Why Do People Self-Harm, and How Can We Stop It?

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It is sobering to consider the reasons why someone who is programmed from birth to avoid pain and to flee danger would purposefully inflict harm on themselves; to act in this way requires the need to override the basic instincts which exist not just as individual self-protection but also protect us as a human species.

It is relatively common for a person to come to the attention of mental health services following an act of self-harm. A proportion of these individuals will then be diagnosed as having a mental illness. The converse is also true: being given a psychiatric diagnosis can also lead to self-harm. This is in addition to the fact that certain psychiatric drugs have been found to be associated with an increase in thoughts of suicide and self-harm.

A photo of a woman holding her bandaged wrist

The observations below are made with the intention of provoking a creative response by both individuals and healthcare systems as to how they can help combat the growing use of self-harm as a means by which people try to get their needs met.

The History of Self-Harm

The complex questions around self-harm have always existed, and yet it’s mainly over the last 20 years that attention has been given to exploring the factors that lead up to such behaviours.  At one time, self-flagellation was thought to be a higher calling associated with spiritual gain, and there are historical records of self-harm being used during distress, including a biblical reference to people cutting themselves with stones in response to bereavement.

I had not heard of ‘self-harm’ when I was growing up, either in childhood or as an adolescent in high school. The whole concept of ‘mental illness’, was not discussed and there were only occasional whispers of people having ‘breakdowns’.

At medical school, I enjoyed the few weeks I spent as a student attached to the inpatient psychiatric wards and I accepted what I was taught by the ‘expert’ senior doctors without question. I was given a list of diagnostic categories and I had to interview enough patients from the local mental hospital, to tick all the boxes. It was a fearsome place where the patients were incarcerated and there was little hope of recovery.

Once I started work in Emergency Departments (A&E) several years later, I came across patients who overdosed or self-harmed, often by cutting. The medical culture had for decades suggested that the vast majority who did such things were weak characters, attention seekers and timewasters. They felt that if those who had not made a ‘serious’ attempt on their lives were treated kindly, they would just ‘do it again’.

At the same time, there was also a prevailing belief that if someone really wanted to die by suicide, they would do it ‘properly’ and therefore not ‘bother’ healthcare services. This sort of attitude was commonplace and led to a punitive culture, with the result that patients who self-harmed were treated very badly. It was thought that they ‘deserved’ such ghastly ordeals as having their stomachs ‘pumped out’ or being stitched without local anaesthetic. It was hard for me as a junior doctor to challenge the established culture.

Over recent years there has been wider recognition of the role self-harm plays as an outward response to emotional distress and a simultaneous decrease in the pejorative and often punitive attitudes shown by healthcare professionals towards their patients who self- harm. While self-harm is now talked about and acknowledged in society, perhaps seen as more acceptable, it is also on the increase. I have personally witnessed an exponential rise in the number of cases coming to the Emergency Department following self-injury or self-poisoning. This more or less parallels the lessening of the stigma of psychiatric ‘diagnoses’ and the simultaneous reliance on the medical model of psychiatry, which propagates the belief that emotional distress is a sign that people are mentally ill and in need of treatment.

Why People Self-Harm

I have seen self-harm from many different perspectives and I have learned a lot during my work as a doctor in the Emergency Department, yet nothing quite compares to my own lived experience. It has taken me a long time to really understand what happened during the period that I was labelled as mentally ill. It was then that I learned to use self-harm as a coping mechanism. Something that only ever happened after I began taking psychotropic medication. The relevance of this fact should not be underestimated.

I had an emotional crisis a few years into my work as a junior doctor. Events occurred that triggered memories of my troubled childhood—this compounded the exhaustion I felt from working an 80-100 hour week, whilst simultaneously trying to be a good mother to my four young children during my limited time off. I took myself to see my GP, believing that this was the ‘right thing to do’. I received a diagnosis of depression and a prescription for antidepressant drugs.

My self-esteem took a huge dip. As a doctor myself, I was well aware of the fact that my profession thought those with psychiatric diagnoses were weak characters with only themselves to blame. It was very unusual for any doctor to admit to any symptoms that could indicate ‘mental illness’ and if they did, it was hushed up immediately.

Soon, I decided that I needed to take sick leave. I was very tired, but could not sleep, was feeling unbelievably sad as I constantly ruminated over the past. I thought of myself as a terrible failure. The diagnosis had not helped at all, even though I was now convinced that I was sick and that the medication I had been prescribed was going to make me well again.

However, after a few weeks of religiously complying with the treatment regime, I didn’t feel any better and now had to contend with side effects.  I was feeling nauseous, I was shaky, my mouth was dry, I was constipated and I felt dizzy every time I stood up too quickly. Not only that, neither friends nor family understood what was going on in my life and started to distance themselves from me; I felt like a leper, as if I was contagious. This compounded my sense of isolation. I had become subject to the very real and damaging stigma that was prevalent at that time.

The downward spiral had begun. When I was in such despair that I thought my life was not worth living, I asked for help again; the subsequent admission marked the start of the next seven years as a revolving door patient. I was in and out of psychiatric hospitals, treated with different combinations of over 30 psychotropic drugs and given more than 100 ECT treatments. I was given the revised diagnosis of treatment-resistant depression (which I now believe to be erroneous.)

