In this chapter we examine the difficult problem of trying to offer help and support to a friend or loved one who has Hoarding Disorder. Many people with Hoarding Disorder are reluctant to admit that they have a problem. This may be due to shame and the stigma surrounding the condition, or may be due to a lack of insight as the individual has become so accustomed to this way of living and denies there is a problem. Family members and friends need to be empathetic, patient, and tolerant. Constant nagging is likely to increase resistance and so it is a difficult path between urging them to get help but not causing them to feel persecuted and to cut ties with those trying to help them. If their own health and safety, or that of others is at risk, then we suggest ways in which you can ensure they receive the help they need. At the end of this chapter, we list some of the agencies that can offer help and advice for family, friends, and people living with hoarding problems. While helping a person with hoarding it is imperative you also consider your own health and safety as well as that of the person with hoarding.

The story in Genesis 38 about the salvation of the line of Judah by Tamar inspires the Widow and the Unjust Judge parable. The widow in the parable evokes the oppression experienced by the widow Tamar, who was the victim of Judah’s failure as head of family to implement the levirate duty to reestablish her dead husband’s estate. The Pharisee and the Tax Collector parable depicts a Pharisee extolling his own virtue who would not be “acquitted of his sins,” and a tax collector who berates himself for his sinfulness who would “be exalted.” In the background is Judah’s acknowledgment that Tamar had been more righteous than he because he had not compelled his son Shelah to fulfill the levirate requirement, a neglect that, in turn, prompted her to prostitute herself with Judah to attain a much desired child.

This chapter of the handbook asks whether, and in what ways, emotions can be designated as “moral”. Several emotions have been shown to be associated with moral judgments or moral behaviors. But more than association must be shown if we label some emotions characteristically moral. The author guides the reader through a voluminous literature and applies two criteria to test the moral credentials of emotions. The first criterion is whether the emotion is significantly elicited by moral stimuli; the second is whether it has significant community-benefiting consequences. This second criterion, less often used in past analyses, tries to capture the fact that moral norms, judgments, and decisions are all intended to benefit the community, so moral emotions should too. From this analysis, the author concludes that anger clearly meets the criteria, contempt and disgust less so. Guilt passes easily, and shame fares better than some may expect. Among the positive candidates, compassion and empathy both meet the criteria but are somewhat difficult to separate. Finally, elevation and awe have numerous prosocial consequences, but awe is rarely triggered by moral stimuli.

This chapter begins with a discussion of Avishai Margalit’s misrecognition-based theory of political humiliation. For Margalit, humiliation is primarily understood as the culpable denial of self-respect. Margalit notes that political humiliation usually takes one of three forms – removing people from the human community (as when we liken them to animals), the negation of control (as in torture), and ignoring or looking through others. After providing an account of this theory, we argue that Margalit does not sufficiently consider the contagious nature of political humiliation nor the possibility that the feeling might be present even when recognition is offered or, conversely, that we might be humiliated even by those whose recognition we don’t want. We also look at the conceptual differences between humiliation, shame, and embarrassment. We note that despite these clear differences the way these emotions are experienced sometimes feels similar. We conclude the chapter with a discussion of the effect of technology and, in particular, social media on the character of contemporary political humiliations.

I went back to work in the hospital in Edinburgh, as my previous employers could not give me part-time work. Experience as a psychiatric trainee in this hospital was hard. Passed MRCPsych Part 2.

Around 30% of women worldwide have been subjected to either physical or sexual intimate partner violence (IPV) in their lifetimes. In Europe, one in 20 women over the age of 15 has been raped. Meanwhile gross misogyny and sexual violence against women is becoming more normalised in society. When women have been victims of physical, sexual violence, emotional abuse or coercive control the impact on their mental health can be severe.The sense of shame can be overwhelming. Mental health problems are not an inevitable consequence of IPV but anxiety, depression, post-traumatic stress disorder, psychosis, self-harm, substance misuse and getting a diagnosis of borderline personality disorder (BPD) are all more common. Domestic violence can also result in suicide and is linked to murder-suicide and ‘honour’ killing. However, women who have killed abusive men have been repeatedly denied justice. Mental health services need training about IPV and sexual violence and to make strong links with organisations in the community. Each of us needs to ensure that we would know what we would do to help a friend, family member or colleague who is experiencing domestic violence or sexual assault.

There is a strong link between our capacity to cope with negative emotional states and their associated negative thoughts and substance use relapse. When individuals use substances as a coping mechanism this strategy may be effective in the short term and but proves maladaptive in the long run. The use of drugs provides both negative reinforcement (namely, the reduction of painful feelings via self-medication), and positive reinforcement (that is, the pleasant experience of being high via positive outcome expectancies). The self-medication hypothesis applies when the individual is using a substance to cope with negative emotions, conflict, or stress (negative reinforcement). From a positive outcome expectancy perspective, the person is focusing on the positive aspects and euphoria of using a substance (positive reinforcement), while ignoring the negative consequences. Therefore, an essential component of recovery is learning healthy ways to self-soothe and cope with stress and painful emotions, and the negative thoughts and rumination associated with them. Without healthy coping skills, a key component of recovery capital, individuals in recovery will continue to seek dysfunctional ways to self-regulate. In this chapter the reader is introduced to one of the causes behind negative rumination and over-compensatory behaviour that accompanies it, which perpetuates the cycle of addiction.

In this chapter the workbook’s previous chapters are integrated into an explanation of the dynamics that underlie the cycle of addiction. It highlights that when the I-System becomes hyperactive, individuals forfeit their innate capabilities for creative thought, open-mindedness, and resilience, exhibiting instead overly stringent expectations or assumptions about themselves, others, and circumstances. By presenting examples of thought patterns that obstruct resilience, the authors demystify the nature of problematic and unrealistic “I-System Requirements” or “the shoulds” in life that often breed frustration, physical tension, shame, or withdrawal. The reader is then guided on how to neutralize these negative thoughts or what the authors term the Depressor Storyline. They describe a self-perpetuating cycle often created between a Depressor Storyline and the Fixer Storyline, which involves the Depressor generating negative thoughts that snowball into a Storyline, while the Fixer incessantly devises stories on how to rectify self, others, or circumstances. The objective is to find means to deactivate the hyperactive I-System Requirements, which is crucial to freeing individuals from restrictive and repetitive patterns to attain a state of Natural Functioning.

The feeling of shame (aischunē) is a dramatic key of the Gorgias, notably revealed by Callicles, who accuses both the master of rhetoric Gorgias and Polus of surrendering to Socrates’ refutation out of shame, before yielding himself to the feeling he declared himself immune to. But shame is not only a literary pattern in the dialogue: its function is closely connected to the kind of refutation of each interlocutor. It can be minimally said that shame is a natural effect of refutation, and optimally that it is an essential lever for Socrates to make his interlocutors acknowledge their deep moral commitments. This chapter aims at distinguishing several levels, rather than kinds, of shame among the interlocutors of the Gorgias: shame as sensitivity to others’ opinion, shame as an indication of the beliefs and values we are committed to, and shame as a potential step towards a better understanding of the real good. Though these levels sometimes overlap in the narrative, such distinctions may aid in understanding the role of shame for each interlocutor. Shame remains, for Plato, an ambiguous emotion, which must be used in a certain way to perform purification of wrong opinions.