Is Shame an Antidote to Addiction?

FEB. 3, 2016

To the Editor: Sally L. Satel and Scott O. Lilienfeld criticize American culture for promulgating the idea that shame is “a damaging, useless emotion.” They criticize efforts to “eradicate” shame (by likening drug addiction to cancer) for those with addictions, worrying that such people will see their “habits as unalterable.”

Shame, as a universal social emotion, serves an evolutionarily adaptive function. It is also extremely painful and often dealt with by hiding. Contrary to the writers’ assertions, our culture tends to stigmatize people with addictions — to wit, Drs. Satel and Lilienfeld use the pejorative label “addicts.” Such people avoid treatment because of shame and destroy themselves in the process.

The role of agency is complex in illness whether dealing with addictions or illnesses the writers categorize as “biological.” For example, a patient with lung cancer who smokes is a different patient from a nonsmoker.

Regardless of the condition, it is critical to mobilize the healthy part of the patient to take responsibility for his or her health. This has more to do with mobilizing self-love in the setting of shame.

Diminishing the stigma attached to addictive illness may help some people more readily enter treatment and come out of hiding.

LARRY S. SANDBERG

New York

The writer is clinical associate professor of psychiatry at Weill Cornell Medical Center.