Dr. Allan Schore on the Role of Shame in Suicide

In 2017, Dr. Allan Schore spoke to PschAlive on a variety of topics (https://www.psychalive.org/video-dr-allan-schore-role-shame-suicide/). Dr. Allan Schore is on the clinical faculty of the Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, and at the UCLA Center for Culture, Brain, and Development.

With suicide rates increasing, even before the Covid 19 pandemic, we need to better understand what causes it. Here is Schore.

“I do not feel that suicide is about guilt. It’s about something much deeper, much more fundamental. Shame of course is not verbal. It’s visually being seen in the eyes of the others, etc., non-verbal communications of shame, gaze aversions, the triggers to shame.”

Schore suggests that if we continue to look for the big outward affects, the blow ups, the hyper-arousals, we are missing the more dangerous and subtle affects related to hypo-arousal which makes the individual prone to suicidal depression with little remedy.

“We’re too attuned to looking at enactments, which are explosive affects, which are all over the place as the person now goes into a regressive state or a terror state – and directs it even toward the patient (him/herself). So this is an explosion, a fragmentation of the self.There’s too much energy in the system.But you’re also getting a collapse of the self.And that collapse of the self — when it implodes in these states of hypo-arousal, so to speak, — these are more subtle.”

This internal swinging from hyper to hypo-arousal begins as early as the second year of life.

“The infant is expecting high intensity positive joy state, an attachment, a connection – all of a sudden there’s a mis-attunement, that baby now drops now to hypo-arousal.Somebody’s got to get that baby up and out of it because – yes, it’s difficult to regulate a screaming baby in hyper-arousal.But it’s also extremely difficult to regulate a baby who has dropped down into this depressed [state].”

“Well now you can see this implosion is a parasympathetic state and again…it’s the same collapse of the right brain as they move into the hypo-arousal of depression — excuse me, of the suicidal depression.”

Shame dynamics are critical in the work with suicide.

“Silvan Tompkins, the famous psychologist studying personality theory used to say that although terror strikes, shame strikes much more deeply into the body and into the heart of man.And what happens to us in these overwhelming shame states – now these individuals are literally living in massive shame states over the entire course of their life span.And they are extremely susceptible to it.They have no way to auto regulate out of it. They can’t use others to interactively regulate out of it.”

Shaming leads to increase cortisol levels that may trigger the easy to detect hyper-arousal, but also the far more dangerous habitual hypo-arousal that is hard to observe and therefore may go overlooked for months or even years. This person cannot regulate on their own. They need interactive regulations from the outside. If we are not looking for hypo-arousal, we so often miss it.