The Complex Concept of Shame: A Product of History and Culture.

Abstract

To the Editor: We read Bynum and colleagues’ study with great interest 1 and commend the authors on their exploration of the nature of shame experiences and their role and importance in medical education. The authors mention the difficulty of generalizing their findings, attributing this to the characteristics of their methodology, namely, hermeneutic phenomenology. We believe that another factor is also at play—the concept of shame itself. Specifically, generalizing the meaning and positioning of shame is limited by conceptual variations across countries and cultures. As Japanese scholars, contemplating shame brings to mind Benedict’s influential work on Japanese society 2 that was published in the immediate post–World War II period. Benedict described the Japanese culture as a “shame culture,” contrasting it to the United States’ “guilt culture.” She wrote that the Japanese were sensitive to the expectations and criticisms of others, with their social lives being closely tied to ideas of grace and obligation. 2 Japanese culture, in her view, was founded on feelings of shame and focused on how one’s moral conduct appeared to outsiders; conversely, in U.S. culture, the emphasis fell on an individual’s internal conscience. 2 However, the Japanese sociologist Sakuta criticized Benedict for her one-sided approach to a single aspect, public shame, which ignored other crucial aspects, like the impact of private shame and embarrassment in Japanese society and culture. 3 Sakuta stated that in communities based on rice cultivation and under the social structure succeeding the feudal era, the Japanese people not just felt shame in response to outsiders’ gaze but also embarrassment, arising from a fear of a “difference in orientation,” causing a general shrinking away from all scrutiny. 3 Thus, the concept of shame cannot be discussed without a concrete basis in historical and cultural backgrounds, and hermeneutic phenomenological methods should consider these aspects for in-depth knowledge. We hope that similar research is conducted across countries and cultures in the future to deepen the existing knowledge of shame in medical education.