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Introduction
Sticks and stones will break my bones but names will never hurt me. Not true.
Humiliation, embarrassment and shame, and their opposites, pride and selfrespect, are members of a group of self-conscious emotions that are evoked
by self-reection and evaluation. They dier from primary emotions, such as
anger and fear, which are present very early in life, because they are
*Corresponding author. Email: Julian.Walker@awp.nhs.uk
ISSN 1478-9949 print/ISSN 1478-9957 online
2011 Taylor & Francis
http://dx.doi.org/10.1080/14789949.2011.617542
http://www.tandfonline.com
725
contingent on the ability to recognise the self as separate from others. Shame
and humiliation are of particular interest to forensic psychology and
psychiatry since they are pertinent to understanding some forms of violence.
It is generally acknowledged that the perception of being insulted, put-down
or disrespected can elicit intense emotion and trigger aggression and
violence in response. It is our understanding that self-conscious emotions
underlie much of this violent behaviour, and in particular that humiliation
and shame are the core trigger and vulnerability for violence.
One of the most compelling overarching theories of violence in relation
to self-conscious emotions is presented by Gilligan (1996), who puts shame,
poor self-esteem and humiliation at the centre of his psychodynamic
formulation of violence proneness. He suggested that violence is used to
attain justice by punishing those whom they feel have punished them,
unjustly (p. 18); thus, violence is seen by the perpetrator as revenge for
being wronged unjustly by the victim. What constitutes a wrong in
Gilligans view is usually a personally meaningful insult (humiliation) of
some kind that causes an overwhelming sense of shame. The violent person
cannot cope with this shame due to a lack of self-esteem or a healthy sense of
pride which would normally allow them to cope with the insult. When this
happens to someone lacking the non-violent skills to restore their damaged
sense of self-esteem, violence becomes a way of restoring their pride.
We take the view that humiliation, respect and self-esteem are complex
but central issues to emotional and psychological wellbeing and that they
are important to mental health generally (e.g. in depression). These concepts
also seem to be central to certain oence types and are also relevant to our
personal and professional responses to oenders (particularly those with
personality disorder). This article sets out to describe some of the
mechanisms through which experiences of shame and humiliation can give
rise to anger and aggression, and in doing so highlights the role of selfesteem and narcissism within this process. These ideas are then drawn
together through the authors cognitive model of violence, humiliation and
self-esteem, and presented in the context of literature which is variable in
quality and coverage but which provides some theoretical bases, some
systematic review evidence and some primary data studies. Our emphasis is
also pragmatic and clinical given that even where evidence is lacking,
clinicians still have to make sensible decisions about what to do.
Key concepts
Self-conscious emotions
The terms embarrassment, shame and humiliation are often used
interchangeably in the literature, however, important dierences between
these emotions have been noted. Embarrassment has been dened by Miller
(1996) as an aversive state of mortication, abashment and chagrin that
726
follows public social predicaments (p. 322). Some theorists believe the key
component in embarrassment is negative evaluation by others, however, this
does not account for all types of embarrassment, for example, feeling
embarrassed about being the centre of attention. Lewis (1992) distinguished
two types of embarrassment: embarrassment due to exposure and
embarrassment due to negative self-evaluation. The latter type (also thought
of as mild shame) emerges later in childhood, once a sense of self has formed
and an internal set of standards and rules have been developed. Although
embarrassment is often equated to shame, the two emotions are thought to
dier in terms of the intensity of aect experienced. It has been suggested
that embarrassment is linked to deciencies in ones publicly presented self,
whilst shame results from perceived deciencies of ones core self.
Embarrassment is marked by more humour, blushing and a greater sense
of exposure, whereas shame is associated with greater feelings of
responsibility, regret and anger (Tangney, Miller, Flicker, & Barlow, 1996).
Humiliation describes the experience of an emotional reaction to feeling
demeaned, put down or exposed; the core issue is the negative down rating
of the victims status particularly in relation to the person humiliating them
or in relation to others present. The feeling of humiliation is subjective and
includes various negative feelings about oneself, in particular feeling small,
insignicant, weak or stupid. These feelings are also common to shame,
however, in shame individuals tend to blame themselves for the damage
brought upon oneself, whereas in humiliation the damage is viewed as
unjustly inicted upon us by others. This distinction is highlighted by Klein
(1991), who states that: Humiliation is what one feels when one is ridiculed,
scorned, held in contempt, or otherwise disparaged for what one is rather
than what one does. People believe they deserve their shame; they do not
believe they deserve their humiliation (p. 117). These feelings of injustice are
often accompanied by feelings of hatred and a desire for revenge against the
person causing the humiliation. This can be seen as an externally focussed or
aggressive response. However, a more internally focussed or depressive
response to humiliation may include self-doubt, self-recrimination and
feelings of worthlessness and disempowerment.
