Whenever I write or speak publicly, I feel compelled to frame cutting, burning and hitting myself as something I used to do. I don’t actually outright say I’ve stopped, but I use the past tense and thus I suspect most hear it as implied. Somehow, the pressure to appear outwardly ‘all better’ in that way still seems big. Self-injury (of that type) ranks pretty high up there on an awful lot of people’s scary meters. Just saying you are someone who has ever done that sort of thing seems disconcerting enough for most.
Perhaps others won’t so much see that as a problem, but I think it is one. When I speak about self-injury, I speak about it from a standpoint of advocacy and education. I’m sharing what it’s meant for me, and all the counterproductive pain that people have caused simply by trying to force me to stop. However, at the same time I’m saying ‘this isn’t such a bad and scary thing,’ I’m re-enforcing that this is a ‘bad (enough) and scary (enough) thing.’ So much so that I can apparently only speak up about it once it’s been eradicated from my life.
The truth is I do sometimes hurt myself. Present tense. Its place in my life has changed as I have changed, but frankly, sometimes I still find it to be useful.
So, why does that feel so hard to say?
First of all, self injury was, in fact, the reason I experienced my first involuntary (the ‘you-can-choose-to-go-to-the-hospital-voluntarily-or-else-we’ll-section-you’ kind of) hospitalization. There I was. Locked up. Stripped of all my protections and ways of coping. And, not a single person was asking me why. Why did I hurt myself?
I could have told them, even then. Sometimes I have felt like I’m floating above myself and all that is happening in my life, and I’m just not sure how to get back into my body. During those times, hurting myself has helped ground me. And sometimes, I feel such deep emotional pain rising up in my chest and getting so big that I donn’t know what else to do. Hurting myself has sometimes given me some ability to release and control that pain in a world that otherwise can feel pretty chaotic.
No one asked, but they did teach me a lesson. It’s not safe to tell.
Almost two decades later, things have changed a little bit. Understanding has grown. There are books out now speaking about self injury in a much more human fashion. There are research studies that explain that forcing someone to stop self-injuring raises the risk of suicide, not the other way around. And yet, I still hear all the time about people getting put on alert, hospitalized and forced into treatment because they cut or burn or otherwise hurt themselves to cope.
Another reason talking about self-injury in present tense feels hard is this complicated and often abused concept of ‘recovery.’ When I first ‘came out’ to my work world (a role in the traditional, clinical realm) as someone who had been psychiatrically diagnosed, people were particularly freaked out by my saying I still struggle. One person compared it to the addiction world, and someone who’s still drinking trying to support someone who’s trying to stop. Others wouldn’t even attempt to articulate a reason why my admission of continued emotional distress made them feel so edgy. Apparently, all their lives were smooth sailing. (Not.)
Reality check: We all struggle. Sometimes it interrupts our lives, and sometimes we have enough resources to see our way through quick enough that it doesn’t rock our world. As I said in my blog, ‘The Recovery Trap,’ when did what you get to call ‘life’ become what I have to call ‘recovery’? Why are so many people still so attached to the idea that those of us who have been diagnosed and those of us who have escaped diagnosis are all that different?
Yet, there still feels a certain pressure to act ‘recovered.’ As if, if I don’t act ‘recovered’ enough, then the rest of what I’m saying may lose its legitimacy. How do I need to live my life in order to retain my credibility? My voice?
There’s a funny sort of trap that happens in our world. We’re expected to lay out our most personal and painful experiences so that we can reach people or allow them to evaluate our ‘street cred.’ Yet, at the same time, we’re expected to not lay it out in a way that might make others (too) uncomfortable. We’re supposed to talk about how things could be better in the system, but never in a way that sounds too angry or makes providers feel blamed. And, meanwhile, if we look too good, people are probably going to discount much of our story anyway and claim we were misdiagnosed. But, if we look too bad, then what exactly are we proving about the potential for healing and moving forward? Oh, and, don’t forget that neither what constitutes ‘healing’ nor ‘recovery’ are measured on a scale set by us. It’s easy to get lost in all that.
So, yes, sometimes I still hurt myself. And truth is, so do (at least most of) you. Who among us hasn’t worked too much because it was easier than dealing with a problem at home? Who hasn’t eaten in excess for an emotional reason at some point in time? Starved yourself due to societal pressures? Smoked when you’re stressed out? Drank a bunch after a hard day? Spent too much money? Gotten a tattoo or piercing at least in part because it was a more socially acceptable way to engage physical pain?
I’m pretty sure that a burn on my arm actually poses far less risk to my life and well-being than many of the variety of ways people out there are hurting themselves every day.
