The Polarizing Nature of Shame 

The Long Shadow of Shame 

Shame often comes to me as a revelation that shakes me to my core. It has the power to suddenly evaporate every illusion I have about myself, which often leaves me feeling exposed and unworthy. Because of this, shame can also open the door to my deepest vulnerabilities, including childhood attachment fears, as it carries me into heavy emotions that sometimes feel impossible to hold. Shame is the most demanding internal experience for me, followed closely by grief.  

I don’t like to feel exposed and unworthy, so I typically and automatically try to avoid connecting with my shame. The possibility of experiencing shame is such an unwelcome experience for me at times that it can polarize my avoidance tendencies into two opposite and extreme positions: “the ideal” and “the victim”. These two positions are a safeguard in the short term because my shame does not immediately take hold of me. However, these polarized positions become problematic in the long term. They often initiate a destructive cycle of shame that can pull me deeper into my extreme positions by paradoxically producing more shame within me over time.  

The more common extreme position that I fall into is thinking that I am greater than I am. This polarized focus is something I like to term “the ideal.” Instead of acknowledging myself as I truly am, I attempt to act out an idealized version of who I want to be. This allows me to avoid my shame in the short term since I can remain focused on being an idealized version of myself. However, the shameful reality of who I truly am finds me in the long term when I inevitably fall short of that ideal. 

Unfortunately, the experience of me falling short of that unattainable ideal makes me experience even more shame, which intensifies my desire to avoid my shame once again by pretending that I am in fact closer to an ideal version of myself than I actually am. The only way for me to break free from this cycle is to acknowledge and bear the shameful reality of what I truly am in any given moment rather than trying to avoid that reality by thinking that I am already “the ideal.” 

Evoking the Ideal: The Case of David 

One of my clients, whom I will call David, serves as good example of how shame evokes the extreme position of “the ideal.” David initially sought counseling with me at the request of his partner. David’s partner thought he was struggling with undiagnosed ADHD due to his difficulty in attending to her and his responsibilities at home. She wanted him to get additional support. After working with David for a few sessions, the underlying pattern became quite clear. David had been placing an impossible pressure on himself to attend to all things in his desire to please his partner, and he did this by seeming like he was more capable than he was truly able to be.  

Instead of acknowledging his true capabilities and limits, he would begin to feel overwhelmed by all the responsibilities he would take on, which would then make him miss things that he would normally not forget. These actions would reinforce the shame of him being someone that is forgetful and/or not attentive, which would motivate him to try even harder to not be seen in that way. As this cycle became reinforced in his partnership, David’s shame amplified, and his depression got worse. When I first talked to him, he was nearing a psychological breaking point. He felt that he had somehow become the incapable person that he had been so desperately attempting to avoid. 

At the start of treatment, I encouraged David to be curious about his identity of being the incapable one. We explored the origins of this identity and uncovered his underlying overwhelm and deep sense of shame. As we explored David’s shame with love and acceptance, I also encouraged him to learn how to bear a little of his shame with me. David was able to realize that he was not the incapable person that he and his partner had come to know him as. He also came to slowly accept that he was not the highly capable person that he hoped he could be. He humbled himself and started to give realistic expectations towards himself and others in reference to his capabilities.  

His shame and depression faded, and his true capabilities began to grow as he gave himself space to start over with an honest understanding of who he was. Other people took notice of this shift in David. Instead of taking the bait and falling back into the belief that he was fully capable due to other people admiring his newfound capacity, he continued to humble himself and find slow, but persistent growth in his true capabilities. Through the course of our time together, David cultivated the qualities of the capable person that he always hoped he could become, not be forcing “the ideal” onto himself, but by paradoxically accepting that he was not yet that person. 

Overcoming the Victim Role: The Case of Avery 

The other opposing extreme position that I fall into is thinking that I am much less than I am. This polarized focus is something I like to term “the victim.” Instead of acknowledging myself as I truly am, I exaggerate my inadequacies to avoid facing the real imperfections that I do contain. This allows me to avoid experiencing my actual shame in the short term since I can remain a victim by focusing on all the negativity that I place on myself. However, the hopeful reality of who I truly am finds me in the long term as other people continue to remind me that I am more than I am pretending to be. 

