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Joanne Pizzino, MD, MPH, is board-certified in Preventive Medicine and diplomate-certified in Integrative Medicine. After her own self-empowered healing epiphany in 1997, she has guided people to live healthier through both Eastern and Western medicine, ancient and ultra-high-tech healing. She now practices telemedicine in 10 states allowing you to see the doctor from the comfort of your home or office.

Shame and Disease:
Boulders on the Road to Health

By Joanne Pizzino, MD, MPH

Shame is a dirty little secret, rarely acknowledged as a root cause of illness, yet closer examination finds it inextricably linked to our bodies, our approach to health care, and that which stands in the way of wholeness.

Dr. Pizzino

As soon as we pop out of our mothers, we start receiving all sorts of subliminal messages about the rightness or wrongness of our male or female parts, and even the rightness or wrongness of our larger role in society as a man or a woman. With the advent of prenatal ultrasound, you can even start receiving these messages before birth as they cross the placenta as molecules of emotion, or reverberate as electromagnetic waves of your parent’s judgment about whether they wanted a child of your birthsex.

Because, you see, shame is all about judgment. Do I fit in? Am I lovable? Did I follow the rules correctly? Will the tribe continue to accept me, or banish me to the life-threatening horrors of separateness?

Basic Body Shame

Let’s start with basic body shame. Do I look like the portrayals of attractive people toward which my tribe teaches me to aspire? Am I a funny-looking kid with ears too big, eyes too widely spaced, nose misshaped? Am I too tall, short, skinny, big-hipped, small-muscled to compete with my peers? Will I have to prove my worth to sexual partners by my bank account, my cooking skills, political savvy or something else to make up for my narrow shoulders, small breasts, and so forth? And so begins a lifetime of proving our attractiveness to the tribe with the right car/clothes/hairdo/prep school, etc. 

Shame and Addiction

Shame is part and parcel of addictions. Not only are addictive substances (including food) an effective way to suppress our shameful feelings, the addiction itself gives us plenty of reasons to hide it. The shocking statistics barely tell the story. Eighty percent of us admit we would not want a friend, colleague or neighbor with an addiction. And that is probably because the other 20 percent are already being affected by addiction themselves. People live with so much shameful pain they want to hide from, overdoses kill more than breast cancer, guns, and car wrecks combined. Not just overdoses, but the other ravages of alcohol and drugs makes substance use the third largest cause of death in the nation. And many of these statistics have dramatically worsened with the pandemic.

It can be surprising how well hidden many addictions are, until illness or death leads to an early grave. Food, however, is by far the most accepted, available and widely used substance for stuffing down various unpleasant emotions. It isn’t even counted in the substance abuse statistics. Yet it leads to far more deaths due to heart disease, cancer, diabetes, and more. And food addiction is far more visible—and shaming.  Up until the very recent era when scarcity of food was more the norm, there was a saying: “She thinks she is a queen because she is fat.” Now we have established a culture of fat shaming dramatically increasing disorders such as anorexia nervosa.

Shame and Disease

Many people view certain health conditions themselves as shameful. Anything that implies I might not be able to keep up with the tribe can be embarrassing. This may keep many people, especially men, from seeking medical care in the more treatable stages of a disease. For instance, did you know that the risk factors for erectile dysfunction are the same as those for heart attack? Or they don’t return for further treatment because they are ashamed to admit to the doctor they did not follow through on the treatment recommendations. Many people don’t go for a free annual preventive physical exam because it means someone will check their weight, or their cholesterol, or their blood pressure, implying more shame.

Shame and Suicide

The tenth leading cause of death has so much shame surrounding it that it is almost never even mentioned until someone has taken their secret to the grave with them. It is also the only 100 percent preventable cause of death: Suicide.

Sometimes shame is about something done to you, such as sexual abuse, rather than some terrible act one committed. And yet we take on the guilt and self-blame of something for which we have no responsibility. Can you imagine how much shame someone may have about something in their life that they would rather die than admit it, or get treatment? And, while 45,855 people chose to kill themselves in the first year of the pandemic, that is still about 7,000 more than died in motor vehicle accidents that year. How much pain does one have to experience that death seems preferable to your chances with a fatal virus or a drunk driver? And what about all the lives of the loved ones irreparably shattered by someone who chose the last resort to end a shameful pain they could no longer endure?

The Toxic Impact of Shame

The statistics on suicide are only about those so tight-lipped about the misery of their existence no one could stop them from ending the pain. What about the vastly greater numbers of those leading lives of quiet desperation who would not even consider killing themselves, yet nonetheless suffer debilitating bipolar disorder, psychoses, depression and anxiety. Sixty percent of these are so shamed by their thoughts they do not even seek treatment. Many people would never admit the disturbing thoughts they have for fear they would be locked up in a hospital. Yes, shame is both a root cause and a major contributor to physical and mental health suffering as well as preventing adequate treatment. Whether causing us to lead a life of quiet desperation, or forcing us to the noisy desperation of “solutions” such as substance abuse, we must acknowledge this destructive energy, and its roots in judgment of ourselves or others.

Having a score of four out of ten on the Adverse Childhood Events (ACE) scale increases risk for suicide or narcotic addiction over 1200 percent. Those who scored six or more die on average 20 years earlier than those without any ACEs. Most of these childhood traumas fall into the shame category, being too awful to even admit. Or even worse, we didn’t know it didn’t have to be that way. (For more on ACEs see the blog: “When 4 ACEs Do Not Add Up to a Win.)

Understanding Shame

In the Tree of Life column of this issue is a contemplative approach to this powerful emotion. But first, we have to even notice all the threads of shame woven into the tapestry of our lives. Aiming money and resources at saving lives is of course necessary and compassionate, yet it may do nothing to slake the shame that contributed to the illness at its source. The hidden anguish of survivors needs no less attention. This article is meant to gently encourage us to recognize pain concealed in humiliation, beyond what is socially allowed for dignity. Shining the light of awareness on the skeletons in our closets grants us all the freedom to accept our humanness.