Shame in relation to narcissistic disturbance

For some patients, whose sense of self is fragile, shame may be a more important affect than guilt. It is suggested here that shame functions to enhance and preserve the sense of self, and that shame arises particularly in people whose early environment has impeded the emergence of a cohesive sense of self. Using a clinical illustration several features of shame are described, including its association with vision and with sexuality, and its role in certain kinds of depression; the early infantile precursors of shame are also discussed. The clinical implications are outlined.