Mental Health

Self harm-Why we need to talk about it

By Shreya Giria

Digital Discourse Foundation:

That Mental health is affecting the daily chores and productivity of people in today’s society is increasingly alarming mental health professionals world over.

16 year old Neeti (name changed) is a victim of Deliberate Self Harm. Despite being a smart, lively teenager studying in an expensive International School in Bangalore in India, Neeti cuts herself every few weeks because it makes her “feel okay”. When she is unable to deal with academic pressure, or when arguments with her parents or friends follow, she takes a blade - that she keeps in her bedside drawer - and stealthily cuts herself in her inner thigh or in the inside of her hand – areas - covered by her clothes. The cut, she says, “is superficial… something that does not draw too much blood, but just enough”. Neeti’s emotional scars are largely triggered by the bullying and peer pressure about her body image and sexuality she suffered during school. Secondly, memories of her childhood sexual abuse leave her feeling guilty and wronged. Harming herself numbs the emotional pain, if only for a little while. Neeti is not alone. The malaise is latent. If neglected, this malaise can lead to violence in society.

35 year old Jagdish (name changed) works in a Multi-National software company as an engineer. He says overall he is okay, except when he gets stressed due to deadlines, managing life becomes challenging, - he either punches his hand, or bangs his head on the wall. Jagdish is far from suicidal; but says, when he is stressed, he feels like a failure; hitting himself has been his wont for decades. It is not lethal, he reassures himself, succumbs nevertheless, unable to stop himself. “His family feels powerless to help him. Needless to say it does create a cloud of tension in the family itself.”

Anshul, 22, (name changed) plays cricket and represents his college. Driven by the need to succeed and ace everything, Anshul finds it hard to bounce back from failures. He finds himself “in a black hole…like I’m not even enough of a person”. When coping with his own disappointments, he confesses to sometimes burning his calf muscles by pressing a burning cigarette butt on his skin. Others don’t know it, and he prefers it that way. This youngster’s healthy future is at stake.

As counsellor, I meet many such clients who seek help. Thus, writing for me is in a way therapeutic, pushing me to create awareness…

As in many countries, Deliberate Self-Harm or DSH in India is a latent but silent epidemic. The World Health Organisation of the United Nations recommends, that “Non-specialist health care providers should ask individuals or children over 10 years of age who present (themselves) with chronic pain or acute emotional distress associated with current interpersonal conflict, recent loss or other severe life event. It helps to diagnose any mental disorders to check if they have had thoughts of self-harm in the last month or have plans about or have indulged in acts of self-harm in the last year - if they are suffering from depression, bipolar disorder, schizophrenia, epilepsy, alcohol use disorders, illicit drug use disorders, or dementia.”

Prevalence of DSH varies in different parts of the globe, affected by socio economic, political and psychological factors according to one <study> - “A study of deliberate self-harm and its repetition among patients presenting to an emergency department” by Yip PS et al published in Pubmed ( Society needs to wake up to this epidemic to prevent precipitous manifestation of latent mental health issues, because, DSH is a strong precursor to suicide.

Within the 1st year after self-harming, 16% of people harm themselves again, 0.5-1.8% die by suicide, and 2.3% die by any (other) cause. The World Health Organization (WHO) of the United Nations <> emphasizes the need for health care providers to implement suicide prevention through effective management in persons with DSH.

People indulging in self harm, often mention not wanting to die, emphasizing - when confronted - that it wasn’t a suicide attempt. This leads many to conclude that it is attention seeking tantrum. Contrarily, individuals who harm themselves rarely let their scars show, and often do not share these experiences with others. An in-depth understanding often reveals faulty coping mechanism for dealing with external and internal stress.

This distressing trend may have myriad social and interpersonal triggers. Family, constant pressure, leave vulnerable people with a low self-worth; neglect, or abuse of any kind may trigger unpleasant emotions leaving them vulnerable to self-harm tendencies. One of the other alarming reasons may be bullying, peer pressure, and feeling discomfort about processing one’s sexual identity and behaviour. Though it sounds counterintuitive, self-injury may temporarily provide a relief from all the other trauma or pain one is going through. It may allow the individual to assert self-control. At a time when everything else seems out of control leaving them feel helpless, this may provide a short lived deflection.

Aside from the fact that it is painful, self-harm can also become addictive in itself - flawed ways of dealing with stress. At best it is a harmful coping mechanism.

Avoiding counselling digresses from finding solutions, and indulgence increases sadness, loneliness and emotional alienation. After Neeti spoke to a counsellor for instance, where her insecurities and her low self-worth were addressed, her experiences as a sexual abuse survivor were processed. She was encouraged to practice healthier relaxation exercises, and she developed a healthier worldview and self-esteem; she ceased her self-harming behaviour and learnt coping mechanisms, she could then address them, and also found other ways to understand and work with her emotions.

The need for awareness for mental health issues is best addressed by the Media. Media’s engagement is critical to a positive dispensation towards wholesome mental health of society.