Why would you try to hurt yourself?

Someone who practices self-mutilation may need the help of others in order to stop. Unfortunately, she (or he, it's a problem for males also!) may have a great deal of difficulty in seeking and/or obtaining this aid. Self-injury is seen as incomprehensible and irrational by many people, and self-injurers are often ignored or even scorned. Worse still, misguided attempts at helping can result in serious psychological and physical damage. Understanding the mental processes behind self-injury is vital to bringing about a change for the better. In my experience, the thoughts that lead to self-injury fall into one or more of these patterns:

  • Psychological Disorders. Self-injury goes along with a few different disorders; in my experience, most of the people in this category are either having a major depressive episode, are bipolar (manic-depressive), or have borderline personality disorder.
  • Masochism. Voluntary pain is pleasurable to some folks. This is only a problem if the person decides that it is. Masochism is often expressed in different ways than self-injury; body modification is a common outlet. It is distinct from other forms of self-injury, in that it stems from seeking pleasure rather than self-destruction. Many of the masochists I know were once self-destructive. They use it as outlet for their desires, not as a way of punishing or harming themselves.
  • Repressed Emotions. This is a widely-held idea, and a bit of an oversimplification of the self-injurer mentality. The person has anger she can't express, communication problems, and/or some specific barrier that she sees as being impossible to overcome. She cuts as a way to express frustration, cry for help, and she may gain a physical release as well. The physical aspect is important: Self-injury stimulates both adrenaline and dopamine release, giving an intense, addictive rush.
  • Revenge or Power. Closely tied into repressed emotion, she may be feeling isolated or ignored; self-injury brings attention. She may also be using it as a way of hurting those who care about her, for emotionally harmful acts; most often, this is part of a bad breakup. She may also feel guilty for using self-injury in one of these ways, and so she may try to hide it. This can form a downward spiral -- injuring to get attention, then feeling guilty, hiding the marks, and injuring again. Helping someone that is in this mode of thinking requires breaking that cycle. Show that you care about her whether or not she is harming herself. Listen to the cries for attention. Do NOT accuse her of being manipulative, do not ignore her -- this can lead to escalation. If you find that the injurer is controlling your life by her problems, get others to help her if need be. Abandoning the person does NOT work. (I tried it once when I thought I was out of ideas..)
  • Addiction. "I can't stop myself." This is a very common statement of a self-injurer seeking help. It may actually be a symptom of a psychological disorder, masochistic tendencies, and/or repressed emotions. Whatever the underlying cause, the person finds herself injuring, and is unable to stop. Listen and ask questions. If there is something deeper, find it and help the person overcome it. Otherwise, just give them support in stopping. Quitting any addiction is often a rocky road. Know that there will be breakdowns along the way. Have courage, and build their confidence in themselves any way you can. A change of scene, such as a vacation or relocation, is one thing that can help. There are many others.

Disclaimer: These categories are unlikely to fit absolutely everyone, and they're a bit objective. If you're looking for some more subjective personal accounts, the self-injury node is highly recommended.

What are some bad ways to try and help a self-injurer?

Judging someone as broken when you find out that she is a self-injurer is a bad move. It produces a kind of "help" that comes from the helper's desire to boost his own ego, rather than a truly magnanimous intent. As such, it is prone to do damage; a frequent result is emotional blackmail. So, the first step in helping another is to examine your own motivations for doing so.

Having been both helper and helped, I have experienced firsthand the potential damage of twisted motivation. About a month after I started putting scars on myself, I sought solace in a relationship with a very codependent person. She needed someone to fix, and I thought I needed someone to fix me: as such, it seemed like a good idea at the time for us. The trouble with that approach was that she was only interested in me as long as I was self-injuring. When I tried to move the conversation in positive directions that were not focused on my own mental anguish, she would lose interest. As such, I found myself in a state where I needed to continue my self-injury in order to keep the relationship going.

If you are certain that your motives are driven by a true desire to give aid, the next step is to listen carefully to what the injurer needs. Let her set a specific goal of her own. This may be different than what you are expecting. Self-injurers are a diverse group; it is important to try and see things from their viewpoint, rather than pushing judgement and/or threats at them. Perhaps one of the least healthy things to do is to say, "If you don't stop cutting, I'm going to start too." This will likely lead to one of two outcomes:
1) The individual continues cutting. You start also. Now you act as triggers for each other, and there are two people with problems instead of one. (This has happened to me.)
2) The individual continues cutting. You don't start. Now you have lost their trust; they continue to injure themselves, and they are now a bit more isolated than they were before. (This happened to an acquaintance of mine.)

What is the best way to proceed?

As long as you avoid those pitfalls, you have the potential to be of great help to your friend/lover/spouse who is a self-injurer. The best, simplest way to help out another person through their psychologically turbulent times is to provide a friendly ear. Gain their trust. If they tell you something in confidence, don't repeat it to their friends/co-workers/family, unless there is a definite danger of suicide or permanent damage. If it becomes clear that the person needs more than just a confidant, you should ask them to consider seeing a therapist: a counselor, psychiatrist, or psychologist. This can be a hard thing to do:

  • You may think that recommending that they seek help is a cop-out: telling someone you care about to get their help from someone they don't know can seem cold, uncaring, even traitorous. It isn't. Therapists are professionals at helping people with this sort of thing; techniques such as cognitive behavior therapy can work wonders. Also, a therapist can provide something you can't. Because you care about the injurer, they will likely feel some debt to you, some pressure. A therapist can be more comfortable for them to talk to, and so the injurer can be more honest. A cutter might have a hard time telling you that he had a complete breakdown and sliced his legs to ribbons, but it would be easier to tell an impartial stranger.
  • You don't want to be judgemental or imply that the injurer is crazy, as you might lose some trust. This is why it is important to suggest therapy in a gentle manner. Inform the person of the possibility. Offer to come with them. Ask them if they would like to try it, and if they say yes, make sure they stick by that decision. If the injurer is depressed, you may want to consider getting the appointment for them, and ensuring that they get to it. A therapist can be an excellent tool: it will take some pressure off of both you and the injurer. It is not a replacement for listening to her, but it can speed up the recovery. Note that not all therapists are created equal; don't be afraid to call it off if the therapist is doing more harm than good. If the therapist tries to prescribe medication, use your own judgement; I believe everyone has the power to change without pharmaceutical aids, but I know people who have benefited from them.

Recommended reading, for both of you:
  • Prozac Nation, by Elizabeth Wurtzel (Focused more on depression, but a good read)
  • Cut, by Patricia McCormick (Advised by an ex-cutter friend of mine.)
  • Girl, Interrupted by Susanna Kaysen (An excellent book. It helped me to make sense of my own disjointed thoughts, which was a good first step towards rearranging them.)
  • http://www.nshn.co.uk/ This UK-based website contains facts about self-harm, several emergency numbers, and an active forum.
  • http://www.selfharm.org.uk/ Contains information on common types of self-injury. It has a good FAQ on self-injury, as well as links to resources in the UK.

Notes: I use the pronoun "she" to describe self-mutilators here, but this information applies to males just as well. Self-mutilation is more commonly seen in females, but it is a problem for males also (and I am an example). In fact, due to social expectations, males face an additional obstacle: While it can be difficult for anyone to admit that they have a problem they cannot face alone, it is especially difficult for a male to do so. Thanks to paraclete and squeezie for pointing this out. Credit for the websites also goes to squeezie.