Shame, Social Anxiety, and Psychosis


Researchers in England examined shame and social anxiety in a cross-sectional sample of people with and without psychosis. They found that social anxiety disorder (SAD) is “surprisingly prevalent among people with psychosis.” The authors suggest that shame cognitions “arising from a stigmatizing illness play a significant role in social anxiety in psychosis.” The article appeared in the FirstView section of Psychological Medicine on May 21, 2012.

Abstract → 

Note from Kermit Cole, “In the News” editor:
Of course this study can make no inferences about etiology or causation, being a cross-sectional study, and the question of whether the shame and/or social anxiety pre-existed social anxiety and/or psychosis is open for discussion.


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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected].


  1. Researchers are ‘surprised’ that people feel shame and social anxiety after being criminalized by society for having a breakdown and after being foricbly labeled with stigmatizing labels?

    Wow, these researchers sound bright!

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  2. I think they are overlooking the role of shame in causing a, “Breakdown,” in the first place. Yes, there is stigma that makes things worse, and yes, involuntary treatment and patronising staff who don’t want to know how someone really sees the world or how they came to have the breakdown in the first place can make things a whole lot worse, but I read that shame is a prime driver of extreme states and it seems to be true in many cases.

    This kind of breakdown often comes on in early adult hood, when the person is making a transition form teenager to independent adult. they needed more support than they were getting, often due to earlier traumas that have now resulted in them not having the confidence to deal with adult life. The person then feels ashamed for not being able to deal with things, their mental state spirals down and a breakdown results (hearing voices etc). This can all be compounded by the early trauma being perceived as a shameful event.

    So I think the paper is only partly right.

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      • Perhaps your unaware of the innate responses, of which shame-humiliation is one, Kermmit?

        Soome suggest that shame is the great “social affect,” by which societies form into hierarchical groups of rank & status? Are we suffering from a need to deny our own nature, when we assume that shame belong’s only to “them?”

        Consider Tomkins description of nine innate affects, as the root of our emotions and their physiological/psychological manifestations;

        These are the nine affects, listed with a low/high intensity label for each affect and accompanied by its biological expression:[3]


        * Enjoyment/Joy – smiling, lips wide and out
        * Interest/Excitement – eyebrows down, eyes tracking, eyes looking, closer listening


        * Surprise/Startle – eyebrows up, eyes blinking


        * Anger/Rage – frowning, a clenched jaw, a red face
        * Disgust – the lower lip raised and protruded, head forward and down
        * Dissmell (reaction to bad smell) – upper lip raised, head pulled back
        * Distress/Anguish – crying, rhythmic sobbing, arched eyebrows, mouth lowered
        * Fear/Terror – a frozen stare, a pale face, coldness, sweat, erect hair
        * Shame/Humiliation – eyes lowered, the head down and averted, blushing

        One of Tomkins pupils is Donald L. Nathanson, M.D. A Philadelphia-based psychiatrist with a lifetime interest in the nature of human emotion. Well known for his brilliant understanding of our compass of shame, and how it functions both consciously and unconsciously.

        The hit TV show Lie to Me, is based on Tomkins research;

        and another of his pupils, Paul Ekman;

        Sadly, most people don’t seem to want to know much about this stuff, when their in subconscious need, of unloading an emotional projection. “Its not me, its them!”

        Best wishes,

        David Bates.

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    • Agree 100%, ooo. Society should feel shame for how it treats people who have experienced adverse life conditions and experiences and were not blessed with strong support systems. Its general treatment of such people and situations is inexcusable.

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