“No one knows I do it, cut that is. If they did, they would think I was crazy. A loony. But it helps me. It gives me a break from those thoughts that circle round and round in my head that tell me how stupid, worthless, ugly, bad, dirty and rotten I am and how I can’t do anything right, that I don’t deserve happiness … It gives me a break from the feelings too. When things happen that remind me of my past – the things done to me, the things I’ve done to myself, it all comes on, the shame, guilt, sadness, anger, and fear … It just becomes too much and so I need a release from it, something to take it all away. And cutting does that. I’m not sure how, but it does. The problem is, it never lasts for as long as I would like… but for now it works. I can’t give it up. I won’t.”
“I’m in my sixties and I’ve cut for decades. At first it was a way for me to relax from the pressures of having to live up to the expectations people had of me. When meeting those expectations got too much or when I was left feeling that I hadn’t lived up to those expectations … that I had failed …, let someone down, I would cut. It gave me a sense of control, and took away the pain … the emotional pain I was feeling. I still use it to support myself when things get too much.”
“I cut, burn my skin, starve myself, overdose on meds, drink excessively, and exercise fanatically … I’ve tried lots of things to manage my feelings of failure, disappointment, anger at myself and at others, and they all work for a while but I hate how I feel afterwards. So like after I cut, I look at the scars and think, ‘You are such a loser for doing that’. I feel miserable, like scum.. But then a part of me also looks at those scars and I think they tell a story about me. They remind me of what I’ve been through and that I’m still here … Still surviving. And that’s the thing – the scars and all the other ways that I harm myself, allow me to survive. So it can’t all be bad, can it?”
It is a fact that we will all knows someone who self-injures. Perhaps you self-injure or maybe it’s someone you know from school, college, work; a friend, relative, a parent, a sister, a brother, a partner. For many people, self-injury might not make sense. How they wonder, could anyone harm themselves in the ways outlined above?
In this article we will look at some of the reasons why people self-injure, and what their experiences of self-injury may be like. We will focus on cutting, as this appears to be a very popular form of self-injurious behaviour. We will then look at what therapy would be like for you or someone you know who wanted to talk about their self-injurious behaviour. The article will end with details being given of organisations that can be contacted if you or someone you know is being affected by the issues raised in this article.
The prevalence of self-injury.
In the United Kingdom it is now estimated that self-injury is very common, with there being over one hundred and eighty thousand accident and emergency attendances annually due to self-harm (Haw ton et al, 2007) A large group of people who self-injure are under the age of 35 and two-thirds of people in this age group are female. Overall, women are more likely to self-injure than men (Fox & Haw ton, 2004) There is also a higher rate of self-injury amongst prisoners, asylum seekers, veterans from the armed forces, people bereaved by suicide, some cultural minority groups and people from sexual minorities (Royal College of Psychiatrists – June 2010). As indicated in the quotes above, cutting and self-injury can affect anyone at any age and at any stage in their life, as indeed, it can anyone irrespective too of a person’s gender, ethnicity, class or sexual orientation.
What is it’s nature?
Self-injury can take many forms. The most common form is cutting using razor blades, knives and glass. Arms, legs and stomach are the most popular body areas cut. Other forms of self-injury include banging, hitting and burning, self-biting, skin picking, scratching, burning, inflicting blows on body parts, strangulation, breaking bones, interfering with healing wounds, stabbing, hair pulling, swallowing objects, embedding objects in the body, jumping from a height, hanging and deliberate road traffic related injuries.
There is also a wider group of behaviours that could be classified as self-injurious: These are any behaviour, which involve repeated self-neglect. This includes excessive alcohol or drug consumption, behaviours associated with eating disorders, or excessive exercise, physical risk-taking, sexual risk-taking, misuse of prescribed medication and excessive body piercing or tattoos.
As the quotes above show, people tend to use a variety of ways to self-injure, it is quite common to find those cutting to have eating disorders or to drink excessively. There are many assumptions or myths that surround the topic of self-injury and cutting. There is an assumption that all those who self-injure have experienced abuse like child sexual abuse. Although there is evidence to suggest that rates of self-injury are higher amongst people that do have a history of abuse there is plenty of evidence to suggest that people who have not experienced such abuse still self-injure. It is evident from the research, and from my experience of working with people that self-injury is a result of trauma, neglect or abuse. What that means, is that it is a response to events, which may have involved a single experience like the loss of someone very close to them, or enduring repeated events.
