Dopamine Nation

part of her life, implicitly communicating that she would be rejected or
further shamed if she were open about her struggles. She couldn’t risk losing
what little community she had. But keeping her behavior hidden also
perpetuated her shame, further contributing to isolation, all of which fueled
ongoing consumption.
Studies show that people who are actively involved in religious
organizations on average have lower rates of drug and alcohol misuse. But
when faith-based organizations end up on the wrong side of the shame
equation, by shunning transgressors and/or encouraging a web of secrecy and
lies, they contribute to the cycle of destructive shame.
Destructive shame looks like this: Overconsumption leads to shame, which
leads to shunning by the group or lying to the group to avoid shunning, both of
which result in further isolation, contributing to ongoing consumption as the
cycle is perpetuated.

---

The antidote to destructive shame is prosocial shame. Let’s see how that
might work.
AA as a Model for Prosocial Shame
My mentor once told me about what motivated him to stop drinking alcohol.
I’ve often recalled his story because it illustrates the twin-edged knife blade
of shame.
Well into his forties he would drink secretly every night after his wife and
children went to bed. He did it long after he promised his wife he had
stopped. All the little lies he told to cover up his drinking, and the fact of the
drinking itself, accumulated and weighed on his conscience, which in turn led
him to drink more. He drank for shame.

---

One day his wife discovered his use. “The look of disappointment and
betrayal in her eyes made me swear I would never drink again.” The shame
he felt in that moment, and his desire to regain the trust and approval of his
wife, propelled him into his first serious attempt at recovery. He started
attending Alcoholics Anonymous meetings. He identified the main benefit of
Alcoholics Anonymous for him as a “de-shaming process.”
He described it this way. “I realized I wasn’t the only one. There were
other people just like me. There were other doctors who were struggling
with alcohol addiction. Knowing I had a place to go where I could be
completely honest and still be accepted was incredibly important. It created
the psychological space I needed to forgive myself and make changes. To
move forward in my life.”
Prosocial shame is predicated on the idea that shame is useful and
important for thriving communities. Without shame, society would descend
into chaos. Hence, feeling shame for transgressive behaviors is appropriate
and good.
Prosocial shame is further predicated on the idea that we are all flawed,
capable of making mistakes, and in need of forgiveness. The key to
encouraging adherence to group norms, without casting out every person who
strays, is to have a post-shame “to-do” list that provides specific steps for
making amends. This is what AA does with its 12 Steps.
The prosocial shame cycle goes like this: Overconsumption leads to
shame, which demands radical honesty and leads not to shunning, as we saw
with destructive shame, but to acceptance and empathy, coupled with a set of
required actions to make amends. The result is increased belonging and
decreased consumption.

---

My patient Todd, a young surgeon in recovery from alcohol addiction, told
me how AA “was the first safe place to express vulnerability.” At his first
AA meeting he cried so hard he wasn’t able to say his name.
“Afterward, everyone came up, gave me their numbers, told me to call. It
was that community I always wanted but never had. I could never have
opened up like that with my rock-climbing friends or with other surgeons.”
After five years in sustained recovery, Todd shared with me that the most
important step of the 12 Steps for him was Step 10 (“Continued to take
personal inventory and when we were wrong promptly admitted it”).
“Every day, I check in with myself. Okay, am I twisted? If yes, how can I