The book, entitled The Science of Shame and its Treatment is written by Dr. Geral Loren Fishkin, a clinician whose narrative about shame relies heavily on experiences that have emerged from years of clinical practice and teaching. The author specifically employs a multitude of case studies from his own practice to develop an engaging narrative where he attempts to offer a view of shame as distinct from guilt and as a powerful emotion that can shape people’s lives to the point of severely impairing their daily functioning. The author views this emotion at the core of different forms of psychopathology and skillfully draws the path from them to shame and its sources at the early stages of human development. He argues that understanding the origin of shame and its manifestations in cognition and conduct can enhance the effectiveness of clinical interventions devoted to pathologies where shame is assumed to play a key role. The author’s viewpoint is reasonable, and the objective of the book is worthwhile and admirable. Indeed, shame is an emotion that has received less attention in the scientific literature than other more popular emotions such as fear, anger, etc. Shame has also been frequently confused with guilt, thereby making it a much-needed topic of discussion not only for current and future clinicians, but also for researchers in the social, behavioral and brain sciences. Notwithstanding the importance of the topic to the work of practitioners and researchers, and to the well-being of clients, the author’s coverage of shame is less reliant on controlled studies and more on case studies and observations stemming from clinical practice. 

The book is advertised as a “well-researched book that has many practical applications for clinicians”. Its title even contains the word “science”. Yet, the text is written in the language of a clinician whose certainty about the human condition stems largely from anecdotal clinical evidence, which is then treated by default as superior to science and related scientific discoveries. One of the many examples of the author’s inclination towards clinical anecdotes as deserving enhanced attention and special consideration is the statement which claims that “our thoughts follow our experience of shame rather than the other way around” or “[d]espite the theoretical model of shame and how we try to understand it, most clinicians…” (p. 33). The first statement appears to refer to the phenomenological experience of shame that overwhelms the mind and thus gives the impression of a particular chronological order for the thoughts and feelings that define shame to the person who experiences it. As we all know, several theories exist on the temporal order in which the processes that lead people to experience a variety of emotions may occur (e.g., Schachter-Singer two-factor theory, James-Lange theory, Cannon-Bard theory, etc.). These theories are still being debated as conclusive scientific evidence favoring one over all others for particular emotions is yet to be collected. A coverage of this debate and existing evidence might have guided the reader to appreciate the distinction between phenomenological experiences reported through a person’s introspection and evidence from controlled studies where the nature of a variety of emotions is investigated. The second statement is even more troubling. As we all know, sound theoretical models emerge from data about human behavior and brain functioning through methodologies that are tested for reliability and validity to avoid the subjectivity (and thus the likely biases) of the observer, even one with considerable clinical training, knowledge, and practice. Models that exist in “spite of” the evidence obtained in clinical practice either are not sound models or the interpretations of specific clinical cases offered by practitioners are questionable and thus may not deserve much consideration.

Fishkin explicitly claims that shame is an emotion that “we cannot touch or see or measure it. We can only experience it. As such, shame is not empirical and cannot be subject to scientific methods of investigation, testing, and manipulation” (p.  27). This statement and others of similar content are troubling for a book that is advertised as being “well-researched” and whose title contains the word “science”. The reason is simple. Such conjectures are factually incorrect and thus untenable. They disregard decades of scientific investigations into the human mind and the brain that sustains its functioning. Claims of this nature lead one to ask whether past and current scientific investigations of a host of other mental phenomena and their behavioral correlates are to be discarded because they do refer to phenomena that can be experienced, but cannot directly be observed.

Undoubtedly, the author, as an experienced clinician, has valuable insights into the working of shame and other emotions. Clinical training and practice can offer one a wealth of information that can be used better to understand psychological suffering and its likely causes. The book reflects the author’s knowledge of interpersonal dynamics and sensible clinical reflection. Yet, little is devoted to findings from the field of neuroscience. Some of the writer’s comments (e.g., “the primal part of our brain, the hypothalamus, perceives and assesses environmental stimuli”) are puzzling and without much context to help the reader who seeks both knowledge and insight to understand shame and its sources. Thus, “The Science of Shame and its Treatment” is a book that assembles into an easy-to-read and engaging narrative information obtained from years of clinical practice and teaching, a number of case studies, and a review of the clinical and developmental psychology literature. The book, however, does not discuss the “science of shame”, but rather it highlights “a clinician’s viewpoint of shame”. It can be useful to other practitioners if accompanied by an in-depth review of the literature on theoretical debates and findings regarding shame and related emotions (e.g., guilt) which includes evidence from controlled studies in neuroscience, cognitive psychology, and clinical psychological science.

© 2016 Maura Pilotti

Maura Pilotti, PhD