SELF HARM, STIGMA AND SOCIAL ANGST by Stuart Sorensen

Some forms of self-harm are more socially acceptable than others. The dividing line between ‘acceptable’ and ‘unacceptable’ changes as society evolves. A topical example of the way that society’s tolerances change relates to smoking. Twenty years ago this form of self-harm was completely acceptable, even encouraged. Today society has a rather uneasy relationship with the habit. It may be that in just a few more decades it will be just as socially unacceptable as opium use is today – a state of affairs that would have been very hard for our Victorian forebears to understand. For today though self-harm is generally considered to mean physical injury or ingestion of substances, prescribed or otherwise, that harm the person.

Self-harm is often a response to distress

“The most common reasons given were ‘to get relief from a terrible state of mind’ followed by ‘to die’, although there were differences between those cutting themselves and those taking overdoses. About half the young people decided to harm themselves in the hour before doing so, and many did not attend hospital or tell anyone else. Just over half those who had harmed themselves during the previous year reported more than one episode over their lifetime.”
Journal of child psychology & psychiatry (2008)

Stuart Sorensen

Stuart Sorensen

I don’t want to get too deeply into a discussion of addiction as a reason for self-harm here because that will only cloud an already confused issue of definition. I do think that society is too quick to treat chemical addiction differently from self-harm. In many cases the chemical effect of self harm is very similair indeed – hence the oft-reported feelings of ‘release’, ‘euphoria’ or ‘buzz’ that follows much self-harm.

It has been said that the main problem associated with self-harm is not the physical damage itself so much as the stigma that surrounds it. Personally I don’t think that this is always true but there is certainly a major issue with stigma, including the attitudes of some workers toward people who harm themselves
Much of the stigma comes from the many myths and misconceptions that abound among professionals and the public alike. I remember as a student nurse in the early 1990s being fed these same myths by nursing and medical staff. The failure to see past our own perceived importance as professional ‘experts’ led to some extremely damaging and cruel approaches to people who harm themselves. Let’s look at some of the more common of these misconceptions

The ‘cry for help’

Perhaps one of the most common myths is to do with the notion of the ‘cry for help’. The idea is that by cutting or otherwise injuring themselves service-users are trying to get some sort of assistance from workers. If this is true then as professionals working in the field we need to ask ourselves some very difficult questions such as……
 Do these people really not know how to ask for help?
 If not – why not?
 What sort of help can I offer them that is worth self-mutilation?
 Am I really that special?
 How good am I at noticing people’s distress if they need to resort to self-harm to get my attention?
 What’s wrong with our access policies?
 How good are my listening skills?
 How ‘accessible’ am I if people can’t just talk to me and ask for what they want?
 What does this say about me as a professional and as a person?

The ‘manipulation’ myth

Another myth is that self-harm is an attempt to manipulate or emotionally blackmail professionals.

 Do we really believe ourselves to be so important, so ‘special’ that people will mutilate themselves just to influence our thoughts, feelings and behaviours?
 Is self-harm really all about us as professionals or is it more to do with the personal needs of the client?

The ‘attention-seeker’ myth

Then there is the good old ‘attention seeking’ myth. It doesn’t take a genius to work out how inaccurate such an assumption is likely to be once we understand that the vast majority of self-harm is done secretly and in private.

“Since many acts of self-harm do not come to the attention of healthcare services, hospital attendance rates do not reflect the true scale of the problem.”
British Psychological Society &
Royal College of Psychiatrists (2004)

What we do know is that the incidence of clinically significant self-harm is rising in UK. Ironically this trend of increasing self-harm might actually be the result of society’s angst over the issue. One interesting theory about the rise of self-harm, particularly among the young is that by raising awareness and normalising the behaviour well-meaning campaigns are creating an environment that encourages it:

“In my view, as long as self-injury is discussed as a common and legitimate expression of distress amongst students and young people, and as long as the behaviour is normalised and publicised through awareness initiatives, people will increasingly turn to this very behaviour as a way of communicating and relieving their discomfort. We must therefore seek to question the necessity for, and challenge the usefulness of, such campaigns, and ultimately ask ‘Is awareness making us ill?’ ”

Crowley R (2007)

If we could only stop assuming that self-harm is about ‘us’ (manipulation, attention-seeking, emotional blackmail) we might begin to see self-harm for what it really is – an emotional coping strategy. Then perhaps we might notice that it’s generally far less harmful than other, more acceptable coping strategies such as smoking, hard-drinking or impulsive risk-taking.
But those explanations don’t make the rest of us feel important or special. Perhaps that’s why the old myths have lingered on so long.

References

The British Psychological Society & The Royal College of Psychiatrists, 2004 Self harm (a leaflet)

Crowley R. (2007) The Psychologist Volume 20 – Part 5

Journal of Child Psychology and Psychiatry Volume 49 Issue 6, Pages 667 – 677 Published Online: 10 Mar 2008 Journal compilation © 2008 ACAMH

Stuart Sorensen is an independent social care and mental health trainer and speaker. He is also a practicing registered mental health nurse.

You contact him via his website: http://www.TheCareGuy.com or through Twitter on @StuartSorensen

If you would like to write for Care To Share Magazine please Email Stuart at info@thecareguy.com

You can download this and previous editions of Care To Share Magazine from here

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5 thoughts on “SELF HARM, STIGMA AND SOCIAL ANGST by Stuart Sorensen

  1. Thought provoking piece Stuart. In particular:

    “If we could only stop assuming that self-harm is about ‘us’ (manipulation, attention-seeking, emotional blackmail) we might begin to see self-harm for what it really is – an emotional coping strategy.”

    That sentiment can and should be applied across the board from surgeons to support workers when dealing with any form of behaviour that we and society in general finds challenging. In my experience it’s only when we remove our pre-conceived, hand me down opinions from the equation that we can truly be of use to people. I’m forever banging on about how the language we use to describe someone or something can colour our perception of them or it and hinder attempts at finding better ways of coping.

    • I agree. Language is really important. I have a major issue with the way we say we’ll ‘let’ people do things (as though we have any right to ‘stop’ them in the 1st place). Might write about that shortly.

  2. “In my view, as long as self-injury is discussed as a common and legitimate expression of distress amongst students and young people, and as long as the behaviour is normalised and publicised through awareness initiatives, people will increasingly turn to this very behaviour as a way of communicating and relieving their discomfort. We must therefore seek to question the necessity for, and challenge the usefulness of, such campaigns, and ultimately ask ‘Is awareness making us ill?’ ” I made this point to self harm uk, and they disagreed & said awareness stopped tenagers falling into the behaviour. Yet more & more are falling, so what should we do to educate while at the same time preventing?

    • Hi Self Harm Parent,

      Thanks for commenting.

      Yes – it does seem counter-intuitive, doesn’t it? In all honesty I don’t know myself whether it’s better to raise awareness or not. What I do know though is that there is good evidence that people who see behaviours as common also come to see them as viable options. This has been noted in several fields of study from suicide to binge drinking although I’m afraid I’m unsure of any research particularly aimed at non-suicidal self harm.

      It may be that the real issue isn’t just about raising awareness (a very generalised description). Perhaps we need to consider the type of information that is delivered. After all telling people that self harm is increasingly common and help is available is one thing. Pointing out that there are other coping strategies available, offering signposts to further help and suggesting alternatives is quite another. Both would justifiably be called ‘awareness raising’ but only one would provide a route out of distress.

      Perhaps we need to be a little more discriminating in our use of the term ‘awareness raising’. What do you think?

      Cheers,

      Stuart

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