Self-Harm in Adolescence from a Psychoanalytic Perspective - Essay Example

Self-Harm in Adolescence As Seen From a Psychoanalytic Perspective Introduction Aversion to pain is part of human nature and it is highly abnormal for anyone to relish being inflicted with bodily harm, but in the growing phenomenon called deliberate self-harm, people actually hurt themselves for reasons that baffle behavioral scientists. Most of those who engage in self-harm are young people and they do so by stopping short of killing themselves, which makes this particular behavior distinct from suicide. Unlike suicide, whose motivations have been long understood by experts as utter hopelessness and despair, there is no easy way to explain the psychodynamic of self-harm. Psychodynamic being the study of behavior as to motivation appears to flounder on self-harm, which has been described as one of the human behaviors "incredibly difficult to comprehend (Apter, 2002)." Thus, research has gone no further than setting the psychoanalytic concepts invoked by self-harm and establishing that this destructive behavior typically begins in early adolescence, which is around age 14, with the incidence seeming to peak between 16-25 years of age. This paper discusses those psychoanalytic concepts and explores their practical application in the adolescent stage of one's life. It examines self-harm from the perspective of psychoanalysis to see why adolescents otherwise considered normal sometimes exhibit such an abnormal behavior and in the process gain insights on how to handle such people. . Hypotheses Self-harm is defined as a deliberate and often repetitive destruction or alteration of one's own body tissue, without suicidal intent (Favazza, 1989; Lerner & Steinberg, undated). People who engage in this patently destructive act thus hurt themselves not to end their life but rather to enable them to carry on living by obtaining relief from intense emotions or by creating feelings when they feel numb inside. In other words, a person who truly attempts suicide seeks to end all feelings whereas a person who self-mutilates only seeks to feel better (Adams, undated). Most research on the subject emphasizes the distinction between self-harm and suicide. In fact self-harm is often referred to by residents as a means of survival, or relief from extreme distress and pent-up emotion. Nevertheless, most housing and mental health workers who have experience of this phenomenon will know at least one client who has severely injured or killed him/herself through either miscalculation of method or inability to resolve core problems and subsequent attempted or successful suicide (CSP, 2004). Fillmore & Dell (2005) hold that self-harm occurs and continues unabated because of several factors: - A strong relationship between childhood and adult experiences of violence and involvement in self-harm. - The onset of self-harm occurs primarily during adolescence. - There is a lack of awareness of existing resources for self-harm in the community and in correctional institutions. - Specific programs and clear guidelines and policies on self-harm were generally lacking in both community and correctional settings. Some of the terms used to describe self-harm include self-injury, self-mutilation, self-inflicted violence, auto-aggression, and para-suicide. The exact prevalence rate is unknown but it is believed that 400-750 people per 100,000 make self-harm their release valve for negative feelings. Self-harm is also 10 to 100 times more common than suicide but these statistics are not reliable because of the private nature of this act, compounded by the fact that many of such incidents are never brought to the attention of professionals. In one study, 71 percent of the young people who resort to self-harm considered this act to be an addiction (JCK, 2004), and as such may be as prevalent as the addiction to prohibited substances. A striking feature of the social portrait of self-harming adolescents is the high level of family disruption and trauma in their lives. Only 36 percent of the girls in the Fillmore & Dell (2005) study lived with their families, while the rest lived in foster families, residential facilities or group homes. A small percentage (8 percent) lived on the streets or with their friends. Another significant feature was the high degree of family abuse and violence experienced by the self-harming adolescents, even greater than that reported for the adult clientele. Like the women clientele, the adolescent girls also experienced considerable abuse and violence both from strangers and in their dating relationships. Moreover, the adolescent girls were found to have displayed physical aggression, and that it was primarily against other family members. Some researchers report an equal distribution among males and females with females being more likely to seek help, or be discovered, while others report that females constitute about two-thirds of habitual self-mutilators. It appears that self-harm cuts across the boundaries of race, gender, education, sexual preference, and socioeconomic class (CSP, 2004). The kinds of self-harming behaviors reported by the teachers and other interviewed for the study of Best (2006) were many and varied in