So, even though so few of us who hurt ourselves by burning, cutting, scratching, hitting, pulling out our hair, etc., get asked *why*, I think it’s about time we start asking the rest of the world that very question.
Why are you so convinced that this sort of self-injury is worse than other kinds of self-injury?
Why do you believe that it is bad when I hurt myself and that I must be stopped?
Why are you so uncomfortable with it?
Why can’t you just sit with it?
Why don’t you ask me why?
And how about…
What does self-injury mean to you?
What sorts of ways have you hurt yourself and why?
When you force treatment on me to get me to stop, is that really about me . . . or more about you?
I’m not advocating *for* self-injury. I’m not suggesting people who don’t do it already should start anymore than I’d advocate that someone who doesn’t already hear voices try and figure how to draw one out. But I am suggesting that (just as with so many other things) if we start talking more about it, we’ll learn about ourselves and each other. I’m also suggesting that it’s not so abnormal, and that what gets labeled as ‘acceptable’ verses ‘unacceptable’ self-injury is often a matter of privilege and/or societal values that have very little to do with the impact on the actual person. It doesn’t necessarily need to be eradicated, but we could all do with several doses more of understanding.
Instead of hospitalizing me, if only someone at that time in my life would have been willing to sit with me in pain and ask me questions to understand… If only they would have made space for me to talk about why I was hurting so much . . . If only they would have wondered aloud how my cutting and burning was actually impacting my life (which is what really matters, anyway) and what that meant for how I wanted to move forward . . .
“Beyond Fear and Control: Working with Young People who Self Harm.” Sam Warner
Helen Spandler. 2007.
“Flesh Wounds? New Ways of Understanding Self-Injury.” Kay Inckle. 2010.
“Our Encounters with Self Harm.” Charles Baker, Clare Shaw and Fran Biley. 2013.
“Between the Lines.” Copyright 1997 by Meta Flicks. 21 minutes. Produced by Sophie Constantinou. Available from Fanlight Productions, 4196 Washington St., Suite 2 , Boston , MA 02131 ; 800-937-4113
Healing Self Injury: healingselfinjury.org
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
Hi Sera. Yet another brave and super-relevant essay on a topic that most people still don’t talk about. We lived-experience folks experience so much more pressure than other aspects of society who are trying to move on. What’s that, you are an alcoholic and you fell off the wagon? Well, relapse is part of recovery, per the many AA platitudes. You fell off your motorcycle and injured yourself and you walked 500 more feet in physical therapy this week that last week? Good job! Excellent progress. Oh, you are an officially diagnosed mental patient and you have two big burns on your arm? (insert sad, worried face) You really aren’t any better than ever, are you? (insert head shake) I don’t even bother to explain that since I took the job as the Home Care Health Aide, I have had the chance to cook for people. This is a skill set that is particularly rusty for me and has accidentally resulted in some minor bodily injury. These dolts actually think I have self-injured in plain sight. Dolts.
Thanks, Sharon! When I first ‘came out’ around self injury stuff in my prior job, *every* little mark got interpreted through that lens… as if it was any of their business in the first place.
Very frustrating! Hope you’re doing well 🙂
Thank you. I agree one hundred percent, and I stand in solidarity with you.
I’ve been told that I self-injure in an absurd assessment that was ignorant of the context. Fortunately, the assessor also thought that people with mental illness should not exercise. Perhaps we should start calling the sedentary life-style self-harm. Or perhaps drunk driving, or even road rage should be labeled as self-harm. Maybe football players that play despite knowing the risk of concussion are self-harming. Or what about the tendency of some psychiatrists to share idiotic opinions with patients so that the patients decide to pay someone else?
Thought the mentally ill shouldn’t exercise? I’ve never heard that one before! Did he or she say why?
I tried to query the psychiatrist and was told something about people over-doing the exercise. Though why they thought that mentally ill people were more likely to exercise too hard than anyone else was beyond me. Especially in an age where most people, including him, exercise too little.
Oddly enough, I had just told this psych that I had an old injury which he did not recognize as a sporting injury while every MD I have ever talked to has recognized it. Also, you would think that psychiatrists would have enough people skills to make sure that they are not offending an athlete before they sound off about not exercising.
I just chalked all this up to him being a bad doctor and ran for the hills.
Wow, that’s a new one… I thought the system generally believed that being sober, eating ‘well,’ avoiding coffee and cigarettes and exercising was the perfect cure for all the damage the psych drugs do!!!! 😉
Thank you for reading and sharing!