I have never seen myself as needing to be particularly brave when I have written or spoken of my own diagnosis and treatment within the psychiatric system. Yet, when it comes to my personal experience with self-harm, I am much more afraid of being judged than before.

Despite the reduction in stigma of ‘mental health problems’, there continues to be an underlying belief held by some of my fellow health professionals that individuals who self-harm repeatedly are fundamentally flawed in character. Simplistic answers over why people self-harm can fail to consider the root causes for deep-seated and severe mental torment experienced by some of these people. I was one such person and it led me into vicious cycles of repetitive self-harm, akin to Russian roulette; I became locked into harmful behaviours and I knew there was a risk of death, even though each particular act of self-harm may have been carried out without specific suicidal intent.

Even though my first admission to hospital was for pervasive suicidal ideation, I did not act out on any thoughts of self-harm until several years and multiple admissions later. When I first started to self-harm, I didn’t tell anyone what was happening. I was using physical pain as a source of distraction, to displace the mental torment that seemed so unbearable. But after a while, it wasn’t enough. It didn’t reduce the distress I was feeling. It was then that I started to injure myself in a more visible way.

By then I had a very low self-esteem, and I thought of myself not just as unworthy or ‘bad’, but positively wicked. Therefore, subjecting myself to punishment did not seem a difficult thing to do, but rather a natural sequalae. This resulted in some terrible acts of self-directed violence. During the final period of the seven-year ordeal, I was permanently hospitalised and became obsessed with thoughts of self-harm, which took over my mind until I had injured myself. It became another source of torment.

Often these injuries required treatment that could not be managed on the psychiatric ward. It meant I was taken to the very same Emergency Department where I had worked. My dysfunctional beliefs about myself were further reinforced, not just by staff in the psychiatric hospital, but also by some of the medical and nursing staff I came across during in the ED. Those in supposedly caring roles could be very unkind or judgemental and sometimes they were cruel. This only confirmed to me that my pre-existing self-denigrating beliefs were correct. I felt humiliated when they treated me like I was an unworthy and bad person, which created a breeding ground for the same thoughts to flourish in me, until I no longer cared about myself or my well-being.

Despite this, I still cared very deeply for my husband and children, although I began to believe that they would all be better off without me.

I know I also felt as though my caregivers, the unresponsive staff within the psychiatric system did not listen and I did not feel heard. I believe that part of my self-harm was an attempt to show them just how bad I felt inside. It back-fired, of course, because rather than lead to empathy, it led to increasing amount of judgement and a deliberate disregard for what had happened. No-one would talk about it with me. I was not asked why I had done such a thing and nobody seemed to care that I had almost lost my life. After my recovery, it was confirmed that some staff were angry and frustrated with me.

I must have been angry myself but the numbing effect of the medication meant that I had no awareness of such feelings. I cannot help wondering whether the aggression I meted out on myself was also directed at them.

I was not able to trust anybody in the hospital where I was detained. I was so lost within my head and in terrible torment.

Does Psychiatry Help or Harm?

There are many kind and compassionate people who work in psychiatric care, who are dedicated and well intentioned.

But personally, I do not see psychiatry as being a solution on the wider scale. There are far too many patients trapped within the system who are desperately in need of help and understanding. An equilibrium must be restored for such patients to be able to re-enter life away from the negative influences of psychiatry, which have been unwittingly imposed on them.

My first admission to hospital was ‘voluntary’ and I was told it was to keep me safe and I believed that it would get me better. I soon found that whether voluntary or not, hospitalisation was akin to imprisonment and little else. It was an environment used to contain patients in one place, with the stated aim to prevent them from harming themselves or in certain cases, harming others.

So here we all were, the unsafe people, all housed together in a locked ward with nothing to do except take the medication that we were told would make us feel better. The day room was the only place we had away from our bed, and here we sat for most of the day, men and women and a TV. The nurses were those tasked with keeping us safe, keeping control, and doling out the drugs. Nobody talked to us and there was nothing therapeutic about our stay in hospital.

We, the patients, watched the staff, watched each other, and soon learned the rules of survival in such an environment. I remember feeling horrified and terrified the first time I witnessed another patient use the most effective way of getting the nursing staff out of their office: throwing furniture or various objects or even attacking someone else guaranteed a response.

It was extremely stressful and unpleasant for all of us. I hated it, as did most of my fellow patients. Yet I saw some of the most unlikely people engaging in such violent outbursts just to get the attention they so desperately desired. Some even considered it lucky to get jabbed with a tranquiliser. It gave them relief from the torment of being left in enormous distress, without hope, for days on end.

Self-harm was also widely practiced on these psychiatric wards, long before it became commonplace in the wider community. I could see how it served a similar purpose to other forms of violence, in that it ensured that healthcare staff gave some time to the patient concerned. Some would say that this confirms their belief that such behaviour is purely motivated by attention seeking. I see this not just as pejorative, but also as a wholly inadequate explanation for why patients on psychiatric wards often resort to self-harm. Yet it was clear that there were times when patients really did use such behaviours to get the attention required, just to get their needs met. This way nobody else got hurt.

