New Zealand has a high rate of self-harm among young people, but there are ways to help them cope, writes Victoria University psychology professor and Listener columnist Marc Wilson.
This was just over 10 years ago, and it was the first time I’d come across the idea that a person would choose to cause themselves pain. We are extremely well adapted to avoid pain, because it is the klaxon telling the crew that hull integrity has been compromised. You’ve probably had that experience where a part of your body touches something hot – an oven tray or a radiator. Your body reacts before you even recognise that sensation of heat and pain.
I don’t remember ever seeing deliberate self-harm when I was at school. Of course, there was what’s-his-name who’d sit at the back of the class sticking drawing pins in his arm to show how hard he was … Well, okay, I did see it, but not for what it was. I certainly never thought about doing it myself. In fact, in that conversation a decade ago, I couldn’t understand why people would choose to harm themselves.
We are not the only organisms on the Blue Marble protected by a pain-based early warning system, and we’re not the only species that does injury to itself. You’ve probably heard stories of animals maiming themselves to escape a trap, but that makes sense – the injury serves a function. However, birds will pull out their feathers, cats will lick themselves to the point of losing fur and primates will bite themselves.
Animals don’t usually do this. Common reasons are isolation from others of their species and situations that are distressing. Animals aren’t good at telling us what they’re thinking, but the consensus is that these latter examples represent attempts to self-soothe – over-grooming to the point of harm. And there are clues here for us concerning human self-injury.
The first thing I decided to do in trying to understand self-harm was to conduct a survey. I found a questionnaire on the subject, the Deliberate Self-Harm Inventory, developed by psychiatrist Randy Sansone, a professor at Wright State University in Ohio. It’s a not-fun set of questions that ask “have you ever intentionally, or on purpose”, caused physical damage to your body by cutting yourself, preventing wounds from healing, burning yourself, abusing alcohol, engaging in risky or abusive relationships, starving yourself or “distancing yourself from God as punishment”. Sansone and his team developed these questions for use with people diagnosed with borderline personality disorder (BPD), which is characterised by extreme difficulty in managing one’s emotions and relationships and by poor self-worth. Self-harm used to be on the list of symptoms for diagnosing BPD but, for reasons outlined below, has since been dropped.
Sansone showed that answers to these self-harm questions did a very good job of sorting between people with a BPD diagnosis and “normals” – almost 90% of BPD patients had hurt themselves in five or more ways at least once.
It turns out that more than three-quarters of all psychology studies involve research using student participants, so in keeping with tradition, I asked a large group of my students – high-functioning academically – to anonymously complete the survey. Surprisingly, eight in 10 had hurt themselves at least once, and more than 20% met Sansone’s recommended BPD cutoff. Less than 5% of the population experiences BPD, but more than 20% of my students “look” like BPD, based on their reports of self-harm. Something, I thought, is going on.
Why do people do it?
So began a decade of research that has involved about 10,000 New Zealanders. Along the way and with the help of then-PhD student Jess Garisch and a small army of young researchers, I‘ve found that between a third and a half of our young people hurt themselves before they leave school. In the international context, this is a lot – on average, about 20% of young people around the world hurt themselves. What’s-his-name might still be doing it at the back of the class, but many more young folk are also hurting themselves when they’re alone.
The answer to my decade-old question of why comes, in part, courtesy of a project funded by the Health Research Council of New Zealand, conceived with the help of clinical psychologist Angelique O’Connell and Drs Robyn Langlands and Lynne Russell.
In a nutshell, we spent six years talking to young people and their whānau and surveying vast numbers of young people about their well-being. Sure, self-injury is a big part, but so are such things as their broader mental health, their social well-being and things like their experience of bullying. We also ensured they were safe, by making sure they were supported by a counsellor or someone else they trusted, if they said something that worried us. We also gave away a lot of chocolate frogs and chocolate fish to people who participated. More than 13,000 in fact. Cadbury loved us.
A lot of other people think it’s about attention-seeking, says Penny – or rather the 15-year-old interviewee we’re calling Penny. Penny’s been hurting herself for the past year or so. Although she says everyone has a different reason for hurting themselves, for her it was mainly about “control and release” – releasing and controlling pent-up emotions. Importantly, what it is not about for most people who hurt themselves is suicide. And we know this logically, because self-injury is so much more common than attempted and completed suicide.
Penny’s also right that there are lots of reasons people hurt themselves. Humans, like animals, hurt themselves for a reason. Most self-harm is not “crazy” but understandable when you ask yourself what function it might serve. Basically it’s a way to try to feel better, done in a way that also has a lot of downsides.
The most common reason is to manage your emotions, particularly those that are caused by bad stuff that happens to you – being bullied at school, fighting with your parents or partner, or getting a “bad” grade for an assignment or a test. Self-punishment is the second most common reason, but there are a lot of other much less common runners-up, such as to cope with feeling disconnected from your body, to feel a part of a group, to be in control, to communicate how distressed you are and, yes, to try to control other people’s behaviour.
The role of emotions
For this reason, it’s really important to understand the underlying function of self-harm, not only because you can’t assume everyone has the same reasons but also to help them move forward. If young people hurt themselves because it’s the only way they have to communicate or to exercise control over their lives, there are risks in clamping down and hiding all the cutlery in the house.
Emotions signal to us that something significant is going on for us and help communicate this to others, and we have to learn to regulate them.
