‘SI is not a sign of madness; it is not a failed suicide attempt; it is not mere attention-seeking; it is not selfish, it is not an attempt to manipulate one’s friends and family.’

‘I just want people to keep in mind that we SI because we are in pain and this is the way we cope with that pain.’

Self-injury is beset by myths and misconceptions. Stereotyping people keeps myths, stigma and prejudice alive. Becoming better informed is vital to reducing prejudice and stigma. In Chapter 1, the misapprehension that self-injury is a suicidal act was examined. In this chapter ten more common myths about self-injury are appraised. To start with though, we look at who is likely to encounter self-injury in their work, as well as discussing the issue of self-injury in prison, wherein rates of self-injury are reported to be high.

Who encounters self-injury?

Self-injury is encountered in a range of environments. It is familiar behaviour to staff working in prisons, young offenders’ institutions, secure units, special hospitals and psychiatric hospitals. GPs, psychiatrists, psychologists, psychotherapists and counsellors may also encounter patients or clients that self-injure. In addition, it happens in schools, colleges and universities, and may also be seen in children’s homes, housing projects, and alcohol and drug rehabilitation units.

Youth workers, those working with the homeless, and those working in the voluntary sector with rape victims and abuse survivors may also come across the behaviour during the course of their work.

Self-injury in prison

The following testimony from a former repeated offender provides a glimpse into what motivated him to self-injure in prison:

Research suggests that self-injury is prevalent in prisons, particularly among women inmates. Why is it common in prison? Here are some possible explanations. Besides loss of freedom, incarceration leads to other significant losses such as loss of privacy, dignity, self-respect, income, physical and emotional contact with children, family and friends, and intimate relationships with partners. Control over one’s own life becomes a thing of the past, resulting in feelings of powerlessness and frustration. Outward displays of hostility are likely to result in additional punishment, or prolonged isolation. Noise; poor conditions; overcrowding; bullying; time to dwell on the past, the present, or the future, and lack of stimulating activities can lead to raised stressed levels, depression or other mental health issues. It’s also well recognised that traumatic histories feature in the lives of many of those incarcerated.

Strong emotions don’t magically disappear, they need a release, and if striking out runs the risk of further pain or punishment, what other choice is there? Hurting oneself may seem like the only other viable solution.

Research also suggests that self-injury is used in prison for secondary gain, for example as a way of manipulating others into being moved to a prison closer to home and family or to the hospital wing.

Writer and broadcaster, Angela Devlin, who visited many women’s prisons while researching for her book, Invisible Women (1998), gives an example of one such incident – she writes:

I remember one woman officer telling a prisoner she was an attention-seeker. She told me afterwards: “She loves cutting up so she can get into the hospital wing.” I thought how desperate that woman must be to go that far. (p. 277)

Devlin’s closing sentence demonstrates sensitivity and a willingness to think ‘outside the box’ which is essential to understanding self-injury. This takes us conveniently on to the subject of looking beyond the myths.

Myth 1: Self-injury is about getting attention

Unquestionably, self-injury is occasionally used as a way of drawing attention to one’s pain and suffering if attempts to express one’s anguish falls on deaf ears, words cannot accurately convey what is being felt on the inside or one’s emotional needs are not being met. As disclosed by one respondent: ‘I think the reason I used self-harm to try and get attention was connected to the fact that neither of my parents ever showed me any physical affection.’

Everyone needs attention and affection to feel nurtured, special, valued, a person of worth – starved of these essential ingredients to healthy emotional development in childhood can lead to feelings of loneliness, isolation, low self-esteem, attachment issues, psychological distress, and a fragile emotional template.

Moreover, as many people who self-injure go to extraordinary lengths to conceal their wounds from the rest of the world, tarring all those who self-injure with the ‘attention seeking’ brush not only has the potential to add to a person’s distress, it can also serve as a strong deterrent from seeking help for one’s injuries.

To shift away from the negative overtones implied by the term ‘attention-seeking’ one respondent suggested a turn of phrase to ‘help-seeking’. From a personal perspective, since self-injury is more about needing attention, rather than actively seeking attention, my preference is the term ‘attention-needing’.

Myth 2: Self-injury is a teenage phenomenon

With recent media attention highlighting the issue of self-injury in young people, it is easy to make the assumption that self-injury is an exclusively teenage phenomenon. Figure 2.1 shows the age people started self-injury from the postal survey undertaken for Healing the Hurt Within, 1st edition (Sutton, 1999) and the Internet research, from which you see that the highest percentage of respondents from both studies did start self-injuring in their teens. However, the data clearly demonstrates that onset of self-injury in childhood and adult life is also common, thus contradicting the myth that self-injury is a wholly teenage phenomenon.

Clarifying who self-injures

Self-injury knows no bounds. It affects all strata of society – men and women, all age groups, social classes, ethnicities, religions and educational backgrounds. The bond shared by all is emotional pain.

Myth 3: Self-injury is a female phenomenon

In the main, research suggests that self-injury is more common among females, and data from both studies supported this theory (2 males [5%], 35 females [95%] – postal survey; 8 males [10%], 74 females [90%] – Internet research). Nonetheless, it is important not to lose sight of the fact that males do self-injure, despite them appearing to be in the minority. Indeed, the Internet research drew my attention to how neglected some males who self-injure feel due to much of the research and other media (books, articles, websites and so forth) focusing principally, or exclusively, on women. Here is what some male respondents had to say on the topic:

Why the possible genders divide?

