As discussed in cause #13 of depression, shame is one part of our self evaluating the other parts of our self and concluding that we have serious faults, so bad we should be ashamed. You judge yourself to be inadequate or unworthy or defective. You feel defective in a way you wouldn't want anyone to know about, so you hide your defects by pretending to be different; you create a false self to show the world in place of the embarrassing true self. Alice Miller calls it "soul murder" because you kill or disown a real part of you and start hiding behind a mask, fearful your faults will be "found out." If we can not accept what we really are, we are driven into a lifetime of deception, self-rejection, and suffering. Many serious psychological problems are caused by this kind of self-destructive, unhealthy shame.

 Toxic shame screams at us that we are worthless; healthy shame gently reminds us of our limitations and faults. With healthy shame we aren't happy to have these embarrassing weaknesses and defects but this awareness is healthy. It keeps us in touch with reality--and it keeps us humble. A modicum of self-doubt also keeps us open-minded and searching for better understanding. In this section, we are concerned with the more serious unhealthy or toxic shame.

 Toxic shame comes from toxic parents, according to Forward (1989). For instance, if a child is forcefully told that his/her anger is bad, a terrible way to behave, really shameful, disapproved of by God, etc., that child is going to learn to inhibit anger because toxic shame is felt every time he/she gets mad. Eventually the anger is disowned and denied; the child doesn't even reveal the angry feelings to him/herself; it is repressed. Yet, the child, like everyone else, is still frustrated and disappointed. The anger still exists within the alienated or hidden parts of the self and generates energy. This loss of part of the self and the presence of denied (unconscious) emotions must create a very confusing experience for the child, no wonder he/she feels helplessly out of control. More and more of the self (needs, emotions, actions, thoughts) become shame ridden, even contemptible. You feel more and more flawed. The self feels it must escape from itself, this is done by creating a false self.

A guilty person fears punishment and wants to make amends. A shame-based person wants to be punished.
-John Bradshaw

 John Bradshaw (1988) points out that the false self will be different from the true self but in either a positive or a negative direction, e.g. you may begin to develop a self that is very neat and tidy (perfectionist?) or go in the direction of an untidy slob, you may come to see yourself as the family hero (caretaker) or the family scapegoat (black sheep), you may start heading towards "religious-prudish" or "rebellious-crude" roles, you may shift your anger to being an aggressive, domineering leader or to being a passive doormat, or you may develop a false self of a highly successful achiever or a worthless addict. Thus, Bradshaw says there may not be much difference between the obsessive workaholic CEO and the alcoholic in the alley. Both may be addicts suffering from toxic shame; both have created a false self to hide some awful "hole in their soul."

 Unhealthy, destructive shame is the cause of many kinds of addictions and compulsions. Because we feel defective, we seek something that will make us feel better--many of these activities become destructive compulsions in the long run. Examples: drinking temporarily helps us forget, get courage, and feel better; working hard diverts our attention from pain, reduces our anxiety, and produces results; over eating relieves many unpleasant feelings and occupies our time and mind; sex addiction provides a preoccupation, challenges, and "fun;" over spending feels good until we get the bill, etc. In short, there is a cycle: (1) I'm defective and unlovable, (2) since no one could love me as I am, I must be different or I need something--the addiction--to make me feel better, (3) Wow! This works (getting drunk, making lots of money, fixing a great meal, picking up a hot date, etc.), (4) paying the price (hangovers, being divorced, getting fatter, getting AIDS, bankruptcy, mental breakdown, etc.), and (5) I was right, I am a terrible person--back to (1) again and start over.

Exercises for understanding and reducing shame

 If you think about it, you can see that for an addict, the problem is not really the "acting out" or addictive behavior. In fact, the addiction is the addict's solution. As the alcoholic says, "my best friend is the bottle." For the addict, the eating, spending, working, using drugs, drinking, orgasming provides relief from the inner emptiness--the "hole in the soul"--and escape from facing the shameful defects felt by the 4-year-old inner child. The addict vaguely (and erroneously) senses his/her problem is his/her being inherently, unavoidably defective; thus, there seems to him/her to be no solution (except for his/her "habit"). And, in line with this defeatist notion, AA teaches "I am powerless against my addiction; I must turn to a higher power."

