The Challenge of Bonding, Shame and Social Death

Andrew R. Phelps and Thomas J. Scheff

Draft Version

International Center for the Study of Psychiatry and Psychology
2004 Conference, New York City
October 8, 2004



Abstract. Secure bonds rely on mutuality in constructing lives, communities and social realities. Imbalanced interactions - where power to assign social roles resides in a dominant culture of medical model hegemony - render secure bonding improbable.

Psychodiagnostics leads to shame ('stigma'). Mental health clients are objectified by predicating exposure on being imperfect, inadequate or deviating from popular opinion. Distanced human beings are vulnerable to manipulation and behavior management, commonly experiencing a "social death sentence" in ordinary interactions.

Imposing 'social death' renders communication monological, blocking authentic conversation and connections of trust, partnership and cooperation. The dominant expectation is compliance, impeding significant involvement of clients in mutual/collective creativity and negating efforts to earn 'respect'.

Every person in relationship has wisdom to offer: Ways of knowing obtain beyond shame and distancing into social death. Securing bonds entails deconstructing inequities inherent in shame/power dynamics and taking shame-sensitive social responsibility for restructuring them respectfully and equitably.



This is to acknowledge the role of Sue Poole who
brought us together and co-authored the abstract.




Secure Bonding Rendered Improbable



Begin with mutuality. Past the self based on 'pure individualism' is the self as connected to the social fabric. Constructing lives, communities and social realities requires attention to that 'social fabric', knowing what it is and how it works. [Mead, MSS] What creates and maintains social bonding, what are its agendas and exigencies: why 'mutuality'?

There are arguments for approaching the social fabric for personal gain ("free enterprise") as well as approaching it selflessly ("altruism"). In the first place though, "What makes it tick?" But maybe it is not a clockwork device and does not "tick"; maybe it is not a patchwork and cannot be said to have "glue." In any event, specific emotions are involved [Scheff SSB, 1], the feelings we have regarding the social fabric and what we do to make it what it is. [Vico, NS, #331]

This paper starts with the role of shame as the "premier social emotion," the feeling basis for how people engage the structure and change of societies. 'Shame' is a complex group of feelings which all basically involve "the feeling of a threat to the social bond." [Scheff, SSB, 17] Viewed this way, the social character of shame comes into focus and its analysis can be related to specific social dynamical questions. The derogation of individuals who suffer discriminatory agendas is the immediate subject for shame as a social emotion.

To go beyond emotional involvement in shame and shaming is to intercede a kind of rationality or dialogical modality. [Cushman, CSCA] Human beings negotiate social boundaries in an effort to reduce or eliminate "threat to the social bond." Mutuality, or mutual respect, engages the equitable balance of interactions. [Haan, OMG] Shame-based social dynamics commonly suppress and subvert the full realization of equitable balances.


How do shame-based social dynamics "suppress and subvert?" Threats to the social bond are posed in contradiction with equitable balances. Shame-avoidance or the felt response to such threats comes to take precedence over the rationality of equitable outcomes. To the extent that power to assign social roles resides in a dominant culture of shame-avoidance maintenance, inequities are promoted and the security of social bonding is, in fact, suppressed and subverted.

Today society assigns social roles by categorization or labeling. The nature and social grounding of that labeling process is a central concern in assessing social dynamics and their effect on the realization of equitable balances. Does the labeling work primarily on shame-avoidance as an end in itself, or does it work more on achieving mutuality and thus searching out equitable outcomes? In this paper the present system of social role assignment, known as the "medical model," is examined and the attendant social dynamics are assessed.

The role assignment process is variously regarded as "diagnostic labeling" which has an aura of scientific precision, or "name calling" which has negative associations. [Caplan, BPD: xix] But does "diagnostic labeling" render a substantially different shame-avoidance dynamic than simple "name calling?" This dynamic currently supports a dominant culture [DSM-IVTR] that serves as shame-avoidance maintenance. Still, does its claimed scientific precision render the 'medical model' as dynamically oriented towards equitable outcomes, or is its predominant effect more akin to a "name calling" dynamism?

