A cutting response to a cry for help

Most adults, when confronted with a self-harming teenager, will do exactly what they shouldn't

For many people, the culture of confession, the medicalisation of "normal" human experience, the deification of celebrity, and the general fuss people are encouraged to make about their own tiny feelings, represent all that is wrong with society. For the stiff-upper-lip brigade, the confessions of the 24-year-old actress Christina Ricci are typical of our culture's growing narcissism and self-indulgence.

For many people, the culture of confession, the medicalisation of "normal" human experience, the deification of celebrity, and the general fuss people are encouraged to make about their own tiny feelings, represent all that is wrong with society. For the stiff-upper-lip brigade, the confessions of the 24-year-old actress Christina Ricci are typical of our culture's growing narcissism and self-indulgence.

She said last week: "I used to burn myself. I was in a lot of emotional pain. When you're a teen unable to accept how much pain you are in, physical pain gives you justification." She went on to explain that she had beaten anorexia and self-injury because of her relationship with her actor boyfriend, Adam Goldberg. "I've accepted my body now," she says. "When someone loves you and loves your body, you feel sexy."

Indeed, it all does sound slightly preposterous. The feted teen actress was so very plainly in the public eye at that time. Could she really have been inflicting such seemingly obvious damage without it being noticed? And is that stuff about physical pain legitimising emotional pain really credible? Anyway, could her problems really have been as great as she is now suggesting, if the holy grail of teenage cliché, finding a nice boyfriend, was all that she needed to cure her?

The answer to all three questions is a resounding yes. Ms Ricci's confessions are absolutely certainly genuine, for they chime so perfectly with the experience of very many self-harmers.

First, self-injury and eating disorders are indeed closely linked. Often people suffer from both, as Ricci describes. Sometimes, when an anorexic is forced to eat, she turns to self-harm instead. Second, self-harm is always intensely private. Those carrying out injury do their utmost to conceal or dismiss it. So also do others involved: parents, teachers, and even, sometimes, healthcare professionals. There have been reports that at one girls' boarding school an explosion in self-injury was hushed up, with several of the pupils thought to be the leaders in the practice expelled.

No one really knows how many people in Britain self-harm, but estimates suggest 400,000 women sufferers and 55,750 men. The Mental Health Foundation is fundraising at the moment in an effort to meet the huge rise in demand for services treating young people at risk from self-injury.

As for Ms Ricci's rather banal explanation about physical and emotional pain, anyone cynical about such a crude analysis of cause and effect should beware. Again and again when people who self-injure talk about their motivations, they give an extremely similar explanation.

Finally, that some-day-my-prince-will-come cure. Once more, Ms Ricci's experience is widely shared - although ominously there are some reports suggesting an end to the stablilising relationship can herald a resurgence of the destructive symptoms.

The experience of self-injury can seem uncommonly universal. Ms Ricci is not the first celebrity to share her experience, and she is not likely either to be the last. But the same troubles are seen across the social spectrum, among the pampered and the tough, the rich and the poor, the young and the old. There were, for example, 59 incidents of self-harm logged at the notorious Deepcut army barracks between 1996 and 2001.

Self-harm in prison is widely acknowledged to be rife. And it is among prison populations that that the strong tendency for self-harm to be a mainly female problem is most clearly seen. Men do self-harm, but statistics suggest that women are seven times more likely to resort to this extreme - which is variously described as an addiction, a disorder and a coping mechanism.

In prisons, although women make up just 6 per cent of the total inmate population they are responsible for almost half of all self-injury incidents. Partly this is because of a kind of hysteria, with the impulse to do such an act proving almost contagious.

Today it would be almost accurate to describe self-injury as "fashionable". Just as once the media fell over itself to break the "taboos" around anorexia, now it is doing the same thing with self-harm. The practice has been spotlighted in films from Girl, Interrupted to Secretary. Most recently it surfaced in Thirteen. The current issue of Cosmo Girl, aimed at girls in their young teens, sports the cover-line "You and Self-Harm: All your urgent questions answered". The internet meanwhile offers a plethora of websites, some of them so eager to support self-harmers that you can feel rather freaky for never having thought of trying it.

That may sound flip and irresponsible. But there is a real issue here. Part of the huge increase in self-injury may well be linked to a straightforward increase in the knowledge that such a mechanism exists.

This sort of publicity runs the risk of making self-harm seem attractive to teenagers and also like a distasteful and silly piece of teenage subversion to non-sufferers. And it is true that many people might be tempted to try a little self-harm because they see it in the glossies and the films. But the ones who return to it again and again are the ones who have underlying psychological issues that self-mutilation somehow addresses.

Beliefs about exactly what these are are at present something of a moveable feast. Self-injury is linked to all kinds of other obsessive- compulsive disorders.

Its particular attraction for teenage girls is, however, both predictable and paradoxical. It is predictable because the triggers seem to chime closely with the condition of being a teenage girl - that narcissistic lack of physical confidence, the dread of never "finding love", the fear of growing up and having to assume responsibility. It is paradoxical for the same reason - that it reinforces all the irritations adults have with teenagers about their selfishness and their self- obsession and their inability to get their not-central place in the universal into perspective.

This is why most adults, when confronted with a self-harming teenager, will do exactly what they shouldn't. They show disgust and distress, tell sufferers to get a grip, and sometimes collude in the secrecy that surrounds the act - like the parents and teachers who hushed up the self-harming activities at the school.

Worse, healthcare professionals themselves are sometimes poorly geared up for dealing with self-harm. Some people tell of turning up in the accident and emergency department and being treated with contempt, being left until last to have their injuries stitched or dressed, and generally undergoing ritual humiliation.

However irritating and attention-seeking the self-harmer may seem, the only thing to do is to provide attention rather than denying it, understanding that the need for attention is not shallow but deep.

What the alarming increase in self-harm among young people tells us, quite simply, is that it is getting harder and less attractive to grow up and take a place in adult society. Sadly, our present attitude to this heart-felt and dangerous cry for help - which is to attempt to belittle or reject it - merely confirms the sufferers' worst suspicions.

d.orr@independent.co.uk