23

WITHDRAWAL

Sandy and I are well into the initial history, that group of sessions during which a therapist should be the most intrusive. At forty, she has a graduate degree that allows her to make a good living, but is otherwise unhappy with her life. What she wants out of therapy is clear: “I want confidence—believing in yourself. I am so afraid of intimacy that I am afraid if I meet the right person I won’t know what to do.” Near the end of our first meeting she touched her cheek fleetingly as if to check its temperature, then breathed a sigh of relief and said, “At least I didn’t say ‘I’m sorry’ every five minutes like I used to.”

Married right out of high school, Sandy divorced a year later, worked as a commercial artist, a bartender, an artist’s model, and at various secretarial jobs. Dipping her head slightly and turning a little to the side, she told me, “I did all that while I got my head together enough to finish college and get into graduate school.” We have agreed that, in order for us to learn what lies beneath her symptoms, I will be permitted to ask several deeply personal questions. She is talking about elementary school:

I did very poorly in second grade because my eyesight was so bad. One day the teacher moved me from the back of the room to the front—to the first seat in a row right in front of her. She made the whole class stand up and then she switched me and another girl. Then she said to the class, ‘You can see why we’ve moved Sandy. She flunked because she can’t see.’ I cried all the way home that day. My mom got me glasses, which I hated; now I wear contact lenses. I never opened my mouth again. If I was asked a question I would be terrified. Every move I made I was self-conscious. If anyone even looked at me I would run and hide.

No matter what the cause, the activation of shame affect alters our interaction with others: The sudden loss of tonus in the neck and shoulders makes the head droop; if we are involved with another person our eyes drop from contact and all sense of mutuality is lost. Interaffectivity and affective resonance are impossible. It is at moments like these that we wish for a hole to open up and swallow us, to remove us from the eyes of the other. Right at the moment when we might hope for invisibility, we realize, from the sudden incandescence of our cheeks, that a blush has made our shame even more conspicuous. For all of these reasons, shame produces a sundering of what Gershen Kaufman refers to as “the interpersonal bridge.”

Certainly shame affect itself is capable of pulling us away from our social milieu. Nonetheless, what Sandy has described is a series of powerful and important reactions to shame, rather than the affect itself. Some progression of experiences has made her extremely sensitive to shame—the early stages of therapy will most likely hover around this issue—but her reactions are something more than the affect itself. One place to look for clues to the nature of our reaction to shame is in the thoughts that follow the physiological phase. Between affect and reaction is the cognitive phase, which is summarized in Table 5.

Table 5

THE COGNITIVE PHASE OF SHAME

Search of memory for previous similar experiences. Layered associations to

A. Matters of personal size, strength, ability, skill

(“I am weak, incompetent stupid.”)

B. Dependence/independence

(Sense of helplessness.)

C. Competition

(“I am a loser.”)

D. Sense of self

(“I am unique only to the extent that I am defective.”)

E. Personal attractiveness

(“I am ugly or deformed. The blush stains my features and makes me even more of a target of contempt.”)

F. Sexuality

(“There is something wrong with me sexually.”)

G. Issues of seeing and being seen

The urge to escape from the eyes before which we have been exposed. The wish for a hole to open and swallow me.

H. Wishes and fears about closeness

The sense of being shorn from all humanity. A feeling that one is unlovable. The wish to be left alone forever.

Each of these eight categories is in itself a library of scripts involving shame; each contains subdirectories of scenes and a host of cross-references to the other categories. The cryptic descriptors listed in the table are offered as highly condensed summary statements meant to evoke the spirit of the entire chapters from which each was derived.

As you might expect, initially we tend to focus our attention on the group of memories most clearly associated with the triggering incident. In linguistic terms, we might view these memories as cognates—they are all more or less similar or equivalent to the triggering incident. Thus, when I learn that a friend has told to others something I entrusted as a secret, this mishap is reviewed in the context of my life experience of betrayal. (Anything that breaks the inter-personal bridge will trigger shame and therefore produce an analogous—and highly amplified—further break in the interpersonal bridge.) Defeated in an election, first to spring to mind is likely to be the history of one’s previous losses in competition.