"Name-calling" is a recipe for dialogical breakdown, so prima facie it must be tempered, regulated, and/or managed if the mutuality necessary for equitable outcomes may be supported. The claim of the medical model is that the clinical gaze serves to temper, regulate, and/or manage its effect. [Foucault] While that may happen in given circumstances, the predominant effect of a social role assignment system is claimed to be that of inducing and reinforcing shame-avoidance. The alternative interpretation, to be discussed further on, does not involve an adequate rationality of mitigation for the attendant shame-avoidance dynamic.

The experience of being subject to social role assignment under the burden of the dialogical breakdown reinforcing shame-avoidance, can be devastating. When responsibility is not taken for the dominant culture dynamics of the 'medical model', derogatory labeling induces a social control dynamism. The recipients of the labeling process are subject to behavioral management based on the reinforcement of shame-avoidance. This experience has come to be identified as the "social death sentence." [Reidy]


The effect of labeling is enhanced by the destructive conflict between the family structure and the practice of psychiatry. [Scheff, SLT] There dialogue is challenged for structural reasons, viz. the accommodation of the loop of shame-avoidance. Unacknowledged shame reinforces weak social bonding, creates social boundaries, helps construct imbalanced patterns of interaction. The effect is social distancing (increasing, that is, "the extent to which the individual is an observer of his or her emotions"), [Scheff, CHRD] thus inauthentic emotional expression and interaction.

Unacknowledged shame thus leads to abusive behavior patterns and the justification of perpetration of trauma and emotional pain. The practice of psychiatry is intended to be healing, yet the production of social distancing induces additional elements of trauma. This "trauma of treatment" is the outcome of shame-avoidance social dynamics where mutuality is degraded. It results in habituation to habits of dominance in some and habits of submission in others. [Phelps, FR]

Habits of dominance circumscribe the wholesomeness of social bonding; habits of submission challenge secure bonding outright. Unacknowledged shame in service of habits of dominance leads to pride; in service of habits of submission, it challenges self-esteem. As the self arises from the experience of interaction with others, [Mead, MSS] the sense of self intensifies in the former case and becomes more circumscribed in the latter case. The selves arising from these alternative situations are different, so how can folks deal with the social fabric evenly, how can mutuality play an effective role in their negotiations?

Debi Reidy reports, "Stories from stigmatized persons tell of painful experiences of being excluded, rejected and discriminated against, often through hundreds of subtle day-to-day interactions and experiences. Further, people's experiences indicate that many stigmatizing occurrences are related to attitudes and practices occurring within the mental health system itself." [SSD] The social death sentence is experienced as a self that arises so shamed, with such diminished social bonding that it is forcibly restrained from actualization. The shame of the habitual dominance relations leads to a self "needing" to manage and enforce the social distancing of those who are in the other sort of position.


By "social death" is meant the excommunication of the individual from their normal social interactions. For labeled individuals, with lives highlighted by the shame dynamics, that is represented in immanent experience as stigma. But it also manifests in "life path" experience, where the secure bonding that renders realization of social possibilities and career opportunities is challenged by the shame regime. These people lose their future, so that they are either merely maintained (which is known as "warehousing") or they are expected to "start over and make do" in a climate of restricted possibility.

Here is where the influence of shame dynamics hits directly and with much impact. Instead of action in the direction of social possibilities and career opportunities being based on mutual respect in dialogue, it is grounded in shame-avoidance which expresses itself in accommodation of social control dynamisms. These "mental health rituals" [Knight et al.] operate in the service of disempowerment of those individuals in shame-avoidant disrespect, when it is not explicit scorn. On the other hand, they also operate to avoid the shame of dominance behavior by those in the opposite position.

By "social death ritual" is meant the specific social transition ceremony that leads to that excommunication. More in an originary vein than the above rituals, it expresses social recognition of the consolidation of shame-avoidance dynamics in the individual's involvement in the social fabric. This ritual defines the way the self arises in social interaction by taking the shame-avoidance process and instantiating it in a symbolic social process. That can be as simple as the psychiatric hospitalization of the individual based on labeling, or as subtle as a family ritual where the family's relation with the individual is defined as a nexus for shame avoidance.

