By Sara Todd, LCSW, Rinehart Clinic

The shame experience is complex and holds a variety of feelings. Shame can be debilitating and all encompassing. Eye contact may feel painful, even impossible. At its worst, it can result in withdrawing from the world. A retreat into a darkness that feeds upon itself.

Shame is triggered by an external event and this can even include receiving the diagnosis of a medical illness, such as diabetes. The diagnosis may trigger shame because of feeling exposed as inadequate or incapable. A person may feel they don’t “measure up” to an ideal. The diagnosis can end up confirming what someone already feels about her or himself— that they are flawed or not good enough.

Shame has a social context and occurs in relationship with others. We will say, you shamed me. A tendency toward shame in one’s adult life may come from early experiences of being judged, ridiculed and not fully celebrated and enjoyed by one’s caregivers. This fundamental sense of “badness” repeats a cycle that originated in one’s early life. For some, shame may be a foundation underlying everything one does. Diabetes is just one more channel for that shame.
Shame thrives in darkness and loathes the light. Its antidote is radical acceptance, the full embrace of love and kindness by another and towards oneself.

Because diabetes intersects with a person’s relationship to their body, their relationship to food and eating and the authority of medical providers, it makes sense that all of this would trigger a shame response. The combination of society’s unrealistic beauty standards, feeling constantly “graded” through daily monitoring of blood glucose or A1c tests and the way we ignore the institutional reasons for challenges such as poverty and eating healthy, all contribute to an internal dialogue of “I did this to myself”.

What is the way out?
The first may be to have curiosity about the shame. Ask questions about the feeling and the storyline that you’re “not good enough.” Why do I feel ashamed about having diabetes? Open it up for exploration. If the shame is connected to not measuring up to an ideal version you have of yourself, you can ask: Who set that standard? Is this an ideal that comes from my own values or someone else’s?

Questioning the self-blame can also be effective. What may be other reasons I have this disease? Why else did it happen? Is there a family history, for example? The point is not to deflect accountability, but to bring a more complex understanding.

We can also begin to unravel this knot of humiliation, self-hate, and feeling outcast by “dropping the storyline.” When these thoughts “I’m not good enough…I did this to myself…I’ll never get it right” come up, take a deep breath, feel your body and then let the thoughts go. A teacher once gave me the tool of: Recognize-Refrain-Relax-Remain. Recognize that you are getting caught again in the feelings and thoughts of shame. Refrain from trying to escape the feelings (don’t numb out). Relax by deep breathing, stretching, taking a walk or simply just letting yourself be. And, finally, remain where you are in that moment. It will pass.

If shame is making it difficult to engage deeply with others and live your life fully, talking to a therapist may also be a good idea. Shame that originates in trauma needs healing with a licensed mental health professional. And as we heal the wound of shame, we begin to love ourselves more fully through the gift of improved health.

Most importantly, shed light on that shame because you, at your core, are good and perfect just as you are.