The reasons for self-mutilation are complex but it can be a method of surviving intense emotional pain, writes Nuala Macklin
For a parent to discover that their son or daughter engages in the gruesome practice of self-harming, it may come as some small relief to learn that this activity has more to do with survival than suicide.
Self-harm, or self-mutilation involves the deliberate damage to the human tissue, usually by cutting or burning. This highly common practice, is an attempt to achieve relief from a build-up of mental distress and gain some sense of control. The cutting of the skin precipitates a rapid release of endorphins into the bloodstream, causing the sufferer to experience a numbing sensation. What might initially appear to be a quick solution to emotional pain, can result in a highly destructive cycle of behaviour, leading eventually to a life-threatening situation.
Frequently, this dramatic physical demonstration of mental anguish is written off as self-indulgent, attention-seeking behaviour. What is clinically classified as a parasuicidal act, can also be interpreted as a silent, but graphic language of unexpressed pain.
International sources indicate a female preponderance among people who cut themselves. In contrast to this data, the 2002 National Parasuicide Registry shows a figure of 10,500 presentations to Irish hospitals due to deliberate self-harm, including cutting, drug and alcohol overdose, etc. Twenty per cent of these were due to self-cutting. Of that figure, the practice of cutting was significantly more common in men. Because of the intensely secretive nature of self-mutilation, the majority of those who injure themselves do not seek medical attention. This makes it impossible to assess the scale of the problem.
Consulting psychiatrist, Dr Michael McDonough of St Patrick's Hospital in Dublin says: "It does seem to be linked with people who feel stuck in their lives. Those who engage in this act report feeling less tense afterwards. It may be partly biologically, and partly psychologically mediated. In a curious way, it may be empowering for them.
"It often occurs in some people who have a history of physical and/or sexual abuse in childhood. It is almost like a metaphor for 'you may hurt me, but I can hurt myself more than that. I'm stronger than you.'"
McDonough says: "Some psychotherapists argue the point that people who suffered trauma in the pre-verbal stage, i.e. small children, where language isn't available may revert to acts during adulthood that will match that state. Injuries can vary from superficial cutting, to deeper cuts causing significant blood loss and anaemia. Some will go even deeper and cut arteries which can be very serious."
Citing Marilyn Manson and Iggy Pop as possible cultural influences, notorious not only for their music, but also for their self-destructive behaviour. McDonough says: "There are certain celebrities that would be favoured by rebelling teenagers.We know that when suicides occur of famous figures, it sometimes inspires others to do the same. It's a double-edged sword in that you want people with this level of distress to identify with something, as long as that something isn't hopeless.
"People with this type of problem require professional help. It isn't inevitable that those who develop this pattern will continue to do so. Sometimes they will grow out of it. There is evidence to support the benefits of dialectic therapy which we have here at St Patrick's. This is a form of cognitive behaviour therapy in a group setting, to help recurrent self-harmers find healthier coping alternatives. To enable them communicate their distress, reach some resolution and to realise that self-mutilation is no longer helpful to them and that there is a better way."
Dr John Connolly, secretary of the Society of Irish Suicidology highlights a link between self-mutilation, body-piercing, tattooing and suicide. "Once you start mutilating, the next step is a bit easier than the first. One per cent of people who attempt suicide will go on to complete that within the next 12 months. Over a life-time, 10 per cent who attempted suicide will go on to complete it at some stage.
"Self-hatred can be another motivation, especially in children who've been abused. Self-mutilation may become a way of problem-solving with motivation having nothing to do with suicide."
Paul O'Hare of Samaritans says "We want to stress to friends and families of sufferers the importance of responding to this cry for help in the correct way."
The Samaritans helpline: 1850 60 90 90."