The "social death sentence" is thus ceremonially produced as the institutionalization of the individual's shame and others' proprietary right and duty to be shamers. That sort of dynamic is also instituted incidentally in other circumstances; for instance if a person loses a leg that may become a focus for shame-avoidance. However the primary fact here is that the very self of the person becomes that focus consequent upon the labeling. Such stringent conditions of social being render secure bonding improbable, and disaffection likely.


Behavior Management Imposes Social Death



Now to behavioral health. Historically "behavioral health" arises from the tradition of substance abuse healing, that "mental illness" behavior may be healed or "improved" by behavior modification. The main tool is behavior modification, the practicum "that seeks to extinguish or inhibit abnormal or maladaptive behavior by reinforcing desired behavior and extinguishing undesired behavior." [WordNet] Where does shame-sensitivity to social bond management enter in; where does dysfunctional communication (dialogue breakdown) and destructive conflict (based on imbalanced interactions) enter? [Scheff, SLT]

What is "abnormal or maladaptive behavior?" When mutuality in constructing lives is predominantly absent, secure bonding is disturbed. The interpretation of "normality" or even "adaptiveness" is challenged and transformed by the social dynamics of shame-avoidance. Two alternatives to accommodating the shame-avoidance loop may be considered, depending on the degree that a practicum counter-balances their transformative effect.

One type of moderate practicum (the "community reform" approach). comes from community involvement in behavioral health interpretation. That means that the shame-avoidance effect is potentially diluted by the differential with the community at large. To the extent that the community is itself free of the shame-avoidance social dynamics, this can and will dilute the impact. It does not change the imbalance per se, but it introduces more directly the impact the community has in defining the social bonding.

A more severe type of practicum (the "sociohistorical" approach to reform) incorporates not only the involvement of the community but a critical engagement with the social and historical construction of the community values. [Ratner, VSP] Respect for the historical meaning of these values of will naturally tend to offset direct shame-avoidance driven interpretations of them. Whereupon mutuality in dialogue, respectful conversation, will be more readily accessible. Of course this approach - not easily implemented - subverts the inhibition and extinguishing of "abnormal or maladaptive behavior."


All of which sounds adaptive but actually it's challenged by the formation that keeps the loop operating. The 'medical model' formation that is built upon the derogatory labeling system is resistant to shame-sensitized challenges to its balance. With dysfunctional communication it undercuts the effort of community based reform to mitigate the shame-avoidance dynamics. With destructive conflict it circumscribes any tendency of sociohistorical based reform to deconstruct those dynamics.

The uneven quality of challenges to the 'medical model' leaves the phenomenology of its maintenance of standing significance. Which is to say, there is stress due to the dominant shame-avoidance loop. "Our position should be more one of balancing the tendency to internalise and medicalize distress, not add to it " [Newnes] Other authors have pointed to the tendency to reinforce the medicalization of distress for commercial purposes. [Caplan, BPD].

From the perspective of those who are shamed by being labeled, there is an excess of distressful energy. Instead of being themselves in a direct manner, as that arises from interaction, they are absorbed in accommodating the shame. When that is directly shame-avoidance, it is at the price of a diminishing of self. When the shame is not avoided, however, then it is experienced as a weight upon the person's being.

For the society, there is the problem that its social dynamics are mediated by shame-avoidance rather than by the balance of dialogue grounded in mutual respect. The exercise of power for effective change requires that people "achieve an integrated political and psychological understanding of power, wellness and oppression." [Prilleltensky, 15] The shame-avoidance loop tends to distract emotion away from the business of "effective change." In situations of sufficient intensity with strong enough dominance agendas, the social dynamics will tend toward "the social and cultural conditions that give rise to collective hatred and rage." [Scheff, DR; Reich]


The social differential due to the dominance of the shame-avoidance loop is experienced intensely. Emotional response includes shame, also anger, hurt, what might be called "shame-rage spirals" reflecting "unacknowledged alienation and shame." [Scheff, DR] People on opposite sides of this split experience that very differently, so that it becomes increasingly difficult for them to connect and establish mutuality. Thus there is an emotional disconnect established which is the secondary phenomenology imposed by the labeling behavior.