Once a patient is admitted to a psychiatric ward, feeling suicidal is considered very low key. There is a ladder of ‘risk’, a symptom hierarchy which healthcare professionals used to assess their patients. It seems that they were blind to the fact that patients quickly cottoned on to this.

Even today, psychiatrists, psychiatric nurses, and psychologists may believe that they are uniquely trained and talented in being able to determine how serious the risk of completed suicide is, but they admit that they cannot predict who will or will not go on to take their lives. They make superficial judgements based on a range of factors which nowadays is a variation of what is called the ‘SADPERSONS’ score. For instance, a declaration of feeling suicidal is one thing, while having a plan for suicide puts you further up the ‘risk’ ladder.

For the residents of psychiatric wards, who have become very familiar with the staff responses to those who have self-harmed, they soon see that, without exception, it does bring a measure of extra attention; even when such attention is punitive or judgmental. For those who are desperate for interaction with the staff, negative attention may seem better than no attention at all.

Most of these patients believe what they have been told by the psychiatric profession—that the answer lies in hospitalisation or in treatments that mental health services offer. I was one of them.  I believed that if I did what was advised—took all the medications they prescribed, agreed to all the treatments they offered—I would get better. I can speak from experience when I say that nobody ‘in their right mind’ would want to be locked on a psychiatric ward. Yet, once embedded in a coercive system and heavily medicated, it can be hard to break away and resume your independence.

SO, readers may be wondering, are patients playing the system? The answer is that it is no different from any other aspect of life, where we all learn what works for us as individuals and what does not.

Those who are deemed mentally ill, as I was and want to get better, will do all that we can in our attempts to find the solution to our problems. No one wants to feel sad or hopeless or anxious or frightened. I suspect that most patients who engage in self-harm and are labelled as attention seekers, as was my experience, do so in the subconscious belief that it will help them to be better understood by their psychiatric team—i.e., they do so for good reason, as a valid means to an end, to obtain the help they so desperately need. I believed that if I was really listened to, my concerns would be taken seriously.

In retrospect, I suspect that the nursing staff on the psychiatric ward thought that I was already being taken seriously. The psychiatrists and the psychotherapists thought that they listened. But I did not feel heard. They did not ask the right questions and they did not understand. I remember being subject to logical, rational answers which only served to isolate me further.

Imagine telling an addict that ‘all they need to do is stop taking the drug’ or someone in an abusive relationship, ‘all you need to do is leave’. I was told ‘all I need to do is stop self-harming.’ I was repeatedly told that the reason I didn’t get better was because I didn’t want to get better.

The worst thing about this situation is that, as a patient trapped in the system, it is easy to think that your caregivers will help you to find a way to resolve your difficulties. The relationships with your doctors, nurses, and therapists play such a key role in day-to-day life. They were party to some of my innermost and private thoughts and feelings, which I had shared willingly, believing that my dignity would be preserved. I did not expect to be judged and I thought I would be treated with empathy. I felt so vulnerable when they let me down. That betrayal in trust was devastating.

Patients treated by mental health services quite often escalate their behaviour and complaints because they do not feel heard. This happened to me, and since then, as a professional, I have seen it happen to others on many occasions. Tragically, when patients ‘up the ante’, there is a significant risk of irreversible damage or loss of life. Sadly, it is within the mental health service that acts of self-harm have flourished and spread. Historically, it was on mental health wards that patients learned about self-harm from one another, what responses will be elicited, by whom and for what reasons.

Of course, in the present day, this is aided and abetted by the internet. Suddenly, self-harm has become a commonly used method of eliciting help, even by young children. It has become the ticket of entry to provoke a response from even the most impenetrable of healthcare systems. Self-harm causes understandable alarm and panic from friends and family alike—it is seen as an indicator of serious distress and fills everyone with a desire to urgently remedy ‘the problem.’

Those who remain patients within the psychiatric system really do need to feel understood and often require considerable help to break away from their dysfunctional coping mechanisms. All too often, it is the response of healthcare professionals that reinforces the pattern of self-harm behaviours and thereby hinders, rather than helps, recovery.

As I see it, part of the solution to the increasing and global use of self-harm as a method of eliciting help is to understand how we have unwittingly medicalised very normal reactions to life’s complex circumstances.

Distress and emotional pain are part of being human, without which we will not be able to function or grow into adulthood. Pain has always been a warning system to us, teaching us what is or is not harmful—it serves us well in evolutionary terms. Yet it seems that we worship the idea of being continuously free from all pain and suffering, to the extent that it has taken on the proportions akin to religion—and this has been heavily exploited by western economic systems.

As a consequence, our tolerance of ‘normal’, adaptive or helpful distress and turmoil has declined.

Surely we must re-learn what to expect from ourselves—recognise that it is natural for our moods and feelings to fluctuate and be responsive to the circumstances around us. We need to know that it is perfectly ok to feel what have been labelled as ‘negative’ emotions like sadness in response to difficult situations; that grief is appropriate to experiences of loss, and that the goal of ‘happy all the time’ is based on fantasy. When we accept that suffering is a valuable part of life, as much as ageing is the inevitable consequence of living longer, then perhaps, our general angst will diminish.

