Self-harm and the media – unpicking the ‘rise’ in self-harm among young people

Several articles were published yesterday and today in the UK media regarding an apparently dramatic rise in “the number of children who self-harm”:

“The number of children who self-harm has increased by more than 70 per cent in the past two years to record levels, according to new figures” Ian Johnston, The Independent, Sunday 10th August 2014.

The piece in the Independent was originally illustrated with a picture of someone scratching their arm with a pair of scissors (the image was later changed), while the Times is still running with a picture of a young person with numerous cuts on their arms. These images are problematic for many reasons, not least that viewing such images may be experienced as ‘triggering’ or traumatic for people who have or do self-harm, or that websites containing similar images have been shut down for ‘promoting’ self-injury. There are other problems with the way this story has been reported, and below I offer a few reflections on these, based on my experience of carrying out sociological research into self-harm for the last 10 years.

Firstly, the ‘dramatic’ increase in self-harm that is described in the articles is based on hospital statistics. Thus, the articles should have stated (and some did, but not in the strapline, with the notable exception of the Daily Mail) that there has been a dramatic increase in hospital treated self-harm. Hospital treated self-harm can be used as a proxy for looking at wider rates, but among young people especially we know that the vast majority of self-harm is not treated in hospital (Hawton et al., 2002). What these increased treatment rates might reflect is that people are more aware of self-harm, more willing to seek help, or more willing to take children and young people to hospital. It might be a response to greater levels of fear about young people self-harming. The reasons that people present to healthcare services for any type of condition or injury can be complex, and certainly do not reflect a straightforward increase in ‘rates’.

We know a lot about hospital treated self-harm, research centres in Manchester, Derby and Oxford have been collecting data about this for many years. From these studies we know that the majority of people treated in hospital for self-harm have taken overdoses of medication (Bergen et al., 2010). Few people will be treated in hospital for scratches inflicted with a pair of scissors, underlining another problem with the images used in the Times and the Independent – both of which depicted cuts which would be unlikely to have been treated at hospital. Those who are treated in hospital for self-cutting are more likely to have used razors, glass or knives, to have created wounds that the individual (or someone else) is worried about and feels unable to self-treat. Again – most of those treated in hospital for self-harm have taken overdoses, with only around 15-20% having cut themselves or used other forms of self-harm such as hanging, jumping, drowning or suffocation.

While it might not be clear whether overall rates of self-harm have increased, we can be fairly certain that awareness of self-harm has risen in recent years. Stories such as those run by the Times, the Independent, and the Daily Mail are reflective of a particular way of reporting self-harm among young people – these articles emphasise the ‘worrying’ rise in rates, largely focus on a particular form of self-harm (cutting) and present an analysis of the reason for the rise: young people use self-harm to cope, and they do so in response to ‘pressure’, especially from ‘the internet’[1]. Such stories have appeared intermittently in the UK press for the last 10 years.

This form of reporting presents an inaccurate view of self-harm, one that is complicated by research, particularly qualitative, interview studies which have spoken with people who self-harm (Adler & Adler, 2011; Chandler, 2013). Self-harm can often involve cutting, but it also takes many other forms. My own research with young people aged 14-16 found that most reported engaging in ‘other’ forms of self-harm, as well as cutting and overdosing. These included: scratching, burning, biting, restricting eating, self-criticism, hitting, and punching objects. Crucially, while not all of these practices are formally understood to be ‘self-harm’ they were described as such by young people themselves.

By emphasising ‘worrying rises’ in statistical data on self-harm, news reports present a potentially exaggerated view of how ‘common’ self-harm is. Reports in 2012, for instance reported another ‘worrying rise’ based on increased calls about self-harm to Childline. Again, these do not necessarily reflect rising rates, but perhaps a greater willingness to talk about or ‘name’ self-harm. There were similar discussions of an ‘epidemic’ of self-harm in 2005.

The emphasis on particular reasons for self-harm, which highlight the role of the internet, ‘pressure’ and the use of self-harm as a coping mechanism presents a narrow view of why people might self-harm.Research with people who self-harm finds that a very wide range of explanations can be given: self-punishment, experimentation, expression of emotion, self-care, generating feelings, ending dissociative states, communicating distress – as well as ‘coping’ with life, or emotions (Adler and Adler, 2011; McDermott et al., 2013). What ‘coping’ means in individual cases can vary widely (Chandler, 2012). Similarly, proposed ‘reasons’ for self-harm are diverse, reflecting the range of people who self-harm and the complex and multi-faceted factors that might contribute to self-harm, including, but certainly not limited to: socio-economic disadvantage, family contexts, childhood abuse, and homophobia.

