Explainer
Creed
Psychology
5 min read

Should you be ashamed of yourself?

Shame powers cancel culture, yet its historic role is guarding community boundaries. Henna Cundill takes an in depth look at shame - and empathy.
The word 'SHAME' spray painted onto a grey hoarding in lime green paint.
Anthony Easton/flickr: PinkMoose, CC BY 2.0, via Wikimedia Commons.

“Put on this dunce’s cap and go and stand in the corner!” cries the teacher, and immediately we are transported to a scene that takes place in a schoolroom of centuries past. Likewise, if nowadays we were to see a woman being led down the street wearing a scold’s bridle, we might assume that there was a very odd sort of party going on; we might even intervene or phone the police. Why? Because these are not the scenes of 21st century Britain. We don’t do public shaming anymore – at least, we like to think we don’t.  

But the truth is we very much do; in fact, shame is essential, at least to a certain degree. For a group to survive with any sense of collective identity and purpose, something has to prevent each person within that group from becoming too greedy, or too lazy, or too dishonest. That something is often the fear of being shamed, not even punished – just shamed. It doesn’t feel nice to be judged and found wanting, or to fear that you might be. 

Think back to the last windy day when your recycling bin blew over – did you experience a passing moment of concern about the public pavement acrobatics of your wine-bottles, cake boxes and ready-meal trays? No need to blush – your neighbours probably rushed out ahead of you to hide their own multifarious sins. Studies have long shown that installing self-checkouts at supermarkets dramatically increases the purchase rates of “stigma items” such as alcohol and unhealthy foods. Oh, the things we do when we think no one is watching… 

So, shame is, on one level, a functional tool which does the essential job of guarding the life and boundaries of a community. Perhaps one or two of us still eats a little too much and drinks a little too much, but shame is one of the things that keeps most of us from going too far, too often – or at least the threat of shame tends to discourage. As Graham Tomlin has recently explored – we still live in a society that equates over-indulgence with a lack of virtue.  

It’s one thing for shame to guard certain moral boundaries (as long as we can all agree what they are) but we’re in a troubling place with the social ones. 

However, when an individual does step out of line, then the shaming process has two modes of presentation: exposure or exclusion, sometimes both. This is most clearly seen in a court of law, where an offender is first ceremonially declared to be guilty (exposure) and then is subsequently sentenced (exclusion) – often “removed” from society, at least for a while, via a custodial sentence or a curfew. In this very clear way, shaming plays a functional role for the well-being of society as a whole.  

But these two prongs of the shaming process can also happen in rather dysfunctional ways, some of which are dangerously subtle. We fear the recycling bin disgorging its contents because there is a certain social shame in being seen to consume too much junk. Fine. But what about the teenager who is compelled into a cycle of disordered eating because a schoolfellow has pointed the finger and said the dreaded word, “fat”? Likewise, many people love a chit-chat, and the fear of being excluded from a social group usefully prevents most of us from being too fixed on one topic, or from appearing inattentive or impolite. But in my research with autistic people, some have shared that they feel shamed out of social groups entirely simply because “chit-chat” is not right for them. Some have a language processing delay, others find “small talk” a bit confusing and inane and would rather talk about something specific. It’s one thing for shame to guard certain moral boundaries (as long as we can all agree what they are) but we’re in a troubling place with the social ones. Some of this shaming doesn’t sound very functional, not if the wellbeing of society is supposedly the goal.  

The inverse of shame is empathy. Where shame excludes, empathy shows attentiveness. 

Perhaps the saltiest example of this problem is the now infamous “cancel culture”. I know – even I can’t believe I would risk bringing that up as a writer, that’s how charged this debate has become. But de-platforming, boycotting, or publicly castigating someone for the views that they express – these are shaming activities, an attempt to render an individual exposed and excluded. It can be a very tricky argument as to whether this counts as functional shame, guarding the wellbeing of society, or dysfunctional shame, guarding little more than social norms.  

We ought to try and take it on a case-by-case basis, but even then, sometimes what one person takes as a moral absolute another person sees as a social choice. At the same time, those who hold dearly to certain moral absolutes sometimes lose sight of the societal impact of what they say. The result can be a strange kind of war, one where there is virtually no engagement between two opposing factions, and the only weapons are a string of press releases and a whole lot of contempt. Eventually, often regardless of there being no engagement and no progress, both sides vigorously declare themselves to be the winner.   