Perhaps we should be turning our gaze away from the pseudo-scientific medical models and learn from the ancients. The old-world religions such as Buddhism give us far more insight into the attainment of peace and contentment, as well as guide us on how to live in harmony with others. Surely this is far preferable to taking psychiatric drugs or seeking out nebulous industry-driven formulas to enhance ‘wellbeing’.

I do not belittle any individual who engages in self-harm. It takes a certain courage, yet that very same attribute would better served, if used curiously, to explore what it is that is behind the distress which drives such behaviour in the first place. It can take considerable tenacity and nerve to relinquish the idea of a quick fix or to delve into the past and change past outlooks and responses. Such priorities may be time consuming and costly, but it is well worth finding the right therapy or help and can be life changing.

If I could live my life over again, I would not have sought help for my emotional crisis from any doctor. The psychiatric treatments I underwent did nothing to help me come to terms with my troubled past. Self-harm did not serve me well either; it exacerbated the torment and prolonged the agonies. Not only that, though never intended, it hurt those whom I loved.

Self-harm is a dangerous game. It can escalate from something that starts as relatively trivial to become very serious and I have seen far too many patients die as a result and far too few fully recover.

I am lucky that I did not lose my life and also that self-harm lost its mastery over me. I have come through stronger, am fully recovered and choose to share my experience only to help others do the same. I believe that it is necessary to recognise that it is not just self-harm behaviour that is dysfunctional, it is also the psychiatric system which has given it grounds to flourish. I am one small voice amongst those who share such views. But together, I believe the world really can turn back the rising tide of those who feel the need to use self-harm as a distress signal, to access what I believe is a fundamentally flawed ethos—the bio-medical model of psychiatry.

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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.

30 COMMENTS

  1. No. The problem begins with the broken, non-empirical, and culturally biased and fluid definition held by the established hegemony on what activities even constitutes “Self-harm”.

    Leaving that aside, allowing for your “self-harm” paradigm: it is not always a cry for help or an attempt to communicate. I’m so sick of this narrative. Devaluing attempts to convey meaning through dialogue and pedestaling physical drama is a pathology of the bio-psycho-western medical establishment, eternally projected onto its victims’ systems of meaning. The audacity to presume epistemology on behalf of others without doing a shred of inquiry. Forget medical science, this does not even strike within the wider circles of what constitutes social science.

    I bang my forehead against the wall as a symptom of sheer overwhelming mental pain. I cut as a private personal ritual. I cut as a form of tension relief. Others engage in “self-harm” activities as a way to regain a sense of control over their bodies and lives.

    And it’s nobody else’s business, INCLUDING when and if I ask for help for other problems, the “self-harm” is PRIVATE unless I CHOOSE otherwise, and authorities are NOT ENTITLED TO PRY.

    My visceral suffering alters how my physical form moves through space. These assumptions continue to prove that the majority of those with enough privilege to join the ranks of titled professionals simply lack intellectual/emotional capacity to understand the BENTHIC DEPTHS of social oppression and human suffering.

  2. I was waiting for how you got out of such a horrible system and recovered. To me, it seems that our needs, as children, when not met, is what comes back to bite us later in life. When we don’t have the attention paid to our thoughts and feelings, we’re missing the social glue that keeps us part of things, gives us enough courage to handle life, and is always there to be what we stand on so we don’t fall forever. We need from each other what we need, there is no way around it, regardless of what some people believe. The ones who believe we can do without have not had to do without. We don’t need as much courage, as we need each other, to be interested, to want to know, to give a place in our minds and hearts for each other’s thoughts and feelings, and treasure such things.

  3. I appreciate your story. It is well-written and states a lot of truth. I self-harmed for a while and most of it did go back to the psychiatric drugs prescribed me. Although, I am off the psychiatric drugs and consider myself a walk-away from the system, it still enters my mind sometimes. I notice that occurs when I feel threatened from the abusive talk of others (usually those who only think they are in some sort of authority position over me) specifically towards me. When this occurs, it does dredge up all the old terrors of my heart and mind. But now that I am free of the psychiatric drug and therapy system, I do not do it. I just write in my journal about how terrible I feel. Of course, there was a time when I was in the system that actually writing in my journal non-stop all night almost was considered “manic” rather than “therapeutic.” Psychiatry is actually the basis of that old line, “You can’t win for losing.” Like I wrote you said much truth here and I really applaud the fact that you spoke with such bravery. I was also reminded of the eleven useless days I spent in an alleged mental hospital. All we did was sit around, watch one of the TVs in one of the two dayrooms, wait for our evening drug call, and eat yogurt for breakfast. I still can’t eat yogurt to this day and that was nine years ago. There is further to that story, but I shall stop there. Thank you.

  4. I am not sure if the title is meant to be sardonic, but of course, psychiatry’s real failure lies in the last part of the title. If your goal is to “stop” self-harming behavior, you’ve already missed the boat. Self-harming behavior meets a need, and the key is understanding the goal/purpose of self harm and to help the person evaluate for him/her own self whether or not s/he wants to change that behavior. Attempting to force someone to “stop” self harming has been demonstrably destructive any time I’ve seen it attempted. If self harming is about having control of one’s pain, how can trying to force a person to stop be a good idea?

