Developmental origins of health and disease and epigenetics have expanded understanding of how the environment affects the health of women before and during pregnancy—with lifelong health consequences for the fetus. This has translated to a narrow focus on women’s lifestyle during pregnancy, especially for women classified as obese. In this study, we show that psychosocial harms such as distress or shame felt by pregnant women are rarely countenanced in these endeavors. To demonstrate this, we examine published documents about a large (...) set of trials of lifestyle interventions united through an international consortium. Yet there is now a literature in which pregnant women with large bodies report feeling humiliated and a wider literature on the stigma of obesity. We argue that shame is produced and reproduced through the discursive and material knowledge-making scientific practices of DOHaD translation. Interventions that intensify the shame of large body size in pregnancy may be stressful, and neurophysiological stress pathways are well-known within DOHaD to have consequences for fetal development, so these interventions potentially undermine the very processes they set out to protect. A feminist response may protect women from shame and redirect attention to the social and structural determinants of health. (shrink)

This paper is particularly concerned with shame, sometimes considered the ‘master emotion’, and its possible role in affecting the consent process, specifically where that shame relates to the issue of diminished health literacy. We suggest that the absence of exploration of affective issues in general during the consent process is problematic, as emotions commonly impact upon our decision-making process. Experiencing shame in the healthcare environment can have a significant influence on choices related to health and healthcare, and may lead to (...) discussions of possibilities and alternatives being closed off. In the case of impaired health literacy we suggest that it obstructs the narrowing of the epistemic gap between clinician and patient normally achieved through communication and information provision. Health literacy shame prevents acknowledgement of this barrier. The consequence is that it may render consent less effective than it otherwise might have been in protecting the person's autonomy. We propose that the absence of consideration of health literacy shame during the consent process diminishes the possibility of the patient exerting full control over their choices, and thus bodily integrity. (shrink)

Experiences of shame are not always discrete, but can be recurrent, persistent or enduring. To use the feminist phenomenologist Sandra Lee Bartky’s formulation, shame is not always an acute event, but can become a “pervasive affective attunement” (Bartky, 1990 : 85). Instead of experiencing shame as a discrete event with a finite duration, it can be experienced as a persistent, and perhaps, permanent possibility in daily life. This sort of pervasive or persistent shame is commonly referred to as “chronic shame” (...) (Pattison, 2000 ; Nathanson, 1992 ; Dolezal, 2015 ). Chronic shame is frequently associated with political oppression and marginalization. In chronic shame, it is the potentiality of shame, rather than the actuality, that is significant. In other words, the anticipation of shame (whether explicit or implicit) comes to be a defining feature of one’s lived experience. Living with chronic shame has important socio-political consequences. Thus far, chronic shame has eluded simple phenomenological analysis, largely because chronic shame often does not have a clear experiential profile: it is frequently characterised by the _absence_ rather than the _presence_ of shame. The aim of this article is to provide a phenomenology of chronic shame, drawing from Edmund Husserl’s formulation of the ‘horizon’ as a means a to discuss structural aspects of chronic shame experiences, in particular how chronic shame is characterised by structures of absence and anticipation. (shrink)

Through positing that our capacity for physical vulnerability is at the core of original shame, Sartre’s account in Being and Nothingness reveals shame as an essential structure of human existence. Reading Sartre’s ontological account of ‘pure shame’ alongside recent writing about shame in early child development, particularly Martha Nussbaum’s account of ‘primitive shame,’ this article will explore the inherent links between shame, the body and vulnerability, ultimately positing that our human need for belonging is the fundamental driving force behind shame, (...) and what gives it its ontological status. In short, this article will argue that shame is not merely about a painful awareness of one’s flaws or transgressions with reference to norms and others, but about a deeper layer of relationality through our bodily vulnerability. (shrink)