As above, the shame-avoidance is potentially countered by shame-sensitive processes, be they in the shame-sensitive character of community or in a sociohistorical critique of shame-avoidance. The community can help to reconnect, via inclusion and social bond healing; the critique can turn the shame back on the shamer or on accountability to the shame-avoidance process itself. These political responses to emotional disconnect can succeed to a point with given individuals and given social conditions. But the prevailing dominance system of the 'medical model' is rooted in its stand of maintaining these social dynamics.

In the first place, there is the control system of the dominance system impeding social change. Beyond that, there are the deficiencies in the political response which corrupt that and subordinate it to the dominant social dynamics. These are identifiably the shame-avoidance social dynamics of [1] cult control and [2] rage-terror. Any approach to engaging shame-avoidance social dynamics effectively must ultimately control the assault on self that interaction with those tendencies imposes. [Cushman, SB ]

This general introduction distinguishes the emotional responses to the shame-avoidance based disconnect and the particular manners of framing them. When there is an in-place cult control system in the community, "trauma identity" is provided by the values of community and the social bonds supported by them. When there is an operant rage-terror system, the "social death sentence" critique makes the social distancing more transparent and the shame more accessible. In sum, when labeling is dominant, social bonding suffers, and emotional disconnect results; the advocacy of trauma psychology and the 'social death sentence' naturally comes to the fore.


Distanced human beings are vulnerable to manipulation and behavior management. The inauthentic emotional expression and interaction is consequent upon their objectification as being imperfect, inadequate or deviating from popular opinion. The perception of the dominant 'medical model' system is that their deficit condition requires management that sustains the distancing. Thus they are kept at a social distance, with insecure social bonding, and they experience the social death sentence in ordinary interactions.

For the recipient to explain that distancing is experienced as "stigmatizing" and "traumatic" is true, but even if heard (it often isn't) this contention does not argue squarely against the deficit labeling-based approach. The "social death sentence" critique opens up the dialogue on what is potentially a basis of mutuality. It challenges people's shame-avoidance attitudes and urges them to discuss what they have "killed" (backgrounded) in order to avoid the shame. It amounts to a demand for shame-sensitivity under the conditions of habituation to the lack thereof.

Thus it is that the social death sentence is a canon for behavioral management and also the pivot for the contention for shame-sensitivity. However that does not mean when the subject is broached hat a good conversation can be expected to ensue. It merely foregrounds what was before backgrounded, and puts the shame-avoidance loop back under consideration. Without a strong commitment to respectful interaction, the ensuing interaction will likely be shame-driven and volatile.

In a broader frame, the stubborn fact of the 'medical model' system employing the emotional disconnect in the service of managing the social death will not readily adjust itself. Emotional expression challenging the loop of shame-avoidance will constitute a pressure towards change. Advocacy of relational involvement rather than control-based involvement will help deconstruct the logic and intellectual certainty of the prevailing system. [Gergen, RR] Ultimately, though, a positive advocacy for mutuality in dialogue, for an authentic alternative to the 'medical model' system, will have to carry the day. [Shotter, CPEL]


Apparent Illusions of Reasonableness



The 'medical model' system represents itself as the most reasonable way to go about managing the phenomenology known in lay English as "madness." Above it has been located as the "top end" of the shame-avoidance loop where behavior management is implemented by a form of "name-calling" by labeling. Its advocacy is based on the inductive method, which accepts evidence of observed phenomena and rejects illusory modes of thinking. [Bacon, NO] Thus, if that system is not a reasonable way to manage, then authentic emotional response can be expected to be responsive to the experience of inauthenticity.

Are there not reasonable doubts regarding the authenticity of this 'medical model' system? Achieving dominance by exploiting shame-avoidance dynamics reflects the motivation for dominance. [Vico, NS] The general experience of stigma in our system's practice testifies to that inauthenticity. [Corrigan] Using micro-level discourse analysis it is possible to track that authentic emotional response and show its dependence on shame-avoidance. [Scheff, SLT]

The above argues for the 'medical model' system being empowered by shame-avoidance dynamics and rationalized by illusory considerations about community and social history. One which maintains itself due to the social distancing given by shame-avoidance itself. It adopts Bacon's inductive method and neglects, to its embarrassment, his critique of illusory categorical thinking upon which it rests. The labeling behavior is kept, by that distancing, safe and secure from those who are managed and shamed by the social death sentence.

