A failure to validate an adolescent's feelings of shame can be one of the main reasons why therapy doesn't work in certain cases, he suggested.
“When we acknowledge the common human propensity toward shame with which we all struggle, growth becomes possible,” he said.
Neurobiologic Basis for The Power of Shame
Dr. Wofsey's premise about the role of shame in adolescent psychopathology is bolstered by neurobiologic findings in this population.
For example, research has shown that the frontal lobes lack adult status until the mid-20s, and this, combined with the fact that the limbic system is in full force during adolescence, means teens have “industrial-strength affects and drive–without the cognitive horsepower to harness them,” he explained.
Also of interest is that serotonin levels drop in adolescence–a factor with major implications for early adolescence. Studies of cerebral spinal fluid, brain imaging scans, and brain autopsy results in suicide completers show that low serotonin is associated with a lower threshold to acting on both suicidal and aggressive impulses.
Lower serotonin levels also have also been shown to make one more prone to moodiness, anxiety, panic, minor and major depression, obsessive compulsive disorder, social phobia, and a number of impulse disorders and addictions.
Furthermore, primate studies suggest that serotonin levels correlate with self-esteem and dominance/submission patterns.
Shame and humiliation have been acknowledged by mainstream psychiatry as predisposing factors in major depression and generalized anxiety. The fact that selective serotonin reuptake inhibitors have been shown to improve self-esteem in anxious and depressed patients lends further credence to the role of shame in adolescent psychopathology, Dr. Wofsey said.
“Perhaps this is another way of saying that humiliation can lower serotonin levels and make one more prone to a witch's brew of psychopathology. This neurobiologic substrate may provide some underpinnings for my contention that many adolescents are wrestling with shame-related, self-esteem-related problems, and that serotonin dysfunction may be behind that,” he added.
Adding to the adolescent conundrum is the fact that melatonin in adolescence spikes late at night and lingers into the morning.
The result is a “sleep-deprived cadre of teenage zombies in our high schools,” he said.