As promised, here’s the fourth part of the article I wrote for the Healthcare Counselling and Psychotherapy Journal:

At first glance it may be hard to see how hurting oneself can make one feel better.

Is there a ‘high’? Some kind of ‘rush’? On the surface, it is hard to see what is good about self-injury, especially when the person hurting themselves is ashamed of their action, and/or feels terrible at the distress they may be causing their worried partner or parents.

Talking with a client who relies on self-injury as a coping mechanism may not enlighten a professional, since not everyone can explain what self-injury does for them. It is hard to find the right words; few people are fantastic at talking about their emotions, and fewer still have the emotional vocabulary to discuss their distress and self-injury. It is therefore easier to divine the purpose of self-injury from observation rather than feelings.

Our observations at FirstSigns are that self-injury may have different functions, depending on the situation:

1. Intrapersonal communication / self-expression
2. Making intangible emotions tangible
3. Release and relief from intolerable distress
4. Calm the mind, removing repetitive thoughts
5. Calm the body, physiological reduction in tension
6. A sense of control over one’s emotions and environment
7. Communication to other people
8. Demonstrating a need for help
9. Manipulating other (powerful) people.

With regard to the last point, we should bear in mind that any channel of communication can be used to manipulate people. It is not uncommon for vulnerable people to feel powerless, and within healthcare systems it is quite possible for a client to feel as though the support is being ‘done to them’ rather than provided for them, so it is little wonder that some people feel compelled to play power games.

The majority of people who self-injure tell me that it helps them to cope with overwhelming levels of distress and get on with what they have to do. The release and relief from emotional turbulence is therefore the primary function of self-injury. When a person is upset, breaking down, panicking, or falling into despair, they can rely on self-injury as a way to sublimate or bypass these debilitating feelings. Self-injury therefore provides some control of emotions that would otherwise cripple and arrest a person.

Self-injury is not ‘acting out’ or ‘attention seeking’, though it may sometimes be considered to be ‘attention needing’. If a person feels unheard or invalidated in their home, school or work environments and they rely on self-injury to help them cope with their distress, then by showing their injuries they may perhaps be able to make other people ‘see’ what they have been unable or unwilling to ‘hear’.

So there is method in the madness, and in reality self-injury is a valid coping mechanism because it works. Stressed and vulnerable people are making a logical choice; they are aiming to care for themselves as best as they can, considering their often limited options.

Coming next: Hard to stop.