Brilliant uncovering of the deepness and richness of language to both heal and liberate on one hand, and judge and condemn on the other. Thank you for sharing your wisdom and uncovering another unspoken layer of truth.
Madmom, Thank you for reading and commenting 🙂
This is just a matter of who you talk to when you feel lousy. If someone has an extreme emotional experience and talks to a psychic, some church folks (not all), Star Trek fans, civil war re-enactors, home-brewers or other weird people, they are just one of the crew. And I mean weird in a complementary way just like on http://nerdighters.ning.com However, if someone in distress talks to a doctor, they’re ill.
In this case, using pain for pleasure or for emotional regulation (different, I know) is probably only an illness if you talk to the wrong people. The bdsm people have a super rich history of discussions along these lines. Alot of which are how not to cause permanent harm during one’s sessions. The best can be found on http://fetlife.com. Don’t ask me why I know this, I just learned it from a little birdie somewhere.
lol. Must look at fetlife!
I liked Louise Pembroke’s guide, Harm-Minimisation: limiting the damage of self-injury
I have given it to a few friends in my time
Thanks, John! I will check it out!
Corinna, As is often the case, really… Groups develop their own culture and beliefs that fit therein… Too bad the culture developed specifically around the idea of *helping* is the one we need to hide things things from…
This is so true… It is a total mind-f—. On top of the one(s) many of us are dealing with in the first place. Truly insane.
Please keep writing, Sera…
Sera: Thank you. Just thank you. Yes, some of us still ddo use that coping strategy, and I’ve had to learn to do it secretly as my best friend made it all about her (“I’m hurt you didn’t come to me.”).
And I love the language play about “normal” (undiagnosed) people living life and facing challenges, while those of us who got labeled are “recovering” (or not), having “symptomatic” behavior, and subject to the judgment of someone who doesn’t even TRY to understand. This, of course, is why others protest when I say I’m “recovered.” I still believe I’m the only one who can judge my behavior, and I’m lucky enough not to be under the thumb of some clinician with power.
Thanks, Ann! I know the feeling of having to hide it even from people in one’s own personal life, as well. Granted, I understand why people get scared and worry… And yet, there’s so much that could be gained from simply being with and being genuinely interested in trying to understand.
I’ve largely given up on the word ‘recovery’ altogether, but it drives me up a wall when people try to say that it’s a ‘lifelong process’ as if that were true of everyone.
Thanks for reading and good to meet you this September! 🙂
“It’s not safe to tell.”
I am in alcohol/addiction recovery and still party on special occasions then quickly put it down before it bites me.
“Yet, there still feels a certain pressure to act ‘recovered.’ As if, if I don’t act ‘recovered’ enough, then the rest of what I’m saying may lose its legitimacy.”
That’s what happens.
There is no benefit to me in telling anyone or doing the ‘walk of shame’ and taking a white chip.
If anyone who is showing inability to control his drinking can do the right- about-face and drink like a gentleman, our hats are off to him…
Get your hats off, and thanks for helping me control it.
Damb, I feel like such a total compleate phony having just admitted I ‘cheat’. But WTF ? Lets be real.
I guess the unspoken rule is if you can get away with less than a ‘program of total abstinence’ without screwing up, it is recovery.
I should have left this one alone,the 12 step thing is not psychiatry and I don’t wan’t to bust on it.
Thanks for reading and commenting, Copy Cat. I’ve seen the twelve-step world do a ton of good for people, and yet I’ve also seen the tremendous rigidity and judgement around a one-way fits all approach be hurtful to people, too.
Sounds like whatever you’ve figured out for yourself is working which is great. 🙂
Completely agree with this. I still ignore responsibilities sometimes and spend hours in front of a screen instead, or eat things i know that make me feel well because some part of me wants to not feel well. We all have our “outs,” (or are they “ins”?) and our wellness culture, even alternative systems I’ve been involved with like Buddhist psychology, pathologizes this behavior in such a way that it becomes shameful to even talk about it. Thank you so much for speaking up, Sera.
Hi Matt, Thanks for reading and commenting! People get so invested in their ways and their meanings, eh?
The question is… What if these predispositions are hurting us? How do we find alternatives?
That’s definitely a part of the question… But, I guess my main point here is let’s start from a place of being curious and interested enough to *ask* someone what the meaning and impact is for them and have some trust in what they say in response.
In terms of what helps people to stop or make a change if that’s what they want to do, I think people have found so many paths. Some of the resources I posted at the bottom of the blog (and that others have mentioned in the comment sections) speak to some people’s personal paths through.
