Self-harm Awareness Day: Why we need to transform how we see mental illness

Nadia Mendoza of the Self Esteem Team recalls her struggle with self-harming, and calls for mental health to be tackled better in schools

It is difficult to estimate how many people deliberately injure themselves, because they often keep their behaviour secret (iStock)

Warning: This article deals with the writer’s personal experience of self-harm and some readers may find it triggering

Google the definition of self-harm and you'll likely find "someone who intentionally injures their own body", "a way to deal with difficult feelings" or "a cry for help".

Yet these descriptions do nothing to demystify the paradox of how something so brutal can seemingly give such release.

Voluntarily hurting oneself sounds nonsensical at best, and disturbed at worst. But for many it is a reality. One in every five teens in the UK has self-harmed at least once, while the number of children admitted to hospital for self-inflicted injuries has risen by 68% over the last decade.

So as we mark Self-Harm Awareness Day once more, it's clear that combating this phenomena involves more than just awareness-raising and #endstigma hashtags.

Only in understanding the complexities of why people deliberately harm themselves can we begin to solve this ever-growing epidemic; for confiscating all the sharp objects around the house or inanely telling someone to "stop, can't you see what you're doing to yourself" is as fruitless as telling an alcoholic not to drink as they really must think of their liver.

In fact, I'd argue that alcoholism is to some extent graspable for non-alcoholics, who recognise it as an escape. Eating disorders too, those unaffected are being educated to understand it's more often about control than it is about weight. For cutters – where even the word is grim – it is extremely difficult for a non self-harmer to see beyond the savagery.

And here lies the problem, to focus on the physical means the abstract is so often overlooked.

Complexly, despite its very meaning of "inflicting pain", to me, self-harm was as far removed from this as can be. I was already in pain, not searching for more.

What I was searching for, aged 11 (and continued to do throughout my teens and twenties), was a protector, something to cushion the feelings too raw to process. I wanted to enter a realm free of the bullies at school and away from the deep-rooted troubles at home. I yearned for a constant, having been to four schools by Year 7, intensifying my loneliness and feelings of displacement.

I was looking for an out-of-mind experience.

What I found was a physical pain to take away a mental pain; echoing the sentiment of someone offering to punch your arm should you have a headache to distract you from enduring the migraine. It was about blacking out my reality, not how deep the cut was. It was the silent scream when I couldn’t find the words to articulate how much I hurt. And for all its viciousness, at the time it seemed like a comfort blanket.

I've likened it to Stockholm Syndrome before: an irrational dependency for something that "looked after" me in the most barbaric way possible.

To an outsider, I realise the sight can be horrifying, though to expedite an understanding people must look beyond the harm. Diagnosing someone based on their wounds is like determining the severity of an eating disorder based solely on the number on the scales. You cannot measure someone’s mental torment by judging the physical evidence alone. Crucially, telling someone they're "not that bad" a case, can ignite an "I'll show you" mentality, spurring on self-destructive behaviours to "prove" on the outside how much they're hurting on the inside.

Whether a surface scratch or in need of stitches, the self-harmer requires help.

Yet due to service cuts and the strain on Child Adolescent Mental Health Services (CAMHS), the diagnostics for someone who self-harms to be referred for treatment have increased. One girl I worked with last year was turned away after being told her injuries were not serious enough. Then left to her own devices, the problem escalated, and nine months later she attempted suicide – only then did they admit her. Consequently, she is now in recovery. The message is "go get worse before we can certify your pain".

Similarly, to say someone is "the worst case" you have ever seen carries serious repercussions, validating the person's physicality as something they are "good" at, their efforts are worthy, you can "see" their pain. To say "worst" is to say "best" (as explored brilliantly by Kelsey Osgood in How to Disappear Completely).

When I was told "I’ve never seen self-harm like yours", it was like a sinister parallel of "good girl, you’re top of the class, gold star".

Self-harm is so little about the gore and so much about the path that leads someone to it. If you've ever recoiled in shock or thought 'just snap out of it' after seeing marks on someone's body, thinking you can't understand, you can. Strip away the visual and it quite simply stems from emotion – which we all have. A chronic build-up of tension, isolation, shame; a volcanic eruption of feelings that have been suppressed for too long. Other people happen to drink, take drugs, binge, over-exercise, be promiscuous, yell at their kids… it’s all just response to our individual mental states.