Common theories about why men are in the minority centres on differences in socialisation. For example, holding the beliefs that ‘big boys don’t cry’, or that ‘showing emotions is a sign of weakness’ may serve as obstacles to men admitting they have a problem and seeking help for self-injury. Further conjectures are that men resort to more socially tolerated methods to cope with difficult emotions, such as drinking and brawling; by channelling anger and releasing tension through participating in aggressive sports (rugby, football, and boxing). Yelling support or abusive remarks from the terraces at football matches or similar, or risk-taking behaviours such as high-speed driving, may also provide a useful outlet for discharging pent up emotions. The following testimonies from four male respondents provide insight into their thoughts on the subject:

Closing the emotional floodgates

As borne out by the following testimonies from female respondents, it appears as if males are not alone in their belief that ‘crying is not acceptable’ or that ‘showing emotions is a sign of weakness’:

Crying is an innate response – it is how babies communicate their needs – their hunger, thirst, discomfort, distress and frustration. It’s also a human response to upsetting feelings – to the heartache of sadness and sorrow, the grief of loss and trauma – it takes the sting out of unspent anger and rage, cuts through emotional numbness, lightens the load from pent up emotions, soothes hurt and lifts mood. Crying has a calming effect – it is perfectly normal, healthy, therapeutic, and emotionally healing. An inability to release painful emotions naturally via the conventional channels of talk and tears can lead to unconventional behavioural methods being adopted to cope, one of which, as evidenced from the women’s testimonies, is self-injury.

Tears are the safety valve of the heart when too much pressure is laid on it.
—Albert Smith

The women’s responses also emphasise how parental or primary caregiver’s words and actions towards children, can become an integral part of a person’s internal belief system. Being punished for crying or displaying emotional upset as a child can lead to a sense of shame at giving into emotions – it is a sure fire way to dry up the tears reservoir along with a valid reason to close the emotional floodgates to protect oneself from the possibility of further suffering. Not only does this leave people emotionally impoverished and inadequately equipped to verbalise painful childhood experiences, or to work through ‘stuck grief’ from childhood trauma, it can create issues with trust, and fear that if emotions are expressed, further hurt or rejection might result. The dread of losing control of one’s emotions; being at a loss for words; appearing stupid, foolish or weak, or the fear of making oneself vulnerable by opening the emotional floodgates can also serve to keep the barriers firmly closed.

The sorrow which has no vent in tears may make other organs weep.
—Henry Maudsley

Why more women?

If self-injury is more prevalent among women, why is this? Here are some possible explanations for the discrepancy:

• Self-injury often has its roots in trauma, and more women than men experience traumatic events such as sexual assault, rape, or domestic violence.
• Self-injury frequently stems from an inability to express emotions, chiefly strong emotions such as anger, frustration, or resentment. Anger, often bound with fear of conflict, fear of getting hurt, fear of hurting others, or deemed unacceptable to self, is a particularly troublesome emotion for many women that self-injure. Left unexpressed or channelled appropriately, it can become a ticking time bomb, which, when taken out on oneself, is quickly defused. In other words, many women that self-injure implode their anger (turn it inwards), rather than directing it outwards. In contrast, overt displays of anger (physical aggression, fighting, bullying, vandalism, anti-social activities, and criminal behaviour) are more commonly seen in men.
• Women in general find it easier to share their problems and feelings than men do, hence, when it comes to seeking help they may be less resistant to do so than men.
• Depression and self-injury are frequent companions and more women than men suffer from depression. However, whilst this may be true, it is worth bearing in mind that many men suffer from untreated depression, which may hide itself behind the mask of workaholism, substance misuse, or engaging in high-risk activities or aggressive sports.

Myth 4: Self-injury is contagious

Self-injury contagion (copycat effect) in institutional environments such as detention and treatment centres has been the subject of various research studies. As yet, though, studies of contagion in schools, colleges, universities and other community based settings are limited (Walsh, 2006, p. 231) and further investigation is needed. However, in a UK cross-sectional survey of 6020 school pupils (Hawton, et al., 2002) the authors concluded that an ‘awareness of recent self harm by others suggests a possible modelling effect’. In a similar Australian study by De Leo, D. & Heller, T.S. (2004) of 3757 year 10 and year 11 students from 14 high schools on the Gold Coast, Queensland, the authors came to a likewise conclusion. Due, though, to the broad definition of self-harm used by the study authors, which included self-injury, overdosing, or illegal drug taking, it is unclear exactly which self-harming behaviour the young people are mimicking.

Media portrayal of self-injury contagion among teenagers

The above sub-headline, from an evocatively written article, entitled: Why are so many teenage girls cutting themselves? stirred up a hornet’s nest among people that self-injure, resulting in a string of complaints to the editor. Many readers felt affronted and upset by the article, particularly the author’s reference to self-injury being a ‘blood cult’. Some suggested that the article was written to ‘grab readers’ attention’, was ‘deliberately sensationalistic’ and ‘highly contradictory’, and was based on fiction, rather than fact. Some charged the author with failing to do her research on the subject, of presenting a misleading and biased picture erring on the side of self-injury being attention seeking or a passing fad and of confusing self-harm with teenage experimentation. One felt strongly that it was ‘an appalling piece of journalism’; another didn’t mince her words, remarking that the article was ‘bull shit’. (SIARI, 2001–2007)

Copycat behaviour? Discovered by accident? Just seems to happen?

Two Internet respondents reported copying a friend:

In contrast, a significant number reported discovering self-injury by accident or that it just seemed to happen:

The responses also highlight several other key points: that self-injury provides a release; it makes people feel better, that once started it can become a way of coping, and that several people started as a reaction to their anger. If self-injury is spreading among teenagers, perhaps the most urgent question that needs addressing is why? Further discussion on whether self-injury is on the increase among young people can be found in Chapter 4.