About Dr. Shawn Horn

Dr. Shawn Horn is a licensed clinical psychologist from Washington State (USA). At the time of this interview, she has been in the mental health field for 27 years. She has a private practice in Spokane, Washington, and is also a faculty member at the University of Washington’s Medical School.

During graduate school in the mid-1990s, Dr. Horn was first introduced to “Shame Psychology” and was utterly blown away. She knew at the time that this was her calling. Shame is the core of all of our emotional and behavioural difficulties, and Shawn wanted to understand this more. She even wrote her dissertation on shame-free parenting. Dr. Horn’s mission is to teach people about shame and how to live a shame-free life.

What is Shame?

There are two different kinds of shame: healthy shame and unhealthy shame.

Healthy Shame

Health shame is when you make a mistake, and you feel that inner conviction and you go, “Oh, my gosh. I shouldn’t have done that. I need to apologize”. In this case, shame is helpful and necessary. We want people to have a shame response that is appropriate to the circumstance so that they can develop their consciousness and their sensitivity. It supports the empathy function that we have. So, healthy shame is a good thing.

Unhealthy Shame

On the other hand, toxic or unhealthy shame is the message that when you made a mistake, you didn't just make a mistake - you are a mistake. You're flawed. You're defective. You're not good enough. You're not worthy. Something is just wrong with you or some emotion is wrong. So, in this case, shame becomes very toxic because people merge their identity with shame. Instead of it being a problematic situation, it becomes I am a problematic person. Instead of, “I made a mistake,” it is “I am a mistake; I am dumb; I am a loser; I am a failure.”

Everything becomes an extension of us:

• Our children

• Our careers

• Our material possessions

• Our success

• Our status in life

It's all an extension of us. So, in this way, the belief is that if my body is good enough, then I am acceptable. If my wife, my husband, my kids are the right way, they look the right way, dress the right way, have the right degree, then I am a good parent. I'm a good person. I'm a successful person. So, in unhealthy shame, we get attached to these things in our life that are defining who we are. But when they go away, when they change or there's a situation that is out of our control, then we have a crisis.

We have this complete crisis of what does this mean about me…?

Ultimately, this way of thinking can contribute to suicidal thinking, because if the problem or circumstance is so severe, then instead of seeing it as “this situation needs to change,” they’ll say “It's me. My life needs to change.”

So, toxic (unhealthy) shame is really a motivator and a core root of many of our emotional and behavioural struggles. For this reason, Dr. Horn wants to educate people about unhealthy shame, so they can rewrite those messages of shame that people have attached to in their lives.

What contributes to the development of an unhealthy relationship with shame?

Typically, what happens is when someone is a child, they communicated an emotion or an interest, and when they did something bad happened to them:

• They were physically harmed

• They were labeled

• They were rejected

• They had love withdrawn from them

• Etc.

For example, this is where a parent might say:

• ”Quit your crying.”

• “You're being a baby.”

• “Go to your room. I don't want to hear this.”

• “You're being stupid. Stop that.”

• “Quit your whining, or I'll give you something to whine about.”

These are the kinds of messages that teach a small person that they will be rejected if this emotion or part of them exists. They start to learn that they are not wanted if this part of them exists. They want to get rid of this part of them. But, what happens is that people end up having a disrupted emotion inside that they are trying to fight. They don’t want others to see the unwanted emotion come up and they don’t even want to experience it. So, people start trying to distract themselves in life and redirecting their attention away from the shame, which become unhealthy coping skills.

Any too much behaviour is an unhealthy coping skill:

• Working too much

• Eating too much

• Drinking too much

• ___________ too much (fill in the blank)

Some obvious ways unhealthy shame presents itself is through anger or problems raging. But it can also present itself in some higher functioning ways:

• People who are avoidant of connection

• People who are overly focused on physical symptoms, migraines, ulcers, their health

Shame Dumping

Shame dumping is another coping mechanism. What this means is that the shame message is reversed. For example, if someone comes to you and says, “Hey, why didn't you take care of this chore like you said you would?” The person dealing with unhealthy shame may respond with, “Are you serious? You’re really coming to talk to me about that. After everything I do for you?” The person receiving the criticism starts to character assault back. That's a shame dumping dynamic to divert the attention. Since the individual with unhealthy shame doesn’t want to feel like they’re less than, or like they made a mistake, they flip it and have a very defensive anger reaction.

Unrealistic Expectations

An individual dealing with unhealthy shame is essentially trying to get rid of specific parts of themselves – e.g., a specific emotion, feeling or vulnerability. They are essentially trying to rid themselves of a quality that is, in fact, uniquely human. All of this contributes to having unrealistic expectations.

The individual with unhealthy shame was expected to know things, when they were children, that they hadn't been taught yet. They were expected to have control over their thoughts and feelings when their little bodies and brains couldn’t do that yet. As a result of these unrealistic expectations, the individual would continue to fail meeting performance demands, because their bodies just weren’t ready to do that yet. When they become an adult and they will continue to have unrealistic expectations of themselves. For example, they may think that they shouldn't grieve.

Dr. Horn has had clients who have had a loved one pass away and even if only a few short months have passed, the client wonders why they aren’t over it yet. It is an unrealistic expectation to expect grief to dissipate after such a short amount of time. Sometimes there is no timeline for grief – it is a process.

In these cases, people need to have those expectations rewritten to understand what it really means to be human and that it's okay to feel the way that they are feeling. People are essentially trying to get rid of their human experience, and when they can't control it, they have all these behaviours.

Emotions that are resisted tend to persist. For example, if you try to resist angry, it often becomes rage. If you try to resist sadness, it may become depression. The emotion expands.

