I think itâs, itâs really difficult to get somebody to, sort of, use alternatives, because itâs such a powerful thing, because it involves the body so strongly and [âŠ] the actual cutting and the, the blood thing and, thereâs not much else that can kind of, stand in for that really. (Rease, 28, 2007)
On the surface I wasnât feeling particularly distraught or any- you know, hysterical or anything, it was just, I was wondering what it would do, I was wondering what it would do to my skin, how much it would hurt. (Francis, 25, 2007)
This book is about accounts of self-injury, of bodies and of the role of sociology in helping to deepen our understanding of what self-injury is, how it functions, and why people might do it. The quotes from Francis and Rease, above, indicate, in different ways, the centrality of the body to the practice of self-injury. Reaseâs account highlights the importance of corporeal, tangible aspects of self-injuryâcutting skin and flesh, the resultant bloodâin explaining why self-injury might be difficult, for some, to replace as a âcoping mechanismâ. Reaseâs explanation resonates with findings from clinical research which have, so far, struggled to develop âeffectiveâ treatments for people who self-injure (Warner and Spandler 2011). Francisâ narrative gestures to the importance of embodiment in a different manner, suggesting an exploratory orientation towards his body. Self-injury for Francis is framed as a way of testing out bodily responses and limits in order to discover what his body could do, and how it might feel if he did certain things (burning) to a part of it (his skin).The twenty-first century is unfolding with an escalating epidemic of young people resorting to self-harm as a means of coping with pain and turmoil. (Plante 2007: p. xiii)
Both Francis and Reaseâs accounts indicate the complex ways in which âthe bodyâ is implicated in narratives about self-injury; in some senses being objectified and separated off, with the self acting upon the body. These narratives point to a dualistic understanding of âthe selfâ with body and mind framed as separate from one another (Crossley 2001). Studying the manner in which accounts about self-injury implicate âthe bodyâ opens up important routes through which to interrogate the ways in which bodies and embodiment are understood in different social and cultural contexts. This book is also, then, about accounts of embodiment, and the role of self-injury in helping to expand our understanding of what bodies are, and how people in late modern, âWesternâ societies conceptualise and narrate their bodies, and their selves.
An increasingly dominant explanation for self-injury is that it is a method of coping with difficult emotions (or with âpain and turmoilâ): as illustrated in the final quote at the start of this chapter, taken from Lori Planteâs Bleeding to Ease the Pain (2007). This is one example from a plethora of books which followed the publication of Favazzaâs landmark Bodies Under Siege (first published in 1987) which aim to explore the meanings of self-injury. These books are often aimed jointly at clinical and popular audiences, reflecting the wide appeal of the subject matter, and the sense that the practice is esoteric and difficult to understand. The starting point of many of these works reflects a position of horror and disbelief at the types of practices that self-injury (or self-mutilation) can involve. In these accounts, self-injury is clearly framed as something that âother peopleâ (never the reader) do. Thus, description and discussion is often oriented towards helping readers to understand self-injury from the perspective of those who carry out the practice. However, the language that is used is often sensational and dramatic, serving to highlight the distinction between reader and âself-injurerâ:
Carving the tender, vulnerable flesh of her arms â the only part of her body she considered beautiful â was a way of mapping the pain she felt inside. (Strong 1998: p. 22)
Such a position (of shock and horror) is not limited to literature on self-injury written, as Planteâs and Favazzaâs, from clinical or, as with Marilee Strongâs A Bright Red Scream (1998), journalistic perspectives. Patricia and Peter Adler, who have produced one of the most comprehensive sociological studies of self-injury, note in the acknowledgements of 2011âs The Tender Cut, that their research on the topic had been difficult: âThere was nothing fun or funny about exploring the lives of the self-injurers portrayed in this bookâ (p. ix). They go on to warn the reader that the contents of the book may be read as âgruesome, morbid, and depressingâ as well as âfascinating, revealing and importantâ (Adler and Adler 2011).Self-mutilation is undeniably unsettling to everyone who comes into contact with it. (Favazza 1996: xvi)
I would agree that self-injury can be all of those things. However, Self-injury, Medicine and Society represents an attempt to move past this position of shock and horror, towards one of intellectual and appreciative engagement with the practice of self-injury, and the social and cultural contexts in which it takes place and is constituted as a phenomena. This is not to say that the subject of self-injury is not potentially gruesome, morbid, depressing, shocking or alarming, it clearly is to many people. However, in order to appreciate and understand self-injury I will suggest that we need to move beyond this response. Indeed, it is imperative that we critically explore why such responses might arise in the first place. Such an orientation involves not just attempting to understand self-injury from the perspective of those practising it, but also to examine how self-injury is understood more broadly. To ask what cultural narratives and scripts people who self-injure draw upon to explain, or justify, their actions. To explore the ways that these narratives are understood by those who live with, care for or treat those who self-injure. This book addresses both the accounts of people who have self-injured, and socio-cultural narratives about what self-injury is and what it means. In this way, I hope to avoid individualising self-injury, and rather to develop a broader understanding of self-injury within a specific historical period (late modernity), and within particular socio-cultural contexts (âWesternâ industrialised societies, particularly the UK and the USA).