degrees of severity. The list includes cutting, scratching, burning, hitting or abrading the skin, punching the wall, drinking bleach, picking at wounds and warts, refusing medication, drinking binge, sniffing glue and petrol, jumping from a moving car; overdosing on recreational drugs, sewing pieces of material to the skin, putting oneself at risk of sexual abuse; tearing earlobes with heavy ear-rings, self-administered body piercing and tattooing, and swallowing a range of objects including mobile-phone batteries and zip-fasteners. The most common practice of self-harm is skin cutting, but other popular methods include burning, self-hitting, interference with wound healing, severe skin scratching, hair pulling, and bone-breaking (Favazza, 1989). With cutting and burning, people will choose places on the body that are not likely to be seen by others, or can be easily covered up afterwards like the arms, legs, or chest area. Most people who self-harm report little or no pain during the act and they know when to stop a session of self-mutilation. After a certain amount of injury, the need is somehow satisfied and the abuser feels calm and soothed. Clery (1999) posits that self-harming adolescents reflect the developmental ambiguity of adolescence, when young people find themselves on the difficult transition from childhood to maturity. From this stage, which is widely acknowledged in social psychology as a period of "storm and stress (Dahl, undated)" and a time of "universal and inevitable upheaval (Erikson, 1968)," most adolescents emerge with minimal difficulties but for others it increases conflicts with parents, negative moods and risk behavior in the form of reckless and sensation-seeking activities. These are negative feelings that may lead to self-harming. According to Clery (1999), unbearably painful feelings can be expressed, suppressed, punished, coped with or reenacted, one or all at the same time, by way of a cut, burn or blow. Severe cases are usually linked to traumatic and even unspeakable experiences from the past. Coping is a behavior we use to get through stressful and difficult times. For others, self-harm is the coping method of choice that otherwise looks extreme but is in fact right and effective for them. Although the act of self-harm is often regarded as a morbid behavior, it can be understood as a type of self-help practice that provides temporary, often rapid relief from psychological distress (Favazza, 1989). For the self-harming individuals, it serves the purpose of easing tension and anxiety, escaping feelings of depression and emptiness, relieving anger and aggression, regaining control over one's body, obtaining a feeling of euphoria, and maintaining a sense of security or feeling of uniqueness. Self-harm is also resorted to as a response to self-hatred or guilt, as a continuation of previous abusive patterns, as compensation for feelings of alienation, or as symptom of a more severe mental disorder. Studies show that an individual is at risk for self-harm if one or two of the following conditions exist - low mood; feelings of hopelessness; inability to look toward the future; history of depression, schizophrenia or other severe mental illnesses; physical illness or disability; heavy use of drugs and/or alcohol; history of past suicide attempts; and past record of violence to others ((Freud, 1969). There is also a list of predisposing factors that may lead to self-harm: Drug and alcohol abuse Eating disorders Signs of depression, among them weight loss and insomnia History of childhood physical and sexual abuse Institutionalization in correctional facilities or drug treatment centers Inability to tolerate and express feelings Feelings of worthlessness, hopelessness and helplessness Sense of abandonment and loneliness in childhood Early history of surgical procedures or medical illness requiring hospitalization Disruption or lack of supportive relationships or systems, e.g. social isolation secondary to imprisonment, death of a valued person and family problems like divorce or separation (CSP, 2004). JCK (2004) opines that a person's low estimation of his looks, communication skills and ability to socialize with peers may turn to self-harm as a form of punishment. In the case of those who hate the way the look, they might resort to starvation or self-induced vomiting to accentuate their "ugliness" and will view any scars caused by cutting or burning as a manifestation of their poor self-worth. For those who feel conscious about their verbal and non-verbal communication skills, self-harm may be the only means available to articulate their sentiments or make themselves visible. Erikson (1968) noted the importance of developing a vocational identity and a personal philosophy, which can provide the adolescent with a reference for evaluating and coping with life events; otherwise, the adolescent may not be capable of forming a coherent and acceptable identity leading to self-doubt, role confusion and indulgence in self-destructive activities, such as juvenile delinquency or personality aberrations. During adolescence, one begins to integrate various roles he/she plays in meaningful and constructive ways. As one prepares for adulthood, there is wide variation, however, in