The labeling system itself applies the deductive-syllogistic method of scholasticism to arrive at its "reasonable way of management." That however derives from the social relationship of shame-avoidance and the common language of scholasticism. This prima facie amounts to illusion in the service of reason, what Bacon calls an "idol of the marketplace." [Bacon, NO] That appearance of illusion puts the objective character of the 'medical model' system in question.


Recently complaint has arisen that women's sexuality is being redefined in terms of biological arousal instead of in terms of relationship to the social bonding. [Tiefer, 2001] This "discourse marginalization" is traced to the loop of shame-avoidance, with the 'medical model' adjustment being traced to the influence of a corporate agenda. With that, the social death sentence based management system exhibits how it extends the emotional disconnect to wider populations. The extension of medicalization to larger classes of behaviors is a much-remarked phenomenon. [Newnes, CME]

Frustrated by the intensified "discourse marginalization," psychologists are looking at the shame-avoidance question more carefully. The question of bias in psychiatric diagnosis is coming under scrutiny. "The terms 'mental illness'," 'mental disorder', 'abnormality', 'normatlity', and even 'insanity' are constructs, terms that do not correspond to clearly identifiable, 'real' objects." [Caplan, BPD: xx]. Rather they reflect power relations, which are traced above to the shame-avoidance loop.

An example of bias arising regarding social issues has to do with the 19th century diagnosis drapetomania. That is defined as the propensity of a slave to want to run away from slavery. The bias in that diagnosis has become transparent now because the shame of slavery has become established in the national consciousness and in law. The example of the "biological arousal" is today transparent in feminist advocacy, but it is not so deeply established in the law today.

Bias stemming from name-calling in the service of behavioral health management is not today so transparent as is either of the preceding examples. Labeling theory [Scheff, BMI] asserts that this effect is widespread and marginalizing to psychiatrized people. The shame-avoidance analysis [Scheff, SLT] describes the emotional experience and effect of the social dynamic which supports the name-calling. However the way to establish the shame of this kind of bias in the national consciousness and in law remains to be worked out.


Stigma today is widely recognized as a marker of bias in social relations. The social death sentence approach extends the logic of stigma from attitude and impression to the objectification of behavioral management itself. "Social death" implies monological communication, the shame-avoiding blockage of mutuality in discourse. A "system of care" whose social bonding is based on compliance impedes significant involvement of clients in mutual/collective creativity, in real activity. [Ratner, CPA]

Mutuality - balanced interactions - depends on shame-sensitivity and the respect that empowers it. The general degradation of social relations based on respect is the consequence of the shame-avoidance loop. The demand for stopping discrimination based on stigma is a demand to change attitudes and impressions rendered. The demand to change attitudes and impressions given, however, tends [1] to be shaming and [2] to feed into the shame-avoidance process.

The social death sentence discourse is more difficult to marginalize, as it engages the logic of situations and not just people's attitudes and rendered impressions. Recognition of the inauthenticity of the emotional disconnect is thus better served by being confronted head-on, other things being equal. The direct contention for mutuality is embedded in the social death sentence discourse, and deeper sedimentation of shame-avoidance is thereby exposed.

The stress point of inauthentic connection is where the use of force or threats of force (the "3rd degree") comes in. [Phelps, ERF: "Follow-Up Report" link] The dialogics of "Gulag" involves the shameless intensification of the logic of disrespect. [Koestler] The advocacy for respect at one end is an advocacy for balanced interactions and the breakdown of shame-avoidance. At the other end, its meaningfulness is contingent upon an advocacy against imbalanced interactions and for the upholding of shame-sensitivity.


At the extreme, the operant condition is discrimination and the expectation is the lock-step of compliance. Connections of trust, partnership and cooperation are subordinated to this shame-avoidance driven regime. The social death sentence experience is the basis for social bonding and an underground client culture is fostered. [Guerrero] This situation fosters a secondary mutuality of lives constructed in underground conditions.

