A Case Study of Shame-Based Conflict

A client once came to me with a curious condition.

Calmly, this chap in his late twenties described how his throat would randomly seize up, making him unable to speak and barely able to breathe. I imagined him being like a victim of one of Darth Vader’s strangulations via “the force”.

He would seemingly choke on nothing for a short while.

It’s a quirky and intrusive trait to have, and he was was finding it a serious nuisance – a trait that all such symptoms eventually share.

That he chose to seek out a therapist rather than a doctor is the first implicit clue that he was faintly aware that this was a problem belonging to the realm of psychology rather than medicine. This kind of awareness usually implies that the person knows, even if on an unconscious level, what the problem is really about.

A useful way to approach a mystery like this is to first look at the trigger pattern – what was happening just before, or at the same time as this strange effect?

It had occurred recently whilst at the top of a big wheel with his girlfriend – maybe heights are the issue, or open spaces.

Another time was at a dinner – maybe public spaces are the trigger?

Or could it be food related?

Could even this somehow be a shame-related issue? Surely not.

I soon noticed that the common factor was being with his girlfriend whilst out in public.

A few more questions about their relationship revealed that whilst he’d had a few girlfriends before her, he was her first and she appeared to be rather emotionally dependent on him.

“I know it’s not her” he would say, “I love her to bits”.

And yet, a few telltale non-verbal cues of anxiety, and that strange expression of love that seems tainted by the imagery of literally tearing someone to pieces.

Once I’ve developed a fairly strong hunch based on observations and careful listening, I usually find it useful to test it. A typical counselling method might be to keep my hunches to myself, and have the client pay for twenty more sessions of talking around the subject (and boy, can they talk) hoping that one day they accidentally say something relevant to my hunch that will allow me to say “tell me more about that”. But I believe such “gentle” non-directive tactics whilst appearing noble and non-intrusive could actually reinforce the repression of the anxious cause, the underlying shame-based fear, whilst building continual defensive walls and distractions.

Not to mention unfairly wasting the client’s time and money, who at the end of the day has paid me for my opinion and expertise and should expect to see a little direction here and there. So a method I chose in this case was to explore emotional responses by simply having the client repeat a sentence followed by a report as to whether it feels true or false. It’s basically a game of emotional battleships, except sinking a ship usually results in a visible display of relief, tears, sadness, a loss of control or all of the above.

After much careful deliberation, and sample sentences to warm up, I asked him to repeat the line “I’m afraid of telling Rachel that I don’t love her”. At this point, without even repeating the line he broke down into a state of relieved sobbing, feeling the energy of a shame-based conflict he’d unconsciously pushed down throughout all these experiences come flooding to the surface where he was finally courageous enough to discuss it and speak the unspeakable truth.

So a torrent of confessions poured out, describing how whilst he loved her (to bits, no less) he wasn’t really in love with her, how much pain it would cause him to have to hurt her, and how he was just trying protecting her self-worth with his companionship.

His trying to protect her self-worth is the perfect analogy for what his anxiety mechanism was also trying to do for him. Protect his fragile ego from feelings of guilt, shame and rejection.

His shame-identity, how he didn’t want to be seen was as someone who was uncaring and unloving. The idea of appearing this way was greatly threatening to him.

One could theorise that he really he knew the problem all along and just needed to feel comfortable about talking about his dilemma. Once I raised it to his attention, he could no longer keep nervously wiggling out of it and had to bite the bullet.

But we know that’s not the case because the symptoms, his subsequent confusion and need to seek therapy told an entirely different story – one where his unconscious had repressed the shame dilemma so deep down (wanting to be honest, vs fearing emotionally hurting a girl) that it manifested physically in his body with a throat seizure.

How elegant a response! The unconscious desire to tell the truth and yell “I DON’T LOVE YOU!” at once held back by the fear of her balling her eyes out and shouting “YOU CRUEL BASTARD!” and rejecting him in return. All held together by a random, spontaneous throat seizure whilst with his girlfriend. The perfect physiological illustration of a conflict.

He returned for his second follow-up visit two weeks later.

Shortly after the first session, he’d had an honest chat with his girlfriend about his anxieties about their relationship.

He hadn’t had any of the throat seizures since, and reported a deep sense of certainty that they wouldn’t return. Interestingly, against his unconscious predictions, the girl didn’t “freak out”. She was hurt, sure, but she was understanding. More to the point, she’d no doubt been aware of the potential issue for a while, and was just enjoying his companionship whilst she could.

So the conversation was actually just as welcome to her as it was to him.

He also looked lighter, like he’d lost a weight off his shoulders. He had more energy, and was clearly more contented. She no doubt had also manifested the effects of her own anxiety, hers being “desire for love, vs fear of it not being real”. Along with some short integration work to tie up loose ends, that was all he needed – from there he was back in control of himself and able to handle any more mild anxieties that might crop up by himself.

This real-world case study encapsulates so much about the nature of shame-based conflict and shame identities. Whether a person is aware or not of their anxieties, the fears can still be present and will always operate at a much deeper level, swirling around outside of awareness yet negatively impacting our lives in a myriad of unsettling ways. Anxieties will often be caused by a conflict within any area of one’s life – a desire for one thing pitted against a fear of the consequence of that same thing – and again this can happen far outside of conscious awareness. Shame anxieties will always manifest in physical and/or psychological ways – from the subtle (sweating, tendencies in decision making or how attention is allocated to things) to the moderate (tiredness, negativity, procrastination) to the more extreme (depression, physical ailments, skin conditions, high blood pressure, addictions, violence). Worryingly, the passage of time itself is never a cure for shame issues. By this I mean that only when an inner conflict is resolved, or a false belief or meaning corrected, will the anxiety subside. Shame based fears formed in childhood are perfectly able to span a person’s entire lifetime if they go unresolved. But fortunately shame can be dealt with by building resilience – and the effects, as seen in the case study, can be immediate.

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