Self-harm: cut it out

It is a sign of a sick society when young people start turning to self-harm to work through their emotional problems. But it is an even sicker society in which medical and political authorities give sanction to their actions.

Last week the National Institute for Clinical Excellence (NICE) released new recommendations for dealing with self-harm (1) – cases where people cut, burn, poison, or otherwise deliberately harm themselves. The institute said that self-harm was reaching ‘epidemic’ proportions, and emphasised the need for doctors to be more understanding and remove the ‘stigma’ surrounding it.

Richard Pacitti, an adviser on the new guidelines, said that self-harm could have a ‘positive value’ as a ‘coping mechanism’ for people who might otherwise have committed suicide. He recommended that health workers should see their role as minimising the practise, rather than stopping it altogether: ‘Self-harm isn’t a disease or an illness’, he said, ‘it’s an aspect of some people’s behaviour’ (2).

In March 2004, the Mental Health Foundation and Camelot Foundation launched an inquiry at the House of Commons looking into self-harm in young people, which was backed by MPs from across the political spectrum. The inquiry’s website cheerfully announces its aim to ‘educate and raise awareness about self-harm – for everyone!’. By ‘shifting culture’, it wants to move ‘towards a more flexible, user-focused, non-alienating, “no-blame” culture for young people who have experience of self-harm’ (3).

Of course, self-harm can’t just be blamed on individuals – instead, it speaks of real and worrying problems with our society. But these real and worrying problems can only be made worse when those in authority start sending the message that self-mutilation might be an acceptable way to express yourself.

For some, self-harm can just be a teenage phase – the practise is known to occur in ‘outbreaks’ at girls’ boarding schools, for example, in much the same way as other fads. But for others, it can become a dominating and destructive part of their lives.

Different people give different reasons for why they self-harm, and many say that they simply ‘don’t know’ – but the practise seems to be a response to feelings of extreme social isolation or self-loathing, and it particularly affects young women. Jacqui, one of the board members of the National Self-Harm Network who has been self-harming for the past 26 years, told me that ‘my main trigger is anger; if I get very angry, I don’t have any way to express that anger. I turn it in on to myself’. For her, cutting herself is ‘a release; it has an immediate calming effect’.

On the internet sites where people discuss their experiences of self-harm, one person talks of ‘intolerable distress’, another of extreme ‘tension and anxiety’ (4). The pain of cutting seems to have a sobering effect, with the flow of blood standing in for the letting out of emotions. Some say that it makes them feel more ‘real’ when they’re feeling out-of-sorts, the pain affirming the fact that they really exist. For others, it seems to be a way of communicating their inner distress to others – by wounding themselves, there is something concrete that other people can see. There is also an element of asserting control over one’s own body, as Jacqui tells me: ‘I feel that I am taking back some control for myself; I can control how much I hurt myself, how much pain I cause.’

If people are cutting themselves rather than talking to others, and trying to take control of their lives with a razor, something is going seriously wrong. The self-harm phenomenon is the hallmark of a fragmented, alienated society, where people lack the support networks to deal effectively with their problems – and instead turn them back upon their own bodies.

But this isn’t helped by the current publicity about self-harm. The more that adults talk about the self-harm ‘epidemic’, or discuss its virtues as a positive ‘coping mechanism’, the more that young people will come to see it as an option.

Michael Maher, a group analyst, tells me that when he first started working in the area of self-harm 17 years ago, it was seen as an ‘exotic behaviour’. Now, he said, it has become part of people’s vocabulary: ‘if you’re going to choose a language of distress, self-harm is part of the menu of choices that people use for expressing distress.’ The issue has become part of popular culture: for example, there was a recent story about self-harm in Hollyoaks, the soap for young people. We also hear about celebrities who have harmed themselves, such as Johnny Depp and Princess Diana – which prompted the MSN self-harm discussion group to set up a section entitled ‘Your [sic] not alone – celebs who SH’ (5).

Meanwhile, it seems that some frontline health workers already take the non-stigmatising approach recommended by NICE. Jacqui says that her community psychiatric nurse doesn’t try to talk her out of it: ‘[the nurse] says, “I respect your choice to self-harm, but if you cause yourself any serious damage, we’ll intervene”.’ According to Jacqui, ‘self-harm is my preferred coping mechanism and she’s not going to take that away from me’. The message here is that hurting yourself is an acceptable way of dealing with your problems, so long as it doesn’t go too far – health officials’ aim is to manage it rather than try to stop it.

In terms of treatment, self-harm is always going to be a difficult issue to deal with. It’s not a definable mental or physical illness, with causes that can be diagnosed and treated. As Michael Mayer tells me: ‘there is no formal mental illness problem, nothing organically wrong that can be ascribed to a specific thing.’ Nor are there any quick-fix solutions. Clearly dosing people up with psychiatric drugs is inadequate, as is just telling them to ‘snap out of it’.

But self-harm needs to keep its ‘stigma’, in the sense that we shouldn’t forget that there is something deeply wrong with it. Giving self-harm official sanction as a ‘coping mechanism’ is only likely to entrench the practice, and make it more acceptable. Perhaps part of the ‘treatment’ for self-harm could be social criticism, which can help to explain the roots of the phenomenon – and could also help to build a more engaged, creative society in which young people don’t have to express their feelings with razor blades.

(1) See the NICE guidelines

(2) Self-harm ‘growing issue for men’, BBC News, 28 July 2004

(3) See Young people and self-harm: an inquiry

(4) See the MSN Self-harm discussion group

(5) Celebs who SH on the MSN website