Deliberate Self-Harm is an umbrella term that encompasses any non-accidental activity that a person engages in that, well, harms that person physically. Cutting is the most talked about self-harm behavior. But the term also includes head-banging, pulling out hair, biting, burning, picking at scabs, and frequent biting/picking at nails and cuticles until they bleed. I think the term is mis-leading because it implies that the person’s aim is to inflict pain on himself or herself. But some self-harm behaviors–especially hair-pulling and extreme nail-biting–are unconscious; they serve a role in dissociation. And the purpose of self-harm is not a masochistic desire for pain, but rather an attempt to escape or control unbearable psychological pain.
Today I want to talk about why kids and teens self-harm, have eating disorders, and attempt suicide. Obviously when a kid does any of these things, something is wrong. But I think we err when we treat one of these problems as The problem instead of as a symptom of a larger problem. And it’s a dangerous error.
All of these behaviors are linked to trauma. According to Jon Allen in Coping with Trauma: Hope Through Understanding, “a high proportion of women with eating disorders report a history of childhood sexual abuse.” He goes on to say that eating disorders are also linked to other forms of abuse and neglect and are more likely to develop when women “have problems with attachment.”
Attachment–that’s psych talk for kids (and adults) who don’t feel that they have someone they can count on. I mean, epically. They have been (physically or emotionally) abused, neglected, or abandoned by their caretakers and they neither feel that they can trust someone nor have they developed the skills to do so.
Eating disorders and cutting are both used as forms of control for people who don’t feel like they have any other control over their lives, and as ways to alleviate psychological pain that they don’t have the resources to deal with. Inflicting physical pain on oneself can be a way to focus the pain outside of oneself. Self-harm is often brought on by intense feelings of neglect, rejection, and abandonment that the person can’t deal with. In addition, in families where the caretakers are often abusive or unstable, self-harm is a way to re-direct anger, that it would be unsafe for the child to express externally, back at himself or herself.
Suicide attempts, likewise, are linked to childhood trauma, and are the extension of these other behaviors. If self-harm is used to alleviate immediate, unbearable psychological pain, then suicide attempts are when psychological pain is not only unbearable, but the child or teen is hopeless and can see no way out besides death.
All of this is to say, that if a kid is banging his head on the ground, the problem is not really that he is banging his head on the ground–the problem is that he is in severe pain that he can’t handle. Just stopping him from banging his head on the ground is actually going to be counter-productive because it is going to take away his only tool for dealing with the pain. Instead, someone needs to figure out what has happened to him or is being done to him that is causing him such psychological distress. And after that has been discovered and taken care of, then he needs to be taught other, less injurious ways of dealing with his emotional distress.
Likewise, if a teen girl is cutting herself, someone needs to ask what has happened to her or is happening to her? Likewise if she’s starving herself or forcing herself to throw up or is slitting her wrists.
Too often we focus on the behavior and try to fix it without looking for the cause. As children’s writers what we can do about this is to write books that link these behaviors with their cause.
I know that there must be more books about eating disorders, self-harm, and suicide attempts out there than I know of, but for the life of me, the only one I can think of is Winter Girls by Laurie Halse Anderson in which the protagonist struggles with her own anorexia after her best friend has died of the same thing. It’s a great book (IMO) and a good cautionary tale for teens struggling with eating disorders. But what it lacks almost entirely, is any suggestion that there is a cause for these girls’ disordered eating.
As far as I know, there is no starvation gene. It certainly wouldn’t work in Darwin’s worldview. I think what kids who are starving themselves need (besides, yes, the warning that if they keep doing so, they will die) is to see that their starvation is a coping mechanism. And they need to see why they are using this particular coping mechanism and how they could get out of the situation that is causing them to want to starve, and how they can develop other coping mechanisms.
I think we need to write the books that make these connections, and I think when we work with kids, we need to be more aware of these symptoms and of what the underlying causes might be.
Next Week’s Topic: What I need to know about attachment, I’ve learned from cats.