Barrett L. Dorko, P.T.
"I felt so foolish, and it certainly wasn't lady-like. There wasn't anything there to trip over, but I went sprawling anyway. It was so stupid! I got up immediately and kept up the power walking until I got home. The shoulder didn't start to hurt until an hour later."
Linda says all of this in a rush full of gestures and painful expression. I'm trying to treat her but she is telling me for the third time what happened and, more importantly, how she feels about it. She's not recounting it, she's reliving it.
As I wait for her to stop, my mind wanders to where it often goes; the movies. Last year I saw The Edge with Anthony Hopkins. He plays a man whose plane suddenly falls in the northern wilderness with two others. They have very few resources and the desperate nature of their plight quickly casts a pall over their spirits. Hopkins says, "I read in a book once that the majority of people in our position die of shame."
When asked what he means, he says, "They sit and wring their hands and blame themselves for their circumstances. They carry on about how they might have avoided all of this, they berate themselves for their lack of preparation. Before they begin to act, they die."
Linda's not the first patient I've had fall and I know that her bodily reaction will be unique, but her attitude toward the event certainly isn't. It is the one time I hear people refer to themselves as "stupid" with regularity. They feel and express a loathing toward the one who fell that far exceeds their description of any other failure on their part.
In short, they don't feel guilt, they feel shame. The former is the result of acknowledging one's wrongdoing and the latter arises from the conviction that there is something fundamentally wrong with us.
As it happens, I use a "lost in the forest" analogy on many of my patients. I ask them to imagine that they are deep in the woods, closely surrounded by trees, and that they have to discover the way out. In my experience, they will find it difficult to get past the trees with any sort of willful effort, but that they can instinctively move in a way that leads them toward the warmth and freedom of a nearby meadow.
Of course, instinctive movement requires some self trust, some faith in our personal and unique ability to do the right thing. Shame robs us of that, it holds us still and unsure. It keeps us from acting and that's why people die in the wilderness.
Once she quieted, I told Linda all of that. I recounted a time when I had felt and acted similarly until I got some help from a therapist who understood such things and who trusted in my innate wisdom.
She heard me, she began to move correctively with confidence and precision, and I just followed her out of her fall.