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11 January
NO 1250
Self-injury
According to Grant Charles, there are certain internal dynamics in self-mutilating behavior that need to be understood. From the outset, it’s important to recognize that the young person’s experience is often one in which some or all of these dynamics are occurring at the same time (Smith, Cox and Saradjian, 1999). This means that each person’s experience must be understood as a unique event that cannot be grasped from the outside. According to Favazza (1992), the individual feels a sudden, recurrent and intrusive impulse to physically self-injure. This is likely to occur in situations where he or she feels overwhelmed, being unable to control both the external circumstances and the internal anxiety. As the pressure builds, thinking narrows to focus on past learning and experience in an attempt to release the anxiety.
For this reason self-mutilation becomes an option that, once learned, is
likely to be repeated.
Immediately following the act, there is an immediate sense of psychic
and emotional relief but this is quickly replaced by a feeling of guilt
and shame, and then by depression and withdrawal.
Those of us who work with these youngsters need to make a very clear distinction between acts of physical self-mutilation and suicidal ideation and gestures. The emotional, cognitive and behavioral dynamics are entirely different (see Walsh & Rosen, 1998) but, above all, individuals who self-mutilate are not intending to kill themselves.
Self-mutilation is a learned response to anxiety and is designed to bring about temporary relief, despite the feelings of shame, worthlessness and rejection that usually follow. Ideations and gestures of suicide are concerned with self-annihilation and the considered outcome is final. This means that, in terms of intervention, people who display suicidal tendencies need to be supported in a very different way from those engaged in repetitive acts of physical self-harm and all professionals should be trained to understand and respond to this distinction.
This doesn’t mean that self-mutilating behavior should not be taken seriously based upon the notion that such actions are manipulative or attention seeking. I have encountered situations in which professionals who espouse this belief have withheld services from youngsters who desperately need to find alternative ways of dealing with their inner turmoil. The strategies of intervention discussed in this paper are pragmatic, educational, responsive and caring -- all ingredients of effective Child and Youth Care practice. This is not simply about responding the self-mutilating act, it is about being responsive to the person as a whole and unique human being. It is about developing activities and creating conditions in which youngsters can experience themselves differently while exploring new ways of dealing with intolerable anxiety (Krueger, 1998). It is about building relationships that foster self-expression, self-worth and self-responsibility. In all of this, a practitioner’s commitment to personal and professional development is essential... and this may mean looking beyond the traditional boundaries of Child and Youth Care training. The growing ‘epidemic’ of self-mutilation among young people challenges us to understand the changing pressures of the modern world and urges us to step up to the plate and prepare ourselves for what might lie ahead.
KELLY SHAW
Shaw, K. (2003).A youth care approach to working with youngsters who self injure. Relational Child and Youth Care Practice, 16 (2), pp.9-14.
Favazza, A. (1992). Bodies under siege : Self-mutilation in culture and psychiatry. London. Johns Hopkins University Press.
Krueger, M. (1998). Youth work resources: Interactive youth work practice. Washington, D.C. Child Welfare League of America.
Smith, G., Cox, D. & Saradjian, J. (1999). Women and self-harm: Understanding, coping, and healing from self-mutilation. New York. Routledge.
Walsh, B.W. & Rosen, P.M. (1988). Self – Mutilation: theory, research,
and treatment. New York. Gilford Press.
