The power of shame

doi:10.1136/bmj.324.7350.1397/a

BMJ 2002;324:1397 ( 8 June )

Letters

The power of shame

Behaviour should be distinguished from identity

Patients' perspective is also important

Behaviour should be distinguished from identity

The first 150 words of the full text of this article appear below.

EDITOR $---$ Davidoff's editorial graphically illustrates the power of shame, saying that "it goes right to the core of a person'sidentity.¹ There is another way of seeing this, derived fromthe work of Dilts et al and Hall on logical levels. ² ³

Dilts et al see the human brain as working in hierarchies, starting at the level of environment (where?), moving up to behaviour(what?), capabilities (how?), values (criteria), beliefs (why?),identity (who?), and beyond this to spirituality or connectednessto other people and the bigger world. Each level modulates theexpression of the lower levels. Generally, change at a higherlevel results in bigger changes in behaviour than do changes ata lower level. Our behaviour in the world is an expression ofour beliefs aboutourselves.

Mixing up levels leads to problems. As Davidoff's example showed, the physicians prescribing tolbutamide had mixed up theirbehaviour (prescribing tolbutamide) with . . . [Full text of this article]