Why do people self-injure and what support do they need in their journey to recovery?
Why do people self-injure and what support do they need in their journey to recovery?
In this episode, released on international Self-Injury Awareness Day, Amelia and returning host, Jessica Morrison, are joined by Professor Penelope Hasking, the President of the International Society for the Study of Self-Injury. The three debunk misconceptions about self-injury and explore why it’s important to recognise that recovery isn’t a linear process.
If this episode has raised issues for you, please call Lifeline on 13 11 14, if you live in Australia. If you aren’t based in Australia, please visit https://checkpointorg.com/global/to find crisis hotlines and mental health resources based in your region.
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Professor Penelope Hasking
President of the International Society for the Study of Self-Injury and Professor within Curtin University’s School of Population Health
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You can read the full transcript for the episode at https://thefutureof.simplecast.com/episodes/self-injury-recovery/transcript.
Jessica Morrison (00:01):
Listeners are advised that the content covered in this episode may be distressing as we will be talking about self-injury.
Jessica Morrison (00:07):
This is The Future Of, where experts share their vision of the future and how their work is helping shape it for the better.
Amelia Searson (00:16):
Welcome back to another episode of The Future Of. I'm Amelia Searson And I'm excited to announce our original host, Jessica Morrison has returned and will now be joining me on our podcast. Welcome back, Jessica.
Jessica Morrison (00:28):
Thank you. It's great to be back at Curtin and behind the mic again.
Amelia Searson (00:31):
So Jessica and I will be co-hosting the show from now onwards and to any of you who have been around since the early days of the podcast, you'll know that, as I mentioned before, Jessica was our very first host alongside David Blayney, but Jessica actually left the podcast to become a mother, which is incredible. So how has it been to start what is described as 'the hardest job in the world', Jessica?
Jessica Morrison (00:55):
That was actually probably going to be the way I answered your question, Amelia. It is the best, yet hardest job in the world, but I'm loving it and also loving being back at work and coming back to the podcast because it's always so interesting to be learning about new research happening at the University. So really, really I'm pleased to be back.
Amelia Searson (01:15):
Yeah. Awesome. It's like the best of both worlds. Now you're a mother and then you're also back at work, back with us, what more could you want?
Jessica Morrison (01:22):
The juggle is real, the juggle's real, but I'm sure most working parents are aware of that. But anyway, it's all good and it's, yeah, great to be back.
Amelia Searson (01:30):
Yeah. I'm really looking forward to working alongside you now and of course for future episodes. Your return's come at a good time. I don't know if any of our listeners can tell, but I'm actually recording remotely up in the Northern Territory, trying to stay dry and fight off any crocodiles that come my way. So yeah, it's great to have you hold the fort in Curtin studio.
Jessica Morrison (01:52):
Not a worry, I appreciate it. Now, today is quite a heavy topic. Because of it being international Self-Injury Awareness Day, we will be talking about self-injury and recovery. Now self-injury is a topic that has a lot of misinformation attached to it. It refers to the deliberate and any direct damage to one's body that is done without an intent to die by suicide. Now, this differs to self-harm, which refers to any self-inflicted behaviour that can include potential suicidal intent. With one in 20 adults and one in five adolescents reporting a history of self-injury, it is incredibly important that we learn to identify and address what self-injury means, to raise greater awareness, to debunk myths, to educate people who do not self-injure and, probably most importantly, to reach out to those who do. So to discuss this topic further, with us today is Professor Penelope Hasking, the President of the International Society for the Study of Self-Injury and a researcher here at Curtin. Thanks for coming in today.
Professor Penelope Hasking (02:50):
Thank you very much for inviting me.
Jessica Morrison (02:52):
Our pleasure. Now look, we addressed this a bit off the top Penny, but what are some of the misconceptions about self-injury that you think need to be debunked?
Professor Penelope Hasking (03:01):
I think as you said, there are a lot of myths and misconceptions around self-injury and perhaps one of the biggest myths is that only young girls engage in self-injury, that it's predominantly an adolescent behaviour and that's just not true. So we know that people of all ages self-injure, people of all genders self-injure. One of the largest epidemiological studies that was ever conducted, found that the oldest people to first start self-injuring were in their sixties. So it's really not just an adolescent thing. It's not something people just grow out of.
