Shame And Social Phobia: A Transcultural viewpoint

·期刊原文
Shame And Social Phobia: A Transcultural viewpoint

Okano K
Bull Menninger Clin

Vol. 58 No. 3 Summer.1994

Pp.323-38

Copyright by Bull Menninger Clin

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SHAME AND SOCIAL PHOBIA: A TRANSCULTURAL VIEWPOINT

Shame is given different meanings in various cultural contexts. In
Japan, shame-prone and self-effacing behavior tends to be given
positive functional value and is actively promoted by society. In the
United States, society tends to prohibit such shame-prone behavior and
the show of one's vulnerability, while encouraging the visible
demonstration of one's power and capacity. The author shows that these
different meanings given to shame reflect different values of
secretiveness in these two societies. He concludes by suggesting an
alternative view of shame that encourages flexibility rather than an
exclusively positive or negative value of secretiveness. (Bulletin of
the Menninger Clinic, 58[3], 323-338)

Shame may be one of the most hidden human feelings. People are reluctant to
talk about their own shameful experiences and often do not even want to
admit having this feeling, even though shame is ubiquitous in our daily
emotional life. It is the nature of shame to hide feelings of inadequacy or
inferiority, either from ourselves or from others. Unlike guilt, shame has
never been a central theme in the classical psychoanalytic literature,
despite some significant contributions on this topic by such authors as
Erikson (1950), Piers and Singer (1953), Lynd (1958), and H.B. Lewis
(1971). Morrison (1989) stated that "shame generates concealment out of a
fear of rendering the self unacceptable," in contrast to guilt, which
"invites confession and forgiveness" (p. 2). This fear of rendering the
self unacceptable makes it difficult for us to face shame either as a
general human emotional experience or as a daily personal experience.

Fortunately, however, there has been a rapidly growing interest in shame in
the current psychoanalytic literature in the United States. This recent
burgeoning of publications on shame may be apparent even to those who are
not particularly sensitive to this topic. As some authors suggest, there
has been a "cultural conspiracy to avoid discussing shame" (Broucek, 1991,
p. 4) that we are now overcoming through our own analytic scrutiny. Others
note that this new wave of interest in shame goes hand in hand with the
interest in narcissistic pathology (M. Lewis, 1992; Morrison, 1989).
However, the reasons for the current interest in shame (and the relative
paucity of interest in the past) seem to be much more complex.

One characteristic of recent publications on shame in the United States is
the wide variety of viewpoints that they provide. In contrast to the
unitary drive/instinct conceptualization that Freud and his immediate (as
well as some of his remote) followers developed, current authors have
evolved their own positions, which differ from drive/instinct theory and
shed light on the topic from multiple angles. These authors use
psychoanalytic (Bursten, 1973; Chasseguet-Smirgel, 1985; Morrison, 1989;
Wurmser, 1981), developmental (Broucek, 1991; M. Lewis, 1992; Tomkins,
1962), philosophical (Broucek, 1991), and sociocultural models (M. Lewis,
1992).

Most of the issues bearing on shame have already been covered, explored, or
at least alluded to by these studies. Yet, despite the variety of current
viewpoints, there is still a dominant and, in my view, narrowly conceived
doctrine espoused in this literature. This doctrine asserts that shame is
basically a negative feeling and that the clinical objective is to help
patients become aware of it and then get rid of it. A few authors hold the
opposite view and focus on more positive and functional aspects of shame
(Broucek, 1991; Goldberg, 1991; Schneider, 1987), but they are in the
minority.

The major objective of this article is to provide a wider and more
relativistic view of shame by bringing a transcultural perspective to bear
on this phenomenon. This perspective is based on my personal experience as
a practicing psychiatrist in two different cultures (American and
Japanese). Since, with the exception of M. Lewis (1992), the current
American literature pays little attention to shame in different societies,
clarifying the contrast between the American and the Japanese views may
well enrich our understanding of shame, as well as of social phobia--the
typical pathological manifestation of shame. In my view, these two
culture-bound approaches are complementary, pointing out each other's blind
spots. I wish to suggest an alternative view that can encompass both
perspectives.

