Oxford dictionary defines pride as “consciousness of one’s one dignity” with dignity defined as the right of a person to be valued and respected for their own sake and to be treated ethically.
Pride is not what most of the LGBTQ+ community experience growing up. Instead, they frequently experience shame and suffer the emotional, mental, and physical consequences of shame, leading to significant health care disparities.
“Shame is regarded as being a negative emotion that arises when one is seen and judged by others (whether they are present, possible or imagined) to be flawed in some crucial way, or when some part of one’s self is perceived to be inadequate, inappropriate or immoral” (Dolezal, 2017). Shame is linked to one’s core identity and threatens one’s feeling of belonging and acceptance, causing significant distress and fear of abandonment. “The threat of shame can feel worse than the treat of physical pain or even the risk of death” (Dolezal, 2017).
Shame symptoms create a negative reinforcing loop. There is shame in feeling shame and we want to avoid this unpleasant emotion or ignore it. Individuals will go out of their way to avoid shame even when this avoidance means harming or hurting the self. (Dolezal, 2017).
When individuals feel the threat of shame, this can lead to:
(1) failure to seek treatment
(2) failure to disclose the full details of one’s mental or physical ill-health or one’s situation or identity (for example, one’s sexuality of literacy status)
(3) failure to complete the course of prescribed treatment
(4) diagnosis concealment from family and friends.
Chronic shame (as experienced by marginalized groups like LGBTQ+ individuals) leads to health disparities with higher incidents of mental and physical health problems and increased chance of engaging in health risk behaviors. Chronic shame creates a prolonged stress response in the body with clear negative impacts on the immune system, cardiac system, and the sympathetic/parasympathetic system (Dolezal, 2017). Shame is physically and emotionally damaging. Health care systems and physicians also contribute to creating and reinforcing shaming of groups and individual patients.
Let me share a patient story with you. Chandler*, a transgender man I cared for, was in a serious automobile accident in western North Carolina. After struggling with shame and “self-hatred” for feeling like a man trapped in a woman’s body, he had come to a place of self-acceptance and self-love with effective treatment of his gender dysphoria through therapy and testosterone treatment. He was living his best life until the accident. He was transported to a local emergency room for trauma evaluation. He had been cut out of the vehicle, strapped to a board with a hard cervical collar in place. Scared and alone, he was taken to the trauma room of the emergency room. As part of the surveillance exam, his clothes were removed at which time a nurse loudly exclaimed, “look here folks, we have a freak!” That comment was far more damaging than the automobile accident and creating a long-lasting fear of the medical community. He had been shamed.
We must do better!
At Avance Care, we celebrate the dignity and the individuality of each of our patients. We want you to bring your whole self into our offices and exam rooms. We provide support, guidance, and acceptance in partnering with you to achieve your best self and your optimal health. We understand achieving your optimal health status includes resolving the negative health effects of shame.
Overcoming shame relies on self-acceptance, self-forgiveness and development of stress resiliency. In addition to outstanding physicians and advanced practice providers, we partner with our psychiatrists, behavioral wellness therapists, and nutritionists to create a healing environment you can take pride in. Shame has no place in our offices; pride is welcomed! We are excited to celebrate Pride month, and we remember to celebrate the uniqueness and dignity of our patients every day.
To learn more about our Midtown clinic that offers gender-affirming care, click here.
*Name has been changed to maintain patient confidentiality