adolescent experiences in accomplishing a set of developmental tasks. Developmental tasks are skills, knowledge, functions or attitudes that individuals must acquire at various stages during their lifetime in order to adjust successfully to the more difficult roles and tasks that lie before them. They are acquired through physical maturation, social fulfillment, and personal effort. Failure to attain them can often result in maladjustment, increased anxiety, and an inability to deal with the more difficult tasks to come. Adams (undated) believes the developmental tasks of any given stage are sequential in nature; that is, each task is a prerequisite for each succeeding task. The optimal time for each task to be mastered is, to some degree, biologically determined. The nine major tasks are: 1) accepting one's physical makeup and acquiring a masculine or feminine sex role; 2) developing appropriate relations with age-mates of both sexes; 3) becoming emotionally independent of parents and other adults; 4) achieving the assurance that one will become economically independent; 5) determining and preparing for a career and entering the job market; 6) developing the cognitive skills and concepts necessary for social competence; 7) understanding and achieving socially responsible behavior; 8) preparing for marriage and family; and 9) acquiring values that are harmonious with an appropriate scientific world picture. At any given time, adolescents may be dealing with several of these tasks. The importance of specific developmental tasks varies with early, middle and late periods of the transition. The Developmental Tasks Model expects an adolescent who mastered these tasks to emerge from adolescence as a well-adjusted and well-socialized adult. However, some tasks are now more difficult to master. For example, in entering the job market there are fewer lower skill jobs and more jobs that require advanced training now than ever before. Psychoanalytic Concepts The urge to self-harm is usually impulsive, such that it has been part of the person's life since childhood and is considered essential to his survival and well being in adolescence. This is not expected to disappear like magic and may in fact stay with that person for the rest of his life. Nonetheless, this dangerous behavior can sometimes be modified and replaced with safer behavior, although it will take perseverance, common sense and pragmatism on both parts. Freud (1969) noted that this brings about a recurrence of the Oedipal situation, which must be resolved through attraction to peers of the opposite sex. The increase in sex drive among adolescents creates stress and anxiety, which may call into play one or more defense mechanisms to restore equilibrium and protect the individual from experiencing anxiety. According to psychodynamics, a person activates his defense mechanisms by usually exercising asceticism or denying his instincts. In the case of self-harming individuals, they bring pain to themselves as a way of eschewing unacceptable or painful thoughts from their mind (CSP, 2004; JCK, 2004). This corresponds with the view of Erikson (1968), who shifted the emphasis of psychoanalytic theories of adolescence from the sexual to the psychosocial realm. Thus, the emphasis is on the acquisition of ego identity and sense of who and what one is, which has to do with the psychoanalytic concepts of projection and projective identification. Projective identification is the process of identifying one's self through jutting out. Erikson placed development within a series of psychosocial stages that are partly biologically determined. Associated with all these stages of development is a crisis, which is simply a psychosocial task that is encountered. Each crisis involves conflict and has two possible outcomes. Erikson believed there is a disruption of identity during adolescence resulting from both physical and social factors, such as increasing emphasis on making educational decisions and beginning to consider a future occupation, that force the adolescent to consider alternatives. From a psychoanalytic perspective, projection in self-harm may also be explained in terms of object relations where the body being injured is seen as a stand-in for any person in the family and immediate surroundings that an adolescent dislikes (Best, 2006). Projection is used as defense against a sense of inadequacy or guilt. In that sense, self-harm becomes a symbolic act in which the adolescent punishes himself but projects another person into his ravaged body. Self-harming is also another method of acting out emotions derived from inadequate attachments or ambivalent feelings toward significant others in early childhood. From such a perspective, Gardner (2001) argues that self-harm is a response to an "irreconcilable psychic conflict" associated with a feeling both of being held captive by a significant relationship yet fearful of the freedom or lack of attachment that would follow if this relationship is broken. In this case, the cutting of the skin may represent both the bondage and the release. A common feature of psychodynamic interpretations is the attention given to the process of dissociation or transference. Transference in psychoanalysis is