Several articles were published yesterday and today in the UK media regarding an apparently dramatic rise in “the number of children who self-harm”:
“The number of children who self-harm has increased by more than 70 per cent in the past two years to record levels, according to new figures” Ian Johnston, The Independent, Sunday 10th August 2014.
The piece in the Independent was originally illustrated with a picture of someone scratching their arm with a pair of scissors (this was replaced later in the day), while the Times ran with a picture of a young person with numerous cuts on their arms. These images are problematic for many reasons, not least that viewing such images may be experienced as ‘triggering’ or traumatic for people who have or do self-harm, or that websites containing similar images have been shut down for ‘promoting’ self-injury. There are other problems with the way this story has been reported, and below I offer a few reflections on these, based on my experience of carrying out sociological research into self-harm for the last 10 years.
Firstly, the ‘dramatic’ increase in self-harm that is described in the articles is based on hospital statistics. Thus, the articles should have stated (and some did, but not in the strapline, with the notable exception of the Daily Mail) that there has been a dramatic increase in hospital treated self-harm. Hospital treated self-harm can be used as a proxy for looking at wider rates, but among young people especially we know that the vast majority of self-harm is not treated in hospital (Hawton et al., 2002). What these increased treatment rates might reflect is that people are more aware of self-harm, more willing to seek help, or more willing to take children and young people to hospital. It might be a response to greater levels of fear about young people self-harming. The reasons that people present to healthcare services for any type of condition or injury can be complex, and certainly do not reflect a straightforward increase in ‘rates’.
We know a lot about hospital treated self-harm, research centres in Manchester, Derby and Oxford have been collecting data about this for many years. From these studies we know that the majority of people treated in hospital for self-harm have taken overdoses of medication (Bergen et al., 2010). Few people will be treated in hospital for scratches inflicted with a pair of scissors, underlining another problem with the images used in the Times and the Independent – both of which depicted cuts which would be unlikely to have been treated at hospital. Those who are treated in hospital for self-cutting are more likely to have used razors, glass or knives, to have created wounds that the individual (or someone else) is worried about and feels unable to self-treat. Again – most of those treated in hospital for self-harm have taken overdoses, with only around 15-20% having cut themselves or used other forms of self-harm such as hanging, jumping, drowning or suffocation.
While it might not be clear whether overall rates of self-harm have increased, we can be fairly certain that awareness of self-harm has risen in recent years. Stories such as those run by the Times, the Independent, and the Daily Mail are reflective of a particular way of reporting self-harm among young people – these articles emphasise the ‘worrying’ rise in rates, largely focus on a particular form of self-harm (cutting) and present an analysis of the reason for the rise: young people use self-harm to cope, and they do so in response to ‘pressure’, especially from ‘the internet’. Such stories have appeared intermittently in the UK press for the last 10 years.
This form of reporting presents an inaccurate view of self-harm, one that is complicated by research, particularly qualitative, interview studies which have spoken with people who self-harm (Adler & Adler, 2011; Chandler, 2013). Self-harm can often involve cutting, but it also takes many other forms. My own research with young people aged 14-16 found that most reported engaging in ‘other’ forms of self-harm, as well as cutting and overdosing. These included: scratching, burning, biting, restricting eating, self-criticism, hitting, and punching objects. Crucially, while not all of these practices are formally understood to be ‘self-harm’ they were described as such by young people themselves.
By emphasising ‘worrying rises’ in statistical data on self-harm, news reports present a potentially exaggerated view of how ‘common’ self-harm is. Reports in 2012, for instance reported another ‘worrying rise’ based on increased calls about self-harm to Childline. Again, these do not necessarily reflect rising rates, but perhaps a greater willingness to talk about or ‘name’ self-harm. There were similar discussions of an ‘epidemic’ of self-harm in 2005.
The emphasis on particular reasons for self-harm, which highlight the role of the internet, ‘pressure’ and the use of self-harm as a coping mechanism presents a narrow view of why people might self-harm.Research with people who self-harm finds that a very wide range of explanations can be given: self-punishment, experimentation, expression of emotion, self-care, generating feelings, ending dissociative states, communicating distress – as well as ‘coping’ with life, or emotions (Adler and Adler, 2011; McDermott et al., 2013). What ‘coping’ means in individual cases can vary widely (Chandler, 2012). Similarly, proposed ‘reasons’ for self-harm are diverse, reflecting the range of people who self-harm and the complex and multi-faceted factors that might contribute to self-harm, including, but certainly not limited to: socio-economic disadvantage, family contexts, childhood abuse, and homophobia.
In conclusion, I urge caution when reading news coverage about self-harm, and particularly when making inferences from statistical evidence. Statistics are extremely useful, but must be treated with care. I suggest that these public accounts of what self-harm is, and what it means, underline the need for further research with young people about how they understand the ‘pressures’ they face, how they experience life in a ‘24/7 online culture’. Finally, what other, structural, social and economic factors might be shaping the experiences of young people? Self-harm is not ‘just’ an individual, psychological problem – it is shaped by social and cultural contexts; analysis of these must go further.
 Last year I supervised an MSc Childhood Studies dissertation project carried out by Caroline Plaine. Caroline carried out a discourse analysis of print media coverage about self-harm among young people, which we are currently writing up for publication. These reflections are based in part on Caroline’s analysis, which found self-harm being described as an ‘epidemic’ in newspaper reports from at least 2003.
Adler, P. and Adler, P. (2011), The Tender Cut: Inside the Hidden World of Self-Injury, New York, New York University Press.
Bergen, H., Hawton, K., Waters, K., Cooper, J. and Kapur, N. (2010), ‘Epidemiology and trends in non-fatal self-harm in three centres in England: 2000–2007’, The British Journal of Psychiatry, 197, 6, 493-498.
Chandler, A. (2012), ‘Self-injury as embodied emotion-work: Managing rationality, emotions and bodies’, Sociology, 46, 3, 442-457.
Chandler, A. (2013), ‘Inviting pain? Pain, dualism and embodiment in narratives of self-injury’, Sociology of Health & Illness, 35, 5, 716-730.
Hawton, K., Rodham, K., Evans, E. and Weatherall, R. (2002), ‘Deliberate self harm in adolescents: self report survey in schools in England’, British Medical Journal, 325, 1207-11.
McDermott, E., Roen, K., & Piela, A. (2013). Explaining Self-Harm: : Youth Cybertalk and Marginalized Sexualities and Genders. Youth & Society.