  5. We know little about mental health. Even the person suffering mental health issues may be unaware of how many aspects of his or her perceptions, behaviors and activities are affected by, or symptoms of their mental/emotional struggle.
    Unfortunately the professionals “treating” them may be just as clueless. In my own experience, the most effective form of “treatment ” is talk therapy, through which I have learned very effective ways to recognize, cope with and manage the challenges I face every day. It has also helped me communicate to my family that my emotions and behaviors have rational explanations. They are not my fault. I’m learning how to live my life as this new “me”, and my struggle has not changed the fact that I love them with all my heart.
    None of the medications have been particularly effective for me. In addition, many of the PsyD’s I’ve been treated by have labeled me with issues that do not fit my experiences and “symptoms”. (i am not and never have been a drug addict , for example. )
    I am not sure what a better title would be, but I dislike the term mental illness. It sounds strictly physical and tangible. Fever, heart rate, swollen glands etc…. Those are symptoms of physical illness iimposed upon the body. But anxiety, depression, ptsd, bipolar, obsessive/compulsive… these are traits imposed upon a person’s psychic wellbeing, and while they may be related to the brain they also affect the person’s feelings, coping skills, thought patterns etc… in ways that science can provide very little data. That doesn’t make them any less real, or the patient any less of a person.
    The idea that medical doctors would avoid getting needed psychiatric treatment and/or therapy for themselves because of the stigma attached to mental illness by their peers is truly alarming. I know if my physician needed mental health care I would want her/him to have it readily available and compassionate, right along with a compassionate work environment. That way I could feel confident that the people caring for me are either able to perform their job while seeing to their own health … or if unable they’d have a qualified and skilled psychotherapist who could help them accept that, arrange for a temporary leave of absence, provide support, guidance and education, and help them recover to the greatest extent possible.
    The idea that a psychological challenge is a sign of weakness is ludicrous. Ask anyone struggling with such a challenge. It is a constant struggle against an intangible force of destruction. The people faced with it are not weaklings, they are warriors.

    • Thanks for a great post!

      I’d just add that is possible medical doctors don’t go for “mental health treatment” because they know better than most people how dangerous some of the “treatments” are. If you ever read the entire label for Abilify or Seroquel, or even an SSRI antidepressant, you’d be a lot more careful about ever being “treated” with one of them!

      • You are right, it’s a worrisome list.
        Would I have progressed and feel the same as I do now, if I’d been able to comprehend the risks and done without the meds? Will I slip back into hysteria when I’m off them? Is the degree of ‘help’ worth the level of risk?
        Providers ask, “How is this med/dose working for you?” and I think, “How the heck should I know?” I have been using both meds and therapy. Progress has been very slow. Except for negative side effects, I haven’t noticed changes that I can feel confident crediting the meds with, within a couple of weeks or a month. Would the few, small improvements that have happened… be there now- with or without them?
        I’m now in the process of getting off meds, so I can answer those questions. If things go badly, I’ll know they did something, but I’ll still need to assess whether it warrants returning to them.
        Therapy is a fascinating and enlightening process. I suspect it’s been the primary source of the gradual bit of improvement; but I don’t know that for sure, yet.

  6. Hmmm…well. this article didn’t go the direction i thought it might. i understand this is the author’s experience and so she’s an expert on her experience. And I think she voiced a lot of truth in it…but some of the things she only mentioned in passing, i think were of vital importance to the subject…as well as some of the comments below.

    I think Steve’s comment hits the nail on the head; you don’t stop self harming by focusing on the self harming. So much of what i see described here on Mad in America as the focus of psychiatry today is just symptomatic. Who cares if we stop the self harming if we don’t deal with the root issues?

    My wife didn’t cut, but she viciously bit herself…and i sat with her and held her while she did it. I tried to minimize it, but more importantly i held her and talked with her and acknowledged her pain…and as she healed and other parts of her joined us and were able to process the long dissociated trauma, then she gained access to things she had lost in the past…and eventually, she wasn’t overwhelmed by those feelings from the trauma anymore…and once the root issues were dealt with…then the symptomatic issues disappeared.

    I’m truly sorry that anyone in the author’s position would ever self harm for attention. I know it didn’t start out that way for her…but it seemed to move that direction as she never got the care and affirmation she needed…and to me, the saddest part of her entire story is that she saw the psychiatrists, psychologists and psychiatric nurses as her ‘carers’ instead of her family…How I wish we family were taught and empowered to stand in the gap for our loved ones when they are struggling…that’s how it ought to be. We are the only ones there, 24/7 when they are in pain and overwhelmed by it…even our children can help the healing…our son has had a huge role in my wife/his mother’s healing…i don’t push it…but let him choose what he wants to do…and he does things for her, I could never replicate…
    Sam

  7. I am having a difficult time formulating a comprehensive response to this article. On the one hand, it includes bits and pieces of a deeply personal story, and I hate to try and counter that because… Well, it’s the author’s story, and their truth. It’s not my business to counter or tell them that they are wrong about them.