But now, let’s expand that last scene. There are lots of reasons anyone might covet elected office, ranging from an altruistic desire to perform the duties of that job with dignity and grace to the wish for an increase in social status or the power to punish those who had earlier caused one negative affect. A victory may bring pride simply because it is an efficacy experience, but it may also bring the extra increment of positive affect we call triumph because it decreases or dispels shame from some other form of defeat. Although the first layer of associations to the combination of incident and affect might well be that of the cognates, following immediately will be a group of associations linked to the metaphorical importance of elected office. Assembled alongside the scripts representing our bundled memories of defeat may be the archives of our humiliations by more powerful others, the sting of shame caused by one’s relative powerlessness in society, the feeling of overall inferiority, or the haunting misery of a snub by a much-desired lover. Each of these realms of remembered shame will operate as a metaphor for the triggering incident and add its own particular seasoning to the stew.

To each of these memories we are likely to have further associations, all uncomfortable or unpleasant. For a moment, then, we may wish to be alone with our discomfort. It is at this point that we may elect to accept the hint given us by the physiological phase of shame and withdraw further into ourselves. Withdrawal allows us to ponder everything that has just flooded into consciousness, to contemplate it in the privacy of our inner world. Withdrawal allows us to be overwhelmed.

Under most circumstances, this removal will provide respite from the worst of the shame experience. Each of the affects, after all, has its own temporal contour. Affects begin when triggered but, unless constantly restimulated, eventually they end. Left to our own devices, we heal pretty well. Should we have the luck to be born into a family that understands the pain of shame and sees no need to augment so searing an experience, we may find ourselves readily welcomed back into the fold once we have recovered enough to meet the gaze of the loving other.

The duration and the intensity of this withdrawal are quite variable and depend on a number of factors. If, through the history of one’s development, shame has occurred sporadically and then only as a relatively minor component of interpersonal life, then each shame event is likely to be self-limited and of relatively slight toxicity. But for those to whom shame is the climate of their lives, whose expectation of shame is constant, each new humiliation adds its flavor to a huge and growing cauldron of stew. (One greets rain quite differently in Painted Desert, New Mexico, and Seattle, Washington.) In a loving family characterized by good empathic relatedness and a healthy sense of mutual respect, failure or incompetence or loss will produce shame soon to be mitigated by love. In a family whose very style of operation involves the use of shame for each to achieve dominion over the intimate other, and in which there is no habit of solace for an injured other, the wounds of shame demand withdrawal to some deeply private space where they can be licked until the pain has decreased enough to permit reentry into the ever-dangerous social milieu.

Accompanying withdrawal, of course, is a certain amount of safety from the immediate increase in shame that might occur should one remain in the view of those before whom one has been shamed. In our society, withdrawal is considered a proper response to shame. Who among us has not witnessed the abject humiliation of one who could not escape the taunts of a far more powerful other? Each of us knows a myriad of such horror stories; no season of feature films goes by without some such spectacle gracing the screens of our theaters. Indeed, the intentional use of humiliation to achieve social control is properly considered a form of torture—witnessing such a scene we tend to avert our own gaze and cry out our wish that the protagonist be shielded from view.

One of the most painful parts of the psychotherapist’s job is the responsibility to hear and to respond properly to such stories. I remember particularly my own sense of helplessness, when, as a beginner, a patient told me this story: In order to explain how thoroughly her grandfather dominated their family, this young woman recounted the legend of what he did to her mother, when, at 18, she had asked to attend a school dance. They were a farming family in a region becoming increasingly gentrified, increasingly sophisticated. “That Saturday night, while everybody she knew was at the dance, he made her walk the family cow through the entire town, right in front of the place where the dance was being held. She never asked him for anything again.” Then, 20-odd years ago, I could do no more than wince. Today I might have a bit more to say.

Crucifixion is one epitome of public humiliation. The famous witch trials of colonial Salem, the public stocks of colonial Williamsburg, arrest, trial and imprisonment of any sort, public spanking or reprimand, any form of punishment by exposure to public censure—all these are but the merest hint of the catalogue of punishments made all the worse because the culprit is denied the recourse of privacy. Shame teaches us the value of privacy: the privacy that protects us from shame, and the private place to which we must repair when humiliated. Just as shame follows the exposure of whatever we wished to keep private, the wish to withdraw provides a reasonable compensatory stratagem.

The more you think about the relation between shame and privacy, about the natural tendency toward withdrawal associated with shame, the more you are forced to reconsider the nature of psychotherapy. As E. James Anthony has said, all of the uncovering therapies produce an “arena of shame.” Best known of the uncovering therapies are those based on psychoanalytic or psychodynamic principles, in which the therapist assists the patient by promoting the process through which current malaise is linked to past experience. Each revelation—each clump of memory brought into the open from the place where it had been hidden—must bring with it a sudden burst of shame. Memories are hidden for good reason!

