Self-harm is when someone starts to hurt themselves on purpose for perceived psychological and physical gain. In most cases, the intent to actively commit suicide is not present, but for the sake of ascertaining whether or not this is the case, it may be necessary to have the young person assessed by somebody suitably qualified to do so. Both sexes self harm but we are seeing a rise in the rate of boys and men who self harm alongside the doubling of the male suicide rate since 1985. The Mental Health Foundationstates that the UK has one of the highest rates of self-harm in Europe, with 400 per 100,000 people harming themselves. Those with current mental health problems are 20 times more likely than others to report having harmed themselves in the past, yet self reporting and indeed reporting family members discovered to be self harming can be impaired through guilt, shame and fear of the consequences. Teenagers who self harm have been labelled as attention seeking, ‘acting out‘ – or parents told that ‘they’ll grow out of it‘. By failing to address self harm effectively, are we in fact encouraging our teenagers to see these coping strategies as functional and ‘normal’ thus impairing their ability to learn methods that will better serve them in adult life? Indeed my own previous career in the mental health services provided ample evidence of this. Staff were often poorly equipped to offer support and were ill supported in their attempts to provide the consistency required to help self harming teenagers manage their feelings and adopt safer and healthier coping strategies. Staff were often dismissive, judgmental, perceiving such clients to be wasting of their time and frequently projecting their own frustration at their failure to help back on to the clients. The results – more distress, more relapses and ripples of distress spreading outwards through families, friends, society. All this adds to the toxic soup of secrecy, guilt and feelings of helplessness regarding self harm and other mental health issues in our domestic and private spheres and in the statutory mental health services. Oddly, This can contrast with the very public ‘ownership’ of self harm and its growing politicisation online. No wonder children and teenagers see online support and peer groups as an easier option to turn to for help and validation. Instead of having their expressions of pain, distress and feelings of frustration and powerlessness invalidated by societal disgust or apparent disinterest, they feel powerful, a ‘superstar’ in the secret online world of the self harmer whether this be from competitive self harming or by offering support and a non judgemental ear to other cutters. In addition, when all around you (at least, the people who you look up to and respect) are engaged in self harm, you lose perspective. The Western prohibition on this behaviour loses some of its potency. Dr David Kingsley, the consultant adolescent psychiatrist at the Priory Hospital in Cheshire and quoted in The Huffington Post says self-harm among young people is “noticeably” on the increase.
“It used to be taboo and kept private and secret but now, particularly with the internet and chat rooms, it’s become more public,” he says. “This has meant some people have latched onto it and now use this means of expressing their distress.”
The swift development of the internet and mobile wireless technology has led to the widespread and everyday adoption of online social media which provide a place to live ones young life out on the most public of platforms; the adoption of anonymity via the use of an avatar providing an illusion of privacy. Access to opinion, feedback and critique is hyper real, often savage and too intrusive to ignore, especially for teenagers with their as yet immature neural pathways and emotional responses un-mediated by years of hard experience. To a younger person, social media and the Internet are not the amorphous adjunct to the everyday that those of us who grew up without them may mistake them for. The internet is a mirror, their showroom and a field of dreams too. They feel they can order it to their own design and proclivities because adolescence is indeed the time where independence and the acquisition of agency dominates. A teenager severely edits those places from whom he/she will accept advice and guidance but sadly this does not prevent the unwanted and unhealthy from creeping in and exerting their negative pull. Because teenagers are not yet adroit at identifying the difference betweenwhat can be controlled and what cannot. All humans test their perceptions through seeking input from those around us; it is how we differentiate between the worlds of the subjective and objective experience and how we develop our schemas- the cognitive frameworks or concepts that helps us organize and interpret information of all kinds. The internet bestows upon us multiple and never ending opportunities to test our beliefs, our feelings, our reality and for the teenager (and us adults too), this can become truly mindbending. Our sense of self will not form in a healthy manner if we never get the time to stop and reflect upon the seemingly never ending feedback- to see where we are in it all and to learn that an online ‘status’ is usually an illusion in itself. Children have responsibility beyond their years but little authority (or agency) to do anything about what they see and do online – and then in the world at large. We want to trust that they have absorbed all these lessons about internet stranger danger, about online privacy, aboutcyber bullying, about the sharing of personal data but we lack true knowledge ourselves about the onslaught of potentially distorting and damaging images they are subjected to. A quick search of the social platforms that I myself use throws up some alarming images, memes and information about self harm. On Pinterest, the popular site whereby users develop and share their own online ‘pinboards’ of images, the vast majority of boards may be full of pretty photos of cakes, fashion and cute animals, but it also hosts a thriving community of teenagers and adults who self harm and use pinboards to engage in competitive self harming. The fetishisation of their wounds and scars and adoption of fashion, music and a neo-political set of views about their ‘rights’ to self harm flourish here in this most visual of sites, capitalising upon an adolescent favouring of short fast bites of information with graphic visuals. Despite Pinterests own code of conduct which bans ‘images promoting self harm’ and in spite of the vigorous reporting thereof, these images continue to flourish. Many organisations set up to help people who self harm have taken to posting comments on these boards with links to their own sites and the reactions from both the owner of the pinboard and their followers are often hostile. I found the same on Facebook and, Google+ alongside many other teen-popular online forums. Guardians…need to guide! Parents, children, schools and MH practitioners need to understand the potential for benefit and harm and develop a good understanding of how to harness the Internet for their own use in order to provide a mitigation to these sites. In offering a