Self-harming behaviors in prison: a comparison of suicidal processes, self-injurious behaviors, and mixed events

ABSTRACT

Self-harming behaviors occurring in prison disproportionately consume resources and cause considerable disruption. To date, theoretical paradigms have explained self-injurious behaviors and suicidal processes either via a continuum or dichotomy of self-harm. This current study examines all documented acts of self-harm (n = 1,158) occurring in South Carolina’s 28 prisons over a 50-month period. We test and find support for a tripartite schema of self-harm; differentiated with regard to suicidal processes, self-injurious behaviors, and a ‘mixed group‘ of self-harming behaviors. These groups of behaviors were distinct with regard to situational variables (i.e. body part targeted, injury severity) as well as institutional responses (i.e., medical treatment needed, employment of suicide protocols). Findings indicate that self-injurious behaviors are likely to result in physical injury and/or hospitalizations.

KEYWORDS:

• Self-injurious behaviors
• suicide
• incident reports
• prison inmate
• count models

Acknowledgments

We would like to acknowledge the South Carolina Department of Corrections, Resource and Information Management Unit, for its support and assistance in this study. Points of view or opinions are not necessarily those of the South Carolina Department of Corrections.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. ‘Anger in’ is a term that denotes the focus of aggression, psychopathology, and deviance towards oneself (i.e. self-injurious behaviors, suicidal processes, anorexia nervosa, etc.). ‘Anger out’ denotes expressions of anger, hostility, and violence directed towards other. While prison inmates who self-injure are clearly internalizing the anger process; Smith and Kaminski (2010) revealed that these self-injuring prisoners also receive more disciplinary infractions when compared to their non-self-injuring counterparts. Thus, the self-injuring prisoner is thought to display both ‘anger-in’ and ‘anger-out’ simultaneously.

2. We recognize and include the terms ‘mutilation’ and ‘parasuicide’ in accordance with the original usage of the terms by Karl Menninger (1938). However, for the reader, we add the caveat that these terms are now considered outdated and inappropriate for the purpose of researching self-injurious behaviors. In fact, recidivistic and serious self-injuring inmates find terms like ‘attention seeking’, ‘manipulation’, and ‘mutilation’ to be misleading and offensive.

3. Note Stanley and colleagues (2001) did not utilize the term ‘mixed group’ to define this population, although the characteristics of this group of self-harming behaviors have been defined as such in this study.

4. Suicidologists and econometricians have documented the effects of Rosenthal’s Game Theory which posits that professionals prefer to provide resources and attention to suicide attempters who are perceived as ‘serious’. If a suicide attempt is perceived as being less-than-credible or the act defined as a ‘cry for help’ then professionals are less likely to provide significant resources or treatment to the attempter. Ironically, this been shown to produce more resources, care from others, and even increase income status for suicide attempters who tried to kill themselves and survived, when compared to counterparts who seriously considered suicide but did not attempt the act (see Marcotte, 2003 for further discussion).

5. Brown, Comtois, and Linehan (2002) utilized a Parasuicide History Interview technique to document that self-injury is often an act designed to make oneself feel better (i.e. symptom reduction), whereas suicide is more likely to carry the intent of making other people feel better (i.e. perceptions of being a burden on others).

6. We contend that an unknown number of inmates accidentally kill themselves every year in American prisons while engaging in major self-injurious behavior that is entirely devoid of a death motive. An inmate who cuts him or herself to ameliorate psychopathological symptomology is paradoxically making an attempt towards living. However, if this inmate dies because of physiological trauma (i.e. hitting a vein or artery, miscalculating blood loss, etc.) then the event will be recorded as ‘suicide; completed’. Despite the differences in motivation between suicide and self-injury, fatal self-harm occurring in prison continues to be intransigently coded as ‘suicide’ with self-injury excluded from consideration. However, self-injurious behaviors, typically in the form of cutting with a razor blade, can and do lead to accidental death of the inmate and further research is required to reassess current prison suicide statistics.

7. There were 46 incidents for which a determination could not be made, typically for a lack of detail in the narratives regarding injuries. Excluding these incidents did not affect the conclusions, except that the estimate for ‘no treatment’ in the situational model became very unstable due to a sparse cell size. We, therefore, excluded these cases.

8. We do not interpret the effect of Hosp_Unk, i.e., where it is unknown whether or not inmates were admitted or treated and released when transported to a hospital (n = 48% or 4.2% of the sample) because its meaning is unclear.

9. Time of day, as a proxy measure of social control, did not show variability between the three self-harming behaviors. This contradicts the findings of Doty et al., (2012) which found time differentials for self-injurious behaviors.

Additional information

Notes on contributors

Hayden P. Smith

Hayden P. Smith is an Associate Professor of Criminology & Criminal Justice at the University of South Carolina. His principal focus of study is the intersection of the criminal justice and public health systems. This includes self-injurious behaviors by inmates, the mental health needs of correctional populations, health and resilience in staff, and reentry programs. Dr. Smith's previous publications have appeared in Justice Quarterly, Crime & Delinquency, and Criminal Justice & Behavior.