Dignity is the state or quality of being worthy of honor or respect. It is the inherent right of people to be treated with dignity. From a religious point of view, dignity may be seen as God’s gift to each individual. From a secular point of view, dignity can be seen as one’s human right to act and have their own agency in the world based on the simple fact of their human existence.
Dignity is displayed in a calm and controlled demeanor. But, it can be harmed through a humiliating experience or crushed through repeated humiliations. Dignity is a sense of pride in oneself, of self-respect. The polar opposite of dignity is humiliation.
Humiliation is the crushing of dignity by an outside agency – in the case of DID etiology, by an abuser attacking a young child. Unfortunately, dignity and humiliation are usually outside the language spoken by psychiatrists, or mentioned in diagnostic formulations.
Humiliation is mentioned a few times in the DSM 5, but not in the context of DID etiology. But, it remains undefined in the DSM so far as I have been able to determine. It is used (on page 703) in this way: “Sustained feelings of shame or humiliation and the attendant self-criticism may be associated with social withdrawal, depressed mood, and persistent depressive disorder (dysthymia) or major depressive disorder.”
This quote from the DSM infers that shame and humiliation are interchangeable terms, but that is not the case. They are not identical. Nevertheless, it should be instructive to clinicians that the listed symptoms resulting from sustained (or one might say repeated) such feelings are often presented by individuals with DID. Despite this, such symptoms are instead usually seen as pathology markers on their own rather than in the context of a potential DID diagnosis.
While humiliation and shame both make a person feel bad about himself, it is important to distinguish between them. Humiliation is always provoked by someone else, while shame is connected to one’s own actions or simply chance circumstances. With shame, people mostly focus on themselves and how others might perceive them. With humiliation, there is the added traumatic factor that the other person is intentionally causing them harm. Abusers often seek to instill shame in those abused by blaming them for the abuse itself. This is true in early childhood abuse, in spousal abuse and in other abusive circumstances.
In short, we bring embarrassment upon ourselves and may feel ashamed as a result. But, humiliation is brought upon us by others. From a therapeutic point of view, it is clearly an abuser’s assertion of power over a child that cuts far deeper, leaving both scars and open wounds which show up as triggers in the future. Because humiliation is traumatic, it is kept hidden by the one humiliated while being simultaneously used as a weapon by the humiliating abuser. Fundamentally, humiliation involves abasement of pride and dignity, along with a loss of status both personally and socially.
Respect is something earned through one’s actions. Self-respect is a state of mind that is founded upon pride and confidence in oneself. It is a feeling that expresses itself through behaving with honour and dignity. Self-respect means proper esteem or regard for the dignity of one’s own character. This self-respect is part of both the path and a marker of healing.
We can easily trace many negative character traits to their origin in a loss in dignity, in those with DID and others whose negative conduct does not rise to the level of being pathological. This can happen when a child is under assault in the form of bullying or massively disproportionate and severe punishment. The result may be perpetually defending oneself even when one is not under attack, in excessive one-up-man-ship. It may show up in excessive social competitiveness, aggressive or even abrasive personality or social phobia and excessively passivity. Mistrust and paranoia can often be linked to pronounced early childhood humiliating experiences.
Alternatively, it can result in a child developing an overwhelming passivity. In the face of ongoing humiliation, a child may internalize the message of the abuser that the child as no ability to defend itself – even internally. In effect, such a child may end up adopting of an abuser’s weapon of humiliation as an adaptation of survival. By giving up any fight, the child survives another day with the abuser.
As noted in Part 1 of this extended sequence of posts, because humiliating experiences are not necessarily physically overwhelming, they may not be seen by an outside person – therapist or other adults – as being genuinely traumatic. This is a tremendous mistake. This kind of humiliation, this abusive power dynamic, is often no less damaging than physical trauma. But, it is easier for a therapist or other adult to ignore because the evidence does not show up externally – at least not immediately – the way one can see a broken arm or the bruise from a punch.
One must consider instead the fact that the damage may show up in the future as violence directed inwardly as self-harm or outwardly against others. When it appears primarily as a psychiatric morbidity, as depression for example, therapists as well as patients may miss the possibility of humiliation as a causative agent. The result may then be medication to suppress the depression rather than helping the patient process the early-childhood psychological trauma through therapy.
When anti-depressant medications don’t work, it may lead to a diagnosis of “treatment resistant depression.” I don’t consider treatment resistant depression to be an accurate categorization. Rather, in the current environment of prescribing antidepressants as the primary method of treating depression, it should be seen as drug resistant depression. When medication doesn’t treat the cause, and instead solely treats the a symptom, the cause remains intact. If the cause remains intact, it will continue to manifest in some way, shape or form despite the medication. The unfortunate result can often be over-medicating patients to the point that the medication causes dysfunction separate and apart from the cause of the depression.
With unresolved early childhood trauma, the antidepressants may have limited benefit but that does NOT mean that you should just stop taking them. Instead, work with your doctor to have meaningful psychotherapy with the antidepressant as an adjunct to therapy rather than the principle method. With proper psychotherapy, as you heal from the trauma, the medication should be able to be successfully and safely reduced. Because suddenly stopping a psychoactive medication has potentially quite a bit of risk, if you are on antidepressants, only stop taking them under your doctor’s guidance.