Professor Penelope Hasking (03:35):
And I think one of the other misconceptions is the reason people engage in self-injury. It's not uncommon for people to think it's about attention seeking or manipulating other people or that it's an attempt to die by suicide. But the primary reason people self-injure, the main reason people report, is to cope with intense emotions. It's really about coping with life, using it as a coping strategy. Whereas suicidal behaviour is about ending life.
Jessica Morrison (04:04):
Is self-injury a mental illness or is it the result of mental distress? I think we touched on that, but can you go a little further into to what that is?
Professor Penelope Hasking (04:13):
It's not a mental illness. So as I was saying, we tend to conceptualise it as a coping strategy. It has been proposed as a mental disorder and it's in our diagnostic classification as a condition that needs further research. So it's not there right now, but there is a call to do more research on what that might look like if it did end up in that diagnostic categorisation. But by and large, it's not a disorder. It's a behaviour, a coping strategy. It is associated with mental distress. It's associated with mental illness, but not always.
Professor Penelope Hasking (04:46):
So it's a not insignificant number of people who self-injure who have no diagnosed psychiatric history at all. And I guess that's another one of the misconceptions, is that it's inherently linked to psychological illness or mental illness. Because it is a coping strategy, because it's a strategy people use to cope with distress, it's not surprising that there are higher rates of depression, anxiety, et cetera, among people who do self-injure because that's why they're self-injuring. But I think it's a misnomer to automatically equate it with mental illness.
Jessica Morrison (05:17):
Amelia Searson (05:18):
And Penny, you mentioned before that it's not just one gender or one age group who are more likely to self-injure, but is there a group who is most at risk?
Professor Penelope Hasking (05:31):
I think, I said it's not just adolescents who self-injure, that's usually when the behaviour first starts to emerge or when people first start to engage in self-injury. So in terms of looking for particular groups that may be vulnerable, it's not unreasonable to look at young people and think, "Okay, that's a group when this might be something that people are starting to try out." But there's also a second peak in people first starting to self-injure in their twenties, particularly among university students. We see a relatively high uptake in the first couple of years of uni, which we know can be quite stressful.
Professor Penelope Hasking (06:05):
But aside from demographics, ultimately it's people who have a number of things going on in their life. They have a number of stressful circumstances. There might be mental illness there and have difficulties with regulating their emotion, difficulties being able to recognise what they're feeling, difficulties in then appraising that emotion and thinking about how they actually manage their own distress and manage their own emotions. So if those emotion regulation skills are not working or aren't there and people don't feel they have a range of other coping strategies available, then self-injury is something that they might turn to as a means of alleviating some of that distress.
Amelia Searson (06:47):
Right. And that links in well, for the next question that I have. If someone does self-injure or knows someone who does, what should the first step taken be?
Professor Penelope Hasking (07:00):
I think we ... In knowing someone who self-injures, I think one of the first things people can do is to educate themselves. So to be aware of what self-injury is, why people engage in self-injury, to recognise it as a coping strategy and recognise that people who self-injure are just trying to do the best they can to manage their emotions, to cope with the situations at the time, to be aware of your own reactions. So people can have some quite strong reactions about self-injury, particularly if it's something new that people haven't really come across, there's often an element of shock, of "why would somebody do this to themselves"? Sometimes there's anger.
Professor Penelope Hasking (07:40):
And I think being aware of your own reactions and your own views on self-injury then helps to talk to somebody who self injures. And I guess that would be my second point, is to sit down and listen to people, talk to people. When we ask people who self-injure, what they would like other people to do. The number one response is, "listen to me". Just sit down and hear what I have to say. Don't judge, don't make assumptions. We use the term 'respectful curiosity' to talk about having conversations with people who self-injure and it's conveying a genuine desire to truly understand somebody's experience and to ask questions like, "I understand self-injury might be a way of coping with whatever's going on for you right now. I want to understand what this is about. Can you tell me a bit about what's going on for you?"
Professor Penelope Hasking (08:27):
And being genuine in that moment and listening to that response rather than putting those judgements on. And I think that's probably a really important first step just being open, hearing what's going on for somebody and what they need in that moment. And that might be all they need, is just a non-judgemental ear to listen to what they have to say.
Amelia Searson (08:50):
Yeah. And understanding recovery and how to begin that process or help someone begin the process is obviously an extremely important step for people to take, as well. Can you explain to us what recovery is and how people can kick start those processes?