What we resist persists and expands.

Trying to resist our human emotions and experiences can have real consequences on a person’s life. They say to themselves – “I really am flawed; I'm depressed; I'm anxious; I have anger problems; I just verbally abused my family; I really am a problem.” That is how the vicious cycle continues. When trying to get rid of or suppress an experience or emotion, it will expand and bubble up – eventually spilling out. This is the fundamental dynamic of how shame takes shape.

How can we heal from unhealthy shame?

People need to be educated about shame, so they can begin to understand what is happening for them. When we can step out of a situation, it is often easier to see it clearly. A therapeutic relationship can help to inform and educate people about why their body is working in a certain way and why they have certain behaviours.

Sometimes people feel guilty talking to a therapist because they think they are doing something wrong if they are negatively talking about their loved ones. Dr. Horn tells them that it's not about shaming and blaming your parents, your early life experiences or even yourself. It is about bringing awareness to a pattern or behaviour, without judgement.

One of the things that happens when we talk about unhealthy shame is that people become acutely aware of their patterns and behaviours with their own children. Dr. Horn reminds her clients that it is not about blaming yourself or your family. It's about identifying patterns and bringing awareness.

• What parts of you have you denied yourself?

• With which parts of yourself do you have unrealistic expectations? 

• How do you think about your experience as a person in this world?

In therapy, work is done to rewrite some of a person’s core beliefs and help them identify their triggers.

• What kind of things trigger your shame?

Identifying what triggers feelings of shame provides insight into their reactions. Furthermore, as the client become more informed about what their triggers are, they can intervene with themselves in real-time. Implementing tools talked about in therapy (e.g., mindfulness skills, emotion regulation) can help people to flow with their reaction - rather than resist it. The goal is not to resist the emotion, but to let it flow through you. Just as the thought comes in, it goes out. Just as the memory came, it goes. Clients then begin to challenge themselves to have a different behavioural response than what was typical. The goal is to equip people with new skills and new tools, so that they can have effective responses rather than ineffective reactions.

The key is to bring awareness and observation to a given situation without judgment. You don’t want to continue shaming yourself. From a non-judgemental perspective, you can still describe what is problematic, what is harmful, etc. Judging is where you're assigning a value (to a person or experience) versus just acknowledging. You are letting your awareness inform you, so you redirect your attention. Judgement free acknowledgement is a skill that you must learn and practice. Dr. Horn has so many clients that they cannot do this because they have been judged their whole life, but she asks people to give her three months. Three months of practicing this and you will see a difference. And sure enough, after three months of practicing, it starts to become more natural for them.

Dr. Horn’s “Connecting the Dots” column in TOI Magazine

Dr. Horn has observed that many of her clients, when they first come in, don't realize that there might be other reasons for their mental health symptoms. They're having a struggle and a mental health challenge, but they may not be aware that their body might be contributing to a health condition.

Most of the time when people struggle with mental health, they think it's because

• They're not trying hard enough

• They're choosing to be unhappy

• They're lazy

• There’s something wrong with them

• Etc.

However, after being assessed by a psychologist and medical provider, it becomes apparent, for example, there is a problem with their thyroid. Or, that their heart palpitations are due to low potassium levels. Getting laboratory work done to check levels (e.g., potassium, magnesium, and zinc) is important because it could be contributing to symptoms (e.g., feeling anxious).

For example, some men in their 30s experience a drop in testosterone. People often think that low testosterone will only present itself as a low sexual drive. However, this is not the case. It can also present itself as feeling generally run down, unmotivated, not feeling alive and vital, feeling irritable, having a hard time concentrating and so forth. If any man is struggling with mental health, Dr. Horn likes to check their testosterone levels. Dr. Horn suggests having a good medical check-up done to rule out any other factors that could be contributing to their experience.

Dr. Horn’s Connecting the Dots column is addressing the above topic.

You can visit the TOI magazine website by clicking here.

What should listeners do if they are experiencing any mental health symptom, but are not sure if there is a physiological cause?

You want to see someone who will look at the whole person. You want to work with someone who wants to help you heal from the inside out. When visiting a doctor because of mental health symptoms, the doctor should be looking at various elements, including:

• Gut health

• Nutrition

• Lifestyle

• Are you moving your body?

• Are you drinking enough?

Ideally, you want to see a doctor who will look at what is happening with your health from a holistic point of view.

Beware of doctors who don’t look at your symptoms from a holistic point of view. If you are, for example, feeling anxious or depressed, and the first thing your doctor does is give you medicine, this can be problematic.

Ideally, you want to see a doctor who is going to get a full “wellness panel bloodwork” done and look at all of your numbers:

• Thyroid

• Hormones

• Iron levels

• Vitamin D levels

• Etc.

You want to ensure that all your numbers are right where they should be, and then from there decide on the appropriate intervention. For example, you might benefit from a nutritional intervention (including supplements), exercise plan, sleep study, etc. And then from there, see what is working and what isn’t.

Certain kinds of diabetes, for example, can be treated with lifestyle interventions and changes to nutrition; but, in other cases, people need to take insulin, or integrate a combination of lifestyle modifications and insulin.  

There are absolutely cases where people need to use medications to help treat their symptoms. Dr. Horn reminds us to be open to exploring other options, if possible. In this way, it is so essential to work with a team, including a therapist and a medical provider who can, ideally, do a holistic functional medicine evaluation of your overall health.

 Conclusion

To learn more about the work that Dr. Shawn Horn is doing on shame, you can access her content in the following places:

Website - click here

“Inspired Living” Podcast - click here

“Connecting the Dots” column in TOI magazine - click here

Instagram - click here

Facebook - click here

YouTube - click here