Unfortunately, the uncovering of my victimhood makes me experience even more shame which intensifies my desire to avoid my shame once again by trying to convince myself that I am completely irredeemable. The only way for me to break this cycle is to acknowledge and bear the hopeful reality of what I truly am in any given moment rather than trying to avoid that reality by allowing myself to play “the victim.” 

One of my clients, whom I will call Avery, can serve as a useful example of how shame brings about the extreme position of “the victim.” Avery initially sought out counseling with me due to her worsening depressive symptoms. She had solidified a deep-seated belief through the course of her life that she was fundamentally unlovable and that her future was hopeless. She struggled with suicidal thoughts and felt as if most of her life was simply a constant battle for survival. After working with Avery for a few sessions, the underlying pattern began to emerge. Avery had become so terrified of accepting the possibility that she might truly be worth something that she trained herself to believe that she was in fact completely worthless to save herself from the shame of falling short of the real potential she did contain. 

Instead of acknowledging that she might have some level of significance as a human being, negative thoughts would quickly flood into her mind telling her that she couldn’t be more mistaken. These negative perceptions of herself would then make her feel worse about herself, which would only solidify her self-created identity as someone that is fundamentally irredeemable. As this cycle became reinforced in her own identity, Avery’s shame intensified, and her depression got worse. Her skewed sense of self had become so ingrained that the affirming comments that trusted others gave to her only made her feel more unworthy and alone. When I first talked to her, she was nearing a suicidal breaking point. She was seriously considering an act that would forever symbolize her fundamental sense of unworthiness in this world—taking her own life. 

At the start of treatment, I encouraged Avery to be curious about her identity of being the unworthy one. We explored the origins of this identity and uncovered her underlying fears of having to bear the real shame of her faults. As we explored Avery’s shame with love and acceptance, I also encouraged her to practice bearing a little of her shame with me. Avery was able to realize that her shame was not as scary as she initially feared. The negative perceptions of herself that she previously entertained were slowly replaced by images of her innate goodness as she learned how to embrace her shame in a real and healthy way. Avery’s newfound ability to be present to her shame also opened to her new avenues of growth as she welcomed higher aspects of her own goodness despite her fears of falling short of her potential.  

Her shame and depression faded, and her former hopelessness was replaced by a solid sense of self-worth as she cultivated the courage to start over with an honest understanding of who she was. Other people took notice of this shift in Avery. Instead of resisting their positive feedback and falling into her former belief of being unlovable, she allowed their love to enter her as she cultivated a healthier balance between her goodness and the ways in which she fell short of that goodness. Through the course of our time together, Avery cultivated qualities of the worthy person she secretly hoped she could become, not by pretending to be “the victim” of a cruel world, but by paradoxically accepting that she truly might be worthy of love. 

The middle path of shame amid both extremes is humility. It is the integrating virtue that allows us to cultivate freedom from these extreme positions by acknowledging that we are simultaneously a mix of good and not good enough. I always encourage my clients, along with myself, to work on bearing just a little shame. I don’t need to pretend that I am shameless, and I also don’t need to allow myself to be crushed by the weight of my shame. Bearing just a little shame opens the door of humility, which allows me to resist extremes and move through my shame in a redemptive and life-generating way. 

I must take a stance towards my shame. There will always be a risk that I orient toward my shame in a polarizing way, but attempting to avoid it altogether leaves me in an even worse place. The shame that I never acknowledge accumulates within me and only leads to more shame and isolation in the long term.  Shame is not something I can resist; it is something I must move through to find integration, healing, and wholeness. 

As a final note, I have always found it to be a deep irony that I tend to respond to my own experience of shame with avoidance and fear, but that I feel a deep sense of empathy, connection, and attention when I am in the presence of my clients experiencing their shame. I often consider how that experience as a therapist serves as a signpost for how I should be orienting towards my own shame. Though the process of shame can feel paradoxical and shrouded in mystery at times, the outcomes are always perfectly clear. The clients I have known that have truly become integrated, alive, and whole have been the clients that were courageously willing to face their shame and bear it in the presence of trusted others. 

Crossing Zero: The Art and Science of Coming Off—and Staying Off—Psychiatric Drugs

Leaving Behind the Disease Identity

I hope I’ve succeeded in conveying the message that psychiatric drug withdrawal is often more than pharmacology, dose reductions, and withdrawal symptoms. For many, stopping medication also represents a departure from seeing themselves as ill and lacking agency. This important process can be challenging if those around them continue to embrace the medical model and view them through the lens of illness as a “patient”. 