The skillful therapist must recognize the inevitability of this discomfort and provide for the patient the type of relational safety that fosters both the emergence of whatever must be disclosed and the healing balm of love that soothes the inevitable pain associated with disclosure. It is fascinating to note that most of the great teachers of therapy have stressed this point without ever mentioning shame. When Carl Rogers taught us to treat the patient within an atmosphere of “unconditional positive regard,” he was creating a counter-shaming attitude. All of the great psychoanalytic masters stressed the need to treat patients with infinite respect. All of the regulations about the nature of “privileged communication” are veiled references to the importance of shame within the therapeutic encounter.

The psychotherapist takes the position that disclosure, despite the pain of shame that attends the move from withdrawal to revelation, will ultimately be of benefit to the patient. Yet there are many situations in which our tendency to defend against shame by withdrawal is treated with much less respect. The enquiring reporter takes the position that, notwithstanding the pain it will cause for the one so exposed, disclosure serves the public interest. Journalism thrives on the energy that links shame to withdrawal.

There are other motives behind our cultural preoccupation with journalistic exposure. The scripts that characterize the cognitive phase of shame reference our most uncomfortable memories—there is not a good moment in the lot. To the extent that we can see somebody else suffering from the pain of exposure, we can feel at least a little better than somebody else. Whereas Freud taught that all spying and prying derived from our curiosity about sex, it now seems clear that sex is only one of several realms of human life held in privacy for the sake of shame. Whoever is impelled to ferret out the secrets of others in disavowal of the meaning of withdrawal bears some special relation to shame.

Were it not for our affective history and the dynamic relation between the innate affects themselves, none of this would be important. That which was revealed in each of these situations would stimulate only the response normally accorded the appearance of new information. If I am a scientist searching the forest for new plants, then whatever new plant I see will be entered into my log book and studied in its turn. Yet to be a scientist of the self fills one with the pain of shame because of our history of shame. People cannot be truly open to self-scrutiny until their archives of shame have been examined and understood. For most of us, this is the role of psychotherapy—a guided tour of the self in the company of a trusted other whose professionalism guarantees that the shame of self-discovery will be minimized.

Often I wonder just what goes on in people during the period of withdrawal in response to shame affect. Just as our modern electrophysiological studies have demonstrated that sleep is an active phase of mental life, rather than “down time” for a machine that has been switched off, I suspect that it is during the periods of withdrawal that we make a lot of decisions about our nature. Certainly this is a period of time when many of the thoughts listed in Table 5 gain even more magnification, rise even more in significance.

Because nearly everything associated with shame goes into the category we call “hidden,” these cognitions (and indeed the entire process of such thinking) tend also to be hidden from consciousness. Tomkins views consciousness as that portion of mental life which has garnered enough affective amplification to take center stage; that which remains active but not so amplified might be what Freud called “preconscious” life. It is beyond question that shame is the primary affect in our resistance to releasing material from its hiding place in the unconscious. If shame, with all the force of its amplification and urgency, is what keeps things hidden, then might it not be one of the major forces that helps create that layer of mental life we call the dynamic unconscious? In some of his earliest work, Freud spoke of disgust, shame, and the moral ideals derivative of these affects as the primary forces that create repression. This intuition was later ignored as he shifted the focus of his attention from shame to guilt. Not only is the withdrawal phase of reaction to shame a natural response, but it may be one that is essential to the formation of a normal personality.

Notice that there are degrees of withdrawal just as there are degrees of shame. Normally we drop our eyes for a moment on unintentionally meeting the gaze of another—perhaps the briefest example of this mode of reaction to shame affect. Should it be noted at all, this form of shame is called politeness. More vivid, but still well within the limits of a healthy and normal response to shame, is the behavior of a small child who ducks behind mother when caught inspecting the face of a stranger, or who might run and hide when embarrassed. In each of these examples, the subject has experienced shame affect, then run through some version of the thought process listed above, reacted by withdrawal, and returned to society when the affect has waned and the coast seems clear.

Often, as adults, we demonstrate this mild degree of shame as withdrawal by small, economical gestures—putting a hand to our lips as if to prevent our very mouth from leaking unacceptable words, briefly biting the lower lip while glancing down and away, or stuttering for a moment while looking clearly uncomfortable. In some cultures, a woman will indicate sexual interest by returning a man’s gaze and lowering her eyes briefly, as if embarrassed by her own arousal. Nietzsche, among many others, described his own feeling of pleasure when a woman exhibited such apparent embarrassment.

