Sue Gottlieb, 'Smell and disgust in the consulting room: an exploration of shame and shamelessness'

Shame is a deeply unpleasant emotion in many forms, from embarrassment at one end of the spectrum to humiliating disgrace at the other. But shame can also be thought about in the opposite sense, as a necessary attitude of humility and modesty, which protects the privacy of the self. This constructive form of shame began to interest me when I tried to understand my shameless patient, who was remarkably un-embarrassed by his state of offensively smelly degradation. I, on the other hand, was scornfully cast by him in the role of oppressive fusspot, over concerned with cleanliness, and wanting everything to smell falsely sweet: I should be ashamed of myself for having such contemptibly superficial values. I came to think that such shamelessness may be understood as a defence against excessive shame, which is projected into others via scorn, ridicule and disrespect. 

    This paper is an exploration of various ideas about the origins of shame, first theorised by Freud as a defence against normal childhood ‘exhibitionism’ and ‘voyeurism’ but then largely neglected in psychoanalysis in favour of studying guilt. I suggest that Freud could have found a place for shame in his theory of narcissism, and that some degree of shame may naturally arise in development at that point when we lose our infantile omnipotence. The natural development of shame, as valuable modesty, is traced in Freud’s observation of ‘Little Hans’ and compared with the pathological shame suffered by Schreber, who turned to immodest grandiosity in defence against humiliation. I suggest that my patient turned to shameless smelliness in defence against an unbearably persecutory form of shame, and the bulk of the paper is an extended clinical account of the work.