Even if this doesn’t apply to you personally, I encourage you to keep reading. It will provide you with an understanding of the daily challenges faced by those who do. 

I recall a former client, Ulrik, who arrived at my office one cold and grey Scandinavian February morning, wearing the broadest smile. He had just been to the student counselor the Friday before and was thrilled to be re-enrolled at university, having recently tapered off the antipsychotic that for so long had numbed his emotions and the cognitive abilities he needed to study. Yet it wasn’t just his return to university that was the source of his smile – it was his encounter with the student counsellor. She was the first person he’d met in years who didn’t know he had once been a psychiatric patient diagnosed with – and now fully recovered from – what psychiatry labels paranoid schizophrenia. This made all the difference in how she saw him. 

Like many people with psychiatric labels, Ulrik’s diagnosis had levied such stigma upon him that his completely normal emotional fluctuations and reactions were often misinterpreted as symptoms of illness. 

Those around him had grown accustomed to seeing him through the lens of illness, constantly scrutinizing and judging him, and his freedom to act naturally was heavily limited as a consequence. But for once, this way of being classified in advance as a sick person was gone. For Ulrik, it was a relief not to be defined and judged by his diagnosis. “She saw me as a regular person with aspirations, dreams, and a future full of possibilities. I haven’t felt this way in years. She had expectations of me, and that made me want to try,” Ulrik said, clearly emotional upon realizing the contrast with how many of his friends and relatives still sometimes viewed him as fundamentally sick and defective. 

That Monday morning, our entire hour together centered on the profound impact of others’ perceptions and how they shape a person’s path to recovery. “I also need to be part of something where I am need-ed and people count on me, where my contributions are valued and expected. People with jobs and families can easily take that feeling for granted – but for me, it’s what I long for most,” Ulrik added thoughtfully. 

Breaking free from over-identification with a diagnosis can be challenging, especially if the important people in your life continue to view you through that diagnostic lens. One common obstacle is when loved ones undergo so-called psychoeducation, where they are “educated about the illness” and where a person’s supposed “lack of insight” is interpreted as part of the illness itself. 

The question of disease identity – becoming so intertwined with a diagnostic label that it becomes an identity – is too big to fully cover here, and frankly, I believe it’s not appropriate for professionals to intrude into such deeply personal territory. Instead, we should leave the subject to those who have lived through it firsthand. Fortunately, one such book has just been written by American author and director of the Inner Compass Initiative, Laura Delano, titled Unshrunk

Research also indicates that family dynamics can significantly impact the recovery process. A meta-analysis dating back to 1998 showed that a family’s degree of what’s known as “expressed emotion” could predict the likelihood of relapse of psychosis, depression, and eating disorders. Expressed emotion is defined as “emotional over-involvement and critical communication from family members and closeones.” In such cases, addressing the issue with individual psycho- therapy can inadvertently problematize the individual who may merely be the bearer of symptoms within a broader family dynamic. Family therapy and Open Dialogue may be necessary. 

A Strategic Choice

Many people have to be strategic about who they involve in their efforts to taper off psychiatric drugs, knowing that the decision may not be well received or supported by everyone around them. It’s understandable yet unfortunate that this is sometimes the case, as support from loved ones is crucial to both coming and staying off psychiatric drugs. 

From loved ones, I often hear that the powerlessness and fear of revisiting past struggles from before the medication can be a difficult combination. For both parties, I hope this chapter has eased the feeling of powerlessness and that together you can see concrete, practical steps to take if withdrawal and emotional re-emergence becomes challenging. The situation is likely new and unfamiliar to both of you, and there is often an element of having to chart a path through it together. 

And to loved ones: Remember that simply being present as a human companion offers a powerful antidote to low mood, racing thoughts, and anxiety. In the end, the same principle applies to any form of sup- port during difficult times: The more atypical and to you incomprehensible your loved one’s reactions and behaviors, the more crucial it becomes to remain open and curious about what they are experiencing. Strive to look beyond the surface – to the emotions, experiences, and unmet needs they are grappling with. 

This excerpt is published with permission from the author, Anders Sørensen.