 Is there no solution for toxic shame or for compulsive habits or addiction? Bradshaw says, "...there is no way to change your being by your doing." He means that you can be highly successful--rich, president, an Oscar winner, etc.--but the toxic shame, the inadequate feelings, the "I'm bad" feelings, the "hole in the soul" will remain the same. So, what will fill the hole and reduce the shame? Bradshaw is certain it involves sharing your faults and feelings--all those things you've had to hide--with accepting and supportive others. That is exactly what happens in therapy, support groups, and 12-step groups. In groups or some other way, we have to remember the hurts and re-live the "original pain" that made us feel ashamed. Self-help methods might help too.

 One emotional technique Bradshaw uses is writing a letter to your parents telling them what hurt so much when you were little and what you needed that you didn't get. As part of the uncovering and grieving of our childhood, we come in contact with our "inner child" (the 4 or 6 or 8-year-old inside each of us). Another powerful technique is to go back (in fantasy) as an adult to your childhood and find and get re-acquainted with your hurt, scared, needy inner child. Then tell your inner child you are going to take him/her away from the hurts of the childhood home, that you will always take care of him/her, never hurt or leave him/her alone, and always attend to and love him/her. Then, do these things for your inner child; this is starting the process of accepting and taking care of your true inner self. Group acceptance also reduces our shame; recognition and acceptance of our shamed inner child by ourselves and by others help heal the hurting inner child.

 Within individual or group therapy, many other techniques are recommended. Examples: we need to own our disowned parts (or "voices"), i.e. to become aware of and accept all our previously rejected emotions, wants, and needs. One way to do this is to think of the 6 or 8 people you most dislike--they often represent your own disliked parts! You have probably over-identified with the opposite traits, i.e. if you dislike a pushy, rude person, you are probably prone to see yourself as being and try hard to be a nice, polite person. As a child, you may have disowned the pushy, rude jerk part of yourself. So identify the traits you dislike in these 6-8 people and consider if you think of yourself as similar or different from them in these ways. Since you may be using lots of energy keeping the disliked internal voices quiet, have a silent conversation with each of your 6 to 8 disliked parts (based on the people you dislike) and get the views and reactions of each. For instance, see what your pushy, rude part has to say about your overly nice, quiet, passive, mousy, doormat part. For you as a 4-year-old, the demanding rude part was probably a problem; try to see how you handle it now. If you can get in touch with a negative part and it feels like it might be part of you, accept it back, get in tune with it, and learn from it. Don't act on the pushy, rude part necessarily, just realize the brash, self-centered, demanding, tactless part still exists inside. Make yourself whole again by becoming aware.

 Bradshaw also suggests using self-esteem building techniques (chapter 14), self-acceptance (chapter 14), assertiveness and communication skills (chapter 13), desensitization and visualization to reduce shame (chapter 12), cognitive methods to stop irrational ideas and false conclusions (chapter 14), dream analysis (chapter 15), and others. I agree that those methods might help.

 Bradshaw's dilemma is that he says that more than half the people in the world have a compulsion or addiction involving eating, drinking, achieving, being perfect, intellectualizing, sexually relating, shopping, trying to look attractive, cleaning, rescuing, or some other habit. Many of these people suffer from shame. But, supposedly, according to Bradshaw, shame can't be cured without years in a 12-step program plus long-term Psychoanalytic psychotherapy in which (a) an emotional bond is established, (b) the old hurts and repressed parts are uncovered, (c) the inner child is nurtured and protected by the adult, (d) false beliefs and irrational ideas are challenged, (e) the images and voices that convince us that we are weak and unworthy must be replaced with optimistic ideas, and (f) we must have a "spiritual awakening." That is a lot of therapy for two billion people or so. Bradshaw is, nevertheless, right to emphasize the importance of preventing shame (see Bradshaw On: The Family on PBS). And, although the psychoanalytic theory sounds good, we need to look for more efficient and effective therapies.

 Perhaps (it is an empirical question) some or much of this therapy can be done by ourselves. Pollard (1987) recommends "self-parenting" which consists of learning how to support, nurture and love your "inner" child. Another of the early and more original writers about shame, Gershen Kaufman (1992), says that an effective antidote to shame is caring, warm relationships. People bothered by shame need to be loved and accepted, and they need to give to, care for, love, and relate warmly with others. Helping others is good self-therapy too.