The presence of observers can heighten the humiliation and sense of
injustice, making the insult feel more public and provoking, perhaps leading
to rage and violence in response. This relates to Lazares (1987)
conceptualisation of humiliation as being simultaneously exposed, attacked
and wishing to escape. Violence, which rapidly changes the dynamics of a
situation, is action oriented, and perhaps less aversive than passively
accepting humiliation.
The opposite of shame and humiliation are the more positive selfconscious feelings of pride, healthy self-esteem and self-respect. Pride can be
dened as a personal sense of worth or self-esteem. The concept usually
refers to feelings about the self or ones own achievements, but can also refer
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stable vs. unstable; global vs. domain specic. They argued that, despite
dierences in how self-esteem is presented by authors, the core underlying
theme is that people are motivated to achieve and maintain high self-esteem
and to defend their self-esteem when it is threatened. The point here is that,
although the term self-esteem is often presented as a unied and simple
dimensional concept, it is actually far more complex, multidimensional and
dynamic than our common usage of the term would suggest, given that we
tend to only talk simplistically about people having high or low self-esteem.
It is this fundamental linguistic error that has led to the false dichotomisation of research questions about the relationship of self-esteem to violence.
Broadly speaking there are two positions, the rst being that low self-esteem
relates to violence (Gilligan, 1996) and the opposite being that high selfesteem relates to violence (Bushman et al., 2009).
Violence and self-esteem
There are two recent reviews of self-esteem and violence. The rst by Walker
and Bright (2009a) reported on 19 studies, 12 of which found low self-esteem
related to violence, ve found no relationship, one found high self-esteem
related to violence and one reported a curvilinear relationship in which both
high and low self-esteem were related to violence. A similar pattern was
found when only studies with oenders were considered, but oender studies
used relatively small samples. Six studies found high narcissism to be related
to violence. Walker and Bright (2009a) noted that there were signicant
problems reliably measuring self-esteem, but nonetheless the low self-esteem
hypothesis prevailed. They suggested that self-esteem may be falsely inated,
as described by Salmivalli (2001), in that self-esteem may actually be low, but
be presented as high, resulting in high scores on simple measures of selfesteem. It is important to distinguish between narcissism (superiority and
thinking you are much better than others) and healthy high self-esteem
(recognising your strengths and qualities and having a good view of yourself).
The second narrative review by Ostrowsky (2010) described the key issues
that have resulted in inconsistent and inconclusive ndings. First, he too
identied problems with measuring self-esteem, noting that self-esteem is a
multidimensional rather than a unitary concept and that self-esteem may be
unstable. Second, he suggested that dierent types of violence are associated
with dierent self-esteem structures; reactive aggression is associated with
lower self-esteem and instrumental aggression with high self-esteem. Finally,
much of the research is cross-sectional, done with university students,
looking for linear relationships and does not disentangle gender dierences.
However, Ostrowsky (2010) seems to conate the idea of narcissism with
high self-esteem, which we believe over-simplies the factors involved.
Baumeister, Bushman and Campbell (2000) have long been proponents
of the view that low self-esteem is not related to violence; they also
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leading to feelings of anger and hostility. The sense that ones status has
gone down in the eyes of another is aversive and damaging to the self, and
generates feelings of anger and hostility which are directed towards the
perceived disapproving other. When one feels humiliated the perceived
humiliator becomes an obvious target for this hostility and aggression. With
shame experiences, internal feelings of shame are projected outward onto an
imagined disapproving or critical other. From a social hierarchy perspective,
anger and aggression can be viewed as a defence against feelings of shame
and humiliation, since they signal power and dominance and move the
individual up the social hierarchy (Gilbert, 1997; Gilbert & McGuire, 1998),
restoring any damage created by the humiliation experience.
Shame, anger and aggression
An early observation of the link between shame and anger was Lewiss
seminal work (1971), in which she reviewed the emotional content of several
hundred psychotherapy transcripts. More recently, Ray, Smith and Wastell
(2004) carried out a detailed analysis of interviews with racist oenders, in
which they examined verbal, visual and paralinguistic markers of shame.
They observed a high number of shame markers during discussions about
the oenders racist violence. Similar ndings have also been reported in
analyses of marital disputes (Retzinger, 1991). Gilligan (1996) interviewed
over a hundred men who had been convicted for violent crimes, and
reported that the majority described their motivation for violence being to
restore their pride and self-esteem after being shamed or disrespected.
Quantitative evidence in this area largely comes from correlational
studies. These have generally examined student populations, with only a
small number of investigations in oending or psychiatric samples.
Tangney, Wagner, Fletcher and Gramzow (1992) investigated shame, anger,
hostility and aggression in a large student sample, and found that shame was
positively correlated with anger arousal and indirect hostility. Similar results
were found in a series of further studies by Tangney, Wagner, Hill-Barlow,
Marschall and Gramzow (1996), however, other researchers have failed to
replicate their ndings (Lutwak, Panish, Ferrari, & Razzino, 2001). In
oending populations, Milligan and Andrews (2005) found a positive
association between levels of shame and anger in a sample of female
oenders, however, this was not detected in a similar study of young male
oenders (Farmer & Andrews, 2009).