In the environment of the apparent reasonableness of the 'medical model' system, the client culture renders the appearance of conformity to that reasonableness. However the discourse takes life in the exploitation of the illusory aspects uncovered in that regime of reasonableness. Shame- avoidance is identified and the client culture helps to support that revival of shame-sensitivity. The person takes "the discourse about himself and his world," [Bakhtin: 53] his rap, so to speak, and nurtures the shame-sensitivity of his social environment.

The severity of the shame-avoidance dynamics is reflected in the degree to which the client culture integrates with the community versus the degree it separates. Respect is earned by achieving authentic integration with the community and/or from voicing in challenge to those dynamics. Raising "from the underground" the "trauma of treatment" experience of 'medical model' dominance empowers the dialogue with the community. Challenging shame-avoidance by arguing the social death sentence perspective provides an advocacy for deconstructing the apparent reasonableness of the name-calling based psychodiagnostic system.

Finally it comes to the apparent illusion, which is in a dynamical relation with its other, the client culture. People have constructed the reality of "mental disease," and people must ultimately replace that with the reality of "democratic dialogue." [Gergen, AD] The sketch of an outline for the social constructionist alternative to the 'medical model' illusion of reasonableness appears to be in place. [Shotter, CPEL] Its empowerment is still profoundly entangled in the web of social-avoidance and the emotional understanding of its power problem needs serious work.


Shame-Sensitive Social Responsibility



In our time, there is no ready opening for general wholesome social relations. Instead, it is necessary to adapt to what is available and to construct new availabilities as possible. That is in a sense frustrating and unsatisfactory; on the other hand emotional involvement with the problematic of the loop of shame-avoidance dynamics is something people will find engaging. The purpose and prerogative will be - will continue to be - to work on upgrading social relations.

Changing and upgrading social relations is a longstanding concern of social change activity. Work at overcoming and transforming relations based on hatred and bias, relations that embrace racism, sexism, heterosexism, discrimination against people with physicial disabilities, is ongoing. The direct concern with the social bondings that promote "normal behavior" provided by the shame-avoidance analysis is at an earlier stage and needs further framing. [Shotter, CPEL] What is this "bias" and what will challenge effectively the inequities in shame/power dynamics?

Shame, the "premier social emotion," is "crucially involved in the structure and change of whole societies." "Shame/anger loops can create perpetual hositlity and alienation. Acknowledged shame .. could be the glue that holds relationships and societies together, and unacknowledged shame the force that blows them apart." [Scheff, SSB: ?97] The social death sentence perspective helps bring into focus the viewpoints of those who are directly the objects of the dominant 'medical model' system.

"I saw the best minds of my generation destroyed by madness, starving hysterical naked," the poet wrote. [Ginsberg] The "flower power" of the Haight-Ashbury in San Francisco became a symbol of social change dynamics generated by insight into the power of "shame acknowledgement." Every person in relationship has wisdom to offer; ways of knowing obtain beyond shame and distancing into social death

The path forward is open-ended and any "prescription" for it - beyond shame acknowledgement itself - would no doubt serve as a continuation of the illusion of reasonableness that (evidently) presently obtains.


Shame/power dynamics has the capacity to weaken social bonding and then to reconstitute the social bonds with differing equities. Shame-avoidance may be considered as the master term for the deconstruction of the social bond rearrangement process. The moral psychology of achieving or not achieving mutuality in dialogue provides orientation for individual engagement with the shame/power dynamics. [Haan, OMG] Identification of the prevailing inequities may proceed "top-down" from prevailing social critique but it also may hope to achieve centering "bottom-up" from the social death sentence critique.

Equity would seem to have to do with how, for each person in relationship, wisdom is to be achieved, is to be voiced. Securing bonding is a requirement: When everyone is "normal," this does not perforce mean that each one is "exceptional." Shame-sensitivity and the identification and discernment of inequities go hand-in-hand. However the rearrangement of society in a Dostoevskian "polyphony" [Bakhtin] is more immediately to be preceded by breaking down the inequities that currently obtain and moving the values (emotionally charged beliefs) away from bias.

