Self-injury can be difficult to talk about. Even choosing how to refer to the behaviour is problematic. Most mental health organisations and academics within Australia use the term Self-harm or Deliberate Self-harm (DSH). The DSM-V outlined Nonsuicidal Self-Injury (NSSI) as a condition for further study and many international researchers are favouring the term. When I first came across a term for the behaviour, ‘Self-mutilation’ was most commonly used. In less formal circles you may hear the behaviour referred to as Cutting. However self-injurious behaviour is not limited to self-cutting although that may be the behaviour most known to the general public. The definitions listed for each term can vary slightly. The labels are used interchangeably by some and seen as uniquely different by others.
In addition to the problematic aspects of what to call the behaviour and how to define it there are limited statistics on who employs the behaviour and why. Most statistics that do exist are limited. The data may be gathered from self reported surveys which will have a limited reach, or alternatively from hospital and medical records which are then limited only to those who have had some form of medical intervention. Considering the ethical complications associated with researching the behaviour and reliance on self-reported or observed incidents it is possible to see just how difficult it is to give a detailed representation to the extent of self-injury in the general public.
The inclusion of NSSI as a condition for further study in the DSM-V released in 2013, highlights that there is growing research into the behaviour. Awareness and understanding of mental health continues to grow but many mental health issues remain taboo, stigmatised or simply misunderstood. Self-injury is seen by many to be one such issue and is thus the motivation behind Self-injury Awareness Day (SIAD).
LifeSIGNS http://www.lifesigns.org.uk/ is a user-led voluntary organisation based in the United Kingdom that provides Self-Injury Guidance and Network Support. They have also created this useful video that explains SIAD:
For the past two and a half years I have been researching and writing about self-injury. In 2012 I had a recurrence of self-injurious behaviour. Self-injury had been an issue for me previously, my first recallable incident occurring at the age of fifteen, however I had mistakenly thought (or perhaps was simply in denial) that it was something I’d “grown out of” or had “overcome”. While I wasn’t a stranger to the behaviour as such, I still found my own behaviour (the urge to hurt myself) strange. I wanted to understand why I thought about and ultimately did at times injure myself.
That need to understand could be pursued as I was in the early stages of research for my PhD and my supervisor and councillor supported my decision to make self-injury and my experiences with the behaviour the focus of my creative writing doctorate. I am now nearing the submission date for my PhD and am finalising the first draft of a novel which discusses self-injury.
This post could go into the results of my research. I could offer up my opinions on the existing research, which terms I agree with* or dislike, which definitions I feel best suit my own behaviour* and what treatments I’ve tried and would recommend to others – but hey, that’s going to be covered in my PhD. Instead I’d like to focus on the act of discussing self-injury as opposed to the content the discussions themselves.
To say I’m comfortable discussing self-injury, my self-injury, is inaccurate. The first time I presented on my research and openly acknowledged the personal nature of my research I was terrified. I only had three minutes to present, however I was talking to the bulk of the academics from my universities humanities department, a couple of well respected visiting academics, the new head of school and several of my postgraduate colleagues. I opening stated to the crowd “I am a self-injurer”**. My hands shook and I felt a pit of nerves in my stomach. The brief presentation was well received. One academic hugged me (I have known this academic for some time and they were aware that I’d had some mental health issues), others gave me positive feedback and acknowledged that the presentation was not easy to make. More importantly another engaged me in a longer conversation where they outlined their experiences of knowing someone who self-injures and asked questions seeking to better understand their loved one.
I have done a number of public research presentations where I openly acknowledge that I self-injure, within my university, and at national and international conferences. Many who have attended these talks had shared their personal experiences with self-injury or other mental health issues with me. I’ve had people ask questions because they know someone who self-injures, I’ve had others ask simply because they are interested. My research and writing has allowed these conversations to happen by both giving me a platform to discuss self-injury but more importantly by giving others a chance to engage in the discussion.
Talking about self-injury from this perspective has been for the most part rewarding. Most responses to my presentations have been positive and more importantly, respectful and sensitive. There have been questions or reactions that have been hurtful, though I think in most cases they were not intended to be. Presenting on the subject is often uncomfortable, sometimes I get the shakes, or my eyes well up, or my voice cracks. Sometimes I feel really crappy after a presentation, triggered or I simply need a moment to myself. Mostly though the experience has helped me to form a narrative and find a language to talk about my experiences with self-injury.
Private conversations and talking about my self-injury outside of academia is a different experience. I am much more selective as to who I talk about my experiences with, when I might be willing to discuss the issue and even how much I reveal or say on the issue. When I first experienced the behaviour there was mixed reactions from those who knew, guessed or assumed. Some people treated me angrily, others didn’t know what to say and avoided the subject, some tried to “fix me” or weighed in on how I should go about “recovery”, some thought I should be feared (thinking I might be violent) and many said really hurtful things. I still experience some of these reactions although I think people have become better equipped to react appropriately when confronted by someone who is experiencing (or has experienced) a mental health issue.
One of the reactions to my public discussions of self-injury that I’m most uncomfortable with is when the word “brave” comes up. The word does not sit right with me. I acknowledge my discomfort and the difficultly in discussing my experiences with self-injury but whether intended or not, stating that doing so is “brave” infers a sense of fear. I’m not saying that every individual who self-injures should talk publicly about their experiences, nor that any conversation about self-injury is without apprehension. I am saying that I’m hopeful that stating that you self-injure, think about self-injuring or have previously self-injured is something that will be met with understanding and appropriate support. I’m hopeful that other individuals who self-injury can have some of the positive experiences discussing self-injury that I have had.
Not everyone is going to react well but I hope that someone does. If someone discloses self-injury to you or you wish to discuss it with them, please be respectful and considerate. Do some reading, ask questions with some sensitivity, don’t try to “fix” or “stop” them but offer whatever support you can – that might be a hug at the time, that might be assistance seeking professional help or further information, it might be first-aid, it might be helping to dispose of shards/sharps/tools or a willingness to hang out when the individual is experiencing urges. Self-injury is complex, what is helpful to one person might be harmful to another. Listen without judgement.
This year’s SIAD I’m allowing myself to acknowledge how far I’ve come. Recovery is a slippery term as too often when discussing self-injury, it’s seen as an absent of the behaviour – this is problematic. I don’t like people asking me about “my recovery”, or if I’m “recovered” or suggesting how I should try to “recover”. Such conversations are only the business of me and my councillor (and my councillor would not phrase the discussion using that term). Instead I’d like to recognise that I feel better within myself than ever before and that I’ve actively worked to feel this way. I acknowledge that my research and writing has been useful as a component to that. I’m pleased that I have been able to discuss self-injury with people who may not have otherwise discussed the topic. I am excited to learn more and continue to research and discuss self-injury, hopefully in a way that can improve support for those who do experience self-injury. More importantly I’m coming to terms with my own experiences and this is what I’ve been working towards and will continue to work at.
Talking about self-injury is difficult but remaining silent can be much tougher. Who can you start a conversation about self-injury with: a loved one, a professional or support service or maybe, you might start that conversation with yourself?
Call Lifeline crisis support 13 11 14 or find them online https://www.lifeline.org.au/
*my preferred term is nonsuicidal self-injury (NSSI)
**I have used the term “self-injurer” to describe myself in an effort to confront and accept my own behaviour. I’d advise others to instead say “an individual who self-injures” as this distinguishes self-injury behaviour from identity.