defined as the revival or transferal of unpleasant childhood emotions toward a different person from whom these emotions were initially experienced. Thus, it serves as a psychological mechanism that allows the mind or body to split off or compartmentalize traumatic memories or disquieting thoughts from normal consciousness (Best, 2006). This may be associated with anesthesia, which goes some way to explaining why the normal aversion to pain fails to constrain behavior. Some of those who self-harm describe the experience as shifting the focus of attention from what is going on inside to what is outside, meaning the skin and the world beyond, in order to release an emotional overload which is "too real," "out of control" and "overwhelming." Others use the pain to reintegrate the physical and emotional dimensions of the person, thus overcoming the feelings of unreality and numbness that accompany dissociation (Best, 2006). Other psychoanalytic concepts developed on self-harm are called internal world, which refers to the psychological wall self-harming individuals build around themselves, and container-contained, which has to do with treatment. Teenagers, according to the internal world concept, have become easy prey to our highly toxic, media-driven world such that they closet themselves in front of a computer or TV screen for up to six hours, leaving them little time for family and friends (Adams, undated). Adolescent girls especially are constantly being bombarded by images in the media about how they should look and act. If they fail to live up to these idealized images, this can lead to an eating disorder and/or engaging in self-harming behavior as a form of self-punishment. The container-contained technique can avert self-harm by seeking to prevent an unwelcome feeling from expanding or going ugly. At the start of such treatment, the professional may set limits, such as on how the adolescent should respond. This way, the professional will help the adolescent feel safer and more contained (Lerner & Steinberg, undated). One major reason why adolescents gravitate towards self-harming behaviors is the endorphin effect. When adolescents cut or burn themselves, endorphins are quickly secreted into their bloodstreams and they experience a numbing or pleasurable sensation. For some of these youth, cutting or burning themselves numbs away unpleasant thoughts and feelings or they feel "high" from the experience. Like addiction to a particular drug, the endorphin "high" provides fast-acting relief for adolescents from their emotional distress and other stressors in their lives. Other important reasons as to why teens engage in self-harm include: feeling emotionally disconnected from or invalidated by their parents; wanting to "fit in" within a particular peer group that encourages and rewards self-harming behavior; feeling emotionally dead inside or feeling invisible in their parents' eyes. Self-harm makes them feel alive inside and helps confirm their existence in reality. For girls, self-harm may be used as a coping strategy with overly demanding parents, especially in situations where the father is the dominant voice when it comes to discipline and decision-making (Best, 2006). Therapy usually focuses on helping the self-harming person tolerate greater intensities of emotions without resorting to self-harm and develop the ability to articulate emotions and needs. The adolescent can also learn alternative and healthy means for discharging these feelings, such as problem solving, conflict resolution, anger management, and assertiveness training (Clery, 1999). Risk management in fact involves finding kindness, understanding it better, and attending to your own responses to it (Clery, 1999). References 1. Adams, M.M. "Adolescent Self-Harm." MFC, Thustin CA, 2 Apter, A. (2002). "Adolescent Suicide and Attempted Suicide." Tel-Aviv University, Israel. 3. Best, R. (2006). "Deliberate Self-Harm in Adolescence: Report of a Research Project in some English Schools." Roehampton University. 4. Clery, C. (1999). "The Psychodynamic and Systemic Approach to Self-Harm." APSA Rapport, Vol. 6 (3). 5. CSP (2004). "A Closer Look at Self-Harm." Centre for Suicide Prevention, Canada. 6. Dahl, R.E. "Adolescent Brain Development: A Framework for Understanding Unique Vulnerabilities and Opportunities." University Of Pittsburgh Medical Center. 7. DfES [no date). "Self-Harm." Department for Education and Skills TeacherNet website: www.teachernet.gov.uk/teachingandlearning/library/self-harm/ 8. Erikson, E.H. (1968). "Identity, Youth and Crisis." New York: Norton. 9. Favazza, A. R. (1989). "Why Patients Mutilate Themselves." Hospital and Community Psychiatry 40. 10. Fillmore, C.J. & Dell, C.A. (2005). "Community Mobilization for Women and Girls Who Self-Harm." Canadian Center on Substance Abuse. 11. Freud, A. (1969). "Adolescence as a Development Disturbance." In G. Caplan & S. Lebovici (eds.), Adolescence, New York: Basic Books. 12. Gardner, F. (2001). "Self-Harm: A Psychotherapeutic Approach." London: Brunner-Routledge. 13. JCK Training (2004). "Why Do Some People Harm Themselves" Weymouth, Dorset, UK. 14. Lerner, R.M. & Steinberg, L. "The Scientific Study of Adolescence Development: Past, Present and Future." Read More