Shame and Expressed Emotion: A Case Study

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Abstract
This article interprets excerpts from a dialogue between an ex-patient and his wife to develop a theory of “expressed emotion” (EE). EE has been shown to be predictive of relapse among schizophrenic and depressed psychiatric patients. I propose a model of emotions occurring both within and between family members to explain the relationship between EE and rate of relapse. EE is hypothesized to correspond with the shame/anger dynamics of a patient's family interaction. Microlevel analysis of a tape-recorded conversation between a patient and spouse rated for EE is used to identify cues for emotion in the couple's interaction. My analysis suggests that high ratings of EE correspond to high levels of unacknowledged shame and anger in patients' families. When shame is evoked and not acknowledged or dispelled, affectional bonds are threatened and symptoms are likely to recur.