Since the previous Clinical Tip was about guilt as an emotional cause of disease, it makes sense to discuss now shame as an emotional cause of disease. I think that shame is as common as guilt in Western patients while it could be argued that Eastern societies are more prone to shame than guilt.

Shame may be caused by a feeling of shame about one’s behaviour in breaking society’s rules or customs; more commonly, it is an in-born feeling of shame due to one’s upbringing. It is a feeling of blame which often makes one feels “dirty”; with shame, one feels that one has to hide from the frowning look of society. One feels observed all the time.

According to Solomon, in small doses, shame is an affirmation of one’s autonomy, a confirmation that one will live by one’s standards and accept responsibility. In small doses, shame is conducive to self-esteem. However, in larger doses, shame is overwhelming and it is self-demeaning, making one extremely defensive and impotent.

As a cause of disease, we consider the shame that is overwhelming, that is due to one’s upbringing and that is not related to one’s actions or to have done anything wrong. A person suffering from this shame will always feel as if they had done something wrong and will want to hide.

It is often said that Western societies are “guilt-based” and Eastern ones “shame-based”, so it is useful to explore the differences between shame and guilt. Shame is related more to one’s place in society, what people think of us, the feeling that one has to hide because one has done something wrong, something that society frowns upon, something “dirty”.

In other words, as long as we do not do anything that society disapproves of or, most importantly, we are not seen, not found out to be doing something “wrong”, we do not feel shame. By contrast, in such situations we would feel guilty even if nobody sees us doing something “wrong”.

It is certainly true that Eastern societies are shame-based probably due to the strong Confucian influence. As the Confucian ethics is all about social relationships, and about one’s “place” in society and conforming to strict rules of conduct and social hierarchy, it is natural that shame ensues from contravening the established rules of society. Thus, people are worried about not being seen to be doing anything that society would frown upon.

What is paramount in shame, is how one appears to the other members of the community, not how one feels inside. Guilt, is a “darker” emotion, more inner-directed, an emotion from which there is no escape, the judgement is there, whether anyone sees us or not. The big difference between guilt and shame is that guilt has no redemption, it “eats” one inside for ever; shame has redemption and repair.

With shame, we have a feeling of being seen doing something wrong (by implication, if we are not seen, we do not feel shame). With guilt, we hear an inner voice condemning us and we cannot escape it.

Wollheim explores the differences between shame and guilt and I have summrized them in this Table.


The term “guilt” (zui) occurs very infrequently in the Analects of Confucius. By contrast, shame (chi) is mentioned in many passages. It is always used with reference to a lapse of responsibility, often accompanied by insult, estrangement and humiliation at the hands of others.

Shame is very ingrained in Confucianist ethics. It is even something that is considered a beneficial “tool” to keep people in line. Consider this passage from the Analects of Confucius:

“The Master said: ‘Lead the people with administrative injunctions and keep them orderly with penal law, and they will avoid punishments but will be without a sense of shame. Lead them with morality (de) and keep them orderly through observing ritual propriety (li) and they will develop a sense of shame; and, moreover, will order themselves”.

This passage is an attack on the Legalists who advocated keeping people in order with strict laws and harsh punishments. In other words, Confucius is saying that laws and punishments may keep social order, but even better is to lead by example so that people will regulate themselves due to the sense of shame from not following the social order.

The importance of shame in Chinese society is also apparent from a study of the penal system and amnesties in ancient China: there is evidence that the ancient courts acted harshly in cases of serious crimes but relied on shame entailed in the process of litigation to discipline the more minor offenders and restore their commitment to social responsibility.

In terms of the effects on Qi by shame, I think that this emotion makes Qi stagnate but also possibly in some cases, sink. Indeed, sinking of Qi is, in my experience, a common result of shame; Dampness also frequently accompanies shame.

When one feels shame, one feels “dirty” and “dirty” is characteristic of Dampness. Thus, shame often manifests with sinking of Qi and Dampness: for example, prolapses, very chronic and stubborn vaginal discharge, excessive menstrual bleeding from sinking of Spleen- and Kidney-Qi, slight urinary incontinence.


1. Solomon R The Passions, Hackett Publishing Company, Indianapolis, 1993, p. 245. 2. R Wollheim, On the Emotions, Yale University Press, 1999, pp. 155-6.