Why do we work with shame?

Shame is a complex and influential emotion that provides a powerful window into experiences and processes that affect our daily lives. Shame can be a highly active emotion--albeit often hidden--within organizations, where it can affect individuals and teams, shape environment and culture, and influence outcomes. In particular, we work with shame because...

Shame is the 'master emotion.'

Shame evolved for a reason: we need it in a functioning society, and it regulates our social behaviors in meaningful ways. Shame is an emotion to be engaged with, not avoided or denied.

Shame can be destructive.

Despite its prosocial potential, shame can fuel intrapersonal distress, impair relationships, undermine psychological safety, and reinforce inequity. These tendencies create significant challenges within organizations, especially when shame is wielded as a tool to reinforce hierarchies, exert power, or control others.

Shame can be hidden behind challenging behaviors.

Shame is painful and itself taboo. Accordingly, people engage in behaviors to avoid or repress it, including withdrawing, blaming, attacking, and self-harm. These behaviors may drive intrapersonal distress, interfere with relationships, and provoke defensive responses from others.

Shame is a distributed emotion.

Shame is a uniquely individualized emotion: no two people will experience it in the same way. However, its presence and effects are found throughout an organization: in relationships, in teams, in the culture, and in the practices, policies, and material conditions that form its structure.

Its presence must be addressed at each of these levels.

Shame Engagement in Medical Learners

In this qualitative study, which is a continuation of a program of research exploring the nature of shame in medical learners , we ask the question: How do medical learners engage with (i.e., recover from, struggle with, navigate through) shame, once it has developed?

Our ongoing analysis has thus far revealed that:
- shame often centers on--and is sustained by--entrenched assumptions about oneself, especially in relation to others, operating as facts.
- constructive engagement with shame involves challenging these assumptions and considering alternate possibilities.
- shame recovery often includes a transition from an internalized, distressed state to an externalized, other-oriented state.
- constructive shame engagement entails efforts to stabilize self-concept, the success of which is afforded by underlying emotional "scaffolding." We are still in the process of more fully understanding what comprises this scaffolding.

Measuring shame exposure in medical learners

Anchoring this research program is a 12-item survey instrument we developed and validated to measure the frequency of shame feelings--or "shame exposure"--over the previous three months. The paper outlining its development and initial validation is scheduled to be published in Academic Medicine in 2024.

We are planning follow on studies to explore the prevalence and epidemiology of shame in medical learners and healthcare professionals. This will include exploring relationships among shame and factors such as gender, race/ethnicity, specialty, etc. These data will provide different, meaningful insights than those afforded by our qualitative research program.

Will is an Associate Professor of Family Medicine and and a veteran of the United States Air Force. He received his M.D. at the University of South Carolina School of Medicine in 2010 and Ph.D. in Health Professions Education at Maastricht University in the Netherlands in 2023, where defended his thesis entitled “Out of the shadows: a qualitative exploration of shame in medical learners.”

Along with Luna, he is a co-creator of The Shame Space, a global consortium that advances open communication about the role of shame in healthcare, a co-producer on the award winning “Shame in Medicine” podcast series produced by The Nocturnists, and a co-founder of The Shame Lab, which catalyzes research and training to advance shame competence in healthcare and beyond. He is the author of over 30 peer-reviewed publications and has given over 150 workshops and presentations to top hospitals, conferences, and organizations such as Massachusetts General Hospital, Children’s Hospital of Pennsylvania, and the American Hospital Association. He has received numerous awards for his research including Best Paper by the AAMC Research in Medical Education Committee in 2021 and Best Doctoral Report by the Association of Medical Educators of Europe in 2023.

Luna is Professor of Philosophy and Medical Humanities at the University of Exeter, based at the Wellcome Centre for Cultures and Environments of Health. She has been researching shame for over 15 years, and is PI of the Shame and Medicine Project (2020-2025), funded by the Wellcome Trust, and was PI of the Scenes of Shame and Stigma in COVID-19 Project (2020-2022), funded by the UK’s Arts and Humanities Research Council. Luna is author of The Body and Shame: Phenomenology, Feminism and the Socially Shaped Body (Lexington Books, 2015), and co-author of Covid-19 and Shame: Political Emotions and Public Health in the UK (Bloomsbury, 2023), co-authored with Fred Cooper and Arthur Rose. She worked with Matthew Gibson to develop principles for Shame-Sensitive Practice, and subsequently Luna developed training in ‘shame competence’ in collaboration with the Devon & Cornwall Police. She has also worked closely with the Plymouth Trauma Informed Network to embed shame competence into trauma-informed approaches to practice. See Luna’s University of Exeter Staff Profile here.

James is a member of the Enterprise & Innovations Programmes Team, working on commercialisation and consultancy for the Humanities, Arts and Social Sciences. James supports academics in understanding and developing the best pathway to ensure greater impact from research. This could be seeing if any potential licences, spinouts or consultancy projects would be the best routes. James also works on the ESRC/AHRC SHAPE Catalyst, which supports the commercialisation of research across all UK Universities and SHAPE academics.

