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Abstract
Self-injurious behaviors (SIBs) represent a significant threat to the morbidity and mortality of vulnerable prisoners, and are now a ubiquitous aspect of the correctional system. Currently, correctional staff receive little specific training or appropriate guidance from national standards to respond to this dangerous behavior. To date, the overwhelming majority of empirical research on self-injury in prison has relied upon the viewpoint of academicians and/or correctional staff. This select viewpoint has reduced the perspective of the self-injuring prisoner to a passive role. In response, we utilized a qualitative methodology to access the perspectives of 20 highly recidivistic self-injuring inmates housed in three South Carolina prison. Interpretative phenomenological analysis was employed to identify fundamental themes underlying SIBs. Findings indicate that the meaning of self-injury is rooted in traumatic family milieus with the behavior becoming a fixed coping mechanism over time. Respondents perceived stress and control as dominant themes, though mental illness, physiological responses, and negative emotional states were also important. While desistance from self-injury appears unlikely, key policy solutions are presented in accordance with these inmate perspectives. This phenomenological inquiry suggests that efforts to understand these inmate “accounts” and personal history serve as a potentially efficacious means of understanding SIBs occurring in prison.
Acknowledgements
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. The author wishes to thank Jenelle Power of the Correctional Service of Canada for her great advice on early drafts of this manuscript. The author also appreciates the valuable comments provided by the anonymous reviewers.
Notes
1. Basic demographic, name and date variables were altered in order to protect inmate privacy and confidentiality.
2. This manuscript uses the term “SIBs” to denote “prisoners who routinely practice self-injurious behavior/s”. We recognize that it is erroneous to define individuals by their physical illness, mental illness, or any associated pathological behavior. Therefore, the term “SIBs” is used solely to meet functional restrictions of space related to publication requirements.
3. Highly-recidivistic SIB-inmates were selected because they have engaged in the behavior over the life-course. Regular practitioners of SIB are thought to possess the most knowledge on the etiology, manifestation, and benefits of the behavior. The term recidivism is used in this manuscript to denote repeated acts of self-injury rather than habitual offending.
4. Karl Menninger (Citation1938) tells the story of a man who after murdering his child and citing hatred of his own mother as a causative factor then proceeded to self-amputate his arm in machinery. Menninger (Citation1938) wrote: “… instead of offering up his life he offered up his arm, which was quite logical since it was the guilty organ. It was logical if one assumes the personification or autonomy of various organs of the body, and this, as we shall see, is one of the devices of the unconscious for unloading guilt. ‘It is not I but the arm that was guilty, therefore I shall sacrifice the arm, my guilt is expiated and I have saved my life’” (p. 236).
5. Phenomenology is rooted in the fields of psychology and philosophy and is related to, though distinct from, the field of enthnomethodology which has close ties to linguistics and sociology.
6. As Schutz (1967) suggests, “the ordinary man in every moment of his lived experience lights upon past experiences in the storehouse of his consciousness. He knows about the world and he knows what to expect. With every moment of conscious life a new item is filed away in this vast storehouse. At a minimum this is due to the fact that, with the arrival of a new moment, things are seen in a slightly different light. All of this is involved in the conception of a duration that is manifold, continuous, and irreversible in direction” (p. 81).
7. Snow (Citation2002) found that suicide was differentiated by the following explanations: grief/bereavement, hopelessness, homesickness, relationship problems, and lengthy sentence. Self-injurious act were explained as: anger towards others, to experience physical pain, to relieve stress/tension/anger, wish to see blood, alternative to drugs/alcohol, and alternative to outward expression of emotion. There was a correlation between SIB and suicide in Snow’s study with vulnerable prisoners experiencing cycles of violence, self-injury, and suicidality. Note that only one form of self-harm (SIB or suicide) would manifest at a specific time point due to the differing etiology, manifestations, and goals underlying each of these behaviors.
8. During the research, the Department of Corrections (South Carolina) offered individual, mental-health therapy as well as specialized self-harm (SIB) therapy group sessions for appropriate inmates.
9. Borderline Personality Disorder (n = 6); Antisocial Personality Disorder (n = 4), Schizoaffective Disorder (n = 3); Personality Disorder not otherwise specified (n = 3); Bipolar Disorder (n = 2); Schizophrenia (n = 1); and Depression (n = 1). Psychosis was evident in n = 5 of the sample, and was associated with exorbitant surgery and hospitalization costs caused by self-injurious behaviors.
