“Mental Illness” and the Spiral of Shame


A researcher from the University of California in Santa Barbara writes today in the Journal of Social Psychiatry that “one reason that theories of mental illness have made little progress may be their focus on individuals, omitting the social/relational and emotional world. Adding these components will be difficult, however: in modern societies they have become virtually invisible, particularly the emotion of shame … most symptoms of mental illness are products of shame and relational feedback loops: emotion and alienation can both spiral leading to further alienation and chaotic or hidden emotions.”

Abstract → 


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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. I’ve never shared a Facebook page, so I hope this link works correctly. It is a picture of “The Emotional Guidance Scale”. In case the link doesn’t work, I’ll type it’s contents:

    The Upward Spiral:

    1. Joy / Knowledge, Empowerment, Freedom / Love, Appreciation
    2. Passion
    3. Enthusiasm
    4. Positive Expectation, Belief
    5. Optimism
    6. Hopefulness
    7. Contentment

    The Downward Spiral:

    8. Boredom
    9. Pessimism
    10. Frustration, Irritation / Impatience
    11. “Overwhelment”
    12. Disappointment
    13. Doubt
    14. Worry
    15. Blame
    16. Discouragement
    17. Anger
    18. Revenge
    19. Hatred / Rage
    20. Jealousy
    21. Insecurity, Guilt / Unworthiness
    22. Fear / Grief / Depression / Powerlessness / Victim


    I don’t see “shame” on the Downward Spiral list. Maybe the whole of the Downward is all shame.

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  2. I think that guilt was the crucial element which sent my son on a downwards spiral. Shame came later; shame of having been diagnosed mentally ill, shame of having been sectioned, disempowered and treated like an idiot, shame of not being able to find a job although he has university qualifications and he is an intelligent young man. He doesn’t even dare to apply for jobs anymore. The shame has taken his confidence away. Definetly: shame plays a big part role and reasoning alone doesn’t take that shame away: it is pervasive.

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  3. It occurs to me that this explains the unfulfilled promise of the medical model relieving stigma by eliminating guilt. The problem isn’t guilt, it’s shame. Hard to tell the difference, but it’s a critical one for its debilitating effects.

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    • It is possible that the medical model of mental illness does exactly the opposite of what its proponents proponents claim. The biological model may take away some blame from parents and caregivers, but it can have a very different effect on the patient, not only when it comes to shame, but also maybe even more when it comes to hope.

      If you have been told that you have a broken brain and you search on the Internet about the prognosis, you may find that this is a so-called neuro-degenerative disease and that you will have to take medications for the rest of your life.

      Then you see that these medications rob you from the little life you had. Of course you lose hope, and of course you can feel ashamed that you have a brain that is different from other peoples brains, that you cannot function, and that this is in your biology.

      So you cannot do anything about it, apart from taking medications that make you even worse in many ways: fat, sluggish, cognitively impaired, with a lot of other side effects. Of course, you would have to be in extremely good psychological health to not lose all hope!

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