I'm going to admit it: I have used shame tactics when it comes to health. I've used them in the office, with my family and quite honestly with myself. Today we're going to first acknowledge it and then understand why.

We have to start with acknowledging that shame tactics are there because honestly we're just disavowing what's in front of us, pretending that we're all good and wholesome and nurturing, when we are actually using tools that are keeping us from achieving what we want to create.

What is shame?

Shame is that icky feeling - one that for me feels like my belly is turning, my cheeks are flushing and I want to run and hide. It's a feeling that we have when there's one of a variety of thoughts happening:

I am not good enough.

I am bad

I am wrong

I don't belong

I am the problem

I am unhealthy

It's all my fault

I am to blame

Notice the prevalence of thoughts that start with "I" - shame is created as we make actions or situations mean something is wrong with us.

Oftentimes it's our interpretation of what is going on, perhaps a mis-placement of the problem. Take for example, when I slipped on a patch of black ice on a fateful day over college break. I broke every driving rule by watching out for the fire hydrant that was poking its head out of the piling snow and I'll be darned, that's exactly where I skidded, right into the hydrant.

This is dating myself: it was before the times of cell phones, so I hiked myself back up the hill to my dad and called the fire department, the tow truck, and work that I was no longer able to get to on time.

I shared with my dad what had happened and I knew what I had done wrong:

I had miscalculated the temperature and road conditions, I had focused on the freaking hydrant when I skidded and it led me to take it out. I had done wrong.

But I didn't feel shame. Because while my actions were faulty, I didn't make it mean anything about me. Even when my *entire family* found out about it, and for years Gigi posted a sign by her own fire hydrant that said, "Don't Hit Me, Wendy!" in big festive lettering, I didn't feel shame. They poked fun at me for years and I'm still telling the story.

Because I learned from it. It was a mistake, but it didn't mean anything about me.

Contrast that with the shame that I felt in medical training - being told, "I can't believe you don't know that." Or "You shouldn't be asking me that question." Or "You're wrong." Or "Have you had assertiveness training? You ask too many questions!" "You're not doing it right." My fave, "I'm not sure that you're going to pass."

Each and every one of these statements could have been something that I didn't let it mean anything about me, and I'm working now to see how they reflect more about the person who said it than the student and doctor that I was then. But instead, I felt shame.

I thought I wasn't good enough and that I was the problem. And to be honest, at times that was the intended outcome of the person wielding the words as tools.

Shame isn't something that is reserved for discussions about weight, health and bodies, but oh man, does it sure apply here! Our culture has taken a remarkably individual-responsibility approach to health and weight. I am reading Aubrey Gordon's "What we don't talk about when we talk about Fat" and she tells in detail about her experiences as a woman in a fat body (using her words, as she is one of many who are reclaiming the word fat not as a slur but as a descriptor, just like short or tall) and being shamed for daring to travel on a plane. The message that she received repeatedly was "How dare you travel in a plane, in the middle seat, with a fat body?" If you're going to do that (travel), you should change your body.

The message: You are wrong, you don't belong here.

This is cultural and quite honestly institutionalized shame.

While it isn't necessarily said out loud, there are so many shades of weight bias in our society that we just don't see them in the day-to-day.

Shame is wielded by experts who think they have the corner on the market about what is right or wrong. As a physician, I have had to confront this expertise and really ask myself, do I really know what is right/wrong, healthy or unhealthy for another person?

Interventions are often approached this way: others see that change needs to be made - not by them, but by another person. "You've gotta change." There is again a relative hierarchy or control in play here. Think about a 3 year-old telling you you have to change your eating habits (unlikely to prompt more than a funny memory or video opportunity) versus your doctor or your mother-in-law telling you this is it: it's their job to point it out.

The pointing out and shame that results leads the person on the receiving end to withdraw, hide (perhaps hiding eating habits), be stressed (and BTW stress never is helpful for creating self-care change).

Shaming often is used in a way that is meant to spur conformity: "Why can't you be like....?" (insert other student's name, sibling, etc). It's point how how you're different or don't belong. I've seen this time and again in the military as we have had the ideals outlined about what is a good military officer, fitness levels, weight and performance. Shame has been used to incentivize conformity but it misses out on 1) understanding what an individual is actually experiencing and 2) how is it that their differences are not liabilities but perhaps strengths or shedding light on new perspectives?

Shaming is the tool of the bully. It's pointing out how you are wrong, different and don't belong. This is something that as adults I think we all need to consider: shaming is bringing middle school tactics into our home.

But that isn't about creating shame about... well, shame. I think it's about seeing just how pervasive these approaches are in our society. The bullying that we experienced or quite honestly imparted upon others is a habit that comes up today. It's a habit. Think about that. Our brains see things so black and white (because we are trying to make sense of the world and having one of two options is the easiest way): the way that we are trying to define what is right or wrong, sorting and comparing - and for our brains to determine safety in this community: do I belong or not?

We are often unaware of it. It's such a part of our society. Think about health messaging. When we say, "You are what you eat," what does that mean about the person who is eating pizza? Or what is being said when that statement is offered to a person in a larger body?

"You're not going to eat that, are you?" I have both said this phrase and been a recent recipient of it.

I didn't realize that when I said it to family members in the past, I thought that I was offering them a chance to think, say no, make a healthy choice. What I learned is that my question asked something that the words did not: "You see how you're wrong?"

When I received that same question, I noticed that icky feeling of shame starting up in my belly and going to my cheeks. And I called it out: "Damn straight I'm eating the peanut butter cup ice cream. It's amazing."

"Again? You just ate it last night."

"Damn straight.Your questions are not going to change my mind, and quite honestly may lead me to full-on rebel and eat the whole damn thing tonight."

We can't just excise shame with a scalpel. It's one of the many emotions that we feel as humans and quite honestly it's there for a reason. I like to ask what emotions are telling me, and I think that shame is telling me I'm at a risk of not belonging. That's a protective mechanism, because we need a community and belonging to thrive as humans. AND we can start having the hard conversations about how we've learned to wield tools that are actually not helping us build health and are driving us further apart.

So you're being challenged right now, just like I'm challenging myself - not to police words, because that is NOT the intention of this conversation - but to think about what the other person is experiencing. Why are they struggling? What position of power or authority am I in that I think that I have all the right answers? How can I get curious and connect with them?

There's so much more to the conversation about health and shame and this is specifically not creating closure today. Because there is no such thing about closure on emotional experiences. But we can learn and start making little experiments - perhaps yours is looking for where shame is lurking in your life, perhaps looking to the reaction or response others have when a correction is made, and asking yourself is the correction about the action or about the person? The more we can separate out the two, the more that we can learn (new actions) without shame (making it mean there is something wrong with the individual).

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YouTube version of Episode #105 here.

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Disclaimer: While Wendy Schofer, MD discusses health and wellness, this is not medical advice and she is not your doctor. Optimal health is achieved in combination with your physician, who collaborates with you for your individual health. Talk to your doctor. And tell them about Family in Focus. Mwah!