Professor Penelope Hasking (09:07):
Mm-hmm (affirmative). Recovery is a term that's going to mean something different to every individual who self-injures or is looking at recovery. So I don't want to put the message out there, that recovery's just one thing. It's going to be incredibly idiosyncratic and that journey is going to look different for everyone. I think one of the fallacies, I guess, that people get into, or this idea that people have, is that recovery from self-injury is ultimately about stopping the behaviour. And we often hear people say things like, "Why don't you just stop?" This is a behaviour that people engage in voluntarily. They're doing it to themselves. Therefore, they should just be able to stop doing that.
Professor Penelope Hasking (09:49):
And it's not that simple. People are engaging in self-injury for a reason that's serving a function. So there's often ambivalence about stopping, where somebody can see the benefits in engaging their behaviour, can see the emotional relief that it brings, but also see some of the negative effects in the relationships they have with other people. There may be long-term scarring. It may cause more psychological distress. So weighing up those costs and benefits can be part of that recovery process for somebody.
Professor Penelope Hasking (10:17):
I think ultimately I'd like people to see recovery as more than just stopping the behaviour and recognising that having realistic expectations for recovery is important. That it's not a linear process. People may decide that they want to stop and have setbacks along the way when something's going on in their life or things are particularly stressful. And that's a normal part of the process, that it's not going to be this linear journey where somebody just says, "Okay, I'll stop now and that's the end of it." And I think recognising that both for people who self-injure and people who care for them is really important.
Professor Penelope Hasking (10:52):
So if people who self-injure recognise that, they're going to be less hard on themselves, if there is a setback. And people around them, family, friends, clinicians, if they're seeing somebody may also have less disappointment, if they realise: this isn't a failure, this is part of the process. Ongoing thoughts and urges about self-injury are part of that and part of that growth process then is how people then address those ongoing thoughts and urges.
Professor Penelope Hasking (11:19):
And I think one of the other parts of recovery is, as we said before, self-injury is often associated with other psychological difficulties. There might be underlying depression, anxiety or other things going on and addressing those underlying concerns is part of it. It's not just about taking away somebody's coping strategy, but thinking about what were they coping with and how can we address that?
Professor Penelope Hasking (11:43):
I mentioned scarring before. Not everyone who self-injures will have scarring as a result. But if people do, somebody who self-injures may need to accept those scars, come to grips with them, make decisions about whether they conceal those scars or not, think about other people's reactions, if they're visible scars and how they might cope with those reactions.
Professor Penelope Hasking (12:07):
There's a lot of stigma around self-injury and I've heard some pretty horrific stories about what other people have said when they see somebody's scars and they're pretty unkind sometimes. So if somebody's going through that, how are they prepared to cope with that, to hear those reactions and what's their response going to be? And I think mentally preparing for that is part of that process, as well. And I guess that all ties into this idea of self-acceptance. That if somebody is able to address any underlying concerns or underlying difficulties they might have, that they have thought through what their scarring means to them.
Professor Penelope Hasking (12:45):
And it means different things to different people. Some people find strength and resilience in their scars as a reminder of what they've been through and that people can then learn to accept themselves. And I guess the last thing I'll say on that is: if we're talking about people no longer self-injuring, then it's important to have other coping strategies in place because stuff happens, life's not easy and we all have stressful times. We will have things that happen that we need to cope with, but finding alternative coping strategies isn't easy and it takes effort to practise those and to put those into practise, particularly in times of heightened distress.
Professor Penelope Hasking (13:26):
And I think for people who self-injure to recognise that it is a process, that it is trial and error, some strategies are going to work, some are not going to work. And that they're committed to recognising that it's effortful, I think, yeah, feeds into that realistic expectations about recovery that I was talking about earlier.
Jessica Morrison (13:48):
Penny, how has your research helped to increase awareness of these behaviours that you've mentioned?
Professor Penelope Hasking (13:54):
What we like to do within my group is use a lot of the research to educate the public. So I do a fair bit of work in talking to schools, school boards, parents, peers of people who self-injure, universities and trying to get some of this information out there. So doing things like this podcast. You mentioned the International Society for the Study of Self-Injury. We do a fair bit with them, as well, in terms of trying to use social media to get some of these messages out, developing infographics.
Professor Penelope Hasking (14:30):
One of the other groups I'm involved in is an International Consortium on Self-Injury in Educational Settings, at schools and universities, and we just translated a whole bunch of material into, I think, it's eight different languages now, that we now have up to, again, just try and get information out there to raise awareness of what self-injury is. And perhaps importantly to try to give people tips for how to talk about it.
