Trigger Warning: Mention of self-harm
Back when I was in the 10th standard, a new dangerous trend spread amongst us young teens like wildfire and almost all of us got onto the bandwagon. Perhaps because we were at this crucial stage of life, just beginning to understand the world and ourselves, with a strong desire to fit in, hence, easily influenced. The trend involved cutting up our skin with paper cutters. I don't remember how it started, but I remember every girl who got dragged into it, including myself. While some did it for the sake of conforming to the trend, there were those who went a bit too far and decorated their wrists with multiple deep crimson slashes, scarring themselves for life. I didn't understand any of it at the time but isn't that how addictions are meant to make you feel? Aren't they supposed to provide us with a compelling biological incentive to pursue them despite the detrimental consequences repeatedly?
The memory of this one incident, in particular, is still fresh in my mind when one early morning a classmate of ours locked herself in a bathroom stall and slashed both her wrists. All the young faces of our class were filled with horror that day and the girl was immediately rushed to the hospital. We never got to know her story as she got suspended for that incident and by the time she returned the news had already dissipated, homeostasis in the school had restored. Now when I look back to that day, I can't help but wonder whether suspending her was the right thing to do. Surely, there must have been a reason that drove her to commit such an impulsive act, but her cry for help went unheard and misunderstood.
Harming the self is not always considered pathological because behaviours such as body piercing, tattooing, elongation of the neck, and facial scarification are common to certain cultural groups. Studies suggest that self-harm is considered abnormal when it contravenes cultural and subcultural norms and can include cutting/scratching, burning, picking, substance abuse, eating disorders, hair-pulling, bone-breaking, joint dislocating, head-banging, castration, and limb amputation.
In the West, Non-Suicidal Self-Injury (NSSI) has been identified as an important self-directed violent behaviour with major public health implications. Some theorists consider NSSI as a gateway to suicide, as it is perceived that repeated engagement in NSSI may lead to increased pain tolerance and reduction in the fear of death, which in turn, may increase the risk for suicide attempts. Apart from its association with suicide, NSSI has various other health implications, such as its associations with disorders like anxiety, depression, eating disorders, and borderline personality disorders. NSSI is also associated with developmental and personality-related vulnerabilities. Hence, NSSI may serve as an indirect indicator of not just suicide but also various other mental health concerns.
Even though self-inflicted injury is a common clinical problem, it is poorly understood and arouses ambivalent feelings in individuals. It is one of the most common, yet one of the most stereotyped addictions. We often hate what we do not understand; in this case, label the ones who harm themselves as crazy, self-obsessed, or attention seekers. It remains a taboo about which society continues to hold negative attitudes, fear, myths, and repugnance. To intentionally hurt oneself, to make oneself bleed, burn, lose consciousness, or in some way deliberately damage one’s body is seen to go against core human values. Moreover, such stigma prevents people from reporting the incidents and is often dealt with by the person in private without proper attention from mental health services or professionals. The lack of understanding and action, strong reactions from others, as well as the shame and guilt associated with harming oneself may further provoke the individual to enter into a vicious cycle.
Whether we acknowledge it or not, self-harm is a global health problem which seems to have been rising, especially among the adolescent population. It is especially common in 15–24-year-old women, a group in whom rates of serious self-harm seem to be increasing. India has one of the largest populations of adolescents in the world. According to the census of 2001, 30.5% of the people of India are in the age range of 10-24 years. Unfortunately, due to the ignorance and stigma attached to mental illness, it is not surprising that India also has one of the highest suicide rates in the world among the youth. Where even suicide is not considered as a major public health concern, self-harm is far from being recognized as an issue in India. Considering that self-harm is rarely talked about in our community and is seldom researched upon, it is imperative to accept it as a major health hazard at both individual and community levels so that preventive strategies can be planned and put in place.
Anam Khan