Before proceeding, however, I would like to stress that the following
transcultural approach to shame never eliminates the significance of innate
temperament, which could determine one's shame-proneness and propensity to
social phobia. All human beings definitely share a potential for
experiencing shame. It is the meaning people attach to the experiences of
shame that is dependent on the sociocultural context. This is what I will
discuss in this paper. In the following sections, I will first describe the
almost opposite Japanese and American viewpoints on shame and social
phobia, and then present my alternative perspective.

Shame and social phobia in Japan

Since Benedict's (1946) penetrating but rather simplistic formulation of
Japanese society as "a shame culture" (as opposed to American society,
which she termed "a guilt culture"), shame as a psychosocial phenomenon has
been a continuing topic of discussion in Japan. Sakuta (1967), a Japanese
sociologist, argued that Benedict's dichotomous view considered only one
aspect of the shame experience among the Japanese. Relying on Scheler's
(1913/1957) theory of shame, Sakuta divided shame into what he called
"private shame" and "public shame." The former is what an individual
experiences privately in terms of personal inferiority and inadequacy,
whereas the latter is what is experienced privately in direct social
contact with other people who have noted public manifestations of the
person's inferiority and inadequacy. Sakuta contended that Benedict focused
only on public shame in the Japanese, whereas actually the Japanese also
have an internalized form of shame (i.e., private shame). This private
shame is an internal sanction akin to guilt, which Benedict assumed governs
people in Western society. Using Sakuta's formulation, Inoue (1977) further
classified shame-related feelings into three categories: (1) public shame,
(2) private shame, and (3) shyness. Most current Japanese authors agree
with this classification.

Historically, Japanese people have become used to being characterized as
shame-prone, shy, self-effacing, reserved, and apologetic, even though they
show some resistance or reservation in accepting the designation of their
culture as a "shame culture" with its rather negative connotations.
Japanese psychiatrists regard shame and shyness as playing an important
role in the pathogenesis of several mental disorders, including social
phobia, dysmorphophobia, paranoia, and depression (Uchinuma, 1983). Among
these conditions, it is the pathological shame reaction, social phobia,
that I will discuss at length in this paper.

Generally speaking, Japanese authors appear to assume that the culturally
encouraged show of shame-proneness among the Japanese is enough to explain
the reported high prevalence of social phobia among them. Many authors
argue that social phobia has a much higher prevalence in Japan than in the
Western world (Kasahara, 1974; Kora, 1955; Yamashita, 1977). However, it is
not easy to demonstrate this presumed higher prevalence in Japan with
relevant statistics, primarily because of the lack of extensive comparative
epidemiological data on social phobia in the United States and in Japan.
Kasahara (1974) reported that 10% of new students in a Japanese university
who were under psychiatric care had a diagnosis of social phobia, and that
its prevalence was second only to depressive reactions and psychosomatic
disorders. A report by Uchinuma (1983) indicated that 2.5% of psychiatric
outpatients in a Japanese mental hospital had a primary diagnosis of social
phobia.

Furthermore, it is widely believed that there is a large "subclinical"
population of persons with social phobia among the Japanese. One study
showed that nearly a third of new students in a Japanese university
believed that they flushed easily or that they were overly aware of the
gaze of others (Uchinuma, 1983). Another report indicated that about 50% of
students in a university in Japan had a tendency toward social phobia
(Fukui, 1984).

In Japan, a cluster of neuroses with socially phobic features as well as
hypersensitivity and pervasive hypochondriacal concerns has been called
"shinkeishitsu," which a Western textbook of psychiatry describes under the
rubric of "cross-cultural syndromes" (Kaplan & Sadock, 1988). Half a
century ago, Morita (1960), a pioneer in the study of shinkeishitsu,
postulated that there is a shinkeishitsu-prone innate temperament that he
called "hypochondriacal temperament." According to Morita, people who are
born with this temperament are overly sensitive, self-reflective, and
notice even minimal changes in their mental and physical states. He stated
that the cure for these people is to get rid of their tendency toward
excessive self-reflection. Morita Therapy advocated that these patients
establish a state of "arugamama," which is the readiness to admit the
nature of their own symptoms and anguish. Instead of resisting or rebelling
against them, patients learn to accept them as part of their existence.

