As we mentioned on the last daf, our Gemaras have been discussing various self destructive impulses. On the last daf we examined self-destructiveness that hurts others simultaneously. On today’s daf we still discuss self-destructive urges that are directed at self instead of others.

According to researchers Tiffany B. Brown and Thomas Kimball, there a number of misconceptions about self-harm behaviors as well as functions that should be understood better by clinicians. ( Cutting to Live: A Phenomenology of Self-Harm, Journal of Marital and Family Therapy · April 2013) Their research was based on a phenomenological approach, which is a fancy way of saying gathering information from people about their subjective experiences. The disadvantage of such research is that it is less scientific and objective. However, in certain kinds of research, the phenomenological approach has advantages in being able to take a deeper look at what the internal process is. Psychological research might sound scientific when you apply all kinds of objective terms and studies, but in truth mental health is more of a moving target. Life’s problems, especially those subject to emotions, are not only about the technicalities but also the stories we tell ourselves. A headache is merely a headache, but a headache on a bad day after a string of personal disappointments and frustrations is a much more painful experience. Therefore, gathering data about what people experience when they do acts of self harm is not only about trying to understand a fact, but also trying to decode the human narrative so as to consider how to help people re-write other more adaptive narratives, or at least cope better. 

The researchers define self-harm as: “The intentional harming of one’s body in order to reduce emotional pain and cope with overwhelming emotions (Turner, 2002). Cutting, burning, punching oneself, banging one’s head, pulling one’s hair out, constantly scratching oneself, picking scabs or interfering with wound healing, and breaking bones are common self-harm behaviors.”

The reported prevalence of these behaviors are as follows: 4% in adults, but up to a whopping 38% in college students! I cannot help but wonder if easy access to drugs and promiscuity, in an environment of relatively little accountability and lots of free time is what increases the apparent distress levels that drive this spike in self-injury. While some researchers have maintained that self injury is more prevalent in females,  other studies show similar rates in males, however the sense of stigma and deflation of a macho male image leads to less disclosure and reporting by males.

While there is an intuitive link between self harm and suicide, research indicates that the correlation is not strong. Furthermore, some who self injure report it as a coping mechanism to prevent suicide and manage overwhelmingly painful emotions. Despite this, there is some correlation and therefore self-harming individuals should also be assessed for suicidality.

“Many sufferers of self-harm have either witnessed violence or other traumatic events or undergone a traumatic experience such as physical abuse, sexual abuse, or severe emotional abuse (van der Kolk, 1996). Favazza (1998) estimated that between 40% and 65% of self-harming individuals have been sexually abused in the past. Briere and Gil (1998) examined both clinical and non-clinical samples of individuals who self-harm, and their results suggest that self-harming behaviors help decrease dissociation, emotional distress, and posttraumatic symptoms.”

Another interesting finding is that individuals experience increased opioid production after a self-harm episode. Coupled with conditioning biochemical processes, this subconscious physiological process has the potential to induce dependency and make the self-harm behavior addictive (Sandman & Hetrick, 1995)

Brown and Kimball’s key findings about what people who self harm report and how they wish to be treated are:

1. People who self-harm often felt misunderstood by loved ones in that they equated their behavior with suicide when many of them reported no suicidal feelings or thoughts.
2. It feels like an addiction, and has certain similarities to the process of addiction such as isolation and progression. Isolation as in a sense of not being understood or able to share experiences due to judgement or misjudgment. Progression, in the sense that it may start by experimentation and escalate in intensity and frequency.
3. Experience with professional help is fraught with being stigmatized and misunderstood to what feels to be more extensive than more run if the mill mental health challenges, such as anxiety and depression.

Those who engaged in self harm reported the following key motives underlying the experience:

1. The self-injury genuinely provided a release from emotional pain and is often followed by strong euphoric feelings.
2. It relieves guilt by functioning as a form of punishment for perceived sins.
3. The physical pain is highly preferred to the emotional pain, and subjectively, a logical trade off.
4. The self-harming provides a subjectively powerful sense of self-control and mastery. This is especially meaningful in the context of past traumas and a sense of chaos and lack of control in other areas of life.

Some clinical implications from these findings are to be even more careful about the stigma and shame attached to this behavior as well as not to underestimate the powerful subjective benefits that the behavior offers. It is much harder to adjust a less adaptive behavior to a more adaptive behavior when there is naïveté and denial about the function and power of the so-called dysfunction. The functionality of the dysfunction must be addressed and taken seriously before it can be considered for modification and adjustment.

Translations Courtesy of Sefaria, except when, sometimes, I disagree with the translation

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