Deliberate Self Harm (DSH)

Editor’s note:  A friend told me an horrendous story that he was working at a client’s office last summer on one of the rare hot days and he noticed one of the young women in his area was wearing a cotton top with long sleeves.  When he said “Isn’t it a bit hot today for long sleeves?” she became somewhat flustered by the comment and insisted that no, she was fine.  During the exchange he noticed that the sleeves of her shirt had several spots that looked a lot like blood stains.  He later found out from another young woman that the first girl had for some months been cutting her own arms with a razor blade.

Scott Probst is a psychologist who works in child and adolescent mental health.   This is story.

What is self-harm? This is when a person deliberately hurts themselves with some kind implement to cause pain and injury. Who does this? Men and women, as well as young people, both male and female. The people who harm themselves seem to be skewed towards being more younger than older, and more female than male, although it is hard to be definite about this. Why do people do this? My own experience in speaking with them professionally is that there are a few common reasons.

First, they seek to decrease very large amounts of emotional pain by inflicting physical pain on themselves – harming themselves ‘lets the pain out’ in some sense. This works reliably for a lot of people – this is why they keep doing it. Second, they seek to feel real, as they feel either numb from the impact of trauma and neglect, or feel so totally overwhelmed by emotion that they feel they are losing contact with the world around them. In some cases, people self-harm in order to lessen the feelings they might have about killing themselves – it’s the lessor of two evils. This isn’t an exhaustive list – there are other reasons people do these things to themselves and they are slightly different for every person.

While the fact that a proportion of people harm themselves deliberately has gradually been percolating through the public consciousness in recent years, deliberate self-harm has been a known fact of life for many in the health and mental health professions for a number of years. So common is this behaviour that there is a common acronym for it – DSH, short for “deliberate self-harm.” People have self-harmed for many years; my working life covers about 30 years, and it certainly was not unknown at the beginning of that time.

There are accounts that this behaviour is becoming more common, which is a disturbing thought. While I’ve not seen reliable statistics about this, there are certainly a lot of people harming themselves deliberately, and many of them on a regular basis. For a number of reasons it is very hard to know if it is becoming more common or not – most obviously, many people who do this avoid letting anyone else know. Also, statistics are often only based on people who present to hospital with damage from self-harm, which does not really tell us much about others who may be harming themselves without having to go to hospital. A quick search on the internet will return numbers from different countries that indicate different trends, according to how these estimates are made.

Psychologists are in the business of trying to figure out why people behave the way they do, and then attempting to help change the things that cause their clients problems. So of course there has been a great deal of discussion and research over the years into the causes of self-harm and ways to help people out of this cycle. I’m not going to go into this here; much of it is freely available on the Internet and is there to be read in one’s own time. A couple of starting points are: Reach Out and Kids Helpline, which provide support for young people over a range of issues. There is even some peer-reviewed research available online for free, such as this article from the Medical Journal of Australia. This site for America’s National Self Injury Awareness Day provides access to some information about the level of the problem in that country.

I’m interested in the link between the rise of the ‘cult of the individual’ and things like self-harm.

What is this cult? I think it has a number of aspects. Most obviously, there can be not much doubt that we are living in an age of entitlement; usually aimed at the government, we feel we should be given more and more help, usually in the form of money, and pay less and less in the form of tax. The concept of ‘the social contract’ has itself contracted, till it is tiny, nearly invisible. The idea that we might be in some kind of relationship with everyone around us, where we give a little and they get a little, and vice versa, seems archaic and almost curious to many people.

This entitlement extends in many directions besides the most obvious ideas about money. One of the most frequently heard phrases in public debate, or general discussion of any kind, is an expression along the lines of “I’m entitled to my opinion.” It’s odd that people even say this, as most of us, in previous times, would actually take it for granted. What this statement seems to really signify when people say this is that having their opinion means that others have to accept it, and agree with it. Argument, much less criticism, is not acceptable. We are entitled to say whatever we like, without having to brook any discussion from others. And often enough, opinion is taken to be a legitimate reason to act, regardless of the opinion of others or any actual evidence that might be available.

My sense is that these kinds of entitlement are part of a larger picture across society, where old orders have been in the process of breaking down for generations. These orders – church, state, cultural dictates – were not necessarily good in their own right, however they provided obvious binding values of behaviour that we were meant to conform to. As these dictates have faded away, they have been replaced mostly by a radical kind of individualism, where we are entitled – in fact, required – to claim as much as we can for our own and leave as little as we can for others. This individualism rises as much out of lack of alternatives as anything else. A concrete example of this might be the Christian Church: while we are almost weekly subject to horrific stories of abuse committed and ignored, we are also much less subject to ideas such as “love thy neighbour.” In the latter case, there are no similar messages coming forward to encourage the idea that we might take some responsibility for the welfare of others.

The effect on this is that while we are superficially much more free to do anything we like, we are also much less supported to be the people we need to be. We have failed to replace the strictures of the old social order with things we need to have a place in the world. We have instead replaced it with the idea of ‘the individual’.

As I alluded to earlier, there are good outcomes of the fading of the old order. More and more there is equality between the sexes, for example, in terms of career, social behaviour and responsibility for family life. I like this very much. Some of the emerging equalities, however, have been disturbing and we see evidence for this. Women and girls, for example, are committing violent assaults at rates never seen before – in an era when the rate of these is falling overall. Women, I understand, are also suffering more heart attacks than before. I would have liked to see both of these trends reversed – men committing fewer assault and having fewer heart attacks and so achieving equality in those ways – however it seems we have managed to doom ourselves to some kind of atavistic race to the bottom in terms of human behaviour.

Some people will see this as a pleading for the Good Old Days. They could not be more wrong; many evil, malignant and spiteful forces were at work then, and we are still paying the price now, such as in the continuing saga of the Church and sexual abuse. What it is though, is an observation that if we continue to worship The Individual as the single desirable outcome for ourselves, we will in fact be killing ourselves, emotionally and literally.

How does this link to self-harm? If we regard self-harm as driven in large part by emotional pain, and stop to consider that isolation is one of the contributing factors to emotional pain, and that strong social support is a recognised antidote to distress, then I think this begins to be plain. Some young people, in many ways, are isolated. They have parents who have had 30 years or so of conditioning to look after themselves rather than form communities; many of the messages they see tell them to be everything, do everything, have everything, but give no clues as to how to be themselves. For all the wonders of today’s world, with media, connectivity and information at every turn, the complexities of today’s life is hair raising. Many young people respond by being smarter than we were at their age, more switched on and sophisticated by far than we were; others are left with superficial experiences that do not make them feel like they are part of anything. These young people, the sizable fraction left alone and with no support, are the ones who self-harm.

One of the most compelling pieces of evidence that supports this that I’ve seen for myself is that very often, young people who self-harm form their own communities. That is, they go to each other for support, and many of them are very open about the fact that they do this because they get no support from the other people around them.  Some of these communities are in the schools, some are online, and some are on the streets. This is not a message that needs decoding. Sometimes this grouping together is seen as some kind of morbid subculture where young people devolve into an orgy of self-indulgent misery and frightening behaviour. To be sure, given that they are adolescent there are elements of self-imposed exile and exaggerated suffering in some cases, however it is making a grave error to think this explains everything that young people do.

So what now? Should we be less individual? My outlook on this is that we should at least be a little less self-absorbed. We need to look at our collective sense of entitlement and wonder what we can spare for others. We should be acting differently towards each other and our children. We should be taking responsibility for each other and the world in some subtle but important ways, and valuing qualities such as integrity and honesty a great deal more than we do.