For the past half century, Morita's theory has been widely accepted among
Japanese clinicians as well as lay people (Takahashi, 1989), with the
establishment of self-help groups among people suffering from
shinkeishitsu. The popularity of Morita's theory could be accounted for by
the large prevalence of clinical and subclinical populations with
shinkeishitsu. It could also be ascribed to the fact that the basic
principle of Morita Therapy fits well with the philosophy of Zen Buddhism
that the majority of Japanese people are familiar with, especially its
discouragement of opposing natural as well as bodily phenomena, including
physiological manifestations of social phobia such as flushing,
palpitations, and hand tremor.

As the principle of Morita Therapy indicates, in Japan shame tends to be
considered a feeling that all human beings share, and it is the failure to
accept one's feelings of shame that could create problems. It even seems as
if something in the Japanese culture is actively promoting, facilitating,
or at least allowing people to show manifestations of the experiences of
shame and related feelings such as shyness, secretiveness, embarrassment,
and a sense of inferiority. If the core emotional experience of social
phobia is an intense and disabling feeling of shame, the high prevalence of
subclinical social phobia symptoms in Japan compared with Western society
could be related to the socially promoted show of shame among Japanese
people. In this context, I (1991) once described Japanese society as a
pseudo-sociophobic culture, because so many cultural phenomena that are
considered proper in Japanese society are phenomenologically isomorphic to
attenuated subclinical forms of sociophobic symptoms.

I want to stress here that what is promoted by Japanese society is not the
feeling of shame itself. It is rather the external manifestations of the
feeling of shame in the sociophobic-like symptoms, which could occur even
without actual feelings of shame. In other words, what is promoted is not
exactly shame per se, but the "sense of shame" (i.e., one's awareness and
sensitivity to the shame experienced by oneself or others).

Typical Japanese examples of this culturally promoted show of shame
include: It is considered impolite to stare at people, especially one's
elders or superiors; and it is often regarded as improper to be verbally
assertive and to make one's opinion too clear and distinct in public.
Generally, it is not wise to show off your competence and competitiveness
to others. It is also regarded as taboo not to be in touch with one's own
feelings of shame, and in the Japanese language "a man who does not know
what shame is" is equivalent to a "thickskinned" and "insensitive" person
who is practically unfit for society. Therefore people are even required to
"fake" sociophobic-like manifestations to be accepted in the society (hence
my term "pseudo-sociophobic" society). Accordingly, it is a reasonable
expectation that a certain number of people who live in this society will
develop "real" symptoms of social phobia, such as a fear of eye-to-eye
confrontation and oral communication. People may feel free to show these
symptoms, which are already encouraged by society.

The question may now be posed: What purpose does this shame-promoting
culture serve? The most obvious function of these sociophobic-like
behaviors is to reduce the envy-ridden competitiveness among people. Every
show of an individual's strength and assertiveness is carefully modified or
camouflaged in this society so that an individual is better accepted.
Verbal assertiveness and staring straight into another person's face are
discouraged because they are regarded as a provocative, defiant show of
one's own power and strength.

On the contrary, one's bashful and overpowered looks, lack of verbal
assertiveness, and avoidance of gaze that mimic the appearance of "true"
sociophobic symptoms demonstrate one's weakness, limitations, or
inadequacy, which reduces the potential of arousing jealousy and feelings
of competitiveness in others. Thus, as I suggested earlier, shame is not a
feeling to be avoided, but instead it is considered a feeling that can be
actively used to reduce friction in one's relationships with others.

This readiness to show one's feelings of shame probably reflects a belief
that most Japanese people share: One's importance, power, or value should
be only implied or suggested, but not revealed openly. This belief implies
that what is hidden is powerful. On the other hand, what is manifest has
already lost its power or value. This belief goes hand in hand with the
Japanese pseudo-sociophobic attitude, because the latter does not threaten
one's narcissism as long as the belief asserts that hiding one's strength
and value does not mean that one does not have them.