10. We thank Dr. Armando Favazza for his continued support in researching incarcerated SIB populations.
11. Oddly, no respondents in this sample conceptualized self-injurious behavior as an expression of violence directed towards the self. Restated, this sample enjoyed the benefits of violent self-injury in which they were in complete control of their own trauma, while adamantly opposing violence and force directed from others. The issue of who is in control remained fundamental to the interpretation and meaning of the self-injurious experience.
12. Pacing was both representative of an impending SIB event as well as the inmate ‘staying busy’ to avoid an SIB event. Pacing was indicative of spikes in either pathological (moving towards SIBs) or protective (avoidance of SIBs) efforts. Correctional staff who are familiar with recidivistic SIB inmates and notice increased patterns of pacing in their cell or persistent pacing of the prison grounds should initiate friendly questioning to ascertain if the inmate is becoming more disturbed. Increased pacing by a known SIB-inmate should also be reported to qualified mental health staff as it may signify an impending cutting event.
13. Respondents indicated that SIB processes delayed physiological pain until they had often received medical care. Then excruciating pain was often felt, and largely could be attributed to medical complications. One respondent recalled being told by a team of surgical experts that they were now out of medical options due to his repeated SIB, and that any subsequent acts would likely lead to his death because so many bodily organs had been previously removed due to his self-injury. This individual simply had no more organs to remove. Related, hospital staff should be advised of the presence of a recidivistic SIB inmate because many respondents recounted awaking into states of rage and psychosis in the hospital leading to more act of SIB and/or hospital staff assaults.
14. In the United States the practice of tattooing in prison or jail is illegal. The use of improvised tattooing equipment carries an increased risk of infection or disease, particularly through the use of contaminated needles.
15. The need for control may also explain the lower levels of drug and alcohol use in this sample. These substances aggravated psychopathological symptoms and when consumed in large quantities produced feelings of losing control. In contrast, SIB provides a psychological escape or high while the inmate remains fully in control of their faculties. In all of these inmate accounts, the only account in which a respondent reported losing control was during serious SIB events when they “zoned out”. Yet, even in these rare examples the prisoner who serious SIB and “zones out” also became unconscious and typically had to be rushed to hospital. Future SIB research (and therapeutic programs) should continue to explore the feeling of a lack of control as an antecedent to self-injurious behavior.
16. Ironically, while the phenomenology of SIB-scarification is an expression of survivorship and life, the behavior itself carries increased risk of early death.
17. Claghorn and Beto’s (Citation1967) found that, “our interpretation of the (SIB) event as outsiders often reflects as much of our own personality as that of the injured person” (p. 133).
18. While punitive strategies appear to have an iatrogenic effect on SIB treatment; there is the exception of SIB inmate psychosis which does require the immediate deployment of crisis intervention responses including cell extraction, restraints chairs, and placement in observation cells in order to avoid accidental death.
19. The role of dreams as a trigger for future SIB events requires further testing. However the significant weight that this sample placed on traumatic nightmare sequences suggests that alternative therapies could hold efficacy in reducing SIB. This may include lucid dream and art therapies. We recommend that cognitive-behavior therapies continue to occupy the dominant position in SIB-prisoner treatment programs, but add that alternative therapies should be incorporated to access dreams, creative expressions (e.g., drawing), and the recounting of earlier victimizations. This may be more relevant for male prisoners because they are often less forthcoming about abuse compared to female prisoners, thus requiring alternative (non-verbal) approaches in their therapy.
20. Therapy staff must be aware that SIB-inmates are readily presenting their history of trauma, abuse, and feelings in a reified expression for them to see. While this provides an opportunity for good therapy, it also carries the risk of counter-transference in which the care provider can become emotionally entangled with the inmate (Favazza & Conterio, Citation1988; Rayner, Allen, & Johnson, Citation2005). Consequently, mental health professionals should be cognizant of this risk and take steps to psychologically protect themselves when working with SIB-prisoners. This also includes consideration of the physical safety for therapy staff when interacting with prisoners who routinely self-injure.
21. Adolescence as a starting point for SIB is true also for non-incarcerated samples (Barrocas et al., Citation2012; Nock & Prinstein, Citation2004, Citation2005). The finding of a peak of SIB during adolescence is reinforced by studies that feature very large sample sizes, multiple research sites, and complex methodological designs.
Additional information
Notes on contributors
Hayden P. Smith
Hayden P. Smith is an assistant 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 studies on self-injurious behaviors by inmates, mental health needs of correctional populations, jail diversion, national standards of care, and premature morbidity and mortality associated with reentry.