valuable source of social support for teenagers, especially socially isolated ones, the internets’ benefits here are counterbalanced by the real risk of self harm and suicide posed to these same individuals. In a global review carried out by the University of Oxford and published in PLOS ONE, researchers found that in one study reviewed, well over half (59%) of young people interviewed said they had researched suicide online; of 15 teenagers who had carried out particularly destructive and risky acts of self-harm (in itself a significant predictor of future risk to self via suicide) , 80% said they had gone online to research self-harm beforehand. Of 34 who self-harmed via cutting, 73% admitted to having researched it online. The old adage of ‘physician know thyself‘ needs to be amended, to, ‘people know thy child’s internet usage‘. As parents, educators, peers and practitioners we need to know what these sites are before we can work towards offering an alternative point of view and a tailored approach. We need to be comfortable in talking with our children about this subject and if we cannot do this, know what online resources are out there for our children to consult in privacy about their feelings towards self harm. The home can only function as a place of shelter and safety from the adult world if parents are supported and equipped to do so and can recognise that the web encourages a damaging and risky blurring of the boundaries. We recently saw this very issue raise its head on a Mumsnet talk thread posted by a Mother seeking advice-
“I’m worried that my 10yr old DD might be vulnerable to self harm. Most of the time she’s fine but she is having some friendship issues which are worrying her quite a bit. The reason for the self harm worry is that she does already pick at any scabs and seem to enjoy tending to them – it sounds like nothing I know. What has prompted me to write this though is that I found her copying out a poem from her iPod wallpaper app which seemed to encourage self harm. I don’t think she realised that but obviously something resonated with her. (Needless to say the wallpaper app has been deleted)”
The internet is a double edged sword in as much as it offers both beneficence and maleficence with regards to the perception of belonging to a community of like minded people- research shows that it is also a force for good in offering a sense of community for those teenagers who feel disenfranchised and disregarded, allowing teenagers (and adults) with less mainstream’ interests to meet each other and acquire knowledge and experiences hitherto denied them.
Large Parenting sites such as Mumsnet provide their parents with the same and to this end Mumsnet has been working with the charity STEM4 to offer advice, support and education to our online community, many of whom are parents, some whom work in education and health care too. Aimed at improving teenage access to mental health via the ‘stemming’ of the most frequently encountered mental health issues at a crucial early stage, STEM4 has developed an online fact sheet about self harm that has been published on the Mumsnet national site and focuses upon four main groups-
- the young people who may self harm or are thinking about it.
- their peers.
- their parents, families and carers.
- and finally the educators, health and social care professionals who come into contact with them.
Parents are helped to understand that an effective way to challenge self harm is by helping to remove the cloak of shame, guilt and secrecy that their self harming children may have wrapped themselves in.
In order to do this, Stem4 knows that parents themselves need support and education so as to remain calm in the face of what is undoubtedly a deeply worrying (even terrifying) discovery- that their child self harms. Everything about parenting is about pre-empting danger, getting out our imaginary sword and defeating that big dragon looming over our children. We may try to get fit for pregnancy, we engage in 40 weeks of self denial when it comes to what we eat, drink, go, do and desire in order to keep our unborn baby safe. An entire billion pound industry has emerged to both potentiate and service our fears for our children with safety advice, equipment and guilt, guilt, guilt sublimally and overtly induced within us. We look at our children, remember their perfect baby skin, their absolute health and vigour and we think “How can you cut yourself?“. And then we think “What did we do wrong?“. Organisations like Mumsnet are worth diamonds and rubies to parents at times like these. Their online national and local talk boards include adult mental health sections alongside child development and child and adolescent mental health and over the years Mumsnet has seen the valuable support, advice and education these safe spaces offer. From these early desperate pleas for immediate help will come an immediate response-one that the everyday ‘real life‘ world will struggle to emulate.
“Apart from feeling like the worst mother in the world and struggling to understand why and what has bought her to this point , I just don’t know what to do!” ” I am being positive in front of dd1 but inside I feel as if nothing well ever be quite right in my world again. My dc are my world and all I ever wanted to do with my life was be a good mum and I have failed so badly”
With these swift responses of those who have been there, who are still there or who have experience with self harming teenagers or the many others who post that they have no experience or words of advice but want to offer and kind words, we see the internet at its very best. It is partly for this reason that we mustn’t be too hasty to pin all the blame for these worrying trends in mental health upon the internet and media. Human isolation existed before the internet and was quite possibly harder to address especially in rural areas like East Anglia with their poor transport infrastructure. Apportioning too much of the share of blame to the overuse of the internet by children can be a convenient way of dodging and obfuscating wider issues of inequality, poverty and declining access to mental health services, particularly relevant in Suffolk and Norfolk . We have seen our mental health service systematically damaged by the Norfolk & Suffolk Foundation (MH) Trust enacted ‘Radical Redesign’ aka redundancies, cuts in beds and service provision. Many providers, especially voluntary organisations such as STEM4 and online sites like Mumsnet and Mumsnet Local see the effects of cuts upon mental health support for children in schools. Staff lose vital training, children’s centres lose funding and parents lose vital support from the cradle onwards too. How can you inculcate parents with the knowledge to cope with what the mother above described as “sounds like nothing I know” without walking towards the funding of new and creative services instead of away from them. And underpinning all of this is the fundamental (not basic) need to address the problems that make families including their children so very vulnerable to all mental health issues. The internet is not to blame for these but it WILL fill the vacuum where social, economic and political equality should be.