Doi (1986) suggested that this belief has a long history in Japanese
culture. He quoted the following statement by Zeami, a master of Kado (the
art of flower arrangement) in the 15th century, which most Japanese would
immediately agree with, even in this modern era:

Know the concealed flower. "What is concealed is the flower. What is
not concealed cannot be the flower." To know this distinction is the
flower, and among all flowers this flower is the most important. From
the beginning, the respective houses in the various ways and arts have
called all matters pertaining to their disciplines secret, precisely
because great work is done by making these matters secret. (p. 110)

If what is essential is always hidden according to what the Japanese
believe, then strength and capability are covert. Even though the society
discourages the direct show of strength, this does not militate against a
basic narcissistic need, such as possessing strength or identifying oneself
with strong others. However, because an essence must be hidden to be truly
essential, true strength should be hidden by the very people who have it,
unless it reveals itself naturally. It is not that one should not be strong
and capable, but rather that the person should not reveal these traits
spontaneously, which proves the individual's real strength and capacity.

In a pseudo-sociophobic culture, what is discouraged is the striving to
show one's strength and capacity in an overt way, but this does not mean
that it also discourages the individual from being really capable and
strong. Rather, a well-adapted sociophobic-like individual should have an
inner strength and confidence that makes the individual immune to the
culturally promoted submissive and self-defeating attitude, which otherwise
would hurt the person's pride and narcissistic self-image.

Kitayama's (1985, 1987) recent psychoanalytic contributions shed another
light on this issue of truth and strength in what is hidden. In a study of
an old taboo found in Japanese folklore against seeing and then revealing,
Kitayama (1985) argued that the preoedipal "prohibition of 'don't look'"
(p. 177) is repeatedly observed in this folklore. He pointed out that in
many Japanese stories, when the hero (usually a man) violates the
prohibition of "don't look"--that is, when he breaks a promise to his
attractive lover or wife not to look at her in certain situations--he
usually sees, instead of a beautiful woman, an animal that is "an ugly
mixture of split 'good' and 'bad' mothers" (p. 184). Even though this taboo
is eventually to be violated (as opposed to the oedipal incest taboo, which
is never to be violated throughout life), the abundance of this type of
folklore in Japan indicates the belief that revelation will spoil one's
positive values, such as beauty and attractiveness.

In another contribution (1987), Kitayama pointed out that the Japanese
language is generally used loosely and is grammatically ill-structured. He
contended that "to a large extent the Japanese communicate ideas while
keeping them unspoken" (p. 499), implying that this is a manifestation on
the level of language of the previously mentioned Japanese propensity to
hide in order to preserve values. Of interest to our topic is that Kitayama
also suggested a possible relationship between the ambiguity of the
Japanese language and the high prevalence of social phobia. His idea of a
"morbid fear of ambiguity" (p. 501) refers to the Japanese paranoid fear of
being misunderstood by others because of their secretive and ambiguous mode
of speech, which is inherent in the sentence structure of Japanese
language.

To summarize, in Japan shame tends to be regarded as an important and
functional emotional experience. The society promotes a sociophobic-like
attitude, with humility and self-deprecating gestures in social
relationships and with a resultant proliferation of shame-prone, avoidant,
and sensitive demeanor similar to social phobia. This "feigned" socially
phobic attitude has at least two adaptive functions. First, it inhibits
envy and competitiveness that a show of one's capacity and strength would
elicit in others. Second, it protects both one's strength and vulnerability
by keeping them invisible to others as well as to oneself, so that they
remain unchallenged and unharmed by others. Despite these merits, however,
the abundance of pseudo-sociophobic attitudes among the Japanese tends to
facilitate the occurrence of true sociophobic symptoms, which are
maladaptive and dysfunctional.

