Shame, Responsibility, and the Dignity We Share: Finding the Middle Path in Public Health

The Conversation We Keep Getting Wrong

A recent New York Times piece tracking the rhetoric emerging from Robert F. Kennedy Jr.'s tenure in public health has reignited a debate medicine has struggled with for decades: when someone's choices contribute to their illness, what do we say to them, and how do we say it? For years, public health professionals deliberately moved away from language of blame and personal fault, recognizing that shame rarely motivates lasting change and frequently drives people away from the care they need. Kennedy's approach reverses that current, reintroducing the vocabulary of personal responsibility and, critics argue, the implicit sting of moral judgment.

Both sides of this conversation are trying to protect something real. Those who resist shame-based messaging are guarding the sick from cruelty and the vulnerable from abandonment. Those who insist on personal responsibility are guarding something equally precious: the truth that human beings are agents, capable of genuine choice, and that flattening this truth does no one any favors. The tragedy is that both goods keep getting sacrificed for the sake of winning an argument.

There is a more coherent account of the human person available — one that holds these two goods together without collapsing either. It begins, perhaps unexpectedly, with a very old question: what kind of thing is a human being?

Created With Dignity, Capable of Fault

At the foundation of a Catholic Christian understanding of the person lies an irreducible conviction: every human being carries an inherent dignity that precedes every choice, every diagnosis, every failure. This dignity is given, not earned. It cannot be forfeited by poor lifestyle habits, nor bolstered by clean bloodwork. It simply is. To treat a person with contempt because of their body or their choices is to misread the most basic fact about them.

And yet the same tradition holds, with equal seriousness, that human beings are genuinely free — that they make real choices with real consequences, that their freedom is one of the highest expressions of their dignity, and that treating them as passive objects of circumstances does them a disservice just as profound as shaming them. Freedom and dignity are inseparable in this account. You cannot honor the person while denying their agency, any more than you can honor their agency while humiliating them.

This dual conviction — that we are made good and that we are genuinely responsible — is what gets lost when the public health debate collapses into two opposing camps. The shame-heavy approach honors responsibility while bruising dignity. The anti-stigma approach, at its weakest, protects dignity while quietly evacuating responsibility. A fuller account of the human person refuses to trade one for the other.

The Problem with Shame as a Tool

Psychological research has been fairly consistent on this point: shame — the experience of the self as defective, rather than the behavior as wrong — tends to produce withdrawal, concealment, and paralysis rather than constructive change. Brené Brown's now widely cited research distinguishes shame from guilt precisely along these lines. Guilt says, I did something bad. Shame says, I am bad. The former can motivate repair; the latter tends to collapse the person inward.

Public health messaging that activates shame, whether intentionally or not, typically backfires. People who feel judged by their doctors report their symptoms less accurately, avoid preventive screenings, and delay seeking care. The mechanism is not mysterious: shame is a social emotion oriented toward hiding, and medicine depends on disclosure.

Catholicism has always understood sin as distinct from the sinner — a distinction that confessional practice encodes structurally. The act is named, confronted, and released; the person is restored. This is not a softening of moral seriousness. It is, in fact, a more demanding posture: it refuses to let the person hide behind their failure, but it equally refuses to reduce the person to their failure. What the confessional tradition models is moral clarity without cruelty — precisely the combination that public health has been searching for with mixed results.

Personal Responsibility Is a Form of Respect

The reaction against shame-based messaging has sometimes drifted into a different error: treating illness primarily as a structural phenomenon in which individual choice plays almost no role. There is important truth here — poverty, stress, food, deserts, environmental toxins, and systemic inequity are genuine determinants of health, and any honest account must reckon with them. But taken too far, this framing quietly removes the person from the moral equation, reducing them to the product of forces acting upon them.

