It happened during the 10th interview. It was spring of 2004 and I had just come across what is now called “non-suicidal self-injury.” Despite my long history of frontline work in women’s and adolescent health, I had not yet encountered self-injury, particularly as a means of feeling better. Moreover, it was way outside of my research focus on connectedness and thriving. Having encountered a couple of friends whose kids were self-injuring, this prompted me to do a little digging. I was now conducting interviews with individuals who had lived experience of self-injury, as well as with professionals who treated it.
It was particularly interesting to me that at the time there was almost no scientific understanding of how common self-harm was and why it worked. The gnawing sense this was important to understand was what led me to the interview room. When our 10th interviewee, “Jenny,” shared that she had never before talked about her self-injury experience, I knew that I was not going to be able to simply satisfy my curiosity and move on; I was in this for the long haul.
Now, over 15 years later, I can comfortably assert that we collectively understand much more about what self-injury is and why it so commands the attention of those of us who study it and who want to understand it.
For those of you who have not yet encountered this term, non-suicidal self-injury or self-injury, is generally defined as the “deliberate, direct infliction of tissue damage for purposes not socially sanctioned and without suicidal intent.” People usually think of cutting as an example of self-injury, but there are many more. Self-harm works in a variety of ways, but ultimately, most people who have lived experience of self-injury say the physical pain helps make emotional pain less acute. That’s because neurologically speaking, the perception of physical pain and emotional pain are yoked together. The net result is that the physical pain can help reduce the emotional pain.
We have learned a lot by listening to people talk about their journey with self-injury. We have heard stories of pain, confusion, unsuccessful attempts to find help, and serious challenges in trying to communicate to others why self-injury helps relieve the invisible hurt — sometimes simply by making it visible. And, we’ve heard about how self-injury can affect relationships — particularly those with family members who cannot understand why it helps but who often express shock, dismay, fear and sometimes anger upon finding out.
But, while our interviews and other studies reflect pain of various types, they also reflect moments of deep self-awareness, resolve and, for many, deep compassion for oneself and others with similar challenges. Indeed, over a third of individuals who have injured regularly for at least some period of time report feeling like they have grown as a person and report wanting to help others. Many of those we talk to are young, but many show signs of hard-won wisdom. And that wisdom has a lot to convey about resilience, connectedness and about how even chronic experience of such deep challenges can yield hope, clarity, and a deep desire to live and give.
Ultimately, the capacity for healing, strength and growth is the underlying message of our book, “Healing Self-Injury: A Compassionate Guide for Parents and Other Loved Ones,” co-written with Elizabeth Lloyd-Richardson. We want our readers to understand that self-injury can be really difficult to navigate but it can also provide opportunities for growth — as a person, as a family and in relation to the wider world.
While we wrote this book with a wider readership in mind, we wrote it most especially with parents in mind. For most parents, knowing that a child self-injures can be particularly difficult. There are many reasons for this, but one is because parents will often wonder what they’ve done wrong, wonder where things went awry. Many parents report feelings of guilt and deep worry for their child’s future.
Since these questions can never fundamentally be answered, parents may find themselves sorting through painful memories. In cases where there is clear trauma or abuse history, a parent may spiral into their own deep dark night of the soul, making it much more difficult for them to support their child. For people who live with and love someone who self-injures to feel better, it can be like a long-forced march, an unwanted journey into uncomfortable parts of themselves and their loved ones’ inner worlds.
What a parent and loved one does know for certain is that seeing wounds or scars evoke a strong visceral reaction. The powerful alchemy of the physical reaction so many of us have to seeing wounds or blood coupled with wanting to protect a loved one and stop the source of the harm is potent and can provoke myriad difficult and unwanted feelings.
Perhaps this is why parents and loved ones often describe feeling like they’re walking on eggshells as they wonder when it will happen again. Because self-injury can come and go, with days, weeks, months, even years in between episodes, loved ones often wonder when the next shoe is going to drop, or whether their own actions or enforcing family rules will “push” their child into injuring again.
All of this said, one of the most fascinating things researchers have learned in studying self-injury is how important parents and other loved ones are in the recovery process. Study after study suggests that even when parents or loved ones are unaware, inadvertently reinforce the behavior or do not live with their child with self-injury experience, parents matter — a lot. This is because interactions with parents and caretakers, easy and hard, are part of what forms the “authentic self” — the part of each of us not defined by a job or role or by an idea of what we are supposed to be, but that reflects a deeper sense of self. It is also because it is in families, regardless of the forms they take, that children learn about human connection, stress and coping.
Ultimately, parents need to know that self-injury, too, can be part of a hope- and growth-filled passage — for a child and for a parent and family. It may not be a journey they chose or wanted to take, but they can, and many do, come away feeling a deeper connection with their child and themselves. As two parents shared:
My child and I now allow each other to be human, to say, ‘I am sorry’ and to forgive each other for not being ‘perfect.’ She knows she is loved and supported and has voiced that to all of her therapists.
I have learned so much about myself, my parenting style, my marriage and my children because self-injury entered our lives. It has made me more introspective about what she needs from a parent to be healthy.
While it is tempting and common to bypass anything but the most critical issues when a child has self-injured, it is important to understand that the journey into and through healing will most often involve parents and other loved ones. Learning how to “believe up” by seeing the more positive potential in the crisis, learning to clearly communicate their own needs and to understand their own emotional states, will help parents model healthy behaviors for their children. Watching how a parent deals with challenges is one of the ways that a child trying to figure out how to deal with intense emotions and confusing events will learn how to navigate difficult times.
Being conscious, emotionally steady and a good coping role model can be exceptionally challenging for parents of youth who have lived self-injury experience. For example, how does a parent have hard conversations about wounds without causing discomfort or tension? How do they help a sibling or another relative or friend understand what a child is experiencing, that they’re not actually trying to die? How do they encourage a child who self-injures to seek and stay in treatment, even if they do not want to? And, how do they deal with the overwhelming rush of feelings and challenges that come with trying to assure that a child and everybody else affected, including caretakers, are cared for and supported?
“Healing Self-Injury: A Compassionate Guide for Parents and Other Loved Ones” was written to address exactly these questions, and then some. Our goal was to understand what self-injury is, why it helps manage difficult emotions and what helps in the recovery process. But we also wanted readers to have evidence-based research and tools related to therapy and current treatment approaches, communication strategies, and practical tools, tips and techniques. We include current research, interview excerpts from real people, self-assessments and activities, as well as an array of helpful external resources.
Elizabeth and I wrote “Healing Self-Injury” out of a deep desire to share what we have learned from our own research and that of our colleagues. We also wrote it as a beacon of hope for the many parents and other loved ones we have spoken with over the years looking for a way to understand what their child is experiencing and what they can do to help. Above and beyond the focus on self-injury, this is a book of human adaptation, response and growth. If you or someone you know has a young person in their lives who self-injures, this book is for you.
You can pick up a copy of “Healing Self-Injury: A Compassionate Guide for Parents and Other Loved Ones” here.