Shame and social phobia in the United States

Even if Benedict's (1946) dichotomy of the Japanese shame culture versus
the American guilt culture is too simplistic, American people would never
assert that they are shame-prone, or that American society in general
facilitates sociophobic-like symptoms as does Japanese society. Although
the literature on shame is rapidly increasing among current American
psychoanalytic authors, they unanimously agree that shame has traditionally
been a widely neglected topic in their field. As Nathanson (1987) noted in
his monumental monograph on shame: "Shame seems to be an emotion little
discussed in our clinical work" (p. vii), and there has been a
"culture-wide avoidance of pertinent discussion" (p. viii) on this topic.
In this section, I would like to consider this "culture-wide avoidance" in
two respects: (1) its sociocultural implications, and (2) the classical
psychoanalytic movement's deterrent effect on the discussion of shame.
ociety, American society has few moral or ethical codes that appear to
promote sociophobic-like behavior in individuals. Regardless of any
statistical data, it is clear that there are few customs or moral codes in
American society that promote self-effacing, inhibited, and avoidant
attitudes toward others. Let us take the same examples we considered in the
previous section as indications of a pseudo-sociophobic Japanese society.
In the United States, it is generally not considered impolite to gaze at
people. Rather, avoiding eye contact is often interpreted as a show of
vulnerability, insecurity, or even dishonesty. Also, American society
rather actively promotes verbal assertiveness and making one's opinion as
clear and distinct as possible in almost any social situation. Lastly,
those who are shame-prone are considered less likely to prosper in American
society because of their lack of competitiveness.

In American culture, showing one's ability and power in a most visible and
tangible manner, such as through verbal assertiveness, publications, or
publicity in the mass media, seems to be a royal road to success. In The
Culture of Narcissism (1979), Lasch suggested that this tendency is even
more pervasive recently in modern society, where people are devoted to
superficial images and personal advancement. He also asserted that
"narcissism appears realistically to represent the best way of coping with
the tensions and anxieties of modern life" (p. 50). For the sake of
highlighting the contrast with Japanese pseudo-sociophobic society, we
could call American society a narcissistic society, in line with Lasch's
assertion. American society constantly pressures people to manifest their
strengths and abilities in the most overt and visible way, if they want to
thrive socially.

However, the narcissistic quality of American society, which appears to be
the opposite of the pseudo-sociophobic society, could serve as a strong
protection against one's vulnerability to feelings of shame and
inferiority. As I suggested, shame could be a universal feeling that every
human being shares across the sociocultural context. What differs is how
this vulnerability to shame is translated and (de)valued, which varies
widely in given sociocultural situations. In the United States, what we are
witnessing in people's narcissistic strivings could be a show of active
avoidance, or even a counterphobic attitude toward admitting their
experiences of shame. H.B. Lewis's (1971) notion of "bypassed shame" refers
to this type of shame, which people experience without realizing it. The
narcissistic society dictates that the winners will be those who
successfully hide their vulnerability to shame and their sense of
inferiority behind their narcissistic grandiose facade.

The "culture-wide avoidance of pertinent discussion on shame" (Nathanson,
1987, p. viii) is endorsed by a belief of the American people regarding
what is hidden and unseen, which again is in sharp contrast to the belief
generally held by the Japanese. Instead of believing in the true value and
essence of what is hidden, Americans generally believe more easily in what
is visible and obvious, which typically characterizes their narcissistic
society.

Doi, a Japanese psychiatrist with extensive clinical experience in the
United States, is well aware that this view of secretiveness is typical in
Western culture. Referring to this Western attitude, Doi stated in his
Anatomy of Self(1986) that "the tendency to think of secrets as something
that should not exist, and ultimately as something that must not exist, is
a phenomenon of the modern age" (p. 108).

