Recent studies show that there has been a rise in the rates of self-harm in England, with the highest numbers seen in those aged 16 to 24. Over recent years, this rise appears to have catapulted self-harm into public awareness and common language, yet do we really understand what drives young people to engage in self-harming behaviour? Over my 12 years of working in schools, I have met with courageous young people who have granted me permission to hear their personal stories and experiences of self-harm. This exclusive access to so many first hand personal accounts has afforded me a panoramic view of how self-harm can surface as a response to uncomfortable and overwhelming emotion. Here I will share some of what I have learnt from these remarkable young people, which although may not be exhaustive, may hopefully help us to understand a little more of the puzzling role self-harm can play as a response to stress and suffering.
Self-harm is in itself not unusual human behaviour. In response to emotional discomfort, many of us may have behaved in ways which can be harmful. Consider for example how some people may bite their nails when nervous, over-eat or drink alcohol when sad and smoke or turn to caffeine when stressed. However, when we refer to self-harm, we often think of behaviours at the more severe end of the scale, whereby significant harm and disruption to wellbeing is occurring as a result. When we talk of self-harm we might immediately think of cutting, however, it can take many forms such as skin burning, scratching and picking, ingestion, insertion or inhalation of harmful substances and objects, punching, head banging and kicking, hair pulling and picking, lip biting and picking, restriction of food, drink, sleep and oxygen and delaying evacuation of bladder and bowels. Although some self-harming behaviours can be alarming and minimisation of risk is of course of great importance, it can be helpful not to get too preoccupied with actions and to look behind the behaviour to understand what circumstances and emotional need might be causing this response. Sometimes it may be possible to track the behaviour back to a particular upsetting event, although it is just as feasible that the harm may be a manifestation of small experiences which have amalgamated and collectively formed a sense of unease and unhappiness.
“Just stop doing it” is a directive young people often tell me they hear from well-meaning friends and family, but if this were possible, ‘just stopping’ the behaviour is somewhat like cutting off the head of the weed instead of removing the roots. It is likely going to return either as it was or re-route and surface elsewhere because the source of the behaviour remains. It is more helpful to tackle the root. If we continue with a plant metaphor, we could perceive the behaviour as the shoots of the plant, demonstrating a tendency and attempt to survive, in whatever unfavourable conditions people are experiencing. Psychologist Carl Rogers once wrote “The clue to understanding their behaviour is that they are striving, in the only ways that they perceive as available to them, to move toward growth, toward becoming. To healthy persons, the results may seem bizarre and futile, but they are life’s desperate attempt to become itself.” The title of this blog is a lyric from the song “Blinded” by Abattoir Blues that a student introduced me to; a line I feel beautifully illustrates this outwardly paradoxical nature of self-harm; that self-harm is usually a way of coping and surviving. We may not always be able to affect the circumstances we find ourselves in or prevent undesirable events and therefore, as part of the pathway to recovery it can be helpful to explore alternative safe mechanisms for growth, self-care, resilience and wellbeing.
So just how can something harmful seemingly help someone to endure or respond to painful emotion? By understanding why an individual may be drawn to harm, we can approach either ourselves or loved ones without judgement, criticism or shame, which is essential for building support networks. When speaking with young clients it has become clear to me that self-harm holds different roles for different people. It can for some, feel like the only way to externalise, objectify and translate very confusing, abstract inner felt experiences into something more tangible that both individuals and society can recognise and respond to. For others, internal pain which feels stuck and unresolvable, can seemingly only be released and repaired by creating an external wound that the body can then heal. Some young people engage with harmful behaviours as either a desperate means to feel something when in a state of emotional numbness and disconnection from reality or the reverse; harming to induce a dissociative state to escape, dilute or distract from overwhelming emotion. Self-harm may arise as a last-ditch striving to control something, when individuals feel helpless, and in the absence of secure relationships, people can form an attachment with their behaviours which may feel consistent, dependable and easily accessible sources of acknowledgement and soothing. For individuals who have low self-esteem and hold negative beliefs about themselves, harm can sometimes serve as self-punishment to cancel out or discharge feelings of shame and self-loathing. Such retribution may sound wholly deleterious but can occasionally for some, serve to neutralise uncomfortable emotions by feeling that justice has been served. It is worth noting that although suicidal thoughts and intention do not as a matter of course co-exist with self-harm, there can be an overlap for some, particularly where feelings of worthlessness and hopelessness are present and is a question that needs to be asked.
Although we can begin to make sense of how harm may have come to feature in an individual’s menu of self-support, it is of course not an ideal coping mechanism as it comes with great personal sacrifice, penalty and risk. No matter how the harm manifests and the nature of the background disturbance, the key route to healing is usually the same; human connection. We are still essentially pack animals and hard wired to thrive when connected, accepted and included. Secure relationships with interested, trusted and caring individuals can serve to interrupt the inward self-cycle, promote acceptance and understanding and offer validation and emotional regulation. If we can instead of turning to and relating to ourselves, relate to others who are reliable, consistent and non-judgemental, then we no longer need to substitute these relationships with self-harm. If we can vocalise and gesture through words, tears and facial expression to another, what we are feeling, this offers a clear and direct way of sharing and connecting with others. If it feels too difficult to put into words or too exposing to say out loud in front of another, creative activities such as art, poetry, dance, music, acting, sculpture and writing, all offer healthy vehicles, at arms length, for safely externalising and representing our feelings for us and others to witness. Even engaging with a creative piece produced by someone else that resonates with your own story and experience, can equally help to recognise and represent what we are feeling. In whatever way possible share your story and establish connection; with friends and family, neighbours, trusted adults, counsellors or online and telephone support services. By relating to others, individuals can begin to process and release strong emotions, feel understood, cared for and validated as their humanity and suffering is witnessed and understood. We learn from how others respond to us, how to treat ourselves and a concerned and empathic companion can model self-acceptance and valuing. Self-harm is surmountable if we can strive for its antithesis; connected-care.