“Shame is the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love, belonging, and connection” - Atlas of the Heart, Brene Brown PhD MSW

First and foremost, shame is a UNIVERSAL emotion. We have all felt shame at one point or another. However, we hide our shame because of the underlying fear that acknowledging those dark, imperfect parts of us will cause us to be shunned from our community and our people. As a result, shame festers and grows when it is held in secret isolation.

Shame can show up in palliative care when a patient can no longer control their bladder and bowels. It can also look like a patient denying a desperate dying wish to connect with children who are estranged due to the patient’s alcoholism.  Sometimes shame is hidden behind grandiosity, anger, and defensiveness. Shame can be big things: “my family won’t talk with me because I left their mother for the pastor at church”, and small things: “my emphysema from lifelong smoking prevents me from attending my grandchildren’s sports activities”. Another way shame can appear is with symptoms: “I am weak because I can’t tolerate the pain without medications”.

Why should we be worried about shame that our patients feel? Of course, as palliative care community specialists, we are usually the people in the medical community who take time to sit and listen to patients and their value-based goals. With that comes sharing about deeper worries and fears. In addition to the palliative care practice to show compassion to all of our patients, patient outcomes improve because they feel unconditional positive regard and are less fearful to admit symptoms to providers.

The antidote to shame is empathy, and witnessing without judgment. When we meet with patients and families who are sharing their innermost regrets and humiliations. Having compassion for ourselves starts with others’ unconditional love and positive regard, and we can create a safe environment for patients to share their deepest scars in order to heal.

The article below by Trindade, Duarte, Ferriera, Continho, and Gouveia addresses shame in relation to serious illness and how it impacts communication and connection with others:

The impact of illness‐related shame on psychological health and social relationships: Testing a mediational model in students with chronic illness (wiley.com)