If what is hidden is to be revealed in this modern Western age, then the
general trend in current American psychiatry represents this tendency in a
salient manner. Some recent and currently hot topics in American psychiatry
are clearly under the influence of this revelatory zeitgeist. Topics that
we traditionally have had a strong reluctance to fully discuss, such as
death, sexuality, and violence, have been argued more openly, and their
related psychopathology has been more systematically formulated. For
example, Kubler-Ross (1969) described the mental process of dying people
and delineated several steps of the process that have specific
characteristics. People are increasingly aware of the glaringly high
incidence of marital violence and incest as well as sexual abuse in
childhood. Related pathologies such as multiple personality disorder (now
termed "dissociative identity disorder" in DSM-IV, American Psychiatric
Association, 1994) and posttraumatic stress disorder are both currently a
major focus of American psychiatry.

Because the modern American zeitgeist is to reveal and disclose what has
been hidden, shame is bound to be a negative feeling with its inherent
secretive nature. If what is hidden lacks the value and truth of what is
manifest, people will not be encouraged to assume a self-effacing
sociophobic-like attitude toward others, because it only hurts their
narcissism with a crude sense of worthlessness and shame. This lack of a
pseudo-sociophobic attitude may be a strong deterrent to true sociophobic
manifestations, because these symptoms are not well tolerated by this
society. Consequently, the result could be either an underdiagnosis of
social phobia or a belated recognition of its true prevalence. I will
discuss this latter possibility at the end of this section.

In addition to the American sociocultural prohibition of shame, classical
psychoanalysis has provided people with a "shame-free" theoretical basis
for human psychology. As several authors have already pointed out
(Goldberg, 1991; Morrison, 1989; Nathanson, 1987), shame has been neglected
since the beginning of the history of psychoanalysis. lt is often argued
that Freud did not do justice to the feeling of shame, focusing instead on
the pathology of guilt and the Oedipus complex, as well as on the superego
as its "heir." The analytic literature since Freud has only occasionally
referred to shame, in contrast to guilt, which has always been in the
limelight of psychoanalytic discussions.

Although Freud (1905/1953, 1932/1961) discussed shame to some extent, his
attitude toward it was rather misleading and simplistic. In his view, shame
has almost uniquely been dealt with as a defense against exhibitionistic
instinct. As Morrison (1989) aptly summarized, "Freud (1905) introduced
shame as a 'resistance' against these drives, which 'impede the course of
the sexual instinct and, like dams, restrict its flow--disgust, feelings of
shame, and the claims of aesthetic and moral ideals'" (p. 23). Freud's
basic understanding of shame was passed on to his direct followers, such as
Alexander (1938) and Fenichel (1945).

Most current authors of shame-related literature stay away from this
Freudian instinctual/libidinal view of shame and instead take diversified
approaches to the topic. However, there is a widely held assumption, or a
"central dogma," in most of the current literature on shame. This dogma
dictates that the feeling of shame is not a healthy emotional experience
and that the goal of treatment is therefore to diminish or eliminate it.
Only a minority of authors, notably Schneider (1987) and Broucek (1991),
challenge this dogma. Schneider (1987) stressed that even though shame has
been treated with disrespect in our society, it is a mark of our humanity,
given that the interplay between covering and uncovering is a part of human
nature. Broucek (1991) also stressed the "shamelessness" (p. 135) in our
modern society, which coincides with my argument of the relative ignorance
of shame in this society.

So far, I have asserted that shame has traditionally been rather avoided as
a topic in American psychiatric literature, primarily for two reasons: the
sociocultural implications of shame, and classical psychoanalytic theory's
deterrent effect on the discussion of shame. However, my basic contention
again is that shame is a universal emotion that all human beings are
vulnerable to and defend against, whether it is overtly manifested or not.

A recent study on the constitutional basis of shyness (Kagan, Reznick, &
Snidman, 1988) supports this contention. Shame-proneness could be
reflective of one's temperament, which is found across societies. (This
idea has much in common with Morita's notion of "hypochondriacal
temperament," discussed in the previous section, which is manifested by the
individual's shame-proneness and sensitivity in interpersonal
relationships.)

If my contention is correct, then there should be some manifestations that
people experience shame in American culture as much as they do in Japanese
culture. In my view, there are two current indications. One is the rapidly
growing literature on shame that we have witnessed for the past several
years, which successfully shows the significant role that shame plays in
the pathology of narcissism (Broucek 1991; Morrison, 1989; Nathanson,
1992). The second indication is the relatively high prevalence of social
phobia recently reported in the United States.