    However, the reality is that this piece lost me at the title: Why Do People Self-Harm, and HOW CAN WE STOP IT?

    Operating from a place of ‘we must stop this’ is a fundamentally harmful and flawed place to begin. When self-injury was most prominent in my life, the people who approached me with a ‘How can we stop this’ attitude were threats in my eyes. They were people who generally didn’t care WHY I was hurting myself in the way that I was. They simply sought to define my problem as ‘self-injury’ and the solution as ‘stopping’ it, while ignoring everything else along the way.

    In a world where I’d already lost so much power and control over my own life, they were there to take even more away. And, overall, loss of power and control (in the form of sexual and physical abuse and so many other things) was precisely what my problem was. Efforts to take more of it away only caused additional harm, even if it might have made others around me more comfortable or feel like they were somehow doing their job.

    I’m particularly puzzled – in this article so focused on the problems with medicalization of distress (a point with which I certainly align) – why there’s so little insight on the author’s part into how identifying self-injury as a “problem to be stopped” is just another form of that very same phenomenon. Along similar lines, I’m also curious as to why there continues to be so little understanding of just how many people actually self-injure in ‘socially acceptable’ sorts of ways with drugs, alcohol, food, exercise, work, and so on. As I’ve said in my own writing on this topic, I certainly posed more risk to myself with some of the ‘socially acceptable’ ways that I was hurting myself, then by a (non-socially acceptable) burn or cut on my arm.

    To that end, I’m also puzzled – and very worried – about the alarmist thread throughout this piece that suggests that so many people are spiraling toward their own inevitable demise if they continue to self-injure. While self-harm certainly can cross a line into dangerousness, the vast majority of folks who self-injure don’t do so in life threatening ways. And, in fact, one of the risk factors for self-injury moving in a more dangerous direction is precisely when someone else swoops in to take more power and control away and force them to stop (which this article may – in some ways – encourage them to try to do).

    For so very many people, self-injury is a way in which they stave off death or even urges in that direction. It can be an adaptation born of trauma and other challenges that serves so many purposes. And so this ‘how do we stop it’ focus can become even more dangerous for all that.

    In stead of asking ‘how do we stop it,’ and feeding into the idea that self-injury is among the worst or most dangerous things anyone could do, why not instead ask:

    * How is this working for you?
    * Is it something you want to change or stop?
    * How has it helped you in the past, and is it still serving that purpose?
    * Have you experienced negative consequences as a result?
    * What does self-injury mean to you/in your life?
    * If it’s something you want to continue, do you want support to explore ways to do it in the safest manner possible?

    Approaching the topic as if it’s something already understood and simply to be controlled is a mistake, and a dangerous one at that. We’ll get much further by being willing to sit in the muck with people who are struggling, and being willing to support them to explore and making meaning for themselves. Having other people tell you what is ‘wrong’ with you and what you need to do about it is a profound loss of power and control. The sitting in the muck and partnering to explore is the place where some ground can be regained in that regard, and where we can find points of collaboration in supporting people to live their lives to the fullest.

  8. Having “self-harmed” myself in the past, I cannot understand why anyone would argue for doing it? I do think the only person who can stop oneself from doing it is the person doing it to him or herself. At one time, I did this (which was actually before the psych drug time) an enlightened counselor suggested I write a contract with myself to not do it. The contract worked. I carried it around in my billfold until it faded away and became pieces of scrap paper. Sadly, by the time I was involved in the toxic psych drug world of today. (or rather some years past) I can see no good in harming oneself. In my person history, it was almost always a reaction to very critical people who, in some manner, were trying to take advantage of me. But, then, in consideration of this, my actions of self-harm did nothing to stop their mean-spiritedness. It only took away my power and actually, in a subversive way, gave them power. At the very least, in my mind, when we self-harm, we do not control our pain or our power, we actually gives those we believe who are harming us the power. The question, which may be a philosophical or religious question, is “do we really have the right to harm ourselves?” If we do, then, for instance, it makes taking these psychiatric drugs which harm so many, a moral thing to do. So again, who wins, those who promote these drugs, the very people we have claimed who harmed us—psychiatrists, big pharma, etc. It is a dead end street. It takes courage to stop a harmful act and find better ways to deal with those who abuse us in mean-spirited ways. But, it is necessary or the balance of power shifts to them, not us and obscures the truth that “it is them, not us.” Thank you.

    • Rebel, You can for sure hold this view *for you.* However, it is not a global truth, and we need only look at the words of so many others who self-injure or have in the past to know that.

      As I said in my longer comment here, so much of what drives so many people’s pain in this world is loss of power and control in all its forms. And having other people step in and make meaning of one’s own experiences and actions is a profound example of that loss. For some of us, maybe we *want* someone else to take that power – at least temporarily – because we are too tired or scared or overwhelmed to feel like we can hold it all or make sense of it ourselves. But many if not most of us will want or benefit from taking that meaning making power back at some point even if we don’t hang onto it right from the start.

      For you it sounds like self-injury did mean a giving up of power. If I understand you correctly – allowing other people’s words or actions to drive you to harm yourself felt like giving them control. I can understand that perspective. It is your truth. It simply isn’t truth for so many others, though. For me, self-injury has absolutely felt like taking power back.

