(Extract from the Mind Publication "Understanding Self Harm ")

'I am a survivor of both sexual abuse and self-injury. I no longer self-injure, but it has been a long struggle to try to acknowledge and work through emotions which once felt overwhelming in their power.'

'Self-harm is not a phenomenon known only to a few like me who have inflicted injury on our bodies. Self-harm involves all of us on some level. We may all punish, distract or numb ourselves as a way of dealing with difficult feelings or situations.'

'I am twenty years old, presently attending a day hospital and rebuilding my life which I once believed had been destroyed.'

'I belong to a women's self-harm support group. The group was the start of changing my life. The support and encouragement from both has given me the strength and courage to continue my life and I now value myself. I am a survivor of incest. I still self-harm but nowhere near as much as I used to. By talking about it, I am learning to deal with my feelings.'

This booklet is for anyone who self-harms, for their friends and family and the mental health workers who care for them. It should give readers a greater understanding and knowledge of the condition and of what can be done to help.

What does it mean to self-harm?

Self-harm is really a broad term for many acts which cause personal harm, whether deliberate or not. It can incorporate a wide spectrum of self-abusive patterns. These can range from failure to give attention to one's own emotional or physical needs, right through to the more direct forms of self-laceration, burning or injury through taking toxic substances. Self-harm can also include eating distress and addictive behaviour.

Little is known about self-mutilation, a frightening and yet quite common act of abuse. Often called 'attention-seeking' and 'manipulative', it could better be described as the expression of an inner scream. Self-inflicted injury involving cutting, burning, scratching or gouging can be seen as a symbolic way of expressing deep distress - a non-verbal form of communication in which the feelings are 'externalised', through the body, where they can be dealt with in a more visible way. Yet because of its very visibility, self-injury is often treated with mistrust and fear.

No accurate statistics are available about the numbers of people who self-harm, since few people are willing to admit to having caused their injuries themselves. Staff feel helpless when faced with self-inflicted woulds and this may cause them to blame, rather than support, the person involved. When time and resources are limited and no-one really knows how best to help, it's easier to make judgements and use labels than spend time looking for possible causes of distress.

Why do people injure themselves?

We all self-harm although not necessarily in conscious and direct ways. We may smoke, drink or have some form of eating distress; find ourselves in abusive relationships; or simply, we may deny our own needs. We find many ways to distract ourselves from feeling. Hard physical or intellectual work are all-consuming occupations which can use up lengthy periods. Time may be taken up with doing, keeping busy or distracted - anything rather than finding ourselves alone with our thoughts. The idea of such aloneness can seem very threatening indeed, but avoiding it can be costly. People may end up physically and emotionally overspent and vulnerable to becoming ill.

Women

Women often habitually take care of the needs of others, putting themselves last. They are frequently protrayed as weak victims in need of protection. Their sense of worth, their opinions and strengths can become grossly undermined. They may feel themselves to be unimportant, often silent witnessess to the many abuses imposed on them. As a result, they may lose a sense of their own identity, their power and their rights as individuals.

One survival strategy is to dissociate themselves from their real needs, and seek to gain some control of their neediness by, for instance, controlling their size or shape by denying themselves food and nourishment. Sometimes, women may have been so traumatised by their experiences that they become fragmented - so disengaged from their feelings and body that these feel quite separate from them. If it has nver been safe to feel emotions, women injure themselves to maintain this sense of being separate and, for some, to try to end their neediness.

Men

Trying to conform to a macho stereotype may leave men unable to experience their emotions and detached from that valuable part of themselves. Men are more likely to express their anger overtly, but those who are locked up in institutions - especially if they have been abused - may well express their pent-up feelings through self injury.

Young people

Young people may well feel under severe pressure from families, school and their peers to conform and achieve. If there's no chance of realising expectations, even for the higher achievers, some express their anger through aggression and acts of destructiveness. For others, feelings of powerlessness and lack of self-worth may be expressed through acts of self-injury.

Topics also included in this leaflet are: