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The phenomenology of shame in the clinical encounter

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Abstract

This article examines the phenomenology of body shame in the context of the clinical encounter, using the television program ‘Embarrassing Bodies’ as illustrative. I will expand on the insights of Aaron Lazare’s 1987 article ‘Shame and Humiliation in the Medical Encounter’ where it is argued that patients often see their diseases and ailments as defects, inadequacies or personal shortcomings and that visits to doctors and medical professionals involve potentially humiliating physical and psychological exposure. I will start by outlining a phenomenology of shame in order to understand more clearly the effect shame about the body can have in terms of one’s personal experience and, furthermore, one’s interpersonal dynamics. I will then examine shame in the clinical encounter, linking body shame to the cultural stigma attached to illness, dysfunction and bodily frailty. I will furthermore explore how shame can be exacerbated or even incited by physicians through judgment and as a result of the power imbalance inherent to the physician-patient dynamic, compounded by the contemporary tendency to moralise about ‘lifestyle’ illnesses. Lastly, I will provide some reflections for how health care workers might approach patient shame in clinical practice.

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Notes

  1. Quoted in: Benedictus (2011).

  2. "Embarrassing Bodies Series Saves Nhs £280 k in a Month," http://www.channel4.com/info/press/news/embarrassing-bodies-series-saves-nhs-280k-in-a-month. (Accessed 6 June 2015).

  3. Wiseman (2010).

  4. Davidoff (2002).

  5. Ibid., 623.

  6. Lazare (1987).

  7. For example, see: Sabini et al. (2001), Babock and Sabini (1990), Keltner and Buswell (1996), Tangney et al. (1996) and Miller and Tangney (1994).

  8. In this way, embarrassment can be consider to be a ‘mild’ or ‘less intense’ form of shame, and there are several thinkers who argue to this effect. See: Kaufman (1993, 24). See also: Crozier (1990, 39–40), and Lewis (1995, 210).

  9. Dickerson et al. (2004, 1196).

  10. See the ‘shame’ entry in the Oxford English Dictionary. Also see: Klein (1967, 1430).

  11. Liddell and Scott (1889, 19).

  12. Williams (1993, 78).

  13. Zahavi (2014, 216).

  14. For example, see: Gilbert and Miles (2002).

  15. See: Dolezal (2015). The ideas in the paragraphs which follow here are discussed at length in chapters 1, 2 and 4 of this monograph.

  16. Pattison (2013, 62).

  17. See: Merleau-Ponty (2012).

  18. Kaufman (1993, 17).

  19. Quoted in: Gimlin (2006, 707).

  20. Miller (1996, 17).

  21. Goffman (1967, 97).

  22. The shamefulness of shame can vary for certain groups. For example, it is suggested by Aneta Stepien that shame is particularly shameful for men. As a result they are much more likely to repress, hide or deny shame, perhaps bypassing it for other emotions or experiences such as depression or anger. See: Stepian (2014).

  23. Scheff (2000, 90).

  24. Lewis (1971). See also: Kaufman (1993, 4, 20).

  25. Lee and Wheeler (1996, 7).

  26. Thomas Fuchs makes a similar point arguing that an individual undergoes, what he terms, a ‘corporealization,’ where the spontaneous performance of the body is ruptured in experiences of guilt and shame. See: Fuchs (2003).

  27. Kaufman (1993, 18).

  28. Ibid., 18, 19–20.

  29. Tomkins (1963, 118).

  30. Kaufman (1993, 5, 18).

  31. Ibid., 18.

  32. See, for example: Goffman (1959, 12).

  33. See: Miller (1996, 4–5).

  34. Lewis (1971, 203). And Lee and Wheeler (1996, 2).

  35. Lewis (1971, 196).

  36. Scheff (2004, 231).

  37. Lashbrook (2000, 754).

  38. Lazare (1987, 1654).

  39. Diski (2014, 7).

  40. Brumberg (1997, 64, 70).

  41. Sontag (1989, 100).

  42. Ibid., 102.

  43. Ibid., 17.

  44. Ibid., 102.

  45. Consedine et al. (2007, 440).

  46. Sontag (1989, 113–14).

  47. On responsibility for one’s own health behaviour and risk-factors in the case of obesity, see for example: Lupton (2013).

  48. Tomlinson (2012).

  49. For example see: Metzl and Kirkland (2010).

  50. For example, the distinction between ‘bodily embarrassment’ and ‘judgement concern’ is argued for by Consedine et al. in their study to explore why people do not always seek out medical attention. However, they conclude these elements of medical shame interact in several significant ways. See: Consedine et al. (2007).

  51. Ibid., 440.

  52. Rousseau (1996, 82).

  53. Piers (1953, 16). As quoted in: Probyn (2005, 3). Emphasis in original.

  54. Goffman (1990, 7).

  55. Northrop (2012, 105).

  56. Lazare (1987, 1654).

  57. Davidoff (2002, 623).

  58. Harris and Darby (2009, 327).

  59. Ibid., 328.

  60. See, for example: Keltner and Buswell (1996, 168).

  61. Malterud and Hollnagel (2007, 69).

  62. Lazare (1987, 1655).

  63. Consedine et al. (2007, 440).

  64. Ibid., 440–441.

  65. Malterud and Hollnagel (2007, 69).

  66. Ibid., 72.

  67. Carel and Kidd (2014).

  68. For example: Harris and Darby (2009, 328).

  69. Dickerson et al. (2004, 1209–10).

  70. For an extended discussion of shame in the context of cosmetic surgery, see: chapter 6 of Dolezal (2015).

  71. Bordo (2009, 28).

  72. Cosmetic surgery is a highly gendered practice. While over 90 % of cosmetic surgery patients are female, 8 out of 9 cosmetic surgeons are male. See: Dolezal (2015, 125–26).

  73. Leder (1990, 98).

  74. Northrop (2012, 178).

  75. Wiseman (2010).

  76. Brown (2010, 25).

  77. Quoted in: Wiseman (2010).

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  1. Department of Philosophy, Durham University, 50 Old Elvet, Durham City, DH1 3HN, UK

    Luna Dolezal

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Dolezal, L. The phenomenology of shame in the clinical encounter. Med Health Care and Philos 18, 567–576 (2015). https://doi.org/10.1007/s11019-015-9654-5

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