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March 1 was Self Injury Awareness Day, dedicated to increasing our understanding of a complex topic that affects nearly 14.6 million people each year.
In Intentional Peer Support (IPS), an approach to mental health care, we discuss different languages of pain, such as suicide and self injury. It can be difficult to look at languages of pain; they can invoke a lot of fear. They are also full of opportunity for connection, active listening, and emergence. In honor of Self Injury Awareness Day, I am sharing my story and perspective on languages of pain, and how we can address self injury from a harm reduction approach.
A personal story
I participated in self-injury as a teenager and young adult to process big feelings. It made visible the emotions and words I didn’t know how to express. For me, those feelings centered around deep loneliness and sadness, not feeling safe to express myself to caregivers, and a discomfort and 'otherness' I now recognize as gender dysphoria. I didn’t feel seen by anyone, and I couldn’t see myself.
I used cutting to express and explore my thoughts of suicide and to keep myself from acting on those thoughts. As long as I was cutting, there was an invitation for someone to hold space and walk alongside me while I struggled between wanting to die and wanting to live. My parents found out and were understandably distraught. When their discovery took cutting from me, that invitation became narrow, and my feelings of suicide increased.
As an adult, I opt for other ways to use pain to process, like getting tattoos. Ironically, out of all the words I wrote on my body (most of which were hurtful and derogatory), the only one I can still see the scar of is the one that says: 'Live'.
An intentional shift in language
Traditionally, we have used the language of 'self-harm' to describe these behaviors. That implies the behavior causes harm to the person, but we can’t know that unless we ask. Today, there is a shift toward the language 'self-injury'. When I teach about this language, I call out the possibility of yet another shift, toward the language of 'self-soothing'.
Self-injury can look like many different things. Some forms are more socially accepted, or even celebrated, such as over-exercising or over-working. In some cases, self-injury is even positive or enjoyable. Others aspects of self-injury, such as cutting, are pathologized. The language we use needs to reflect this broad spectrum of experiences.
A harm reduction approach
One myth about self-injury is that it’s a stepping stone toward completing suicide. Instead, it’s often a coping skill that allows us to stay alive during intense feelings and circumstances.
The Wildflower Alliance, a peer support organization, says that to practice a harm reduction approach, we must “radically accept that someone doing or experiencing something you perceive as risky may choose to continue living in that way indefinitely (and even forever), while still supporting them to live a full life.”
Below are some harm reduction approaches to self-injury:
- Be mindful of the natural urge to try and stop it. Taking away someone’s relationship to self-injury before they’ve had the opportunity to learn new skills can make feelings of suicide increase, rather than the behavior itself. An immediate move to stop the behavior often results in shut down and loss of trust. In addition, self injury allows us to have power and control over our own bodies/lives/pain. Removing it abruptly can lead to loss of power and control, which can be distressing.
- Be curious. Ask the person why they self-injure themselves and what purpose it serves. In my years of using cutting as a self-regulation tool, I don’t remember any provider or family member asking me why I was doing it, just that I needed to stop.
- Validate. People self-injure for real and valid reasons. It is a common experience and can be a natural response to distress. Telling someone that it makes sense why they are doing it is powerful and normalizes the shame they may feel about it.
- Consider offering first aid kits/supplies if that’s of interest. If someone is not ready to stop cutting, and if the wounds are not in need of urgent medical care, having supplies can help them access it in a safer way.
Some additional questions and things to say to explore self injury:
- “Why do you self-injure?”
- “I can understand why you would be doing this.”
- “Do you want to stop/does this still feel helpful for you?”
- “It makes a lot of sense why you would feel this way.”
- “Are there times when you don’t feel like using self-injury? When are those times?”
- “What are some other things that help you process emotion?”
- “I’m so sorry that happened to you, I can’t imagine what that must have been like.”
LEARN MORE
Intentional Peer Support
Wildflower Alliance
Self-injury | Mad in America