At the other end of the spectrum, I have met patients afflicted with biological disorders that produced paralyzing degrees of shame, who have described the period of their depression as one in which they became “like a hermit.” One woman told me that in the four years of this illness she did not leave her home for fear of meeting the eyes of any person outside her family. The withdrawal accompanying severe biological depression is not specific to the disease but rather a learned defense against intense and enduring shame affect that has been produced by a defect in neurotransmitter mechanisms. It is an example of the most severe form of withdrawal reactions to shame.

This helps explain the effect on depression of the various forms of psychotherapy. Most often, clarity and relief are obtained when we can identify the experiences from the past that were used to construct one’s personal categories of shame cognition. Some patients, however, are little helped by discussion of the apparent historical roots of their shame or guilt. Despite how real it feels, their emotion has not resulted from the thoughts and memories brought into the therapeutic encounter. These, of course, represent the cognitive phase of the shame experience, even though in this case shame has been triggered by chemical misinformation. Medication that corrects the neurotransmitter imbalance will reduce or remove the inappropriate and unreasonable amount of shame, allowing both a return to society and a remarkable decrease in attention to the thoughts that previously seemed to cause so much distress. On the other hand, cognitive–behavioral therapy, by altering the thought patterns associated with the biological shame state or by setting up conditions that force the patient to give up the withdrawal reaction, can also produce a remarkable improvement in the patient’s outlook. In the more malignant forms of depression, both chemical and behavioral manipulations are usually needed.

Momentary gaze avoidance and hermit-like depression represent two extremes of the withdrawal reaction to shame affect; they help define this spectrum of responses to shame. Between them lie an infinite number of forms and types of withdrawal, each capable of analysis in the manner I have suggested here. There are two realms of benefit conferred by the system of withdrawal. However long it may last, the period of isolation can allow an individual to regroup and recover self-esteem so that emergence into the world of others is facilitated or enhanced. But while secluded, we are relatively immune to further shaming incidents—withdrawal can protect from injury as well as foster healing. Withdrawal can become part of an affect-reduction script or an affect-avoidance script; in either case the action involved is undertaken in order to minimize the experience of shame.

On several occasions I have mentioned the condition currently known as atypical depression, a persistent form of mood disturbance characterized by “rejection sensitivity,” “social phobia,” and “applause hunger.” This, too, presents over a wide spectrum of severity, for in some patients we see these symptoms in the absence of discernible depression, while in others the associated affects of distress and disgust (self-loathing) predominate and cause a morbid, paralytic, self-deprecating withdrawal.

We know that this illness is best treated by the use of medications that make more of the neurotransmitter serotonin available to certain groups of neurons. Most of these symptoms dwindle or disappear when the patient is given one of the monoamine oxidase inhibitor antidepressants (Parnate, Nardil) or fluoxetine (Prozac), for these two classes of medication are (at this writing) the best we have to reduce biologically induced shame. Nevertheless, the actual symptom complex may be understood as one in which a biochemical illness produces an inordinate amount of shame affect against which the patient defends by strategies linked almost purely to withdrawal. All of the patients with this illness seem to have used the withdrawal system of shame management long before there was any evidence of an illness; when they did become ill, the way was prepared for their method of handling it.

I do not mean to imply that biologically induced or maintained shame states produce reactive scripts involving only the withdrawal pole of the compass of shame. Biochemically triggered shame can evoke responses from any of the four poles of the compass; when treated with proper medication, the behavior associated with that script library tends to diminish significantly. Fluoxetine (and, I suspect, the newer drug paroxetine) helps lots of people whose shame syndromes involve the other quadrants of the compass. But most of what my colleagues recognize as “atypical depression” involves the withdrawal pole.

Always of special interest is the relation between shame and sexuality, which is uniquely sensitive to the reactive phase of shame. Wurmser has commented that we are embarrassed to be seen naked unless the viewing other is held under what he described as the spell called “fascination.” This is easy to understand if we accept that when fascinated one is in the throes of an irresistibly attractive influence. In such a situation there is (almost by definition) little or no likelihood that anything can act as an impediment to rapt interest or cause a breach in the interpersonal bridge; the one who is disrobing can feel safe, free from the anticipation of shame.