So what functions does self-injury serve?
Based on my experience of working with people who self-injure, and as reflected in the quotes above, the reasons for this will be unique to the individual. Some of the reasons, which individuals have given for self-injury, are below.
Affect Regulation – Feedback from people who cut has suggested they self-injure to gain some relief from the negative feelings, emotional hurt, anger and frustration and intrusive negative thoughts related to themselves, others or the world which come as a result of the trauma, abuse or neglect they may or might currently be experiencing. Self-injury reduces these thoughts and feelings resulting in the individual feeling a sense of comfort and relaxation. Cutting does this through releasing endorphins, which send chemical messages to the brain, allowing it to relax. It would also seem that the build up to the act, that is preparing for the cut, choosing the blade, getting out the tissues, examining a spare patch of skin begins the process whereby the body and mind begin to calm. This continues with the physical act of cutting as it diverts attention from the emotions and thoughts to the feelings and sensations associated with the cutting, allowing the person to escape, through distraction, to a place of peace.
Self-punishment – A second well reported reason for cutting is that it can serve as a means of self-punishment for the actions of those who may either have abused them (which they wrongly take responsibility for), or is punishment for something they feel they have done to themselves or to others. The act of cutting and in particular the associated sensations of pain which come from the actual act itself, is considered a way of atoning for their perceived wrong doing in life, and for some cutters atoning for the guilt and blame they wrongly feel after they have been sexually abused. How deep they cut can be related to how much they feel they deserve to be punished. They will keep cutting until they feel they have been punished enough.
Control – A function, which is often described by people who self-injure is that self-harm helps provide a sense of control and autonomy when their lives are unsettled and chaotic. It can be likened to changing uncontrollable emotional pain into a physical pain, which the person can more easily control through the entire process of cutting. For example, controlling when and where to cut, how deep, and for how long.
Self-injury can also demonstrate autonomy and control over a person’s own body. This can be of particular importance to someone who has been sexually abused. Cutting is something they may do to their own bodies as opposed to something done by another to their body. An added dimension here is that the cutting may take place in a secure and private part of them, which has not been violated by others. This may give them that sense of control and power they lacked when abused.
Communication – Self-injury can seem to be a way in which an individual can communicate to her/himself, the unseen emotional pain s/he is feeling inside. For example, shame, or anger. However, it can also communicate a message of survival and struggle through branding. Each cut will leave a scar, a reminder to that person of their perceived errors or wrong doings or conversely, their resilience as evidenced in the fact they have survived this emotional pain.
Healing – Self-harm can be used as a means of “cleansing” oneself, especially when the individual has experienced sexual abuse. For some cutters, the blood and cuts associated with the act represent the removal of the bad parts of themselves. The more cuts and blood removed the “less bad” the client feels about himself or herself.
Dissociation – People who cut sometimes indicate that it ends depersonalisation and disassociation. Depersonalisation is a condition where the individual feels detached from himself or herself, observing themselves and their feelings and thoughts as if they belonged to someone else. Dissociation is a condition that alters a person’s sense of reality so that their body or the world around them is experienced as unreal leaving them feeling empty, numb and unreal. Research and feedback from cutters suggests that the pain and other feelings associated with the act of cutting and being able to see and touch the blood plays an important role in reducing these feelings bringing back a consciousness and sense of connection to the body.
However, and as an example of the paradoxical nature of cutting, it can also be viewed as a way of creating a dissociated state. As mentioned earlier, the act of cutting allows the individual to “let go” of overwhelming feelings and thoughts taking them to a place where they may feel numb. This is a sensation felt by individuals who experience depersonalisation or disassociation.
Here we begin to see some of the contradictions associated with cutting. Another area of contradiction and complexity can be seen in the reinforcing, cyclical and addictive qualities of self-harm.
The cyclical nature of self-harm.
After the act of self-injury, individuals often have negative thoughts and feelings. They can feel ashamed, angry, disappointed and guilty for what they have done. For many, this continues when they see the scars associated with the act of cutting.
Cutting can also make individuals feel even more isolated. Many keep it a secret, as they are aware of society’s views that self-harm is socially unacceptable and the lack of knowledge most people have about the subject. Cutters become fearful of being judged or misunderstood.
