Listening to the “Self-Harm” episode I felt a need to educate the therapist presenters. I am a social worker and an expert in self-injurious behavior. I have spent 100s of hours pouring over books, research, and talking to those who self-harm. In addition to that, I have personally been self-harming for nearly 30 years. With that in mind, please allow me to clarify a few things that those of us who self-harm feel most therapists get wrong.
1. Self-harm and suicidal ideation are completely different things. A person who injured themselves rarely intends to cause death, and in fact, will often attempt to prevent things like infection or accidental death by knowing where to harm, and how much is too much harm. We often use methods to clean, sterilize, or otherwise care for the wound.
2. Not all of us carry shame for our self-injurious behavior. Some of us accept a radical idea that this behavior is akin to getting a tattoo, piercing, or exercising. When you exercise, it hurts, endorphins are released and you feel better. When people self-injure it hurts, endorphins are released, and you feel better. It is purely societal discomfort with those that divert from the norm that leads to shame in some self-harmers. I am here to say that shame need not be associated with self-injury.
3. The fear we develop in talking about self-harm is often due to the reactions of those we tell. Those reactions thrive because of therapists who react rather than listen. You don’t have to praise the behavior but holding back the parts of you that are disgusted or disturbed by the self-injurious acts of clients is crucial in ending the feelings of shame and desire for secrecy. Case in point, the way you both started this podcast, talking about self-harm as if it is shocking that people would do it and that a person should do everything in their power to avoid it is incredibly ignorant and, frankly, feels very patronizing.
4. Rather than demonizing self-harm, recognize the incredible tool it has been for clients. It likely kept the internal pressure down, thereby keeping suicidal ideation at bay. It allowed the client to survive.
Now, let me be clear, I have never, nor would I ever encourage my clients to self-harm! I know the act can lead to unintentional death or permanent disability. I also understand the biology of self-harm and that dumping dopamine through self-harm is not sustainable. When dopamine stores become depleted from repeated self-harm, a person is left feeling worse than before. My point here is that the way we approach self-harm in our clients needs to be changed to better support our clients in being gentle with themselves and eliminating shame that could keep them from seeking medical attention when needed.
Since realizing these things, and releasing any shame I used to have around self-harm, I have felt less of a need to self-harm. By approaching the subject with understanding and curiosity rather than fear and disgust, I naturally chose other behaviors. That is how we heal. That is how we grow. That is how we thrive.
Thank you for addressing this topic. I sincerely hope you find this helpful.
My scars are beautiful! They tell a story. I never try to hide them. I am strong. I am courageous and I carry no shame.