My discomfort with the âotheringâ perspectives of many who have written of and researched self-injury undoubtedly arises from my personal involvement with the subject matter. As someone who has âself-injuredâ, I find it difficult to share the positions of shock, horror and disbelief articulated in many accounts of self-injury. While my own experiences with cutting, burning and hitting are not necessarily equivalent to those of othersâ, these experiences do shape how I respond to accounts about self-injury. In particular, I am perhaps less easily âshockedââI have lived with self-injury for over 20 years, it has become more mundane than exotic. Perhaps a further result of this is thatâunlike Adler and AdlerâI do find some aspects of self-injury funny. Humour has been an important part of my research, and of the relationships I developed with participants. Further, humour remains an important resource through which I continue to manage the visible signs of my own involvement with self-injury.
Lisa McKenzie (2015) has written about her discomfort in relating moments of laughter and humour shared with those involved in her ethnographic study of council estate life. She worried about the way in which humour might be seen by others as normalising deeply problematic activitiesâin her case the use of crack cocaine. Humour is a deeply telling device, which can mark our status as an âinsiderâ, acting as a way of deflecting or coping with subject matters that might otherwise be distressing (Sanders 2004). However, in contrast to McKenzie, I am less comfortable with claiming an âinsiderâ identity. While I am clear that I share some experiences with others who self-injure, and these experiences have certainly shaped my research and writing; to call myself an âinsiderâ would be disingenuous. For a start, self-injuryâas we will seeâencompasses a hugely diverse range of practices and positions. There is not really much to be âinsideâ ofâit is not geographically specific, and it is not practised only by a particular group of people. Indeed, a running theme in this book is that self-injury resists easy categorisationâthough there are significant attempts to fix the meaning of self-injury, and these will be critically explored. Further, the very fact that I have spent over ten years studying self-injury academically means that my understanding and experience of being someone who has self-injured is far from typical. I have been hugely privileged to be able to study an issue so close to my own experience; and I have profited directly from this study, in a way that is not possible for many.
Context and Identity
The contexts in which self-injury takes place, and the identities of those understood to be self-injuring, are more contested and variable than is usually acknowledged. For instance, several scholars have charted the way in which self-injury came to be understood as a largely femaleâperhaps feminineâendeavour, over the course of the twentieth century (Brickman 2004; Millard 2013). In the twenty-first century, self-injury continues to be marked as a practice of girls and women, rather than boys and men. However, surveys of young peopleâa key source of knowledge about self-injuryâconsistently find that between one quarter and one-third of those reporting self-injury identify as male. Depending on the definition of self-injury used, the proportion of men reporting self-injury can be even higher. Despite this, researchâsociological and otherwiseâhas consistently focused on women and girls, often without problematising this. For instance, Adler and Adlerâs otherwise comprehensive sample was 85 % female. However, qualitative research in general often struggles to recruit men (also noted by McShane 2012). I would suggest that the pre-existing cultural framing of self-injury as âfeminineâ, and the reliance on online message boards (which are used more often by women) (Hodgson 2004) leads to researchers accepting unbalanced samples and concluding they reflect the gender ratio in the general population. In turn, studies which focus on predominantly female samples serve to further affirm assumptions about the âtypical self-injurerâ as female.
There is another, relatively unacknowledged bias in the vast majority of sociological research on self-injury, including my own. As well as being generally focused on female bodies, sociological research has also tended to address White bodies. Arguably, this bias reflects the demographic makeup of those who predominate in (most) statistical surveys of the prevalence of self-injury, though as we will see there are important reasons to question these surveys. Self-injury (and self-harm) in the USA and UK is not carried out solely by White people, and, as we saw above, certainly not only by women and girls. Adler and Adler note that their sample was diverse in this manner, but race and ethnicity do not f...