More than a decade ago, Dr. Anne Hallward began to notice a similarity in the background of many of her psychiatric patients. Whether they came to her because they were too depressed to get out of bed, or because they couldn’t escape a destructive addiction, or because they were thinking of killing themselves, almost all grappled with deep shame.

This wasn’t just the shame of having a mental-health problem, though that was there, too. And it wasn’t shame from having hurt someone else; they hadn’t. Instead her patients were ashamed of something they couldn’t help; something they were reluctant to reveal, for fear of being branded with a social stigma. Unable to speak to anyone about the source of their shame, they had come to see themselves as bad, defective, unworthy of being loved.