In conclusion, I urge caution when reading news coverage about self-harm, and particularly when making inferences from statistical evidence. Statistics are extremely useful, but must be treated with care. I suggest that these public accounts of what self-harm is, and what it means, underline the need for further research with young people about how they understand the ‘pressures’ they face, how they experience life in a ‘24/7 online culture’. Finally, what other, structural, social and economic factors might be shaping the experiences of young people? Self-harm is not ‘just’ an individual, psychological problem – it is shaped by social and cultural contexts; analysis of these must go further.

[1] Last year I supervised an MSc Childhood Studies dissertation project carried out by Caroline Plaine. Caroline carried out a discourse analysis of print media coverage about self-harm among young people, which we are currently writing up for publication. These reflections are based in part on Caroline’s analysis, which found self-harm being described as an ‘epidemic’ in newspaper reports from at least 2003.

For more information contact Amy by email, or her visit her blog: Mind the Bodies.



References

Adler, P. and Adler, P. (2011), The Tender Cut: Inside the Hidden World of Self-Injury, New York, New York University Press.

Bergen, H., Hawton, K., Waters, K., Cooper, J. and Kapur, N. (2010), ‘Epidemiology and trends in non-fatal self-harm in three centres in England: 2000–2007′, The British Journal of Psychiatry, 197, 6, 493-498.

Chandler, A. (2012), ‘Self-injury as embodied emotion-work: Managing rationality, emotions and bodies’, Sociology, 46, 3, 442-457.

Chandler, A. (2013), ‘Inviting pain? Pain, dualism and embodiment in narratives of self-injury’, Sociology of Health & Illness, 35, 5, 716-730.

Hawton, K., Rodham, K., Evans, E. and Weatherall, R. (2002), ‘Deliberate self harm in adolescents: self report survey in schools in England’, British Medical Journal, 325, 1207-11.

McDermott, E., Roen, K., & Piela, A. (2013). Explaining Self-Harm: : Youth Cybertalk and Marginalized Sexualities and Genders. Youth & Society.

Talking about the self-harmed body

Recent media reports have highlighted an apparent rise in the numbers of young people reporting self-harm. CRFR research fellow Amy Chandler suggests that these reports should be treated with caution: surveys may well have identified a rise in the number of people who are harming themselves, but findings might also reflect an increased awareness of what self-harm is; meaning that self-harm can be more easily identified and named.

Naming self-harm can be a tricky business, and the recent debates about including ‘non-suicidal self-injury’ in the latest edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (American Psychiatric Association, 2013) is just one example of this. My research, with people who have self-harmed, and General Practitioners, suggests that the type of practices self-harm is understood to involve, and the meanings they have, can vary widely. While for some people, ‘self-harm’ is taken to mean skin-cutting; for others it might refer to overdoses; misusing drugs and alcohol, attempting suicide, risk-taking, or maintaining an abusive relationship.

Surveys that collect data about rates of self-harm provide important information; but they do not tell us the whole story about how someone understands self-harm, what kind of practices self-harm involves, how self-harm affects and contributes to their day-to-day life. Even a particular type of self-harm, say, self-cutting, can be used and experienced in many different ways (Chandler, 2012; Chandler, 2013).

In a paper that was published recently (online first) in the BMJ journal Medical Humanities, I explore narratives about living with bodies scarred or marked by self-cutting. The paper uses Arthur Frank’s typology of illness narratives (Frank, 1995): restitution, chaos, and quest, to demonstrate the different ways in which people talked about the impact of scarring on their lives.

• Restitution: For some participants, a focus of their story was to emphasise removal of scars, and attempts to ‘fix’ the problem of the scarred body.
• Chaos: More rarely, people spoke of their scarred bodies as chaotic, indicating feeling out of control of their body and the scars.
• Quest: A more optimistic account was given by others, who talked about the role of scars in ‘telling a story’ – to themselves and to others. Importantly, the story was one of hope, and of overcoming difficulties.