Jesus once said a strange thing when he was talking to a crowd. He said: “Settle matters quickly with your adversary who is taking you to court. Do it while you are still together on the way.” In other words, “Just have a chat first,” says Jesus, “and see if you can’t come to terms.” It was part of a much longer discourse where he also told the crowd to “love your enemies” – and this with the kind of love called agape, a love which favourably discriminates and chooses someone – very much the opposite of shaming them.  

For my own research I have looked in depth at the shaming experience, and one of the conclusions that I come to is that the inverse of shame is empathy. Where shame excludes, empathy shows attentiveness. Where shame exposes an individual, empathy draws them into discussion. To empathise with someone is not to agree with them, but it is to recognise they are human just the same, and that through openness and dialogue it is possible for people, even those who have very different experiences of the world, to explore each other’s perspectives. The end point of that exploration may not be agreement – it might still be everyone back to their corners. But in the process no one has been shamed, no one exposed or excluded, no-one othered or dehumanised.  

Of course, it is far easier to point the finger, to expose someone to the court of public opinion, and then to turn one’s face away, nose in the air, mouth clamped shut in an apparently dignified silence. On the surface this seems like the elegant response – live and let live – but in fact it is not: to designate someone as not worthy of attention is to very publicly inflict shame. We might as well clamp them into a scold’s bridle and lead them down the street. And, as we do so, let’s hope it’s not a windy day – or if it is, let’s be sure that we have firmly tied down the lids of our recycling bins.   

Review
Books
Care
Comment
Psychology
7 min read

We don’t have an over-diagnosis problem, we have a society problem

Suzanne O’Sullivan's question is timely
A visualised glass head shows a swirl of pink across the face.
Maxim Berg on Unsplash.

Rates of diagnoses for autism and ADHD are at an all-time high, whilst NHS funding remains in a perpetual state of squeeze. In this context, consultant neurologist Suzanne O’Sullivan, in her recent book The Age of Diagnosis, asks a timely question: can getting a diagnosis sometimes do more harm than good? Her concern is that many of these apparent “diagnoses” are not so much wrong as superfluous; in her view, they risk harming a person’s sense of wellbeing by encouraging self-imposed limitations or prompting them to pursue treatments that may not be justified. 

There are elements of O-Sullivan’s argument that I am not qualified to assess. For example, I cannot look at the research into preventative treatments for localised and non-metastatic cancers and tell you what proportion of those treatments is unnecessary. However, even from my lay-person’s perspective, it does seem that if the removal of a tumour brings peace of mind to a patient, however benign that tumour might be, then O’Sullivan may be oversimplifying the situation when she proposes that such surgery is an unnecessary medical intervention.  

But O’Sullivan devotes a large proportion of the book to the topics of autism and ADHD – and on this I am less of a lay person. She is one of many people who are proposing that these are being over diagnosed due to parental pressure and social contagion. Her particular concern is that a diagnosis might become a self-fulfilling prophecy, limiting one’s opportunities in life: “Some will take the diagnosis to mean that they can’t do certain things, so they won’t even try.” Notably, O’Sullivan persists with this argument even though the one autistic person whom she interviewed for the book actually told her the opposite: getting a diagnosis had helped her interviewee, Poppy, to re-frame a number of the difficulties that she was facing in life and realise they were not her fault.  

Poppy’s narrative is one with which we are very familiar at the Centre for Autism and Theology, where our team of neurodiverse researchers have conducted many, many interviews with people of all neurotypes across multiple research projects. Time and time again we hear the same thing: getting a diagnosis is what helps many neurodivergent people make sense of their lives and to ask for the help that they need. As theologian Grant Macaskill said in a recent podcast:  

“A label, potentially, is something that can help you to thrive rather than simply label the fact that you're not thriving in some way.” 

Perhaps it is helpful to remember how these diagnoses come about, because neurodivergence cannot be identified by any objective means such as by a blood test or CT scan. At present the only way to get a diagnosis is to have one’s lifestyle, behaviours and preferences analysed by clinicians during an intrusive and often patronising process of self-disclosure. 

