Image: Hands, from Paul Bence's Flickr Photostream

Self-harm is clinically referred to as Non-Suicidal Self-Injury.  It is described as an act which causes direct harm to the body but one where the focus is harm itself and not some other goal. Research into self-harm over the last ten years has resulted in a stream of headlines about rising rates, particularly amongst young people. The research shows that people who self-harm tend not to seek medical help. If they do, they are often responded to with callousness or discomfort, particularly in A&E.  COVID-19 seems to have thrown some of these current concerns into sharp relief. It is widely thought that the pressures of the pandemic and lockdown might result in a rise in rates of self-harm.  Also, that the fears around infection-control and lockdown regulations might mean that people felt or were unable to access the therapeutic support systems which had previously been in place or emergency care for physical wounds.

Particularly in the context of Covid-19, it can be easy or natural to frame these concerns as a question of “risk”, of the “impact” of the pandemic, and of a “mental health toll” of lockdown. However, this emphasises the causes of self-harm and responds to the assumption that this is a problem which must be resolved.  When reported in popular media questions of rising rates are prominently located in headlines and first paragraphs. In contrast, problems about available support, funding for mental health services, and instances of professional advice to avoid seeking care altogether are relegated to final paragraphs or even left out entirely. This allows us to see how self-harm is understood as a “problem or pathology” perhaps even the “ultimate pathology”. Not only does this, as Kesharie Gurung notes, ignore the ways in which self-harm is often experienced as meaningful, but it also ensures that the question of cause remains at the forefront, while the question of response slides out of view.

And while these might seem like two sides of the same coin, I would argue that there is a significant political difference; for the question of cause asks how we can stop self-harm, but also how we can prevent self-harm, how we can protect those for whom self-harm is not yet a reality. In contrast, the question of response centres, in policy and in everyday practice, people with experience of self-harm, their lives and their needs.

Indeed, this question of response is one which my own research has suggested might be particularly important; I’ve conducted interviews with people with experience of self-harm, talking to them about representations of self-harm in fiction. Although the questions I asked were general, inquiring about what depictions they’d seen, and how it had felt to read or watch them, it was notable how often our conversations turned to the question of response.

In a discussion of an instance of self-harm in the TV show American Horror Story Blanche[i] described that at the end of the scene the self-harming character’s boyfriend enters:

“and is like, oh, you’re not doing it properly. You have to go the other way around if you want to actually do any damage. And I remember that sticking with me going, Oh, that’s, that’s really nasty.”

It was evident to her that this was a malicious, cruel response; other participants similarly described finding scenes where self-harm was responded to with shock and horror, or with misunderstanding and dismissal, to be particularly memorable and even distressing.

Other people, I talked to felt that responses like these formed part of a pattern. For Lou, this was related to a tendency, typified by the film Thirteen, for self-harming characters to be presented as isolated and to lead into “a narrative around being discovered”. For her this was a narrow pattern of response and resolution, in which:

 “it’s always stop doing that, that’s terrifying. And often there’s a real emotional response to, to that, stop it. And then that person stops it, you know.”

Francesca made a similar comment, noting that both in fictional representations and in real life, a discovery or disclosure of self-harm often means that:

“the self-harming person is like, this like sort of horrifying object that must be dealt with. And it’s like this overwhelming thing that now I have to handle, you know […] And sometimes people can get angry at the self-harming person.”

Both comments echo (and indeed have shaped) my own concerns about what it means for self-harm and for people who self-harm to be understood and responded to as a problem, how that sense of assumed problem-ness can lead to reactions which are hurtful or dismissive, which prioritise the cessation of self-harm and the comfort of others rather than the distress of the person self-harming, and the meaning that experience holds for them.

All of this suggests that the question we might be better to ask with regards to self-harm is how we can respond to self-harm with care? Or beyond that, how do we create space in which it’s possible to respond to self-harm with care? Research into experiences of fiction offers us the chance to think of that fiction as a space of encounter, or rather a space in which certain encounters are made possible or likely, while others remain invisible or unspoken. This raises questions about how might fictional depictions of self-harm create space for kindness and care? How might they create a textual encounter, a reading or watching experience, in which care for self-harm feels possible, or indeed is even enacted within that very experience? But beyond that, there is a question for us all: how do we create spaces in our society in which it’s possible to respond to self-harm with care? How do we make those spaces in our schools, our homes, our hospitals?

Living in the time of COVID-19 is prompting us to re-think many of the things we take for granted, especially many of our assumptions about space, community, and care. In particular, we might pay attention to how it can feel like we need to frame something as “a problem”, to access resources, to access care. I am supportive of calls to take self-harm seriously, but given the impact of responses of shock and horror on people who self-harm, I wonder how “seriously” might best be interpreted? What does it mean that the same rhetoric through which we attempt to claim care is also that which often shuts down its possibility? What sort of a change in framing might be necessary to make care more possible or likely?

Perhaps this is the perfect time to turn our attention to self-harm: not with the seriousness of shock, or alarm, or disturbance, the desire to ‘fix’ a problem that has been presented to us, but with the seriousness of kindness, of understanding, and of care, an ability to be with someone in their distress.

[i] Participants selected whether to be referred to by their own names, by a pseudonym of their choice, or by a pseudonym which I assigned to their quotes – those preferences have been respected in this blog

About the author: Veronica Heney (@VeronicaHeney) is a PhD student at the Wellcome Centre for Cultures and Environments of Health, at the University of Exeter. Her research explores cultural representations of self-harm, as experienced by people who have self-harmed.