Shame as a moral mood in medicine.

Abstract

The emotional underpinnings that facilitate and complicate the practice of ethical principles like respect warrant sustained interdisciplinary attention. In this article, I suggest that shame is a requisite component of the emotional repertoire than makes respect for persons possible. I use person-centered interview data from a sample of 54 physicians (including 35 surgeons), 60% of whom are women, to examine the emergence and endurance of shame as a mood with moral significance. Drawing on anthropologist Throop's concept of a moral mood, I explore physicians' first-person narratives of the endurance of shame experiences. Narratives demonstrate that shame inheres in biomedical contexts that reinforce the physician's responsibilization and culpability for events beyond their control. As a persistent cognitive and affective state, mooded shame is a recursive and compulsory motive force for a physician's dynamic evolution as a moral actor. Variably distressing, looming and commonplace, mooded shame becomes an atmospheric and imaginative mode through which physicians contemplate their responsibilities and connections to patients. Sometimes in a hypercognized manner that conceals its emotional roots, physicians link the mood of shame to their incessant efforts to fulfill responsibilities to each unique patient. I suggest that through reflection made possible within mooded shame, physicians develop a sense of being both accountable to and alongside patients, and I explore the ties between this position and philosophical concepts of respect.