Of damage that happens within
Current trends show that students are filling up the last category in large numbers. Self-harming and suicidal thoughts among students are becoming serious problems in many countries, including India. One instance is the case of a Class 12 student committing suicide because he had been pulled up by his parents over his poor performance in academics.
His suicide note read, “I don’t deserve to be your child.” In another instance, a Delhi girl in Kota committed suicide after she cleared the IIT entrance exams. She had scored 144 even as the cut-off marks were 100 to qualify for IITs. Apparently, she did not want to pursue engineering but BSc, as she aspired to become an astrophysicist.
According to a study by the Center for Collegiate Mental Health in USA (2014), more and more teenagers and college students are wrestling with self-injury and suicidal thoughts. In India, while suicides among teenagers and college students attract popular media attention, not much has been discussed about self-harming behaviour. It’s high time we discussed this damaging trend.
The right definition
Self-harming behaviour is defined as inflicting harm to one’s body without the obvious intent of committing suicide. These behaviours include ripping or pulling skin or hair, biting, bruising and breaking bones. Research shows self-harming behaviour could be a precursor to suicide attempts. For those who harm themselves, it is a way of expressing and dealing with their deep sense of distress and emotional pain. It sounds counter-intuitive for those on the outside, but for those who harm themselves, it’s a way of making oneself feel better and a coping mechanism for their sadness, self-loathing, emptiness and rage.
Some of the top reasons listed by counsellors for self-harming behaviour or suicidal tendencies in students are anxiety, depression, relationship problems, stress, academic performance, family, grief or loss, mood instability and adjustment to a new environment. In the Indian context, academic distress is strongly associated with many teenagers and college students’ mental health concerns.
Self-harming behaviour or suicidal thoughts are also often associated with eating disorders, childhood trauma or psychological distress. People who have had a history of physical, emotional or sexual abuse are more likely to engage in self-harming behaviour. Individuals who lack skills to express their emotions and lack a good social support network are also likely to engage in self-harming behaviour.
But the problem is that the relief that comes from self-harming doesn’t last long. It is like sticking a band-aid on a wound that really needs stitches. The band may stop the bleeding temporarily, but it does not fix the underlying injury. It also creates its own problems.
While there are several efforts in advanced countries like USA and UK, there is hardly any concerted effort in India to research and understand how to detect, treat and prevent the growing problem of self-injurious behaviour in young adults. Individuals, especially teenagers and college students, when overwhelmed by external stress resort to denial or disengagement as a way of coping. Although it may temporarily alleviate stress, in the longer run, failure to address the problem may leave individuals traumatised, leading to self-harming behaviour.
The general belief among people is that those who injure themselves are mostly trying to get attention. The painful fact is that people who self-harm generally do so in secrecy. They aren’t trying to manipulate or draw attention to themselves. In fact, their own sense of shame and fear makes it difficult for them to come forward and ask for help.
Another myth is that people who self-harm are crazy and dangerous. People who self-harm suffer from anxiety and depression or a previous trauma. Self-harming is a way of coping for such people. Slapping them with a label of crazy or dangerous isn’t accurate or helpful.
A third myth is people who self-harm want to die. More often than not, people who do this do not want to die. When they are injuring themselves, they are not trying to kill themselves. It’s their way of coping with their emotional and psychological pain. Many who commit damaging acts do so to help themselves move forward in life despite their internal pain. The intention to die emerges only when the internal pain becomes unbearable.
Another perspective an outsider might hold is that if the injuries aren’t bad, then it’s not serious. We need to understand that the severity of a person’s wounds has very little to do with how much he or she is suffering. Just because the injuries are minor does not mean that there is nothing to worry about.
How can you help
As a person who is physically or emotionally closer to the person who self-harms, we may feel shocked or confused or even disgusted with such acts. And we may feel guilty about admitting such feelings. Acknowledging our own feelings is the first step towards helping our loved ones.
Learn about the problem and understand it. The best way to overcome the feelings of discomfort or distaste about self-harm behaviour is to learn about it. Understanding why they self-injure themselves can help see the world through their eyes.
Avoid judgmental comments or criticism. That will only make things worse. Following through with the first two steps will go a long way in helping you with this.
Offer support to the person and do not issue ultimatums. It is natural to want to help, but threats, ultimatums and punishments are counter-productive. A good way to manage the situation would be to express your concern and make the person know that you are available whenever he or she wants to talk or needs support.
Encourage your loved one to express whatever he or she is feeling, even if it’s something you are uncomfortable with. If the person has not discussed about the self-harming event, bring it up in a caring and non-confrontational way. For example, it could be like, “I see injuries on your body, and I want to understand what you are going through.”
In the event of any self-harming behaviour by teenagers or college students, or anyone for that matter, the immediate focus should be on stabilising the person by motivating them to develop a sense of control and mastery over the traumatic memories or events that triggered the behaviour in the first place. Dealing with such kind of behaviour immediately can be a crucial step to help the person deal with the traumatic experience or emotions, both in the short and long term.
(Sathiyaseelan is an associate professor, OB & HR and Anuradha is a professor of Psychology, Christ University, Bengaluru)