To the extent that one does not feel such safety within a relationship, withdrawal presents an ever more attractive alternative. Reticence and modesty form the mature and healthy end of the spectrum; they are attitudes or systems of behavior that require of the viewing other either permission to reveal or some sort of safeguard from humiliation. Directly proportional to our expectation of shame in any encounter will be the degree of anticipatory protective withdrawal.

Thus, the effect on sexual arousal and excitement of the withdrawal system of reaction to shame will range from normal modesty to complete impotence and frigidity. The more one expects or actually experiences shame as an impediment to the excitement accompanying sexual arousal, so much will one withdraw from sexual interaction as protection from this particular discomfort.

Although shame is rarely if ever discussed within any of the modern systems of sexual counseling, much of the therapy itself seems directed at its reduction. The use of tasteful illustrations, anatomical models, and well-directed films to demonstrate the range of normal anatomy and normal sexual behavior serves to reduce shame significantly. Even the decision to request treatment implies that one is ready to trade the shame of chronic sexual failure for that accompanying exposure to professional counselors.

Often the withdrawal defense is accompanied by other affects which serve to promote the sense of alienation, resignation, and retreat associated with some forms of shame. When withdrawn, some people weep in distress, while others look frightened. Distress, an analogic amplifier of a steady-state noxious stimulus, stretches out shame and helps to make it a steady experience. Fear, another sort of analogic amplifier of overmuch, worsens the experience of shame by adding the discomfort of overmuch to the pain of impediment to positive affect. To the extent that both of these affects are coassembled with shame that is reacted against by withdrawal, we will interpret the entire package as “classical depression,” with its stigmata of guilt, foreboding, gloom, sadness, tears, and agitation.

Since both disgust and dissmell motivate us to stay at a distance from whatever has triggered them, both affects may be brought into the picture to augment withdrawal. Thus, a withdrawn, depressed patient may see him- or herself as a loathsome object worthy only of our scorn and rejection. The balance between self-disgust and self-dissmell can easily be determined by attention to the individual’s reasons for (cognitive explanations of) this particular feature of the self.

The withdrawal system of adaptation to shame is perhaps the easiest to treat in psychotherapy. Essential is a basic empathic stance that shows you know and feel the other person’s pain. This must be verbalized in a distinctive manner that indicates some sort of joining with the patient. Central to treatment is the understanding that the patient, stuck alone in the shame experience, is unable to return to normal interpersonal interaction unaided. The empathic therapist is able to enter the patient’s pain at this deeply personal level, join with it, and then pull both out of the humiliation.

The therapist must be willing to teach the definition of a shame experience. I try to use the situation of the moment to identify as much as possible about what it feels like to be humiliated. The purpose here is to drive home the concept that the basic feature of any period of shame is an innate affect, a brief, scripted, physiological experience common to all humans, one that has a temporal contour.

It is useful to focus the patient on the temporal aspects of the episode. Even though these moments tend to feel endless, eventually they pass. The very fact that patient and therapist continue to talk, continue to maintain some form of empathic link, disproves or undoes one of the cardinal elements of the shame experience—the sundering of the interpersonal bridge. Whenever possible, I try to catalogue (and get the patient to agree to the existence of) the good features of the self that remain. This helps reduce the dominance of the bad self that was depicted during the cognitive phase of shame.

In summary, treatment of the withdrawal reaction to shame requires that the therapist enter the other person’s system in an empathic manner, identify the shame experience, and define it in a way that demonstrates a conviction that recovery is as certain as is the remainder of the experience. Therapeutic passivity—the decision to remain silent in the face of a humiliated, withdrawn patient—will always magnify shame because it confirms the patient’s affect-driven belief that isolation is justified. In a manner of speaking, one might say that such a mode of treatment encourages the patient to switch from defense by withdrawal to defense by self-attack, the system that will occupy us in the next chapter.

Look once more at the issues listed in Table 5. Might there be one or more categories of discomfort most important to those who use withdrawal strategies? I think that it is the last two categories that matter most here: Issues of seeing and being seen; and wishes and fears about closeness. Wurmser said once that the eye is the organ of shame par excellence. When we withdraw, we escape the eyes of the other, the eyes before which we have been shamed. Morrison has pointed out that much of shame involves the viewing eye turned inward, shame as we face ourselves, as we see what we wish to hide from ourselves. But withdrawal works pretty well as a metaphor for escape, especially in terms of those two specific categories from the cognitive phase of the shame sequence. Other defenses work better for people more occupied by the rest of what we see in Table 5. It is to these script libraries that we will now turn our attention.