Dr. Donald L. Nathanson, 81, of Wynnewood, a gifted psychiatrist and scholar who was one of the first to study, explore, and publish treatises on the human emotion known as shame, died Wednesday, Dec. 27, of complications from dementia at Bryn Mawr Hospital.
Dr. Nathanson practiced psychiatry from offices in the Medical Tower Building on South 17th Street in Center City.
"For years, Don's patients have told me how he 'saved their lives,' and how much they loved him," said his wife, Roz Nathanson. "These words continue in condolence cards I've been receiving. And I know Don loved all these people in return."
Dr. Nathanson blazed a trail when he began to explore how emotions, especially shame, are a critical regulator of human behavior and to discern that the responses to shame can be mapped. He wrote extensively and lectured internationally on the subject.
In 1991, Dr. Nathanson and Dr. Vernon C. Kelly Jr. cofounded the nonprofit Silvan Tomkins Institute to build on what was then known about shame and to extend that knowledge to the layman. Among other contributions, Dr. Tomkins had shown that shame was a normal part of biological, psychological and social evolution.
"The critical thing about shame that Tomkins taught us is there must be something positive that we enjoy that is being withheld from us," Kelly said. "Don's work extended that to the community."
Dr. Nathanson found an application of his shame theory to children with reading difficulties. He looked carefully at the nature of human attention, or the ability to stay engaged with subject matter. He found that ordinary attention is an emotion.
"When the child focuses, pays attention, really gets interested and involved with what's going on, that's what we think is the normal approach to learning in school. But what happens as you look at something that you think you're going to understand, but you can't understand it?
"The amount of interest that you've put into that moment of study is impeded because something has become so ambiguous, so problematic that it interferes with the emotion that was powering attention at that moment," Dr. Nathanson wrote.
An interruption in interest triggers a physiologic mechanism he called "the shame affect." The shame in turn causes "a cognitive shock" in the child's mind, he wrote.
"Shoulders slump, the face is turned away from what a moment ago seemed interesting, and then we begin to reflect on other experiences we've had of this shame happening — inefficacy, inadequacy, unpreparedness," he wrote. "Our mind, our consciousness is flooded, not with the printed material on the page, but with a whole bunch of experiences that have to do with our worst possible self."
In a classroom setting, Dr. Nathanson wrote, "there's a multiplication effect. This business of being unable to decipher what's on the printed page has huge consequences for a child's self-esteem, or how we see ourselves relative to our peers." Not until the feeling of shame is lowered can the child begin to read, he wrote.
In 1992, Dr. Nathanson created an intellectual construct called the Compass of Shame. He wrote that people react to shame by attacking themselves, withdrawing from the situation, attacking others, or avoiding the negative feeling through distraction or substance abuse. The compass is now a building block for other thinkers.
Born in New York City and reared in Brooklyn, Dr. Nathanson graduated from Midwood High School. He enrolled in Amherst College at 16. He earned a medical degree from the Medical School of the State University of New York at Syracuse and served a residency in internal medicine at Hahnemann University Hospital.
He served two years ending in 1966 at the Philadelphia Naval Hospital, where he became interested in the psychology underlying illness. As a result, he took another residency, in psychiatry, at the Institute of Pennsylvania Hospital.
Since 1993, he had been the clinical professor of psychiatry and human behavior at Jefferson Medical College. Before that, he had been clinical associate professor, mental health sciences, at Hahnemann University School of Medicine.
He maintained a busy private practice until retiring in October 2010. He was the author of two books, The Many Faces of Shame, published by Guilford in 1987, and Shame and Pride: Affect, Sex, and the Birth of the Self, published by Norton in 1992.
When not conducting research or counseling patients, Dr. Nathanson was a clock restorer. He loved astronomy and had several telescopes. He also loved to wear hats, and had many of them.
He lived in Wynnewood with his wife. "We loved each other dearly and were not ashamed to tell the world," she said.
Besides his wife, he is survived by a daughter, Julie N. Holcomb; a grandson; and a sister. He was previously married to Dr. Carol Moog. They divorced. She survives.
Services were Sunday, Dec. 31. Burial was private.