A person who is consistently told that their choices have no meaningful bearing on their health is being subtly disrespected. The message, however gently packaged, is that they are not the kind of agent whose decisions matter. Catholic moral thought, drawing on a long tradition of reflection on freedom and virtue, pushes back on this. Prudence — the virtue of practical wisdom — is precisely the capacity to read one's own situation clearly and choose well within it. Fortitude is the strength to maintain good habits when the pull toward easier choices is strong. Temperance is the disciplined moderation of appetite that allows a person to live in right relationship with their own body. These are not luxury virtues available only to the privileged. They are capacities every human being possesses in seed form, however unequally they have been cultivated.

Encouraging their development is a form of respect. It says: You are the kind of person who can do this. Your choices are real and they matter. Done well, this message is not shaming — it is elevating.

The Virtue of Holding Both Truths

The practical question — how does a clinician, a parent, a health communicator, a friend actually speak to someone whose choices are affecting their health — is where abstract principle meets concrete human encounter. Several things become clear from both the research and the tradition.

First, the relationship precedes the message. Accountability received from someone who has demonstrated genuine care lands differently than accountability delivered from a position of judgment. This is not a technique; it is a truth about how human beings actually work. We open ourselves to challenge from people we experience as allies, and we close ourselves to challenge from people we experience as critics. The physician who knows your name, remembers your history, and has sat with you in difficulty is the physician whose hard conversation you can hear.

Second, behavior and personhood must be kept clearly distinct in both the mind of the speaker and the structure of the message. The prudent communicator addresses what was done and what might be done differently — never what kind of person you are. This requires some precision of language, but more fundamentally it requires a prior conviction: that the person in front of you carries a worth that their choices, however poor, cannot diminish.

Third, the virtue tradition is useful here because it frames health behaviors in terms of growth rather than judgment. Temperance and prudence are capacities to be developed, not standards against which people are measured and found wanting. This reframe — from compliance to cultivation, from judgment to accompaniment — changes the entire register of the conversation.

Finally, structures and individual agency must both be taken seriously in the same breath. Acknowledging that someone faces genuine obstacles to healthy living — economic, environmental, cultural — and affirming that they still possess real agency are statements that strengthen rather than cancel each other. Honest accompaniment holds both.

Emotions Are Data, Not the Verdict

One dimension of this debate that rarely gets named explicitly is the role of emotion — both the shame a patient might feel and the frustration or compassion a provider might experience. Catholic anthropology holds that emotions are intrinsically good: they are data about our situation, signals orienting us toward what matters. The problem is never having the emotion; the problem is being ruled by it, or suppressing it, rather than integrating it through reason and virtue.

A person who feels some healthy regret about choices that damaged their health is experiencing something morally intelligible — and that feeling, properly understood, can be a starting point for genuine change. What makes shame toxic is when regret collapses into self-condemnation, when the emotion stops pointing toward a better path and starts simply indicting the person. The pastoral task — for anyone in a helping role — is to accompany people through the productive emotion without abandoning them to the destructive one.

This is where hope enters. Hope, in the theological sense, is a confident orientation toward a genuine future good that grace and effort together make possible. It is the antidote to both the despair that shame produces and the complacency that sometimes masquerades as self-acceptance. A person who genuinely believes that change is possible and that they are capable of it is in a position to act. Communicating that belief to another person is among the most practical and the most profound things anyone can do.

Toward a More Honest Conversation

At Presence+, we find in the Catholic Christian vision of the person a resource that the public health debate is quietly missing: a framework capacious enough to hold human dignity and human responsibility in the same hand, without letting go of either. The person is good, fallen, capable of being restored. The choices are real, the obstacles are real, and the path forward is genuinely open.

Public health will argue for a long time about the right language. That argument will be more fruitful when it is grounded in a more complete account of what a person actually is: an embodied soul, a free agent, a social being, a creature of habit and grace, always more than the worst thing they have done or the hardest situation they inhabit.

Caring well for others — in medicine, in ministry, in family life — asks us to honor both their dignity and their freedom simultaneously. That is a demanding ask. But it is the one that matches the truth of who they are.