      Not dissimilarly, for you, making a contract to not self-injure worked. I’m sure thats true for some others, too. However, for me and so many people, the contracts felt like a weird, infantalizing way to perpetuate shame and guilt. It’s an okay strategy to propose as an option, but should always be explored with the person rather than dictated.

      I am not sure I entirely follow the moralizing piece you write about at the end…. I can only say that for many folks, moralizing about our wants, needs, and choices has also been a pathway to additional shame and guilt… And that is rarely helpful.

      So, again, your truth is yours. Your experience is valid. For you. But certainly not for everyone. Surely, you are right that it can take courage to recognize something isn’t working and make real change. But it *also* can take courage to stand up against moralizing and theorizing and social norms and counter, “No matter what you say, no matter what you assume, no matter how many people may try to forcefully dissuade me, this is still my truth.”

      • With all due respect, I cannot agree with you, but I appreciate your response. I will still hold the belief that in harming oneself, we give our power to those who we believe have harmed us. It hurts to harm oneself. I know. Why fix one hurt with another hurt? That, I will never be able to understand. But, thank you for expressing your opinion. Thank you.

        • Well, here’s the thing… You can’t decide what it is for me, and I can’t decide what it is for you. What it is for me is decidedly not about me giving power to anyone else… and that’s fact, not opinion.

          One of the greatest harms perpetuated by the system is putting one person’s beliefs onto another as if the former holds all the rights to the truth even for another person. Hopefully we can not perpetuate that here! 🙂

          -Sera

          • With all due respect, I am not trying to put my beliefs onto anyone else. I am only trying to suggest that in harming oneself, the power balance shifts and usually not in the power of the one who harms oneself. I realize that you may not agree and that is your right. It took me years, getting off psychiatric drugs and therapy, and then looking at my own life history. Looking at my own life history has taught me a lot and could not be done while underneath the curse of psychiatric drugs and conventional therapy. And, in my opinion, it could not be done if I were “self-harming” which, yes, might also be considered a form of therapy, also. However, in my opinion, psychiatric drug therapy, conventional talk therapy, and “self-harming” all do have something in common–harming oneself and transferring one’s power to someone else (although in “self-harm” one usually does it alone) Additionally, “self-harm” can become an addiction like drugs or alcohol. I noticed when I was “self-harming” the similarities to my drinking while in college and just out of college. But in odd turn of events, I developed a nearly deadly allergy to alcohol, almost akin to many who must suffer through peanut allergies. Perhaps, I have developed an allergy to “self-harm” just recently. I do not know. Recently, I was verbally abused by someone who might be considered an alleged authority figure. I did briefly consider “self-harm” in response to the situation. Although, I am still upset by the situation, I did not “self-harm” as that would be giving this person the power not deserved. I am dealing with the situation on other ways. Thank you.

  9. Dear Cathy (if I may),

    Thanks for sharing your account and for creating this opportunity for public discussion on such an important issue.

    I note your personal account above, starts in your 20s as an adult.

    Apart from saying, ‘….Events occurred that triggered memories of my troubled childhood…’ you don’t seem to explain what actually happened in your childhood and with your parents?

    *Is there a reason for this omission?

    Noting the work of the late Alice Miller and now today, the excellent books by Lindsay Gibson PsyD – is there a possibility that some or many people might ‘self-harm’ due to a deep seated inner-self disconnection, which causes very painful emotional loneliness (a terrifying feeling of death-annihilation) – from having been raised by narcissistic /emotionally immature parents?

    Some might say that the inner-self (psyche) of children who are raised by narcissistic or ’emotionally immature parents’ (Gibson) – was not shown it has a right to exist on earth, to just ‘be’ here without being forced to function, perform, shut down, serve others’ (parents’) emotional or physical needs, including internalised parental/societal pressures to achieve a lofty life-purpose, material accomplishments or ambitious-driven career goals.

    In great despair, some might say that later in adulthood, the inner-self (soul, our ‘true self’) either turns its righteous rage against others, or turns this rage inwards against itself (self-harm).

    This notion of realising our life purpose is ‘not’ to ‘fix’ ourselves (such as with psychiatry), in order to be ‘functional’ so we can chase after a prized career, material accomplishment – but to instead just appreciate the physical experience of being alive on earth – in whatever incarnation and form our life takes – is depicted beautifully in the 2020 Disney-Pixmar movie ‘Soul’.

    https://www.youtube.com/watch?v=kdgOY8vB5mc

    https://www.youtube.com/watch?v=Gs–6c7Hn_A

    The ultimate premise of ‘Soul’ is very different from most American movies; it seems to contain a deeply profound but new philosophy now emerging in our 21st century era.

    (For those who are interested – a similar very popular movie is the 2004 Swedish film, ‘As It Is In Heaven’ : https://www.youtube.com/watch?v=C-INid-Zht8).

    *In addition to child abuse (in all its sad terrible forms) – is not being loved unconditionally, felt, seen, understood and nurtured consistently by our parents/early caregivers – appreciated for our simply ‘being here’ – also a terrifying form of early childhood parental trauma that might need to be explored?