In research on emotions, alexithymia refers to a syndrome of problems in knowing what emotion you’re feeling, being able to label and communicate that to others and managing what you’re experiencing. Teens have to learn how to do this, and many grown-ups are pretty bad at it as well. Remember that the emotional “centres” of the brain are fully developed by about the age of 15, so teens are experiencing the same breadth and depth of emotions as adults. But the part of the brain that helps us make good decisions, perhaps about how to deal with what we’re feeling, doesn’t finish developing till the mid-twenties. If this weren’t the case, fewer people would fall in love and leave home to start their own family. You don’t think so? Would you really have left the warm embrace of your family home if you hadn’t got the hots for someone? I rest my case.
But what if you don’t have the tools to manage your adult-powered emotions when stuff goes down? Maybe you haven’t had the role models for that. You cast around for ways to cope with these intense feelings and maybe you know someone who’s hurt themselves? Maybe you saw something about a celebrity’s admission or have seen it on social media or YouTube? Maybe you were so overwhelmed you spontaneously self-harmed – and it worked. Not everyone gets this experience, but for some people, hurting themselves takes their mind off whatever had led them to that point; it overwhelms what they were feeling. Or perhaps it gives them something to feel when they don’t feel anything.
What you can do
“But what can I do? I’ve tried everything,” says a parent at a community education presentation about supporting adolescents through the challenges of, well, adolescence. The researchers are here to talk about helping young people be resilient. Garisch says, “Resilience is like a bucket of water. It empties out over the day or week, and you have to top it up now and again.” She’s right. For young people, it’s not enough to tell them they can do anything, but to make their buckets bigger by helping them learn that they can really do it.
University of Otago associate professor Jackie Hunter has a great example – young people spending 10 days on the Spirit of New Zealand. It’s one thing to say, “You could swim around a ship if you try”, and it’s quite another to push them off into the water and let them learn that they can. It’s a tough gig being a parent, because we don’t want our kids to cry or to scrape their knees. The problem is that if we help them avoid situations when they might scrape their knee, we prevent them from learning how to ride a bike as well as how to cope with a scraped knee.
Parenting a young person is stressful. And parenting a child who hurts themselves – or is depressed or anxious – is tougher still. Cornell professor Janis Whitlock and her long-time collaborator Elizabeth Lloyd-Richardson are among the first people to study what the experience of parenting a young person who self-injures is like. Whitlock says “most youth who self-injure live with and are loved by family members who are at a loss about how to address a behaviour that looks and feels like a suicide attempt”.
She and her collaborators are the first people to look at the “parental secondary stress” of caring about someone who hurts themselves – you’re not the person hurting themselves, but you have the stress of caring for them. She talks about the hypervigilance that goes with trying to keep an eye on your child without feeling or looking controlling; the chronic stress of “the feeling of walking on eggshells”; and the sheer emotional exhaustion of worrying about a loved one.
In this situation, she says, it’s really important to look after yourself – remember the air safety videos that remind adults to affix their own oxygen mask before helping others? This is important for a caregiver dealing with this stress but also because young people look to adults as role models for how to deal with emotional experiences. When we lean on our social supports at a time of need, we’re teaching them to do the same. But when we freak out, we’re teaching them to freak out, too.
A respectful curiosity
Says Whitlock, “What is known and applicable to every caregiver in this situation is that you matter now more than ever.” Although young people say they’re most likely to talk to their peers about self-injury, they say a parent is the most helpful person to talk to about it, and most of them say they want their parents to start that conversation.
Even though self-injury isn’t automatically the same thing as a suicide attempt, we still need to take self-injury seriously. Things to watch out for include poorly explained injuries, wearing clothing that covers extremities that’s not appropriate for the weather, a change in mood and a preoccupation with self-injury themes in media or arts (think Sylvia Plath, Amy Winehouse). To make it even harder, these may also be signs of the adolescent exploration of identity and nothing to do with self-injury.
At the same time, you might ask if your young person is doing okay and to explain why you’re asking. Barent Walsh, who as well as being a world authority on working with people who hurt themselves is also the walking embodiment of a kindly Santa Claus, advocates a respectful curiosity – don’t freak out if you see cuts, but don’t put on a stiff upper lip either. This is important, so treat it that way. One of the simplest tools in your well-being toolkit is validation – “this must be really tough for you right now”. This doesn’t say it’s okay for people to hurt themselves, but it does say you understand that something important is happening. Remember that self-injury is a symptom of other things going on, not the root of the problem.
Self-injury is often stigmatised – many young people feel ashamed that they do it, and their caregivers often feel guilty or responsible for their young person. You may be able to tackle it on your own, but your chances are so much better if you ask for help.
Your GP isn’t a bad place to start, but research shows that few GPs have ever had specific training on self-injury, so ask them about referral to a specialist service.
Speak to the school – we work really closely with lots of guidance counsellors and they are a fantastic source of committed, competent support for young people. Work with counsellors, GPs or psychologists, because there’s a wealth of research that shows when parents are involved in the therapy process, the outcomes are better and longer-lasting.
For resources for dealing with self-harm, see the research team’s website.
Where to get help with mental health
Need to talk?: free call or text 1737 to talk to a trained counsellor, anytime.
Lifeline: 0800 543 354
Suicide Crisis Helpline: 0508 828 865 / 0508 TAUTOKO
Depression Helpline: 0800 111 757
Samaritans: 0800 726 666
Youthline: 0800 376 633 or email firstname.lastname@example.org
Healthline: 0800 611 116
This article was first published in the February 3, 2018 issue of the New Zealand Listener.