I went back to work in the hospital in Edinburgh, as my previous employers could not give me part-time work. Experience as a psychiatric trainee in this hospital was hard. Passed MRCPsych Part 2.

Around 30% of women worldwide have been subjected to either physical or sexual intimate partner violence (IPV) in their lifetimes. In Europe, one in 20 women over the age of 15 has been raped. Meanwhile gross misogyny and sexual violence against women is becoming more normalised in society. When women have been victims of physical, sexual violence, emotional abuse or coercive control the impact on their mental health can be severe.The sense of shame can be overwhelming. Mental health problems are not an inevitable consequence of IPV but anxiety, depression, post-traumatic stress disorder, psychosis, self-harm, substance misuse and getting a diagnosis of borderline personality disorder (BPD) are all more common. Domestic violence can also result in suicide and is linked to murder-suicide and ‘honour’ killing. However, women who have killed abusive men have been repeatedly denied justice. Mental health services need training about IPV and sexual violence and to make strong links with organisations in the community. Each of us needs to ensure that we would know what we would do to help a friend, family member or colleague who is experiencing domestic violence or sexual assault.

There is a strong link between our capacity to cope with negative emotional states and their associated negative thoughts and substance use relapse. When individuals use substances as a coping mechanism this strategy may be effective in the short term and but proves maladaptive in the long run. The use of drugs provides both negative reinforcement (namely, the reduction of painful feelings via self-medication), and positive reinforcement (that is, the pleasant experience of being high via positive outcome expectancies). The self-medication hypothesis applies when the individual is using a substance to cope with negative emotions, conflict, or stress (negative reinforcement). From a positive outcome expectancy perspective, the person is focusing on the positive aspects and euphoria of using a substance (positive reinforcement), while ignoring the negative consequences. Therefore, an essential component of recovery is learning healthy ways to self-soothe and cope with stress and painful emotions, and the negative thoughts and rumination associated with them. Without healthy coping skills, a key component of recovery capital, individuals in recovery will continue to seek dysfunctional ways to self-regulate. In this chapter the reader is introduced to one of the causes behind negative rumination and over-compensatory behaviour that accompanies it, which perpetuates the cycle of addiction.

In this chapter the workbook’s previous chapters are integrated into an explanation of the dynamics that underlie the cycle of addiction. It highlights that when the I-System becomes hyperactive, individuals forfeit their innate capabilities for creative thought, open-mindedness, and resilience, exhibiting instead overly stringent expectations or assumptions about themselves, others, and circumstances. By presenting examples of thought patterns that obstruct resilience, the authors demystify the nature of problematic and unrealistic “I-System Requirements” or “the shoulds” in life that often breed frustration, physical tension, shame, or withdrawal. The reader is then guided on how to neutralize these negative thoughts or what the authors term the Depressor Storyline. They describe a self-perpetuating cycle often created between a Depressor Storyline and the Fixer Storyline, which involves the Depressor generating negative thoughts that snowball into a Storyline, while the Fixer incessantly devises stories on how to rectify self, others, or circumstances. The objective is to find means to deactivate the hyperactive I-System Requirements, which is crucial to freeing individuals from restrictive and repetitive patterns to attain a state of Natural Functioning.

The feeling of shame (aischunē) is a dramatic key of the Gorgias, notably revealed by Callicles, who accuses both the master of rhetoric Gorgias and Polus of surrendering to Socrates’ refutation out of shame, before yielding himself to the feeling he declared himself immune to. But shame is not only a literary pattern in the dialogue: its function is closely connected to the kind of refutation of each interlocutor. It can be minimally said that shame is a natural effect of refutation, and optimally that it is an essential lever for Socrates to make his interlocutors acknowledge their deep moral commitments. This chapter aims at distinguishing several levels, rather than kinds, of shame among the interlocutors of the Gorgias: shame as sensitivity to others’ opinion, shame as an indication of the beliefs and values we are committed to, and shame as a potential step towards a better understanding of the real good. Though these levels sometimes overlap in the narrative, such distinctions may aid in understanding the role of shame for each interlocutor. Shame remains, for Plato, an ambiguous emotion, which must be used in a certain way to perform purification of wrong opinions.

This chapter focuses on Sappho fr. 1V and argues that as an attentive reader of the Iliad – and of the shame and humiliation experienced by its female characters, both divine and mortal – Sappho, rather than attempting to outdo Homer, or to contest his canonicity, amplifies and recasts “minor” episodes from Homeric epic. Her approach is neither overtly competitive with, nor subservient to, the older poet in that she does not aim to recreate the contours and feel of the original. Instead, in a manner designed to make visible what epic suppresses, she returns us to some of the Iliad’s marginal and dismissed characters, showing us the generative potential of painful experiences, such as Aphrodite’s defeat in Iliad 5 at the hands of Diomedes, and her feelings of shame as she is rebuked by the mortal warrior and demeaned by her father, Zeus. The consolation of her mother, Dione’s, reparative embrace anticipates the similar sort of “repair” Sappho herself, as named speaker of her “Ode to Aphrodite” finds in that poem’s evocation of Aphrodite.

Together with Chapter 1, this chapter helps contextualize the closer readings and case studies that follow by providing an introduction to reparative reading and the cultures of critique (and post-critique) within which it emerged over the past several decades. It also discusses some of the key features of Sedgwick’s development of reparative reading, including shame, materiality, queer futures, and the oscillation between paranoid and reparative positions.

Detailed description of ComB treatment begins in this chapter. The importance of establishing a strong therapist/client relationship is emphasized as a basis for productive, targeted treatment for the BFRB, but also for its potential impact on common, secondary issues such as shame, interpersonal problems, and diminished self-confidence. Specific recommendations and examples are provided for maximizing effective communication with the client about basic information about BFRBs, their treatment, and addressing common obstacles that may impede effective treatment, such as unrealistic expectations for treatment, ambivalence about recovery, perfectionism, frustration, and low motivation for treatment. Also presented are recommended approaches for introducing the five categories of variables relevant to Comb conceptualization and treatment (sensory, cognitive, affective, motor, and place – the anagram “SCAMP” is suggested as a memory facilitator). The remainder of the chapter describes the five phases of ComB treatment that are detailed in later chapters.

‘You should be ashamed of yourselves’ is a commonly heard charge. All those who violate the morals and order of society should be ashamed: tax evaders, corrupt business fraudsters, motorway speeders. Shame, it is said, is hard to bear and calls for remorse, repentance, atonement. Yet shame can also be brushed aside. After 1945, many Germans did not want to acknowledge the crimes and the murders of millions perpetrated by the National Socialists. Even today, attempts are still made to relativize these crimes by pointing out the atrocities committed by others. In contrast, the first President of the Federal Republic, Theodor Heuss, predicted that the Germans would never again be able to cast off the shame for the crimes that had been carried out in their name. Nonetheless, Heuss said that they should attempt to make amends with the victims and thereby restore their own integrity. Against this background, the chapter discusses the thesis that we are on the way to a shameless society that prioritizes selfish gratification over civilized behaviour, as well as the comeback of morality-driven political struggles and campaigns in recent years.