The work of Erving Goffman refers to the “spoiled identity” that often results in people who believe that they have suffered from stigmatization because of mental illness, physical deformities, blindness, and other psychosocial, racial, or ethic prejudices. There is an unfortunate weakness in the common public understanding of psychoanalytic treatment and theory. This chapter focuses on using analysis to work through the destabilizing regression accompanying the analytic treatment of shame and paranoia, thus avoiding analytic impasse. The widespread use of psychoanalytic and dynamic treatments in community clinics and the public sector will both reduce stigma and facilitate the widespread use of psychoanalytic and dynamic treatments. Understanding the role of shame in patients has been central for me in helping patients who are working through paranoia and maniacal triumph in psychoanalytic treatment. Paranoia and the related feelings of vengeance, murderous rage, and hate are understood as being related to a profound sense of betrayal associated with unconscious violent persecutory anxieties.