They can also be fearful of telling others about their self-injurious behaviour for the fear of being labelled as someone with severe mental health issues and worry too about how other people like a parent or a partner might then react/cope with it. Thus the relief they may feel from the act itself may well be temporary because of the above. It also is temporary relief because it does not address the original trauma, neglect or abuse, which underlie the self-injurious behaviour. This remains unresolved and thus the associated feelings and thoughts are still there, meaning that many people will continue to use self injury as a coping mechanism for the overwhelming feelings and thoughts associated with this.
Other reasons for continuing to use self-injury as a coping mechanism can include people not being aware of other coping mechanisms available to manage these overwhelming feelings. It can also be because they believe they can’t or should not stop (more said on this later).
So can you ever stop self-harming?
Yes you can.The journey to recovery will be different for each individual as their experiences of self-injury and their relationship with it will vary depending on issues like the nature of their past experiences of trauma, neglect or abuse. It will also be dependent on the impact, which self-injury and the traumas that have led to it being used as a coping mechanism have had on how they perceive themselves, others and the world around them. For those who self-injure, these perceptions, including perceptions of self tend to be critical, punitive, hateful ones, devoid of self-love or self-compassion. They result from messages received from significant caregivers or other important people in the individuals’ life. These messages encourage hatred of self. Selves, which internalise all of this are produced. These parts or selves are then considered to represent the “bad”, “not good enough”, “undeserving”, “ugly”, “ungrateful”, or “stupid” parts of the individual. These parts can encourage the individual to engage in self-injurious behaviours because they make the individual think and feel they deserve and/or can’t survive without it.
What might therapy be like?
So let’s imagine, you are self-injuring and were thinking about therapy. How might it be? If you were to seek therapy with me, I would start with the premise that anyone who has self-injured is a survivor who has found inner resources to manage overwhelming feelings and intrusive thoughts that arise from the traumas, neglect or abuse that self-injury is a response to. I would acknowledge and respect your courage, tenacity and resilience.
I would respect too, that it is for you and not me to decide how and if you wish to self-harm – to do so reaffirms your autonomy and sense of control. At the same time however, I would work with you to explore alternative coping mechanisms. If you are or know of someone who is self injuring, then you may wish to consider or tell them about the following ways to manage the thoughts and overwhelming feelings. These include snapping an elastic band on the wrist, exercising, listening to music, drawing, making something, taking a hot bath, calling the Samaritans, accessing an online support forum, squeezing ice cubes or rubbing them on your wrist, calling a friend or writing.
We would talk openly about boundaries, confidentiality and limits to it – especially in light of concerns regarding your safety and risk to yourself.
The focus of our work would be to look at the traumas, abuse and loss, making sense of the feelings and thoughts that underlie your need or urge to self-harm. I would do this by listening, empathising, not judging and working with you at a pace you felt comfortable with. I would stand alongside your distress and by doing so hope you would feel supported and not so alone.
Working in this way, would also provide a very important conduit in which to challenge some of the ways you might view yourself. Most self-injurers use words like self-loathing, disgust and hate to describe themselves. These have been created as a result of the traumas and abuse or neglect which self-injury is a response to. Through the process of “working through”, we would work to connect or build up more compassionate, loving parts of yourself. These would create an internal self encouraging you to feel you have the right, the ability and are deserving of managing your emotions in a way that is ultimately less destructive to yourself. It would not be an easy journey but I would be there with you through it all. You would not be alone. I would not abandon you.
Take good care readers.
If you live in Britain and in the case of an emergency, please dial 999
National Self Harm Network – provides a forum, support and information for individuals, family and carers who have been affected by self-harm and an online support forum www.nshn.co.uk
CASS Women’s Self Injury Support Helpline – Tel no: 0808 800 8088 (Open on Tuesday to Thursday evenings from 7pm – 10pm)
Milton Keynes based organisations
If you live in Milton Keynes, England, you can access the following groups:
Surface – offering peer support groups fortnightly to those who self-injure in Milton Keynes E-mail: firstname.lastname@example.org
Youth Information Services – provides counselling to young people aged between 11-21 years of age. Tel no: 01908 604 700
Talk for Change – a first point of contact for people wishing to access psychological therapies in Milton Keynes
The Mix – weekly drop in sessions, offering information and support for those affected by mental health problems.
Arts on Prescription in Milton Keynes – for people with mild to moderate mental health conditions (depression, stress and anxiety)
West Bletchley Counselling Centre – free community-counseling service for people with an MK3 postcode
Balanced MK - for people affected by an eating disorder.