I definitely don’t personally claim to have all the answers for everyone, though. For me, my inclination to hurt myself in that way just reduced over time as I worked through certain things and my overall life developed into something I felt better about. For example, I used to be in bed at night and feel like my worst emotions were crawling around just under the surface of my skin and I would get so overwhelmed that I would start hitting myself until my ex-husband managed to get me to stop or I exhausted myself. That urge just passed at a certain point in my life… Other things I still go back to every now and again… But the cessation/reduction had NOTHING to do with me trying to stop, using distraction skills or doing anything else targeted particularly at the idea that the self injury was anything to do with the problem and needed to stop. Things just changed for me… and when I do go back to it, it’s not in a way that I feel particularly bad or ashamed about.
I guess the biggest questions for people who are really struggling with wanting to change that part of their life somehow are something along the lines of … What’s NOT working for you ? What do you WANT to change? And then really, really, genuinely honestly making space to talk that through.
Srea, I appreciate you talking about this topic in the present tense. Someone asked me recently day why my colleague and I include a section on self-jury in our training on trauma-informed peer support, and I replied that it’s because it’s the behavior that is most likely to get people punished and/or incarcerated by the mental health system, as well as ostracized by other survivors. It still freaks people out, and people still have a hard time having a rational converstaion about it.
Your piece reminded me of a powerful book I read a few years ago, Covering: The Hidden Assault on Our Civil Rights, by Kenji Yoshino, a Yale law professor who is a gay man. While the book was framed around civil rights issues ralated to sexual orientation and race, its mesage applies to people with psychiatric histories, too. Basically what he was saying is that it’s become increasingly more socially acceptable to be different – whether that means being gay, black, or crazy – as long as you don’t act TOO gay, black or crazy and try to mimic straight, white, male, middle-class “sane” mores. I think lots of us who have psychiatric histories and work in the field are faced with this on a daily basis – we’re accepted as long as we don’t act like “crazy” people; in fact, we’re given less leeway to have the normal human range of emotions than people who’ve not been diagnosed.
Thank you, Darby! Excellent points and connections to broader civil rights issues. 🙂 I’m glad you’re out there doing this work (and will miss seeing you next week!!!)
Sera, I really like this blog, and much of what you say resonates with me as a woman who does self-injure, present tense.
I too felt under pressure to be an ex/former ‘self-harmer’, and one of the problems with that is when people feel compelled to put themselves in that box it means there is a long way to fall on injuring again. Not only that, at what point do we define cessation? Two months or years? I see people who live with the need to hurt themselves for decades and whether they have injured or not is almost irrelevant because living with the need in itself can be distressing/disabling. Only each person can say whether the cost is higher or lower in doing it or not doing it. Something which gets missed about self-harm is it’s life saving function because it can avert suicide therefore to forcibly remove the ability to harm does indeed increase the very risks those actions seek to remove.
Close observation, heavy meds do not remove the need, it just means that as soon as we have the opportunity the damage is more likely to be riskier.
I refer to my own need as being ‘active’ or ‘inactive’, I don’t envisage referring to ‘stopping’. What I have learnt to do over the years is to reduce the risks using the principles of harm-minimisation.
When I used to speak on self-harm I would in fact correct anyone assuming that I was an ex/former and point out the continuum of self-harm we are all on at different movable points. Sure there is a difference in the consequences between socially accepted forms of self-harm and needing surgical repair but again we can assist each other for preparing for that possible eventuality. It can place us at risk of psychiatry but probably less so in the UK than the US.
I don’t go along with an addiction model, and most people who cite that have been taught it, likewise I find ‘distraction’ techniques as an intervention about as useful as a chocolate teapot. That fails to grasp the meaning/function of a person’s self-harm, and either makes the facile assumption that all we need is to be distracted like a small child from doing something naughty or we desire pain. Holding ice cubes, pinging bands on the wrists are often suggested by professionals and that would in no way replicate the physical pain of much self-injury.
I think it is one of the most difficult expressions of distress for PH and MH prof’s and even our peers can struggle with it.
Within services it oscillates from being treated like ‘falling off a diet’ (an actual quote to someone in the ED), to being actively violently punished (witholding anaesthesia in surgical repair/verbal abuse/demands for medical photography/but rejected from MH services), through to women being held in high secure facilities for little other reason than their self-harm.
In terms of ‘recovery’ yes it’s uncomfortable to prof’s who view cessation as recovery and even to some fellow psychiatric survivors, you can see online forums where people will post when they last injured.
If it’s permissible to have enduring difficulties with depression (insert preferred term) or hearing voices etc then why do people baulk at the idea of some of us living with the need to self-harm maybe throughout our lives?
