Shame and using mental health services: Connection and validation or alienation and objectification?

Using an interpersonal conception of shame, this paper draws on research data and critiques of the medicalization of distress to explore how mental health services risk exacerbating the very emotional problems they are charged to address.

Prior research provides compelling evidence that shame is central to many of the psychological difficulties for which people seek help from mental health services. Although shame has sometimes been conceptualised as negative self-evaluation, other perspectives, and recent research data, suggest the value of understanding shame as a painful awareness of one’s devaluation before potential or actual others. This underscores the importance of social contexts, and one’s perceived position within them, for the development and repair of difficult-to-manage feelings of shame. However, those using mental health services have often described ways in which the services leave them feeling devalued. In our study of experiences of accessing mental health services, although at times participants talked positively about the support and validation they had received from staff, elsewhere they referred to shame-like experiences of feeling demeaned, disempowered, exposed or rejected. We argue that one key factor in such paradoxical ‘care’ is the dominance of diagnostic approaches. Although some service-users may find elements of psychiatric diagnosis helpful, it promotes practices such as disconnection from, objectification of and silencing of service-users, which are diametrically opposed to conditions necessary for repair of shame. Instead, collaborative and sensitive psychological formulation may offer service-users better opportunities to connect with others and contextualise and normalise their difficulties.