Understanding Self-Harm as Embodied Communication

A recent article published in Social Theory & Health explores non-suicidal self-injury, or self-harm, from the perspective of embodied social communication. The authors, Peter Steggals, Steph Lawler, and Ruth Graham, argue that self-harm has been understood primarily as a psychological condition inside a person. Through in-depth qualitative interviewing of individuals who self-injure, people in relationship with those who self-injure, and those with both experiences suggest that non-suicidal self-injury is instead a deeply embodied and communicative set of behaviors.

As the number of ER visits related to self-harm continues to rise in different parts of the western world, self-harm and non-suicidal self-injury have become the focus of several clinical initiatives.

Dialectical Behavior Therapy (DBT) has been shown to reduce both self-injury as well as suicide attempts. Interventions promoting mindful self-compassion show promise in addressing eating disorders. However, a 2016 meta-analysis does call into question the “low-quality evidence” of research into these interventions.

Some researchers believe that self-harm should be understood as a form of interpersonal communication for people who may find it difficult to express emotions by other means.

The current study picks up on this self-harm theme as a deeply embodied, interpersonal, and social phenomenon, rather than treating it exclusively as an “intrapsychic” and individualistic malady. Reconceptualizing self-harm to include its embodied and relational components may aid in understanding how best to promote healing initiatives.

The authors performed 26 in-depth phenomenological interviews in England with people who self-injure, people in social relationships with those who self-injure, and people with both experiences. Their analysis of the data was guided by “three levels of possible communication: the interpersonal, the intersubjective and the inter-corporeal.” 20 women and 6 men were interviewed, including 9 mothers and 3 fathers. Two of the parents had their own history of self-injury, while the rest did not.

The authors explain the “interpersonal” level of self-harm as a failure of normative communication. Many of the parents interviewed explained that even before knowing about the self-harm, their sons and daughters withdrew into their own worlds. This was sometimes understood as normal teenage behavior until the self-harm was discovered.

Interestingly, some of the parents struggled to communicate about the self-harm as well:

This was accompanied, for several parents, by a general sense of uncertainty regarding how to address their children. They feared that they might trigger a painful response or make the situation worse.

As the authors note, these sensitivities and failures around language show a “partial collapse” in the whole family system, rather than exclusively within the person self-harming.

Additionally, even something as simple as a closed-door was understood by one parent to signal a significant form of communication. Though a closed door can be seen as a “refusal” to communicate, this refusal is itself communicative.

Turning to the “intersubjective,” the authors describe this level as persisting even when normative communication has stalled. They list phenomena such as body language and even physical spaces as important here.

In one interview, a mother described finding razors in her daughter’s bedroom. She let her daughter know that she had found them, but she did not remove them. The authors refer to the daughter’s room as an “alternative bulletin board,” where a kind of indirect communication could occur since the daughter continued to leave razors around even after her mother discovered them.

Additionally, the daughter told a mental health worker where her mother could find old suicide notes in the bedroom. This room served as an alternative place and form of communication—a “communicative zone”—picking up where traditional linguistic communication had failed.

According to the authors, intersubjective forms of communication such as the bedroom example are often ambiguous, rather than pointing necessarily to conscious intent.

The third level of communication, the “inter-corporeal,” is understood by the authors as a more fundamental form of embodied communication.

In one example, a mother explained that she discovered her daughter’s self-harming when she went sunbathing in the family’s garden in a “strappy top,” which made visible scars on her arms. The mother believed this to be a conscious choice on the part of her daughter, as though she was ready to share her experience, although the authors state that the ambiguity here is obvious.

The authors understood this kind of disclosure as “re-drawing the boundary” of the secret or marking off new social space. The daughter’s revealing of her body’s scars “brings the mother in” to the secret, which the mother chose not to reveal to her husband or her own mother for fear of shame and stigma.

This anxiety was now, in some sense, shared between the two of them because of the daughter’s choice (fully conscious or not) to reveal her scars.

The authors believe that these interviews highlight a different interpretation of non-suicidal self-injury, not as something merely private, but also “public” in the sense that the body and physical “lived spaces” can be highly communicative.

In closing, they lay out four elements of this reinterpretation of the body: as foundational, extended, relational, and communicative. They refer to the existential philosopher Maurice Merleau-Ponty on these issues, with his view of the meaningful, relational “lived” body as the ground level of consciousness.

The authors conclude:

 

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Steggals, P., Graham, R., & Lawler, S. (2020). ‘I couldn’t say the words’: Communicative bodies and spaces in parents’ encounters with nonsuicidal self-injury. Social Theory and Health, 18(3), 270-286. (Link)