The recent expansion of the literature on shame is demonstrated by
PsycINFO, a computerized database on psychiatry and psychology compiled by
the American Psychological Association. A search of PsycINFO found that the
number of uses of the word "shame," compared to the total number of records
in the database, has doubled in the past 15 years. (Interestingly, the word
has not been used as an indexable thesaurus term until 1994.)

This new interest in shame has been attributed especially to the rise of
self psychology and the growing interest in the pathology of narcissism.
Most current authors of articles on shame discuss the relationship between
shame and narcissism. Their general consensus is that shame is at the
center of narcissistic experience. Morrison (1989) summarized the consensus
of these authors, which is that narcissistic grandiosity and the desire for
perfection are the underside of the sense of self as being inadequate,
inferior, and shameful. This theory is in accord with my own argument
regarding pseudo-sociophobic Japanese culture and narcissistic American
culture. If Japanese society conditions people to openly accept their
feelings of shame, American society works in an opposite way to powerfully
suppress the acknowledgment of shame, leading rather to narcissistic
manifestations in society. If we follow this logic, the prevalence of
narcissistic pathology indicates how strongly shame is suppressed or denied
in the individual. One of the salient discoveries of the current study of
shame is this recognition of the strong relationship between shame and
narcissism, which actually endorses my assumption that every human being is
equally vulnerable to shame. The American attitude toward shame is
different from the Japanese only in that Americans deal with shame in a
rather counterphobic manner.

Another indication of the American vulnerability to shame can be found in
recent reports on the increasing prevalence of social phobia in the United
States. In the past, especially before the advent of DSM-III (American
Psychiatric Association, 1980), which was actually the first official
recognition of social phobia in American psychiatry, social phobia was
always considered a rather rare condition. Despite little systematic
statistical evidence, social phobia was considered to have a low prevalence
rate, compared to the high prevalence rate in Japan and several other
countries (Kora, 1955; Yamashita, 1977).

Liebowitz, Gorman, Fyer, and Klein (1985) stated that even though social
phobia is still "neglected" among the anxiety disorders, the prevalence of
this condition may be much higher than previously thought. They indicated
that the prevalence of social phobia equals that of panic disorder and
agoraphobia. A recent report (Schneier, Johnson, Hornig, Liebowitz, &
Weissman, 1992) again pointed out that too little attention has been paid
to this disorder, which actually affects 2.4 out of every 100 people among
American adults. The most recent epidemiological study (Kessler et al.,
1994) indicated that the lifetime of prevalence of social phobia is as high
as 13%. Even though the estimated prevalence of social phobia varies among
authors, there seems to be a parallel correlation between the attention
that social phobia is currently attracting in the literature and its
assumed prevalence among the general population. In my view, this belated
recognition of the relatively high prevalence of social phobia indicates
the cultural reluctance to acknowledge social phobia in American society,
although Americans are as vulnerable as the Japanese to shame.

An alternative view of shame

This alternative view of shame is provided by a revision of the markedly
different attitudes between Japanese and Americans toward what is hidden.
As we saw earlier, typical Japanese and American views provide either
positive or negative attitudes toward what is hidden. However, the act of
hiding itself is neither good nor bad, and it would not cause problems
unless an individual is no longer aware of what he or she is hiding and for
what purpose. In other words, the act of hiding could become pathological
when it involves hiding from oneself.

In psychoanalytic terms, we find an analogous argument in repression and
its pathological significance. Like what is hidden, repressed wishes and
impulses are not altogether pathological. It is rather their loss of
readiness to come back to awareness when necessary that gives rise to their
psychopathology in the individual.

