If you ask the average person in the street why some people cut themselves you’ll get the answer that they’re trying to ‘get attention’ which is a common but unhelpful stereotype.
The reality is that motivations for self-harming are complex. Some people find it helps control their intense moods by externalising the pain, other are punishing themselves, others are responding to psychosis, others self-harm for a combination of reasons.
A new study in the Journal of Adolescence looks at motivations in online accounts of self-harm and gives an insight into the various ways young people describe their actions.
The research aims to examine ‘magical thinking’ in explanations of self-harm but this doesn’t necesarilly mean magical thinking in the sense associated with psychosis (i.e. unknown forces and jumping to conclusions) but in terms of how metaphors and symbolism and woven into young people’s explanations.
Part of the article gives examples of various forms of symbolic ‘magical thinking’. It’s a bit wordy but it illustrates some of the psychological complexity of self-harm.
1. Magic substitutions. This term refers to the magic belief in the transformation of one category of phenomena into another, e.g. emotional pain into physical, bad self into blood. For example, “I can’t handle mental or emotional pain, so I turn it into something I can handle, which is physical pain.”
2. Transanimation of objects. Scored if an inanimate object, such as the blood, body or cutting instrument, is described as an active subject independent of the self. For example, “the blade is always so nice, like with every cut it lets the pain flow out; it lets it flood like a river of blood.” This example would also be scored as a magical substitution, where blood magically substitutes for emotional pain.
3. Transanimation of processes. Scored as present if a behaviour or phenomenon is seen as having autonomous agency. For example, “I still cut myself. Because to me that is my only true friend.”
4. Auto-relatedness. Scored if the narrator wrote about himself or herself as a separate person or a poorly integrated part. For example, “Don’t worry me, me will take care of you. It’s okay me, me is here now.”
5. Split between inside and outside. Scored if the narrator describes a metaphysical difference between the inside and outside of the body. For example, “I feel so ugly inside, so dark and cold, on the outside I’m not exactly warm, but I’m not as cold.”
6. Scars reminding and communicating. Scored if scars or cuts communicate with or remind the narrator or others. For example, “I feel better when I see the cuts on my arms, I don’t know why, I mean I hate them. But they seem to make me feel like I guess someone gets it, gets why I do this to myself.”
Unfortunately, the ‘doing it to get attention’ stereotype is also maintained by lots of health professionals as self-harm is also stigmatised by the people who treat these young people.
It’s a complex and frustrating behaviour and, therefore, one that needs some of the most careful consideration in psychiatry.
Link to locked study on magical thinking in self-harm.