    Is self-harm, in some cases, a form of ‘inner-child abuse’?

    If childhood experiences (traumas) are triggered by events in adulthood that lead to ‘self-harm,’ does one’s childhood need to be explored too?

    Narcissistic /emotionally immature parents, for example, might not want to know the underlying ’cause’ of their children’s distressed behaviour (tears, crying, tantrums, self-harm etc.) – they may instead prefer an ‘authoritarian/totalitarian’ approach which is to just ‘stop it’ (such as by sending their children to psychiatrists?).

    Is there a risk that wanting to ‘stop self-harm’, is unwittingly ‘authoritarian’ (perhaps like authoritarian parenting experienced in early childhood for some people in some cultures that pride ‘stoicism’, for example) which seeks similarly, to control, censor and repress the soul’s correct and sane ‘cry for help’ – the trauma distress response of the inner- true self: the inner-child?

    Thanks again for this discussion.

  10. I had my first public breakdown in college. I became obsessed with cutting. I cut, through two more years of college, five years in corporate offices, and about seven years while in a board and care.

    Somebody said once that public speakers have to cuss, because cuss words are the only appropriate words that can describe the shit we survive. Cutting for me was a sacrifice, an atonement. It was the only appropriate punishment for allowing myself to live. The alternative was death.

    Cutting was also creative expression. I spent 14 years as a cutter before someone introduced me to alizarin crimson acrylic paint. And then prussian blue. And then spring green…

    After 13 years in a good board & care , 30 years of competent depth psychotherapy, 20 years in community college learning graphic design and spoken word, 2 years of dance meditation and a life of independence, I don’t cuss so much. And razors, bottle glass, can lids, and Exacto knives are simply art tools.

    I was lucky. I lived through it. I survived psychiatry and found my people as a poet and artist. You don’t cut when you have friends with whom you share love.

  11. I was hospitalized for self injury on and off for about a year. I was dealing with really hard relationship and family troubles. I can honestly say that none of the psychiatric drugs or talk therapy helped because it was all framed as something to recover from.

    Ironically what helped was the bdsm community, I was not a sick mental patient anymore but a badass due to an unusually high pain tolerance. This obviously can’t help everyone, but the complete lack of understanding or concern I got from mental health “professionals” is why I will never deal with those people ever again.

  12. Dear Doctor Cathy Wield,

    I love your article. So generous of you to open such raw wounds to be sharing towards other readers. I am sure many will gain valuable insights from your experiences.

    If I could write a letter to my nineteen year old self I would tell her that it is not smart to lacerate herself. I would tell her she was being an idiot to choose that permanent, disfiguing, never gonna heal, way of being in a temper. I would let her know that scars look flesh pink for a year but that then far from “fading” they look more obvious with the passing of time because they look unnaturally bright and shiny, like stands of white plastic, and this is hard to conceal. I would tell her that although heartbreak seemed the reason at the time, rather the real reason was difficulty expressing ORDINARY emotions. So it was less about “what” those emotions were and more about the ghastly difficulty of how to ventilate them. When she thought it was all about the specific emotions it made it easier to blame others for “causing” those emotions, and then she demands others “change”, not herself change. It is harder to make changes to what you are doing.

    Crying is as necessary an ability as walking. A person can have an ability to walk, and so they may want to walk. Its a sunny day. If they cannot walk they may become frustrated.
    Walk/cry. The problem is not the walk/cry/emotion. The problem is the horrible frustration at not feeling able to. That horrible frustration is what you try to hack out. Conveniently whilst hacking painful wounds you “do” eventually cry, afterwards.

    But over time in this bad habit you then you found a way to deliberately wind people up to “increase your frustration”, at not being able to cry, SO THAT the frustration would lead you to the inflicting of pain on yourself, so that you “could” cry. But eventuall going hunting for things to become frustrated about became more necessary for your daily functioning than finding things that were just plain healing, like nice activities. Then you began to “have a relationship” with your frustration, as if it was a suitor, a count dracula, until you defended that suitor in arguments, because that seemed like defending your right to get frustrated enough to hurt yourself in order to cry.

    But ask yourself this…why not just cry?

    Oh, is it embarrassing? Were you shamed?

    If so, then realize that until you resolve the embarrassment why not just use the embarrassment like a new blade. You can use this bold blunt invisible embarrassment like a steely blade to masochistically revel in humiliating yourself by…

    only crying.

    If you really need to punish yourself to the point of bawling, then be really self harming, in depriving yourself of anything easier to dig into yourself than the sweet sharp shock of getting back to normal, in just normally crying when you
    FEEL LIKE IT.

    It is not that hard. As you will find out some years on. In time to go to a swimming pool with relations, a few of whom are under the age of five. A few of whom look at your scars with worry that you could do such a thing to them.

  13. The author of this article is a doctor which is a great achievement.

    But I have to wonder. Won’t being “outed” with such issues as a doctor make other patients or fellow professionals cautious about being under her care?

    Personally, I would always root for a doctor who has been through stuff like this. Successful people from the psych. labelled group are a positive thing for all of us.

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