The Shame and Medicine Project is an engagement between medical practitioners, social scientists, philosophers and medical humanities scholars seeking to investigate the role of shame in the context of health, medicine and medical practice. It is housed in the Trinity Long Room Hub as part of the Trinity College Dublin Medical Humanities Initiative.
Shame in medicine is a much neglected and under-theorized area of study, yet what work has been done indicates that it is a highly significant force. In his seminal article Shame and Humiliation in the Medical Encounter Aaron Lazare (1987) argues that patients often see their diseases and ailments as defects, inadequacies or personal shortcomings and that visits to doctors and medical professionals involve potentially humiliating physical and psychological exposure. Shame has a powerful impact on the medical encounter and should be carefully considered as a component of the doctor-patient interaction.
Mostly, the shame induced in the clinic is inadvertent but the consequences for the patient remain the same. Sometimes the shame relates to medical matters that are beyond the personal control of the patient/client, such as infertility or some mental health problems. On other occasions though, individuals present with bodily dysfunctions or disorders that in some way are contributed to by the lifestyle choices of the afflicted person. Thus, more recently, it has been asked whether shame in this context is always a bad thing. If an individual patient is shamed into altering her conduct, could the provocation of shame, even if unintended, somehow be seen as a good thing? And if accidental shaming might be good, what might this lead us to believe about the deliberate use of shame as a means to ‘encourage’ individuals to avoid harmful consumptions or activities, or even proactively engage in a healthier lifestyle. Might good ends justify the highly unpleasant means?
Shame is not the sole preserve the patient. Sometimes it pertains to the clinician, who most frequently becomes shamed through real or perceived epistemic or functional failure. In this context shame is both internal (a failure to live up to a personal standard) and external (the failure being represented as a public and visible manifestation of deficient performance).
Surprisingly, since Lazare’s insight into the role of shame in the clinical encounter and the wide reach of shame within medical practice, there has been almost no sustained theoretical reflection on the role that shame plays in clinical practice, medical training, medical treatment and patient experience.
The main objective of the Shame and Medicine Project is to broadly examine the role of shame in the arena of health, disease and medicine through addressing themes such as: the use of stigma in public health policy, shame in professional enculturation, shame and medical failure, the shame and stigma of illness, body shame, shame disorders (e.g., BDD, social anxiety) and shame as spectacle on medical reality television programming.