Narratives of Shame, Tormenting Ghosts, and the Job of the Therapist

Jason Thompson has given us a moving account of his desperate struggle to make sense of his own past. His generosity as a writer is clearly displayed in his honest and bracing account of the way he gradually defined himself by this narrative challenge, and then became imprisoned within it. I am going to focus on a question that the author raises in his abstract. How does a therapist help us out of the sort of deadlocks that we can’t think our own way out of? Adshead (2010) reminds us that the therapist provides a new way of thinking about oneself, a new narrative perspective. Yet I recall the emotional engagement with my own therapist as having a value that was equal to the insights offered, and I think my own patients would be likely to say something similar. I’m going to try to say something about what happens through the relationship between therapist and patient that can be so difficult to achieve alone.

Let’s return to the moment after his mother’s spiteful comment, as Thompson is “stricken by a feeling of shame so intense that he barely talks or eats” (2010, 248). Alone with this shame, he adapts. Writing at first allowed him “to put a name to events and feelings that felt shamefully nameless” (2010, 248). He throws himself into a ‘monastic self-punishment.’ He strives to exorcise, or at least overpower, the shameful part of himself through a project of academic perfection. Years later he finds he ‘cannot let himself stop until the words are perfect.’ What began as a project to rewrite the narrative has now itself been uncannily co-opted into a re-enactment of it, a Sisyphean compromise that seamlessly melds hope and condemnation. Each new draft revives the loneliness and shame of his adolescence, and ultimately leads to depression and suicidality.

Although autobiography is not generally addressed to a reader, as Adshead (2010) notes, memoirs centered on shame may be aimed, explicitly or not, at some important other. I’ve worked with traumatically shamed patients who became consumed by the desire to ‘set the record straight.’ Shame begins in the perception of oneself as defective, inadequate, or vile. But there is also an essential relational dimension of shame that Erik Erikson recognized: “Shame supposes that one is completely exposed and conscious of being looked at” (1995, 227). The experience of shame itself then becomes toxic, as one’s defectiveness seems to be confirmed by the repulsed gaze of the other and the shame is inscribed yet more deeply. For Thompson, the shame seems to become compounded by the depression, and then by the psychiatric treatment itself, until only death seems a way out. Heinz Kohut understood this kind of suicidality as “the wish to wipe out the unbearable sense of mortification and nameless shame imposed by the ultimate recognition of a failure of all-encompassing magnitude” (1977, 241).

Now let’s return to the question—what does a therapist do that may lead a patient out of the potentially lethal impasse that Thompson so vividly describes? Adshead (2010) wisely notes that the therapist offers a more objective view of the patient’s narrative and Perry outlines the limiting indeterminacy of historical accuracy and accountability. I want to add to this—from my own experience on both sides of the couch—that the relationship between the therapist and patient is itself potentially mutative. I believe this is because psychotherapy manages to simultaneously invoke our most basic, universal experiences of nurture and attachment, while also creating a new, historically unprecedented kind of relationship. According to Hans Loewald (1960), in his seminal paper “On the Therapeutic Action of Psychoanalysis,” the therapist holds in her mind a vision of the patient that includes not just who they are now but who they have the potential to be. This therapeutic function builds on the template of a parent’s love for a child and pleasure in anticipation of their growth. We know the child internalizes aspects of the parent and identifies...