Self-Harm

Thanatos or live?

by Katrina Dennehy

The silent cries, the unspoken fears, the choked up anxieties; life and its’ many trials and tribulations invoke specific coping strategies in dealing with them. What makes one person tremble when another thrives?

Many factors contribute to one’s way of operating, their upbringing, their financial status, peer groups, careers, environmental factors etc. While these external factors have inexorable influence over what shapes our reactions, our internal drives are what determines how we choose to think, feel and behave in any given circumstance or situation.

So what happens when the internal narrative is to cause ourselves harm? Freud famously used the Greek term ‘Thanatos’ in psychoanalytic theory to depict one’s drive toward death. This instinct is often expressed through our behaviours in ways such as aggression, compulsion and self-destruction. Is self-harming an expression of this death instinct, or has it become a last ditch effort to expunge all painful thoughts and feelings from our systems? Has this way of operating become the ultimate form of self-sabotage by inflicting hurt to over shadow the internal turmoil that percolates unchallenged or misunderstood underneath?

If the very act of self-harm means to “act deliberately to inflict pain and damage to one’s own body”, the question must arise as to why one believes themselves deserving of this pain. When someone acts in this way and causes themselves harm, it can be for a number of reasons; to change emotional pain into physical pain, to feel something in a time where numbness may be all that is experienced, to give themselves a sense of control over what is being perceived as an uncontrollable life/situation, or to escape traumatic memories.

To inflict pain on the body defies every survival instinct, yet it is becoming a more and more prevalent coping strategy, especially among teens and young adults. The NSRF (National Self Harm Registry Ireland) reported in 2020 that 1 in 128 females and 1 in 233 males reported self-harm. Out of these reported, intentional drug overdose accounted for 62% of cases, 31% cutting and 33% alcohol misuse. Peak time for self-harming was reported to be between 5pm- 1am with an alarming crescendo in these numbers at 9pm.

Strikingly, 13 year old girls are 8 times more likely to self-harm then their male counterparts. While we may endeavour to find the cause for this frightening trend, and this is vital, in the short term, treatment is what is paramount.

Cognitive Behavioural Therapy tells us, through a highly evidence based practice, that our thoughts cause feelings which lead us to behave in the way we do. Within the concept of self-harm, this is never more true. When the layers are peeled back and the vulnerability exposed, one’s negative core beliefs are ultimately what drive and inspire the action of self-harm. If I believe that I am not good enough, I am useless, I am not pretty enough, or I am unworthy of another’s attention or love, then that belief will inevitably lead to a feeling of sadness, despair, loneliness, anxiety, depression. Depending on my ability to self-regulate and cope I may self-harm.

Teens with their quick-firing emotions, sometimes try out bizarre techniques for emotion management. Many try self-harm in a fit of pique, but do not become self-harmers as they will not get anything positive from it. Those that become self-harmers are those who find that physical pain and the sight of blood actually lower the activity in the amygdala (that part of the brain where or fight, flight and freeze response lives), thus bringing about a ‘positive’ effect. Our thoughts and feelings and our neurobiology are intricately connected. Thoughts of self-punishment and the belief that one deserves it may produce relief.

Teens who self-harm have been found to have lower stress levels than those who do not. Cortisol is naturally higher at various points of the day, namely in the morning. When levels are high, the body’s natural ability to self soothe comes into play and bring about a homeostatic cycle. The lower cortisol levels in teens who self-harm disturb this homeostatic cycle. Lacking the ‘normal’ cortisol levels and its calming counterpart, they seek to raise the cortisol level by self-harming. What self-harming teens may need more of indeed may be more stress and stimulation. However, the kind brought about by physical activity for example, as opposed to mental stimulation often caused by technology.

What are the steps we can take to prevent self-harm?

The ability to emotionally regulate as well as tolerate distress are 2 primary factors in dealing with situations that may lead a person to self-harm. Breaking the behaviour down can be done as follows:

There are numerous strategies one may try when trying to improve coping ability and increase distress intolerance.

1. Define the problem

2. Generate alternative solutions

3. List pro’s and cons of each solution

4. Choose the best solution

5. Make a plan and execute it

6. Evaluate the outcome.

Distress Tolerance Skills:

Use distress tolerance skills when

1. You have intense pain that cannot be helped quickly

2. You want to act on your emotions, but it will only make things worse

3. Emotion mind threatens to overwhelm you and you need to stay skilful

4. You are overwhelmed yet demands must be met

5. Arousal is extreme, but problems can’t be solved immediately.

STOP

• Stop: Freeze, don’t move, stay in control

• Take a step back: Take a breath, let go, don’t let your feelings make you act

• Observe: Notice what is going on inside you, notice what others are saying/doing

• Proceed mindfully: Act with awareness, consider goals.

TIPP

(Tip your body Chemistry)

• Temperature (ice) of your face

• Intensely exercise

• Paced Breathing

• Progressively relax your muscles

Mindful Exercise

Engage the senses with the 5,4,3,2,1

Observe:

• 5 things you see

• 4 things you hear

• 3 things you touch

• 2 things you smell

• 1 thing you taste

Neurologically, the more often we expose ourselves to an uncomfortable situation and react differently (ie. Not self-harm) the more the brain learns the different coping style. Engaging in this alternative behaviour literally changes the make up of our brains.

There is no clear cause for why one trembles and another thrives, however the message that we can take from any situation is that, it is not in finding the cause (solely) where the answer derives, rather we need to emphasise the ‘what can we do about it?’