As I write this I have just come through an acute episode of shame. I’ve been hiding from myself for days. In such panic I’ve had trouble breathing. I have a tendency to hold my breath. Not on purpose, my body switches automatically into fright mode, almost like its trained itself to mimic the stillness of death. It freezes without my consent.
I’m trapped on a merry-go-round of self-blame, rage at the circumstances, self-hatred, humiliation, and back round again. Being aware of this does little to quell the panic. The stakes are too high, it means too much. I’m not prepared to break the cycle, exit the ride, surrender to the grief, and feel the enormity of sadness. I’m scared it will break me. So I’m stuck on this carousel. I’m trying desperately to cling to rage but the facade is already crumbling. I have too much awareness and I hate myself for it. I try and numb out. Using is off the table. I’m nearly a decade clean. So I turn to food and Netflix. Both are a constant struggle, simultaneously life-saving and soul-destroying in equal measure. But I’m learning how to drip feed devastation.
I need to apply for extenuating circumstances, again. It’s under review. The uncertainty is vomit-inducing. Based on last years outcome I don’t think I will be successful. The decision was only overturned because a member of staff advocated on my behalf. I won’t be able to complete my degree. I’m only 2 essays short. I need to be clear – this has absolutely nothing to do with my grades. This is about audit culture and being represented by a ‘drop down menu’ of categories that arbitrarily determine my life chances. This particular administrative decision shall be based on whether I am allowed to use the same ‘excuse/reason/option’ more than twice – this is an inherent problem as all my illnesses are chronic. By definition they are ongoing.
The amount of effort it has taken to get through this degree so far has been unreal. Again, this is not related to the academic content. Not that it’s easy, its appropriately challenging. My obstacles have been more like trauma recurrence (post traumatic stress disorder), depressive and paranoid episodes (bipolar disorder), medication ‘adjustments’, and debilitating ME (myalgic encephalomyelitis) flare ups. The cycle of shame is endless. I’m never not in it. I’m ashamed for needing help. I’m humiliated for the amount of times I have needed it. The panic at reading through the changing instructions, at contacting senior tutors and having to explain that my health issues haven’t changed – do I have to invent new ones? And they are sympathetic, and they’re angry on my behalf but any power has been taken out of their hands. It is excruciating trying to advocate for myself. On the other side of the computer I am on the floor hysterical, hyperventilating, reduced to an immobilised mess. I lose days, a week or more of time recovering from justifying illness to a faceless system that dismisses me. I’m back in original wounds, a little girl asking for help being told I am making a fuss about nothing, that it’s all in my head and I’m making it up, it didn’t happen.
Since my last health check I’ve had a little voice, a paranoid whisper periodically telling me this will be taken away from me. I am on the SMI (Serious Mental Illness) register which consists of all individuals with a recorded diagnosis of schizophrenia, bipolar disorder or another long-term psychotic illness. Yearly physical health checks have been implemented because we have a reduced life expectancy (of up to 20 years) due to an increased risk of developing serious health issues.
My last health check threw me off balance due to the random insertion of a new question to the data-set. I wasn’t anticipating it. I wasn’t prepared. I couldn’t protect myself. I instantly reverted to old behaviour – compliance. I was asked for a ‘goal’ I had set myself for the year. So I said ‘to finish my MA’. I gave something too valuable. Next time she will ask me whether or not I have met my goal and if not ‘why have I failed?’ I already feel the panic rising and it’s still 7 months away. She will ask and I will say nothing or mumble ‘I don’t know’. I will allow her to fill it in for me because I will be so paralysed with shame my words won’t come out and my version doesn’t fit on the form.
While shame is usually experienced as an individual emotion that makes one believe they are flawed, defective, unworthy or have fallen short in some way, in fact shame is always political. It goes beyond the clinical encounter and has a global reach, operating across all institutions and areas of society.
Separated from context, in and of itself, shame as an emotional state is political because of its paralysing effects on the agentic capacity of selfhood. Citizenship is conceived as a relationship between ‘a set of practices (cultural, symbolic, economic) and a bundle of rights and duties (civil, political and social) that define an individual’s membership in a polity.’[1] Shame undermines the role of active citizenship and a healthy civil society. In fact shame inhibits the possibility of deep democratic structures such as inclusivity, deliberation and political participation, because often rights first arise as practices and then become embodied in law as status, and shame negatively impacts the agency needed to advocate for them. If the boundaries and meaning of modern citizenship are shaped through the exercise of rights and duties, the presence of shame therefore facilitates their shrinkage.
Audit culture is when the principles and values of financial audit are removed from the world of financial accountancy and applied as the fundamental organising principles in the governance and management of human conduct. The result is dehumanisation – between members of staff, between staff and students, health workers and patients. Ushered in under the New Public Management (NPM) reforms of Thatcher years, core values include ‘competition, choice and service differentiation’. Accordingly, students, patients and service users are treated and viewed as customers.
Luna Dolezal writes about the structure of shame experiences and has noted that ‘structurally, shame involves three components: the self, the other, and a… [perceived or imagined]…norm or standard that has not been met…[S]hame arises when the self is witnessed by the other transgressing or failing to live up to, the norm, rule or standard in question.’[2]
The calculative practices of New Public Management audit culture such as performance indicators and benchmarking, introduce and institutionalise these three structural components of shame. Comparison, exposure and stigmatisation are baked into the system through delivery mechanisms and metrics such as standardisation, idealised targets, rankings and penalties.
Alongside these reforms sits the idea of the empowered, responsible and autonomous citizen-subject which rests upon specific assumptions about liberal self-sufficiency. Through the rhetoric of self-realisation, independence and neoliberal responsibilsation it enables the state to divest of its obligations to citizens. Personal choice, personal responsibility and autonomy are ‘enacted as a mode of governance’.[3]
Trnka and Trundle point out ‘individual patient choice is increasingly cast as an unquestioned social good…[often in direct contrast to]…paternalistic control and constraint, and patient passivity’.[4] Not only does the discourse surrounding responsibilisation serve to hide neoliberal values of individualism and self-sufficiency but creates an impasse for those accessing services.
The margins of ‘personal responsibility’ constantly shift – often within the same assessment. The resultant humiliation and shame upon such frequent encounters has lead me to inevitably withdraw and avoid treatment, mostly notably when I am extremely unwell and can’t cope with navigating the system. The personal responsibility discourse of new public management is echoed in its preoccupation with efficiency, cost-cutting, scarcity and waste, and the focus on accountability is conflated with the accountancy of audit culture. This system demands a level of wellness in order just to navigate it, a condition by definition those seeking help may not be in.
My dissertation work is a survivor research project which looks at shame as a disciplinary technique of new public management and audit culture in NHS mental health services.
Becca Pyne, MA in Art & Politics at Goldsmiths University, rpyne001@gold.ac.uk
8th April 2024