A cognitive model of violence
The ideas presented so far are central to our own model of violence (Walker
& Bright, 2009a), which views violent behaviour as an attempt to protect the
self from further injury (humiliation) and against a perceived lowering of
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Intervention strategies
Elison and Harter (2007) argued that in males whose problematic behaviour
is underpinned by humiliation problems, their early development and
socialisation into the male code (dominance and retaliation versus
weakness and vulnerability) need to be addressed as well as identifying the
precise emotion underpinning the problematic behaviour. Their research on
students suggested that humiliation was a far stronger correlate of
aggression than any other self-conscious emotion and thus warranted
more than the almost absent focus in research to date.
A number of interventions are used for violence where emotion
regulation problems are prominent, including dialectical behaviour therapy
(Linehan, 1993) and mentalisation based therapy (Bateman & Fonagy,
2004). Anger management is used where there are specic problems in
recognising, discharging and coping with anger, with assertiveness training
often being part of anger management (Williams & Barlow, 1998). Any
approach that helps the individual to cope better with negative emotions
and increases their ability to think, reect and tolerate self-conscious
emotions suciently to examine them is likely be an important component
of treatment. However, there are no adequately controlled studies of the
eect of such treatments on oenders and their oending.
There are also specic, often cognitive, approaches for working with selfesteem (see Fennell, 1998), which tend to focus on the modication of
negative perceptual and interpretative self-referent biases in information
processing. Walker and Bright (2009b) also emphasise the importance of
validation as an intervention: Validation of the problem of violence is often
experienced as unusual for patients, who tend to be denigrated by
themselves (privately) and others (publicly), and thus a collaborative
understanding of the problem creates a containing rst stage on which to
build later more challenging interventions (p. 181). A collaborative understanding or formulation is a typical rst step in any cognitive behavioural
intervention, and with violent oenders who are sensitive to humiliation this
needs to be undertaken carefully. The causes of humiliation may have
themes in some cultures (e.g. oenders) but may vary considerably between
genders and cultures and even within cultures. With respect to the building
of positive self-referent or protective structures, Walker and Bright (2009b)
note that with healthy self-esteem, inhibiting factors including guilt and
empathy are not suppressed and can be allowed to aect behaviour. If one
has robust and positive self-esteem, insults are less painful and so there is
less pressure (rage) to respond actively (p. 8).
Gilbert and Ironss (2005) compassionate mind training also ts with the
theoretical underpinnings discussed, although evidence for eectiveness with
oenders is lacking. Compassionate mind training may serve to reduce
dissatisfaction with the self and increase resilience to criticism by others,
thereby reducing anger and aggression. This approach also contributes to the
737
re-evaluation and acceptance of the self with possible consequent improvement in self-esteem. All this has to be undertaken in the context of dealing
with forensic patients who are often diagnosed with personality disorders, so
all the usual caveats about chronicity, rigidity and resistance along with
counteracting techniques from therapists (enthusiasm, collaboration, dimensional thinking, attention to the therapeutic relationship and supervision)
inevitably apply (Allen, 1997; Beck, Freeman, & Davis, 2004; Walker &
Hayward, 2007).
Conclusions
It is perhaps paradoxical that oversensitivity to humiliation can be so
acute that some individuals may cover their experiences with opposites
such as arrogance and aggression. This can make problems with selfconscious emotions particularly dicult to identify and work with. We
have re-evaluated the traditional clinical and expert views that psychopaths
and violent individuals are more resilient than others in the face of
humiliation, but rather take the view that aggression and violence are a
macho cover up for a deeply held vulnerability to humiliation. The
structure that goes with this is false inated self-esteem described by
Salmivalli (2001), which appears as arrogance as opposed to true high selfesteem. The threat of violence coupled with the masking of the true
underlying self-conscious emotions makes this an extremely challenging
area for clinicians and researchers alike, so we have tried to combine some
existing ideas from forensic psychology and approaches to personality
disorder with our own clinical experience and suggested assessment and
intervention strategies.
We agree with Elison and Harters (2007) ndings that humiliation is a
more common trigger for violence than other self-conscious emotions and
that the socialisation of men may be an important factor in the development
of the vulnerability to humiliation and the compensatory strategy of violence.
We also agree with them that this area is neglected by empirical research.
Future work needs to further test the hypothesised mechanisms we have
described, to trial suggested treatments using robust methods (such as
randomised controlled trials) and to nd new and sophisticated ways for
evaluating self-esteem proles and the self-conscious emotions. In assessment
technology, increased research attention could be given to the development
of implicit measures in order to get behind false inated self-esteem to the
underpinning self-referent beliefs. We also take the view that simple scalable
interventions are likely to be more practical, cost eective and equitable than
lengthy specialised forms of therapy and perhaps computer-based approaches may have something to oer in this respect. Finally, we believe
clinicians should be aware of the issues raised in this article in the hope that
this may improve their formulations, the sophistication of their assessments
and the ecacy of their work with violent oenders.
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