Re:

1/24/16

To the editor:

Sally Satel and Scott Lilienfel (NYT, 1/24/16) 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 such individuals 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 authors’ assertions, I believe our culture tends to stigmatize people with addictions– to wit the authors use the pejorative label ‘addicts’. Such individuals often 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 authors categorize as ‘biological.’ For example, a patient with lung cancer who smokes is a different patient than 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. Twelve step programs intuitively integrate this into their philosophy by encouraging people to accept being powerless (i.e., to not ‘lose face’) in relation to their addiction while proceeding to do a moral inventory where reparation is an essential part of recovery.

Respectfully submitted

Larry S. Sandberg MD