The act itself gives the illusion of wiping clean that emotional baggage, voids it from the periphery, the focus of harming narrowed into tunnel vision. It interrupts what is plaguing the mind, a method of distraction as everything else freezes still.

Self-harm is (as other vices are) the mask to shield oneself from having to digest distressing feelings; almost a preventative mechanism rather than a coping one.

Something rarely explored is also the nurturing aspect of it. In particular, the aftermath. Once the deed is done, you are left with someone mothering his or herself. Immediately after an injury, the self-harmer must 'tend' to their wounds. In extreme cases, the parental role is handed to professionals when medical care is needed. The process can continue for weeks.

The attention-seeking label is often lazily thrown around, yet perhaps the term rings true in that the attention is largely centered on nursing oneself.

With this warped self-harm/self-nurture crossover, it becomes clearer how someone might then associate self-injury with something that makes him/her feel "better", thereby repeating the act frequently so it soon evolves into habit. For me, abusing it as a tool to restrict any feelings from filtering through at all (essentially censoring real-life) became a catalyst for monotonous numbness. It then triggered a different reason to harm, as I just wanted to 'feel' again. It became relentless; harming to prevent feeling, then harming as I felt nothing, then harming just out of habit, then harming because I might as well considering the damage I’d already subjected my body to, then harming because I didn’t want to think, then harming to shut these thoughts up. It corkscrewed into a confusing and endless cycle of self-destruction.

This is why giving up is extremely hard. Suppressing emotion meant I lost my sense of self, self-harm became my identity instead. I was terrified of who I would be without it. At the time, "self-harm girl" seemed better than nothing at all. It was easier to maintain my relationship with the visible "friend" of self-harm than confront and defeat the invisible enemy lying behind it. Ultimately, this is why prevention is arguably more straightforward than cure, because if self-harm is externalising what is going on internally, the aim should be to prevent that pressure cooker from bubbling in the first place.

Lucie Russell, of mental health charity Young Minds, explained: “Self-harm is a symptom of an underlying problem, it is not an illness in itself, so it's important as a parent to be able to recognise what might be causing stress in your child and to talk with them about how they can deal with it in ways that build resilience rather taking it out on themselves.

”Try to keep the channels of communication open even though this isn’t easy, especially with teens. Be hopeful and reassuring and let them know it's okay not to feel okay sometimes, and if they don’t feel okay look at finding solutions together, rather than telling them what to do. This will help them to learn how to deal with difficult times and to grow into strong young adults.“

Introducing wellbeing into education is the indisputable place to begin, giving children the emotional vocabulary they need to address their own thoughts. It’s about acknowledging that we all have a mental health just as we all have a physical one. It’s about focusing on how to optimise yours, rather than just shining a light on it when people are unwell. It’s about destigmatising mental illness by culling the "1 in 4 will suffer from a mental health issue" statistic, and realising "4 in 4 have a mental health".

This is why The Self-Esteem Team – the group I work with who go into schools teaching students on mental health and body image – are currently working with the Department for Education and curating Get SET (a menu of short exercises for teachers and students) in a bid to revolutionise the curriculum by including mental wellbeing on the syllabus.

As Russell said, keep conversations open at home – after all, language is what connects us to the world – strike a balance between guardian and unprejudiced ear, providing a safe haven away from the erratic empires of online and school. The Government must encourage the art of resilience, allow kids to exorcise demons, expel energy, applaud vocational interests just as much as A*s – because solving algebra is meaningless if anxiety interferes with a future job interview, dissecting Shakespeare is trivial if break time is spent with a head down a loo vomiting up lunch, and conjugating French verbs is inconsequential if toying with how to kill yourself. Without your mental health, grades mean absolutely nothing at all.

Should your path ever cross with someone who self-harms, don't ask "how can you do that to yourself?", "does it hurt?", or "what if the scars don't heal?"

Try "I'm listening" instead.

For more information on the Self Esteem Team follow them on Twitter @_selfesteemteam or visit their website.