Despite the invidious nature of this diagnostic process, more and more people are willing to subject themselves to it. Philosopher Robert Chapman looks to late-stage capitalism for the explanation. Having a diagnosis means that one can take on what is known as the “sick role” in our societal structures. When one is in the “sick role” in any kind of culture, society, or organisation, one is given social permission to take less personal responsibility for one’s own well-being. For example, if I have the flu at home, then caring family members might bring me hot drinks, chicken soup or whatever else I might need, so that I don’t have to get out of bed. This makes sense when I am sick, but if I expected my family to do things like that for me all the time, then I would be called lazy and demanding! When a person is in the “sick role” to whatever degree (it doesn’t always entail being consigned to one’s bed) then the expectations on that person change accordingly.  

Chapman points out that the dynamics of late-stage capitalism have pushed more and more people into the “sick role” because our lifestyles are bad for our health in ways that are mostly out of our own control. In his 2023 book, Empire of Normality, he observes,  

“In the scientific literature more generally, for instance, modern artificial lighting has been associated with depression and other health conditions; excessive exposure to screen time has been associated with chronic overstimulation, mental health conditions, and cognitive disablement; and noise annoyance has been associated with a twofold increase in depression and anxiety, especially relating to noise pollution from aircraft, traffic, and industrial work.” 

Most of this we cannot escape, and on top of it all we live life at a frenetic pace where workers are expected to function like machines, often subordinating the needs and demands of the body. Thus, more and more people begin to experience disablement, where they simply cannot keep working, and they start to reach for medical diagnoses to explain why they cannot keep pace in an environment that is constantly thwarting their efforts to stay fit and well. From this arises the phenomenon of “shadow diagnoses” – this is where “milder” versions of existing conditions, including autism and ADHD, start to be diagnosed more commonly, because more and more people are feeling that they are unsuited to the cognitive, sensory and emotional demands of daily working life.  

When I read in O’Sullivan’s book that a lot more people are asking for diagnoses, what I hear is that a lot more people are asking for help.

O’Sullivan rightly observes that some real problems arise from this phenomenon of “shadow diagnoses”. It does create a scenario, for example, where autistic people who experience significant disability (e.g., those who have no perception of danger and therefore require 24-hour supervision to keep them safe) are in the same “queue” for support as those from whom being autistic doesn’t preclude living independently. 

But this is not a diagnosis problem so much as a society problem – health and social care resources are never limitless, and a process of prioritisation must always take place. If I cut my hand on a piece of broken glass and need to go to A&E for stiches, I might find myself in the same “queue” as a 7-year-old child who has done exactly the same thing. Like anyone, I would expect the staff to treat the child first, knowing that the same injury is likely to be causing a younger person much more distress. Autistic individuals are just as capable of recognising that others within the autism community may have needs that should take priority over their own.   

What O’Sullivan overlooks is that there are some equally big positives to “shadow diagnoses” – especially as our society runs on such strongly capitalist lines. When a large proportion of the population starts to experience the same disablement, it becomes economically worthwhile for employers or other authorities to address the problem. To put it another way: If we get a rise in “shadow diagnoses” then we also get a rise in “shadow treatments” – accommodations made in the workplace/society that mean everybody can thrive. As Macaskill puts it:  

“Accommodations then are not about accommodating something intrinsically negative; they're about accommodating something intrinsically different so that it doesn't have to be negative.” 

This can be seen already in many primary schools: where once it was the exception (and highly stigmatised) for a child to wear noise cancelling headphones, they are now routinely made available to all students, regardless of neurotype. This means not only that stigma is reduced for the one or two students who may be highly dependent on headphones, but it also means that many more children can benefit from a break from the deleterious effects of constant noise. 

When I read in O’Sullivan’s book that a lot more people are asking for diagnoses, what I hear is that a lot more people are asking for help. I suspect the rise in people identifying as neurodivergent reflects a latent cry of “Stop the world, I want to get off!” This is not to say that those coming forward are not autistic or do not have ADHD (or other neurodivergence) but simply that if our societies were gentler and more cohesive, fewer people with these conditions would need to reach for the “sick role” in order to get by.  

Perhaps counter-intuitively, if we want the number of people asking for the “sick role” to decrease, we actually need to be diagnosing more people! In this way, we push our capitalist society towards adopting “shadow-treatments” – adopting certain accommodations in our schools and workplaces as part of the norm. When this happens, there are benefits not only for neurodivergent people, but for everybody.

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