavailable to me. If it weren’t for shame, I would have been spared so much discomfort, time, money, anxiety.

Doctors feel shame too

Everyday shame affects our relationships with medical professionals. It is there when doctors ask us about our sex lives to determine the risk of sexually transmitted infections. It is there when they ask us about pregnancy, about how we manage the risks that are so often placed mainly at the feet of women, about cycles and ovulation and control.

In those white, sterile rooms, it is not just the patient who is ashamed. Research has shown that doctors may shy away from asking certain questions because they are muted by everyday shame, and because they simply don’t want to hear the answers. This is likely to be profoundly subconscious – it is a testament to the power of shame, not to the ill intentions of doctors.

Psychologist Jonathon Tomlinson has discovered that shame drives disconnection, explaining that “professionals avoid patients who are mentally unwell or dying, relatives who are upset or colleagues who are stressed”.

Approaching uncomfortable subjects

When I was seeing doctors almost every other day to treat my undiagnosed chronic pain, I frequently felt doctors pull away from me if I circled too close to uncomfortable subjects. They would stick to “How bad is the pain out of ten?” and “Can you point to exactly where it is?” and then would look at me sideways when broadly normal blood tests seemed to prove there was nothing actually wrong with me.

Once I had to explain to several different doctors during one hospital stay that I did not have a burst appendix, and that I believed my pain was gynaecological. No one believed me. When they asked why I thought it was not appendicitis, I explained – several times – that my appendix had been removed during a nasty endometriosis surgery I had had a year earlier.

Sometimes doctors have a more explicit relationship with shame. They don’t just catch it, they transmit it. Early on in my illness, a young male doctor saw that I was nervous about an internal examination. Rather than reassuring me, he asked why a procedure like this would make me uncomfortable if I was happy to have sex with different partners in my spare time.

When shame replaces compassion

In 1959 the psychoanalyst Isabel Menzies Lyth conducted a study of an NHS hospital where managers were concerned that doctors were becoming too emotionally involved with patients. The managers’ solution was to compartmentalise doctors’ and nurses’ tasks, breaking them up into small technical jobs that were, on their own, not likely to trigger an emotional response. The result was that every person involved in the interaction – doctors, nurses and patients – became more anxious, not less.

The lesson here is that when we try to avoid emotional engagement, we invite shame to take its place. Take my experience in hospital when doctors focused on technicalities and blood results and scores out of ten and, when they found no hard evidence, ceased to treat my pain. A response grounded in empathy would say at this point: “It doesn’t matter that we don’t know exactly what is wrong. I’m sorry you are suffering. How can I help you?”

Empathy changes everything

In ‘The Empathy Exams’, the writer Leslie Jamison describes her work as a medical actor, someone trained to present with a certain combination of symptoms to test trainee doctors’ knowledge. She had to give each doctor a score for how, and whether, they “voiced sympathy for your situation or condition”.

Jamison was told that the first word of this line is crucial: for doctors to get a good score in this section, the sympathy must be explicit. It must be given words. “I’m sorry you are going through this” takes less than ten seconds to say but, when adopted as an everyday practice, could change everything.

Everyday shame is easy to combat. All we have to do is replace it with a dedication to practising empathy whenever we are faced with a conversation or circumstance that societal norms usually say is shameful. As Jonathon Tomlinson says, “Emotional labour is hard work, but defences against emotions are harder and more damaging in the long run.”