Carol is 27 and a twin. Her reason for coming to see me was her eating disorder which began when she and her twin sister decided to become anorexic together.

She always prided herself on being thin, at least since she went down from l63 pounds to 65. She told herself, "Maybe if I lose more weight, people will love me more." She became bulimic, took diuretics, and ended up being hospitalized twice. Even with antidepressants, Carol complained of impatience, irritability, mood swings, and intense lows. She told me how she would repeatedly pour her heart and soul into relationships with me in an effort to gain her father's love. She would put all her ef-fort into trying to win others' approval and would lose herself in the process. When I explored with Carol the issue of her self image, she told me about the birthmark on her face. Despite the fact that she always had good friends, got pretty good grades, was nominated for the student council, and had supportive parents, Carol always was terribly self-conscious and painfully shy. Even though her birthmark was barely noticeable to others, the tape which constantly replayed in her mind was "What would people think if they found out about my face?" She even developed the habit of sleeping on the right side to cover her birthmark while she slept. Having been raised in a Catholic family where guilt was the norm, masturbation had been out of the question. Her mother always told her "Don't put your hands down there. It's a dirty place." and "We don't talk about those things ." During a very powerful hyp-nosis session, Carol remembered that she was born without the birthmark. She had enjoyed the comfort of her mother's womb and had picked up on her mother's fears about taking care of twins. She was scared to be born, to face the cold world outside.

During our session together, she realized that the birthmark had become apparent several months after she was born. She and her twin sister had agreed to be born as twins and to allow each other to be themselves. She chose the birthmark in order to be different from her twin sister and to be loved completely for who she was. This memory led to a remarkable breakthrough in Carol's self-confidence and self-acceptance. She feels a growing sense of self-awareness, understanding, and love.

What these different women have in common, each with their own unique story, is a profound sense of shame. Each had experienced deep embarrasment and humilia-tion which left a lasting scar on their lives. All three experienced tremendous guilt, self-loathing, and a lack of self-love. This led Edith to totally reject anyone who tried to help alleviate her pain and suffering, resulted in significant physical and emo-tional pain for Roberta, and to Carol nearly killing herself through her extreme anorexia. Working with these and other women inspired me to consider deeply the sub- ject of shame in order to better help and understand them, hopefully with the goal of transforming their self-denial and rejection into self-acceptance and love. This clinical experience has led me to begin to understand this complex subject. I hope the following insights are helpful to you. I would also recommend Bradshaw On: Healing the Shame That Binds You . His descriptions confirm much of what I have found to be true and offer a clear and comprehensive understanding of what shame is all about, include a differentiation between healthy and what he calls "toxic shame".