Breaking down the 'medical model' dominance system is a prime target for the acknowledgement of shame. That means critiquing the shame-avoidance based labeling process, and it means critiquing the behavioral health production of unacknowledged shame - the social death sentence process. Psychiatric diagnosis is not a scientific endeavor, although some of the most powerful people and organizations in the mental health field assert that it is. In the absence of science, biases and distortions rush in - due to social causes, failure to identify real problems, and to shaming people for problems that are attributed to them. [Caplan, TSYC; Caplan, BPD]

The attribution of bias is the social formulation that will challenge the shame/power dynamics. Giving a face to bias, describing what makes it a marker of inequity, may not be as directly accessible as for inequities such as slavery or even patriarchy. The shame is found in that the shame/power dynamics shame the people rather than engage the phenomenology of madness equitably. The avoidance of shame is marked by disrespect for the truth, disrespect for the emotional expression of the person; whence bias may be identified as shame-avoidance of the failure to assert and sustain respect for being.


Responsibility means "ability to respond." Shame-avoidance is failure to take responsibility; acknowledging shame is, perforce, responding. Accountability means an obligation or willingness to accept responsibility, it involves deliberateness. How is there to be accountability for the loop of shame-avoidance, among those who dominate or those who are dominated?

The labeling process, psychiatric diagnosis, is basically unregulated in law, apart that is from the determination of who may do it. If the labels don't fit, no accountability is prescribed under regulation or law. It is a commonplace in the client culture, that a person will over time receive many different, even contradictory diagnoses. [Guerrero] That is, indeed, one of the signals that lends the appearance of illusion to the claim of reasonableness by the 'medical model' system.

Evidently what's needed is people taking shame-sensitive social responsibility for challenging the bias and restructuring the inequities. The helping professionals will need to back off name-calling, restrain the labeling, and move over into mutuality in discourse. The people who are the subjects of the 'medical model' system will need to continue asserting the social death sentence, need to build on the social bonding provided by the client culture. These actions will reduce the avoidance of shame; for full resolution, a new dialogue-based social bonding will have to be constructed. [Cushman, CSCA]]

Full accountability however is not just people taking responsibility for shame-sensitive handling of the shame-avoidance loop. It involves locating the 'medical model' system in the social dynamics of society as a whole. When the bias enmeshed in the shame/power dynamics is related in an authentic way to the problematic of bias in society as a whole, these parallel contentions for freedom will merge. When the society is made to integrate the bias enmeshed in the shame/power dynamics into the social fabric itself, then a new respect dynamic can emerge.


Speak about walking the beauty path (a Native American term), here meaning a positive way to understand the life path where mindfulness of the social death sentence challenges shame avoidance. Speak likewise about a new way to envision "normality," where the complexity of shame-sensitive ways of being does get voiced. It has, in fact, been argued (using National Parks as metaphor) that "we must soon cease to treat the parks as commons or they will be of no value to anyone." [Hardin] Without necessarily subscribing to that analysis, still the insight raises questions regarding the viability of planning how the beauty path or the "new normality" in the commons of our society can be brought about.

What kind of social distancing then would arise, if the present loop of shame-avoidance dynamics were changed? What if the new conditions were favorable to the beauty path and the "new normality?" Those questions, it seems, are beyond the scope of this discussion. But it can be said that a different scheme of social bonding would still produce shame-avoidance issues, issues demanding attention, demanding again resolution.

For now, consider that restructuring inequities inherent in the shame/power dynamics respectfully and equitably is the task at hand. It is possible to abide the perceptions of others and live as "subhuman," on condition of knowing one's place. It is also possible to involve oneself, acknowledge the shame/power dynamics and challenge and confront them. It is thirdly possible to assimilate into the shame-avoidance dynamic, and join (feeling soiled) in perpetrating it.

In taking up the task, one needs to challenge the system of psychiatric diagnosis and make a social movement of it. There the practicum of shame-sensitivity, how to be a full human being in today's social bonding conditions, is the consideration for right action. The regulation of bias is one concern, the advocacy for respect, another. The social death sentence will be challenged, and the ways of being that will lift it will be nurtured.



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