In Defence of Shame by Tanveer Ahmed

Author:Tanveer Ahmed [Ahmed, Tanveer]
Language: eng
Format: epub
Publisher: Connor Court Publishing
Published: 2020-09-05T20:00:00+00:00

CHAPTER THREE Self-Harm and the Tyranny of the Positive

Self-harm is one of the most challenging aspects of working in mental health. Every day I see patients with cuts on their forearms, sometimes partially covered with long-sleeved tops, other times voluntarily exhibited. Others burn themselves with cigarettes, bang their heads against walls or scratch themselves till they bleed. Taking overdoses of tablets is a common way such patients end up in hospital. The vast majority of them do not want to kill themselves. Unfortunately some do, especially if the act is combined with alcohol and drugs. Many celebrity deaths have occurred after such concoctions, à la Heath Ledger.

Despite living in a time when mental health concerns are more visible, there is no clear consensus on whether certain conditions are on the increase. There are many variables contributing, not least in terms of measurement and definitions of terms. But selfharm is one such affliction we can be fairly certain has increased.

This is confirmed in the studies, suggesting a tripling of incidence over the past two decades. There are similar trends in Britain, according to the UK Children’s Institute. In America, a recent study in The Journal of Pediatrics found a 268 per cent increase in self-poisoning among children aged between ten and twelve in the years 2010 to 2017.

It is no surprise then that psychiatry’s much cited handbook the DSM, or Diagnostic and Statistical Manual for Mental Disorders, often called the bible of psychiatry, finally included self-harmas one of its official categories in 2013. It came under the title of “nonsuicidal self-injury”. The British social historian Sarah Chaney, in her book Psyche on the Skin, heralds this as a breakthrough in the history of self-harm, which much like shame, tends to be covered up both physically and metaphorically.

Chaney outlines some of the history, from self-flagellationby the eleventh century Benedictine monk Pater Damian, who said, “When I freely scourge myself with my own hands in the sight of God I demonstrate the same genuine and devout desire as if the executioner were here in all his fury”.

Chaney also outlines John Marten’s 1712 pamphlet, “Onania: or the Heinous Sin of Self-Pollution”, which suggests masturbation was seen as a loss of self-control close to self-injury. She touches on the ritual castration practices of the Skoptsy, a fringe sect of the Russian Orthodox Church, a notable detour into the past expressions of self-harm. A century ago, in the heyday of psychoanalysis, self-harm was seen as an illustration of the “death instinct”.

Self-harm has always occurred in a cultural and historical context. Given we are currently living at a time when self-harm appears to be on the increase, examining the social context is essential.

I have several patients who are involved in self-harm groups. They are all teenagers. At first I assumed the group may have been positive, allowing the members to find support and belonging. This was indeed the case, but many posted pictures of themselves self-harming on the group page as a kind of performance sport.

Sarah is

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