Today is World Mental Health Day. I haven’t exactly been a pinnacle of mental health these past 15+ years – I’ve had diagnoses, suggested diagnoses, and treatments up to my eyebrows. The battle never truly ends, although I’m gratified to be fighting it. Struggling with your mental health has a lot of downsides. Obviously. However, when I think about the worst part, my mind readily supplies the same answer every time: shame. Shame comes back to me again and again. I am saturated in it, plagued by it. It may not be the most overtly dramatic or ugly outcome, but it is certainly the most pervasive. Following a recent setback in my own mental health, I realised that shame still leads me to go to great lengths to hide my negative emotions and inner turmoil from friends and family. Shame isolates you and contributes to suffering, loneliness, and self-loathing.

Multiple studies have shown the connection between shame and mental illness, often highlighting its role in the development or exacerbation of conditions such as depression, anxiety, post-traumatic stress disorder (PTSD), and other disorders. I have unearthed a few notable studies:

1. Gilbert et al. (2010): This study emphasises that shame, particularly “external shame” (the perception of being negatively judged by others), is closely associated with depression and anxiety. The researchers found that people who experience high levels of shame tend to develop maladaptive coping strategies that increase vulnerability to mental health issues.
   • Reference: Gilbert, P., McEwan, K., Bellew, R., Mills, A., & Gale, C. (2010). The dark side of competition: How competitive behaviour and striving to avoid inferiority are linked to depression, anxiety, stress, and self-harm. Psychology and Psychotherapy: Theory, Research and Practice, 82(2), 123-136.
     
2. Tangney, Wagner, & Gramzow (1992): This foundational study discusses how chronic shame, especially in interpersonal contexts, can lead to depression and low self-esteem. The research suggests that shame-prone individuals are more likely to engage in self-destructive behaviours, further contributing to mental health deterioration.
   • Reference: Tangney, J. P., Wagner, P. E., & Gramzow, R. (1992). Proneness to shame, proneness to guilt, and psychopathology. Journal of Abnormal Psychology, 101(3), 469-478.
     
3. Andrews, Qian, & Valentine (2002): This study focuses on the relationship between shame and depression, finding that people with major depressive disorder often report higher levels of both internalised and externalised shame. The results suggest that shame can be a maintaining factor in depression.
   • Reference: Andrews, B., Qian, M., & Valentine, J. D. (2002). Predicting depressive symptoms with a new measure of shame: The Experience of Shame Scale. British Journal of Clinical Psychology, 41(1), 29-42.
     
4. Lee, Scragg, & Turner (2001): This research examines the role of shame in PTSD, particularly in individuals who have experienced trauma. The findings indicate that shame is a significant predictor of PTSD severity, and those with high levels of shame are more likely to experience chronic post-traumatic symptoms.
   • Reference: Lee, D. A., Scragg, P., & Turner, S. (2001). The role of shame and guilt in traumatic events: A clinical model of shame-based and guilt-based PTSD. British Journal of Medical Psychology, 74(4), 451-466.
     
5. Kim, Thibodeau, & Jorgensen (2011): This meta-analysis reviews several studies on shame, guilt, and mental health, concluding that shame is more strongly associated with mental health problems like depression and anxiety than guilt, which is often more adaptive. The authors highlight the impact of chronic shame on psychological well-being.
   • Reference: Kim, S., Thibodeau, R., & Jorgensen, R. S. (2011). Shame, guilt, and depressive symptoms: A meta-analytic review. Psychological Bulletin, 137(1), 68-96.

These studies demonstrate a significant connection between shame and various forms of mental illness, underscoring its role as both a contributing and maintaining factor in psychological disorders.

When you suffer from mental health problems, especially from a young age, shame seeps into your pores and sets into your very bone marrow, and it takes up residence. In my case, growing up as a homosexual in a world before that was openly accepted only doubled that internal build-up. I spent years thinking I had a lot to be ashamed for: my behaviour, my scars, my appearance, my sexual orientation, my inability to focus and achieve what was expected of me, my emotional reactions, not showing up, failing to meet social conventions, being too “larger than life”, having “caused a scene”, disappointing people, annoying people. It goes on. I felt shame for the inconvenience, trauma, and discomfort my mental health problems inflicted on others, and on services.

Would I feel this way about physical illness? Perhaps, perhaps not to the same extreme. While I’m still working on my own shame issues, I can say that the thing to note here is the failure to consider one’s own positive attributes, and what we do bring to the table. The fact is, we are what God made us; or if you aren’t of a religious persuasion, we are here, as we are, and we are perfectly imperfect (cringe lol). We are as worthy of this space as anyone else. Mental illnesses and disorders are not the fault of the sufferer, and shame only doubles the suffering. As we can see from the studies above – you aren’t alone, you aren’t the only one experiencing shame, and if you keep fighting by repeating your better traits to yourself the way you would for someone you love, and more importantly bringing something positive to other people’s lives, you might find a way out of that particular Hell. The first step is knowing how to talk to yourself.

Treat yourself like someone you are responsible for helping.
– JB Peterson