If rates of self-harm are increasing, there are likely to be more people living with scarred bodies in future. It is important to acknowledge that these scars may have very different meanings, and be experienced in different ways. Indeed, a common theme across the research I have done with people who have self-harmed highlights the pain caused by other people’s assumptions about what self-harm, or self-harm scars, might mean.

Read the published article online at: http://mh.bmj.com/content/early/2014/05/08/medhum-2013-010488.long. This article has been made open-access.

Contact Amy by email.

Further reading:

American Psychiatric Association (2013), Diagnostic and statistical manual of mental disorders: DSM-5, Arlington, VA, American Psychiatric Association.

Chandler, A. (2012), 'Self-injury as embodied emotion-work: Managing rationality, emotions and bodies', Sociology, 46, 3, 442-457.

Chandler, A. (2013), 'Inviting pain? Pain, dualism and embodiment in narratives of self-injury', Sociology of Health & Illness, 35, 5, 716-730.

Frank, A. (1995), The Wounded Storyteller; Body, Illness, and Ethics Chicago, University of Chicago Press.

Self-injury and emotions

Self-injury is an under-theorised and little understood behaviour, despite reports that rates of self-injury are on the increase. Measuring the prevalence of self-injury is notoriously difficult: the number of people who present at a hospital reporting self-harm and self-injury are only a small proportion of all cases. Studies that have sought to measure prevalence have tended to focus on adolescent groups, and to date, there is no data on the incidence of self-injury and self-harm among the general adult population in the UK.

Dr Amy Chandler, research fellow at CRFR, contributes to this blog on self-injury and emotions, based on a recently published article in Sociology.

Self-injury is usually studied from a clinical perspective: however, sociological approaches have the potential to greatly improve understandings of the practice. Recognising the emotional aspects of doing self-injury or understanding more about the societal and life factors that might lead someone to injure themselves can be an important way of exploring self-harm. Such approaches challenge some clinical psychological and psychiatric perspectives which tend to frame self-injury as ‘a problem’ located within the individual.

Amy undertook research to explore the ‘lived experience’ of self-injury, gathering the life stories of 12 people who had self-injured. People involved in the study were identified from non-clinical community sites, to increase the chances of including people who had not engaged with formal support services. Participants were aged between 21 and 37 years old from mixed backgrounds, although the majority were studying for, or had gained, higher educational qualifications.

Self-injury is cutting, burning or hitting the outside of the body, resulting, in most cases, in visible, lasting and sometimes permanent marks on the skin. As part of the study people frequently explored the reasons they had self-injured and, in most cases, they referred to how it enabled them to ‘work on’ their emotions through their body:

Control and Release: Release, relief and control were used by many participants when describing their self-injury. For some it allowed them to regain ‘control’ over their emotions, and their lives, while for others it was about controlling otherwise uncontrollable feelings.

“when the situation seems to spiral and I’m whooo losing it. Em and it was like right, regain control, this is what I’m gonna do, I’m going to cut myself…and it’s like, releasing something…and then when that whatever it is is released then your sortie regaining control…” (Anna)

Participants in the research suggested that when they felt they had little or no control over their body or life, control enacted through self-injury could be experienced positively. These explanations for self-injury reflect tensions between being ‘in control’ whilst at the same time needing to have a ‘release’. Similar language is used when people describe other embodied practices such as drinking, smoking and exercising.

Eliciting or Creating Emotions: Others suggested that they had used self-injury to bring out emotions that were ‘missing’. Self-injury in these cases generated a feeling of ‘something’ in response to ‘emotional numbness’:

“I wasn’t pretending that I wasn’t upset but I would just, I wasn’t letting people to know I was upset, if you see what I mean…I wanted to be able to feel I wanted to, you know, live or experience stuff, or… and so, self-harming was, you know a way of, feeling, pain, you know feeling pain ‘cos it was something.” (Francis)

In contrast, some participants talked about self-injury generating positive feelings:

“I think the first time it was associated with kind of a rush and, and a buzz.” (Justin)

These accounts, by indicating that ‘work’ is done on the emotions, through the body, demonstrate the interconnected nature of mind and body, challenging idea that they are, or could ever be, separate.

Chandler, A., (2012) Self-injury as Embodied Emotion Work: Managing Rationality, Emotions and Bodies, Sociology, 46 (3).

Amy’s current research project is exploring parenting among drug-using parents. You can email Amy at a.chandler@ed.ac.uk.