Out of harm's way

Self-injury, a common behaviour among teens, needs to be handled with care and courage

By Sangbarta Chattopadhyay & Namita Bhuta
  • Published 26.08.18
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“It hurts so much… the pain is insufferable. The more I try to control it, the more angry and tormented I feel... and the only thing that gives me a little peace is when I cut myself. The sight of blood oozing out of my hand, the smell of it, the physical pain distracts me from the pain I feel inside…”

Accounts of self-harm can be unsettling even for seasoned mental health professionals, teachers and clinicians. And one can only imagine how distressing it is for parents of a child who’s bent on committing self-harm.

A study done in Australia estimated that one out of every 12 adolescents today subject themselves to self-harm, and these figures are only based on reported cases. The figures are likely to be higher in the UK and the US, and we have no reason to believe that India is far behind. 

Most of the time we confuse self-harm with suicide or attempted suicide, and the shame attached to it prevents the sufferer, or the care-giver, from seeking help. Due to this reason, it is difficult to gauge the gravity of the problem in our society. 

Self-harm is not the same as a suicide attempt, although in some cases suicidal thoughts may accompany self-harm behaviour. The intention in self-harm is more to inflict pain and suffering on one’s self, rather than killing oneself. Usually teenagers from age 14 onwards show these self-harming behaviours, but it is possible to see its onset even earlier on. The commonly seen self-harm behaviour includes:

  • Cutting oneself.
  • Burning with a cigarette butt or incense stick or something similar.
  • Repeatedly banging the head or throwing oneself against something hard.
  • Punching oneself.
  • Overdosing on a medicine.
  • Poking things into the body.
  • Swallowing objects.

It might appear that these acts are done calmly and deliberately. They may seem like manipulative and attention-seeking tricks. But a person who is suffering often does not have full awareness and control of their actions as they are dealing with intense emotions and inner turmoil. While some people do it impulsively, others plan it and contemplate for a considerable time before they actually do something. Some people do it only once or twice in their life, whereas others do it repeatedly over many years even into their adulthood.

PSYCHOLOGY OF SELF-HARM

We tend to take our self-preservation and self-interest for granted and self-harm can seem confusing, baffling and an alien idea. But all of us, most probably, have a small degree of self-punishing, self-sabotaging and self-depriving traits in us.

Some of us harm ourselves in less obvious but more serious ways. These can range from indulging in sweets when we have diabetes, falling in love with the “wrong” person, destroying a settled relationship with a fling or an affair, staying in a volatile and/or violent relationship, driving recklessly, and indulging in substance abuse (alcohol and drugs).

If we look at ourselves closely, we will find that at some point we all have knowingly done something that was clearly against our greater good. Many psychologists have explored this “death wish”, “passive aggressive” or “nihilistic” trait that is hidden. We are all often vulnerable and victims of our own mind’s manipulative tricks to choose pain and suffering. But physical harm is more violent and visually disturbing, and so it stands out.

One of the common features in the psychology of self-harm is intense self-loathing and self-hatred. In most cases, the pain one feel is triggered by or originates from harsh self-judgement because of their perceived failure to be accepted by or belong to a larger group. This larger group can be family, friends, society or even the tribe of the so-called “normal people”. 

Unfortunately, often our concerned and well-intended communication with people displaying self-harming behaviour actually adds to the problem rather than solving it. Imagine a terrified parent watching their child slashing themselves. After the initial panic and shock response the communication with the child will go something like this:

“What is wrong with you?”

“How can you do this?”

“We love you and do so much for you and this is how you reciprocate?” 

“Your mother is worried sick, see what have you done to her!”

“Do you not even care for us?”

“We are giving you everything, what else do you want?”

“You are emotionally torturing us and putting us through a very difficult time. We are depressed and we want to kill ourselves now.”

Each of these sentences is more shame-causing than the other. As a society we believe that to “teach” a child, we must highlight how wrong they are, how they are failing us, how they let us down, how they are unacceptable and unwanted.
As authority figures, we spontaneously guide and teach by punishing, reprimanding, shaming and isolating a person.

Even when we may no longer be using the stick, we end up punishing more severely through our words and our disapproval.

The other extreme of the communication is a panicky saviour who says, “You poor baby, don’t do this. I’ll give you whatever you want, whatever distracts you from this.” This doesn’t help either. It will probably make the person feel more miserable about themselves and you are now rewarding and giving an incentive to self-destructive behaviour.

LISTEN WITHOUT JUDGING

It is important to listen to a person demonstrating self-harm. Listening is not a passive phase where you are waiting impatiently for the person to finish and you jump to what you want to say. Listening is a dynamic process. It needs that we first let go of our need to label things as right and wrong, good and bad. We need to pause and be open to seeing the other person without any judgement, being available to them neutrally (not as an indulgent care-giver or as an interventionist).

Neutrally listening to a person is sometimes enough to remove feelings of isolation and disconnection and restore a sense of connectedness in them. It takes a tremendous amount of courage to be able to be calm and centred after witnessing a self-harming episode of a loved one. But it is of utmost importance, as any desperation or pushing can worsen the situation. 

IF YOU ARE A SUFFERER...

When you want to harm yourself, try to remind yourself that the feeling of self-harm is a passing phase. If you can cope with your distress without harming yourself for a time, it’ll get easier over the next few hours. 

  • Talk to someone. If you are on your own, perhaps you can call up a friend.
  • If the person you are with is making you feel worse, go out or go to another room.
  • Distract yourself by going out, listening to music, or by doing something harmless that interests you or that you enjoy. Exercise, brisk walking and running help.
  • Relax and focus your mind on something pleasant.
  • Find another way to express your feelings, such as squeezing ice cubes (which you can make with red juice to mimic blood if the sight of blood is important), or just drawing red lines on your skin.
  • If you need to, give yourself some “harmless pain” — eat a hot chilli, or have a cold shower.
  • Be kind to yourself — whatever you are feeling is going to be okay.
  • Write a diary or a letter, to explain what is happening to you. No one else needs to see it.
  • Later, think of taking professional help. Talk to an adult you trust.

DO AND DON’T FOR A CARE-GIVER

  • Educate yourself and help the affected person learn about self-harm. There are numerous articles online. Make them feel okay about themselves and normal.
  • Take professional help. Often there’s an underlying mental health issue like Borderline Personality Disorder.
  • Help the sufferer think that self-harm is a problem to solve, not a shameful secret.
  • Don’t try to be their therapist. Therapy is complicated and you already have enough to deal with as their parent, friend, partner or relative.
  • Don’t expect quick fixes, or expect them to change their behaviour quickly. It’s difficult and takes time and effort.
  • Don’t react strongly by being angry, hurt or upset. It’s likely to make them feel worse. Talk about how it affects you, but do it calmly and only in a way that shows how much you care for them and how they are loved and valued.
  • Don’t struggle with them when they are about to commit self-harm. It’s better to walk away and suggest they come and talk about it than do something drastic.
  • Don’t make them promise not to do it again. Don’t emotionally blackmail them. For instance, don’t say you won’t see them unless they stop harming themselves.
  • Don’t feel responsible for their self-harm or become the person who would stop them. You must get on with your own life. Make sure you talk to someone close to you, so you get some support.

Dr Sangbarta Chattopadhyay and Dr Namita Bhuta are medical practitioners and practising psychotherapists. They conduct individual and group therapy sessions