Accentuate the positive, eliminate the negative? The variable value dynamics of non-suicidal self-hurting

Abstract

Medical accounts mostly frame non-suicidal self-hurting as an adverse event, the frequency of which has supposedly increased to a current ‘epidemic’ level, and which can be predicted probabilistically in terms of risk factors. This set of presuppositions gives rise to the common stigmatisation of those who present to Accident and Emergency services as a result of self-hurting. It is now being challenged in a small but growing body of social science literature which emphasises the diversity of self-hurting, and its range of socially situated meanings for those who self-hurt, family and health professionals. The present paper contributes to this research strand by discussing the accounts of their self-hurting given by a sample of 25 UK adults who had not been in contact with health or other services for this reason. The analysis focused on three value issues: the positive gains which motivated research participants to self-hurt; their own active efforts to mitigate associated risks; and the longer-term downsides which some respondents identified.

Keywords:

• lens of risk
• risk communication
• risk management
• self-hurting
• non-suicidal self-injury

Notes

1. The form of injury differs between those who are and are not admitted to hospital, with the former more likely to have self-poisoned, and those who cut themselves, the most common method, least likely to end up in hospital (Ystgaard 2009). Research based on hospital recruitment will therefore not generate representative samples of the overall population who self-hurt.

2. Attempted suicide can be used as a proxy for self-hurting with respect to the identification of probabilistically predictive risk factors. However, individuals who injure themselves for emotional reasons tend to differentiate their actions sharply from attempted suicide or parasuicide, and may resent being put into the latter categories by health professionals (Solomon and Farrand 1996, Harris 2000). Moreover, the rarity of suicide compared with self-injury means that the vast majority of people who self-injure do not intend to commit suicide, a disjuncture which citations of high relative risk always obscure. Although people who commit suicide are much more likely to have previously self-hurt, the chance of people in the latter category killing themselves is very low.

3. The common belief that pain stimulates the brain to manufacture opiate-like endorphins is not supported by clinical evidence according to Chandler et al. (2011). Nevertheless, self-hurting may be motivated by a belief in this causal pathway which may become self-validating through the placebo effect.

4. Although not mentioned by research participants, some of those who use overt self-hurting to elicit social support may find that its efficacy eventually wears off as the sympathy of significant others becomes eroded.