Many CADIs tell me that they want to hide from the world after their accident. Some actively dread leaving their home. Of course there is the real fear that others will be hateful toward them. But the urge to hide is also one of the key signs of shame. We want to crawl into a cave, humiliated by the defects we have inadvertently displayed.
The author and psychologist Michael Lewis suggests that self-consciousness is fundamental element of shame. He believes that shame results from comparison of the self’s action with the self’s standards. Guilt is about what we do; shame is about who we are. We feel ashamed when some part of ourselves that we consider unlovable is suddenly exposed to the world.
Accidents are great triggers for shame, because they are unexpected. We take ourselves by surprise, and our sudden exposure reveals our inadequacies.
As a young boy, the poet Gregory Orr accidentally shot and killed his brother in a hunting accident. In his beautiful memoir, The Blessing, he offers a touching description of his shame though identification with the Biblical character, Cain, who also killed his brother.
“If I were Cain, I knew who I was and where I was situated in the universe. I was the one who had slain his brother. I was the one God was angry at. But he would not kill me. The story didn’t go in that direction. Instead, he would drive me alone into the wilderness. And wasn’t that how I felt? Isolated, alone. Shunned by people… And Cain said unto the Lord, ‘My punishment is grater than I can bear.’ But God would not let Cain die and he would not let anyone punish me. He knew that my own self-hatred was a far more terrible punishment.” 
Under ordinary circumstances, shame can be useful and help us be more moral and humane. We deal with shame in a variety of constructive ways, including humor, seeking support, and self-improvement.
For CADIs, however, the burden of shame can become very heavy, leading to depression, self-hatred, fear, or even rage. When I tell people that their accident does not define them, I am trying to combat shame – the idea that our accident means there is something fundamentally wrong with us.
Because the experience of shame is often linked to earlier life experiences, it can be difficult to manage by ourselves, and psychotherapy can be very helpful. A therapist can help us distinguish between unhelpful, shame-based global attributions or conclusions (such as, I am a terrible person) and more realistic self-appraisals (such as, I made a mistake or I was in the wrong place at the wrong time). A therapist can also offer some support and relief by allowing us to express our feelings and by treating the depression, anger, or fear that may result from shame.
I believe that traumas such as serious accidents can ultimately lead to personal growth, and my goal with this website is to help people on that journey. Shame, however, slow down the growth process because we react with the desire to hide from the world. If you are carrying a heavy load of shame, I recommend talking with a counselor or psychotherapist, preferably one who understands trauma.
I would appreciate hearing about how readers have coped with or overcome their shame or guilt. Please share your insights — Thank you!!
 Lewis, Michael (1995). Shame: The Exposed Self. New York: The Free Press.
 p. 28-29