I think it’s balance as with anything else, to acknowledge the distress and be caring of that with each other, but not ‘over normalising’ to the point where of where it’s casual to the point of indifference, because we’re in danger of saying this is just like being left handed it doesn’t matter. It does matter, and we can be kind and considerate of that without pathologising.
It can be assumed that if we’re not harming then that’s all dandy then, yet grappling with that need can be overwhelming and for considerable periods of time, this gets missed.
Self-harm in relation to experiences which would be defined as psychotic haven’t even been researched yet the response to that is more typically fearful when it doesn’t need to be, because harming to manage voices/visions etc is not that different to harming to negotiate difficult feelings/experiences.
We get hung up on the act, rather than seeing the person.
Something which worries me in the UK is how in the last decade notably self-harm has become classified as ‘Personality Disorder’ and this is something we should all be concerned about because PD is far worse a diagnosis than psychosis (I say this as a person with a diagnosis of psychosis). People defined as PD get the worst of all worlds; attitude, despised, abusive treatment, rejected from any potentially helpful support, drugs, forensic detainment, groups which are like facilitated dog fights. Self-harm is not a diagnosis but BPD (ICD: emotionally unstable PD) is the only diagnosis which cites self-harm as part of the diagnostic criteria, therefore any woman who self-harms (or has experienced child sexual abuse) will attract that diagnosis. If there’s an existing ‘illness’ diagnosis then PD will replace that or be added to it specifically to ‘cover’ the act of self-harm.
The real killer is this – anyone of any diagnosis failing to respond to treatment, failing to functionally recover enough are now at risk of being reclassified as PD. Due to MH service funding cuts in the UK, there are mass discharges happening, many people are losing support (putting aside whether it’s any good), and this is also being facilitated by the reclassification to PD as a reason to discharge on grounds of PD being untreatable.
I don’t feel survivor activists in either of our countries have even started to get to the grips with the PD time bomb exploding and what this means. Getting that diagnosis is the kiss of death to any credibility as a human being,and it’s harder to deconstruct. With psychosis it’s easy, there is no ‘chemical imbalance’, there is no disease process, but even challenging PD concepts makes you vulnerable to being viewed as it.
People with the diagnosis get far worse treatment of their self-harm, it’s shocking and it never ceases to distress me, but the survivor promoters of it are a tough group to challenge. Some were rejected from other services, PD services were the only ones which accepted them so you can guess psychologically what has occurred for some of them. They are so well trained by services they police their every thought and emotion for signs of ‘dysregulation’.
It means that those who have the diagnosis who reject their label have pretty much now where to go. They are not welcomed into those groups unless they accept their diagnosis. Even those of us who stand beside them and argue hard can get seriously disliked for it and take a lot of flak.
One day we will look on the treatment of people defined as PD as one the biggest cover ups of human rights abuses. Professionals view them as being better off dead, and I’ve watched people self-harm to death whilst they offered nothing.
There’s no psychiatric ‘palliative’ care of those they deem untreatable/unhelpable.
Ruta Mazelis who edited the ‘Cutting Edge’ newsletter is a fine survivor writer. Your refs are good they are some of our best writers on the subject.
You are not alone Sera, and ‘recovery’ means bugger all to me neither, it makes me feel ill actually..
Big hug from across the pond x
Eek, Personality Disorder is minefield. In some areas you get no treatment as it is not seen as a medical condition. Sometimes it is seen as untreatable. In some places there are good units, some good therapeutic communities exist, some not so good. Often it means the usual: sedation and a social worker for a patronising chat once a fortnight.
I know someone who tried to get their diagnosis changed from Personality Disorder to Complex Post Traumatic Stress Disorder as she found it much less stigmatising and it actually did refer to something in her past that had caused the problems.
One of the reasons I like Lucy Johnstones articles on Formulation to replace diagnosis is that it avoids all the complexities of PD and similar diagnostic categories. You just ask the person what there problem is, what caused it and what might help, which sounds so much better.
Thanks for your reply, Joanna! Sorry for not replying back for so long. Lost track of this post a bit. 🙂 It sounds like we’re on the same page in so many ways, which is always great to read and reassuring. 🙂
CPTSD and Emotionally Unstable PD are euphemisms for BPD. I agree psychological formulation is a better idea but diagnosis is not going to be removed that easily because it’s infused within so many systems and structures
I agree, diagnosis is at the heart of the psychiatry and therefore embedded deep in the system. But it is still worth challenging and trying to popularise the alternatives.
I was sent here by a YouTube comment on a video I recently posted. I found what you wrote to be quite inspirational and hit pretty close to home. I’d like to share the video with you and any you think it might help. Just…talking 🙂