Vivienne is the Project Administrator and works one day a week to support the team. She has been working at the University of Exeter since January 2013, on a number of research projects.

Vivienne has been a contact point for people wishing to attend the Shame Competence for Trauma-Informed Practitioners Training based in Plymouth. She has been sending the delegates the information needed to attend and is contacting them with the evaluation surveys at each suitable point. This will help us to gather as much data as possible and ensure the final survey is sent two months after the training for each delegate. She is also supporting the trainers with regard to the venue and resources.

Anna is a fourth year medical student at the Duke University School of Medicine. During her time in medical school, she has co-led her medical school’s Wellness Committee and created a podcast entitled “A Flutter” to better understand how stigmatized emotions and life circumstances affect medical learners’ educational experiences. Alongside Will and Luna, she has participated in research that explores medical learner engagement with shame and identifies factors influencing this engagement. She has presented this work at professional meetings, including the AAMC Annual Meeting. Anna plans to pursue a career in pediatrics after medical school.

Sophie is a Second Year Psychology Student at the University of Exeter and a Technology Transfer Student Intern at Exeter Innovation. She has focussed her studies on Cognitive Psychology and Qualitative data analysis.

Sophie is currently a Welfare Officer at Exeter University Labour Society, further creating an understanding of how our cognition affects our behaviour. With training in Sales and Market Research, she will be furthering the knowledgebase of where The Shame Lab sits in the market.

Anna is a PhD student at the Centre for Trust, Peace and Social Relations at Coventry University, supported by Midlands4Cities Doctoral Training Partnership (AHRC). Building on her professional experience in working with people in the social care sector, Anna's research looks at the role of shame in the relationship between marginalisation and violence. She has a BA(hons) in Health and Social Welfare, an MSc in Development Management, and an MSc in Mindfulness and Compassion. Anna is delighted to further develop her understanding of shame through working with The Shame Lab. You can find out more about Anna on her M4C student profile or her Coventry University profile.

With 20 years’ experience working in drug & alcohol services with people who have experienced profound & complex trauma, Vicky initially worked within the criminal justice system with the Prolific Offender Unit, then for 10 years in the child protection & safeguarding arena working with parents. Vicky spent 3 years working across the South-West Peninsula with the Family Drug and Alcohol Court (FDAC), a fundamentally trauma-informed approach to supporting families through care proceedings. Vicky’s background is in delivering training & facilitating group work & she has been delivering training specifically on trauma informed approaches since 2020. Vicky was the Network Coordinator of the Trauma Informed Plymouth Network from 2021-2024 & is now the Trauma Informed Practice Lead with Zebra Collective, facilitating & designing trauma-informed & solution-focused programmes. Vicky feels privileged to be trusted to deliver Professor Luna Dolezal’s shame competence training & believes shame-sensitivity to be an integral & essential component of trauma-informed practice.

As a Social Worker Sarah has worked across a number of different teams working with children and families. Sarah’s roles have included working as a child protection Social Worker, child protection chair and a LADO (Local Authority Designated Officer). She has also worked in a specialist sexual abuse service working therapeutically with children and young people who have been affected by sexual abuse and/or who have shown sexualised behaviours. Sarah has worked with adults where there is a concern of a risk of sexual harm to children along with protective parents. Sarah is also a consultant trainer for a national organisation who specialise in improving understanding of and responses to child sexual abuse. Alongside Vicky Brooks, Sarah has been involved in developing and delivering the trauma informed practice training, for the Trauma Informed Plymouth Network since 2020.

Chay Sutton works for the University of Exeter to support academics engaging in contract research, consultancy and knowledge transfer partnerships. He is the director of a videography, photography and social media strategy company based in the South West of England. In his role with the Shame Lab, Chay develops the social media strategy, creates content and coordinates marketing campaigns. He also looks after the ShameLab website and coordinates training delivery.

Chantelle Lunt is a writer, lecturer, PhD researcher, and activist with extensive experience in public services, including key roles in policing and children's social care. Her current PhD research delves into the further education of care-experienced young people, aiming to understand disparities in tertiary educational outcomes for this vulnerable group.

As the Chair of the Merseyside Alliance for Racial Equality CIC (MARE), a leading non-profit organisation, Chantelle is dedicated to advancing racial equality across Merseyside through innovative, grassroots community-led education initiatives.

In her capacity as a Borough Councillor for St. Gabriel’s ward, Chantelle has made history as the first Black woman elected to this position. She also serves as the Deputy Mayor of Halewood Town Council, where her work continues to drive meaningful change in community empowerment.

Hannah is the in-house artist for the Shame Lab. Hannah works freelance with a wide variety of projects, using illustration and broader creative practice to illuminate stories from research. She is particularly interested in creating images that surface hidden narratives and shed light on the specificity of lived experiences of health. Hannah’s illustrations have won awards, and she also works in many other creative capacities, including making research toolkits and as a creative facilitator in multi-disciplinary research projects. You can find out more about her work at www.hannahmumby.co.uk.