Managing shame in relation to both diagnostic & psychosocial conceptualisations of psychological problems

Although considerable attention has been paid to stigma in relation to mental health difficulties, less attention has been paid to the possible emotional consequences of this, such as chronic feelings of shame, and to the impact on negative or positive identity of an individual’s understanding of his or her mental health difficulties.

This presentation draws on data from a qualitative interview-based study with 22 service users which explored how they managed the potential for shame in using mental health services. We discuss one theme from the data, ‘making sense of having a diagnosis’, with reference to (i) the use of diagnostic categories to resist alternative shaming explanations for changed behaviour (ii) the sense of shame some participants felt about their diagnosis (iii) the discursive strategies they used for resisting this, and (iv) the role of others in helping them to make sense of their difficulties in a validating and non-shaming manner. Conclusions are drawn regarding the need for explanations of mental health difficulties that take account of the interdependence of psychological, behavioural and physiological responses to adverse circumstances, without invoking shaming notions of ‘abnormality’. Otherwise, there is a risk that contact with mental health services may exacerbate some of the very difficulties that lead to referral.