Freud's view of guilt and its psychopathology is well in accordance with
this flexibility of what is repressed (i.e., hidden to oneself), even
though he did not relate this issue to shame. In "The Ego and the Id,"
Freud (1923/1961) indicated that guilt would cause problems when it is
either totally repressed (in the case of hysteria) or "over-strongly
conscious" (p. 51) (in the cases of obsessional neurosis and melancholia).
Based on this idea, guilt would not become pathological if the individual
gives it free rein to be either conscious or unconscious. As a matter of
fact, that is the only way that the person can be at peace with
guilt-provoking wishes and thoughts. The individual should understand that
guilt should be neither totally repressed nor constantly under the scrutiny
of consciousness; instead, it should be able to move back and forth from
unconscious to conscious, depending on the circumstances. This
pendulum-like flexibility and mobility should occur rather naturally,
because any guilt-provoking wish has a reason to be both repressed (because
of its potentially unethical and sinful nature) and in full awareness
(because the person cannot always afford to use mental energy to repress
it). Again, the rigidity of the wish's relationship to consciousness and
the unconscious is what causes psychopathology.

We can apply this view of repression almost exactly to our generalized
discussion of what is hidden. From this viewpoint, neither American nor
Japanese attitudes seem concerned about the importance of the flexibility
of what is hidden. The Japanese tend to glorify and attach too much value
to what is hidden, whereas Americans in general tend to devalue and
minimize what is hidden and instead try to disclose it.

The lack of flexibility in what is hidden in different cultural contexts
has already been hinted at by Doi. In a 1973 article, he discussed the
different mentality of the Japanese and the Americans concerning secrets.
Regarding the Japanese people's attitude toward secretiveness, he stated:
"To cultivate or pursue secrets leads rather to the establishment of one's
separate self and the mastery of the world," but the Japanese "have not
given free rein to them for some historical or sociological reason" (p.
177). Then he discussed the difficulty that Japanese people have with
entering the stage of psychological "hide-and-seek," where making and
discovering secrets is involved. What Doi meant by this analogy was not
that the Japanese could not easily hide things. Rather, Doi implied that
they have difficulty disclosing what is hidden, and that they sometimes
need to pretend that they are not hiding anything to avoid having to
disclose it. As I suggested previously, one reason for this reluctance to
disclose is the belief that the value of what is kept hidden will be
impaired in the process of emotional "hide-and-seek." If we could play and
enjoy our emotional "hide-and-seek," it would mean that we are in control
of the act of hiding, fully in charge of deciding when and what to disclose
or not to disclose.

The alternative view of what is hidden provides the basis for a new
attitude toward shame that is different from both Japanese and American
ones. This alternative attitude toward shame is a hypothetical and
idealistic one that Americans as well as Japanese would adopt if their view
of what is hidden gains flexibility, instead of attaching exclusively
positive or negative value to what is hidden. If the Japanese would give up
their belief in the unconditional value of what is hidden and kept secret,
they would lose their shame-proneness and sociophobic-like attitude,
because their self-deprecating attitude and low profile in society would
only hurt their narcissism. If Americans would no longer attach an
exclusively positive value to what is manifest and visible, with a
concomitant neglect of the value of secretiveness, they would feel less
need to resort to their narcissistic strivings and would more readily admit
their painful vulnerability to shame and a sense of inferiority. They would
then believe that they could still be valuable even if they do not visibly
appear to be so.

From this standpoint, Freud's rather defensive attitude toward his own
secretiveness (Barron et al., 1991) may be consistent with his practical
neglect of the significance of shame. Some authors even suggest that
Freud's sensitivity and discomfort in dealing with shame prompted him to
emphasize "an emotion with which he was more comfortable--guilt" (Goldberg,
1991, p. 124). In other words, with a little more flexible attitude toward
what was hidden in himself, Freud would have shown much more interest in an
alternative to the psychology of guilt: the psychology of shame.

Acknowledgment

The author thanks Herbert Spohn, PhD, for his critical review of this
manuscript and his helpful comments.

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~~~~~~~~

By Ken-Ichiro Okano, MD

Dr. Okano is a public psychiatry fellow at The Menninger Clinic. Reprint
requests may be sent to Dr. Okano at The Menninger Clinic, PO Box 829,
Topeka, KS 66601-0829. (Copyright - 1994 The Menninger Foundation)
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