Boredom, apathy, and tiredness or exhaustion

 Boredom, a lack of interest, tiredness, and the "blahs" are signs of silent depression. Millions of us are bored with work, school, marriage, etc. Why are we so bored? First, maybe we just aren't doing anything interesting or challenging. The Greeks defined happiness as doing one's best and using all of one's potential. That seemed like the problem for Judith Hennessee, a popular writer, who has described her discovery of boredom. She was an active wife and mother, busy in community activities. One day she noticed all her days were alike. She wondered if this was all there was going to be to life. Then she suddenly realized, "I'm bored out of my mind and don't even know it." It seemed like she was missing her life. It was terrifying. She had always wanted to write, so she started. She felt happier and more fulfilled. We all want to do what we are good at doing. Second, even demanding work can be boring if you have no autonomy and simply "follow the rules" made by someone else. We need to feel "in charge" of something; we need to be flexible, adapting to the situation; we need to use our judgment. Third, even challenging work involving decision-making can be boring if we do not consider the work worthwhile and commendable. Life must have meaning. Otherwise, we burn out. Cherniss (1995) studied burnout during the first 12 years of being a social worker, teacher, therapist, nurse, or lawyer. He shows how these professionals sometimes recover from it.

 Therapists frequently ask their clients what he/she see him/herself doing in one or five years. Or, what would you do if you had only three days to live? These ways of asking people about their ideals or dreams can be consciousness-raising experiences. We need to believe there is a connection between our activity today and our hoped for payoffs in the future.

 How is it possible to get bored in a complex, intriguing world? There are some theories: if you add positive and negative feelings together, the result sometimes is "nothing"--an indifferent, blah feeling. Examples: after living with a lover a long time, the positive and negative emotions may combine to produce "no feelings" or a "taken for granted" feeling. A rebellious person may combine the pleasure of expressing anger with guilt and feel indifferent or "I don't care." A student may like some parts of school and dislike others and feel apathetic. In short, apathy may conceal intense and disturbing feelings. Schaefer (1973) illustrates this further: a dying person welcomed boredom because it made life seem longer. Another person, although prudish, was persuaded to watch two friends having sex; her reaction, "I was bored." Each feeling needs to be recognized and dealt with, not denied or repressed. Most of the time, though, we're bored because "there ain't nothin' to do," as we see it.

 Another interesting observation is that we become bored at something: "the lecture is boring," "I'm bored with reading," "we are bored with each other," "my work is boring," etc. One implication is that "I'm not responsible for the boredom, I'm the victim." Another is that "someone else is doing this to me," and things would be okay if I could get away from them. This certainly hints at both anger and helplessness.

 Almost one quarter of Americans report being fatigued for longer than two weeks. It is among the top 5 complaints to doctors. Stress and burnout make us tired (and harm our health). Some people respond to sudden challenges with extreme surges in blood pressure; medicine can help. Most tired people need rest, sometimes with an intimate other and sometimes completely alone. Comfortable companions--friends, dog, cat, or therapist--are usually soothing. If one can avoid hostile, demanding people, it will help. Likewise, reading, exercising, watching TV, conversing, bathing, and doing anything fun will lead to inner peace. If you can't merely walk away from the stress, you can change your view of the situation: meditate, realize "it ain't awful," "I can handle it," etc.

 One of the more debilitating disorders is chronic fatigue syndrome because the lack of energy and tiredness can become overwhelming. Half a million Americans feel seriously fatigued all the time. Sometimes this fatigue is combined with some serious physical problem--arthritis, colitis, multiple sclerosis--and must have medical attention. Sometimes it seems to be more a psychological reaction which can be helped with therapy or self-help. There are several good references for chronic fatigue syndrome, including Friedberg (1995), Lark (1996), and Berne (1995).

 Finally, some therapists (Cammer, 1969) think the body just runs out of energy, causing us to feel depressed. Maybe all feelings are repressed along with the painful depression, producing a lack of interest in anything. Furthermore, lethargic disinterest means we don't have to try new things, take risks, meet challenges, or express feelings. Like all other behavior, apathy has its payoffs. Hoffman (1993) attempts to explain and correct "feeling tired all the time."

 Considering all the good one can do and all the fun one can have, it seems sad to live life bored. Make your work into play (Csikszentimanalyi, 1975). Most of the techniques for depression would work on boredom, but specifically try these ideas: make some changes in your life, find something valuable and important to do (volunteer to a hospital or a school), take an interesting course, exercise, use your brain to think of self-help projects to do, get active--DO SOMETHING. If there is some irritation with the person or situation boring you, with a little tactful ingenuity you can probably change the situation. Examples: turn the mundane chore into a competitive game, simply tell the other person you are bored (they probably are too), or figure out what is irritating you and change the situation or your thinking. Most of the time, the solution is not just finding some way to fill one afternoon but finding a worthwhile, exciting purpose for your life (chapter 3) and developing self-esteem and self-efficacy (chapter 14).

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