Professor Penelope Hasking (14:54):
How do you talk to somebody who does self-injure? How do you have those first conversations? But more importantly, it's an ongoing conversation. It's not just, "I've noticed you self-injure, let's talk about it." If it's somebody you're close to, a sibling or a friend, then it's going to be an ongoing conversation that comes up again and again. So how do you have that conversation and support somebody who self-injures?
Jessica Morrison (15:17):
Absolutely. You've just touched on it, I think, but there's a project that you've recently worked on where you're identifying students who are at an elevated risk of future suicide. Can you tell us a little bit more about that and how that's going?
Professor Penelope Hasking (15:31):
So this is a large project that we're running here at Curtin and it's actually part of an international project across a number of different universities. What we do is survey students in the first couple of weeks coming into first year at university and they do quite an extensive questionnaire that assesses a range of mental health difficulties, as well as some of their supports in their help seeking strategies. We've developed an algorithm that's built into that survey that basically runs live as people are responding, and at the end, based on their responses, can identify people who are at elevated risk of engaging in suicidal thoughts and behaviours within the next 12 months. So a lot of screening measures. We'll look at people who have a prior history of suicide attempts or suicidal thoughts and reach out to them. What's different about ours, is the ability to predict who's at greater risk coming up in the next year.
Professor Penelope Hasking (16:29):
The algorithm then works in the background of that survey and at the end of it, directs people to various resources based on their responses. So all students get access to arrange resources that pointed to Curtin Counselling. People who have a prior suicide attempt are directed to an online safety planning app, which guides them through thinking about what are their high risk situations, what are their support networks? And that's an app they can download, they can use it on their own or with a family member or friend or a therapist.
Professor Penelope Hasking (17:02):
And then people who are flagged by our algorithm as an elevated risk of suicidal thoughts and behaviours, we call them within 24 hours. So give them a phone call, do a bit of a check-in, say your responses on this survey indicate things haven't been so great lately. How are you travelling at the moment? What supports do you need? And we'll do an assessment with them and based on their needs, refer to counselling, suggest they get an appointment with their GP, some see a psychologist. And what I'm finding at the moment is, we're actually seeing double the uptake of GP appointments and psychologist referrals as a result of just reaching out and largely normalising help seeking.
Professor Penelope Hasking (17:45):
A lot of the students we talk to say, "I don't want to see anyone. I don't want to waste anyone's time. It's not really bad enough. I don't want to burden people." So being able to say, "Actually, no. If you're struggling. It's okay to reach out. It's okay to seek support." A lot of students don't know where to go. So being able to say, "Here are the different places," is eyeopening for some students. So it's been really gratifying actually, to feel like we're actually reaching out and helping students and putting them in touch with services that they might find helpful.
Amelia Searson (18:14):
And Penny, something that I would really like to hear your expertise on: when I was in high school, the popular TV show, 13 Reasons Why, came out. And anyone who doesn't know that show centres around the impacts that self-harm can have on the individual and those around them. I remember sitting in my room at three o'clock in the morning after ... I'm pretty sure I watched the whole season, just in one sitting, and in one of the final episodes, there's an extremely graphic scene of the main character self-harming. And since then that scene has been removed. And I've definitely noticed more trigger warnings around both self-harm and self-injury and other types of trauma being included in TV shows, articles, all of that sort of thing. Do you think that we're seeing changes in how self-injury and self-harm are represented in the media? And more broadly, do you think we're seeing changes in how society views them?
Professor Penelope Hasking (19:17):
I think the question about media portrayals is a really interesting one and obviously 13 Reasons generated a lot of conversation around how inappropriate it is to have such graphic displays of suicide on TV and the potential harm that that can do. It did raise the conversation, which is good from my point of view. So people are actually talking about it and what are we four years on or something; we're still talking about it. So raising awareness is great, but we do know that depictions of self-injury, self-harm, suicide, in fictional and nonfictional media, news media, as well as in popular media, can be triggering for some people.
Professor Penelope Hasking (20:03):
In Australia, we've actually had media guidelines around responsible reporting of self-harm and suicide for over a decade, over 15 years, so we've had those-
Jessica Morrison (20:12):
At least, yeah.
Professor Penelope Hasking (20:12):
Guidelines in place, yeah. And they're very, very clear. And ultimately they say we should not be detailing different methods of self-harm or self-injury, that there shouldn't be graphic displays. We don't use sensationalised language or sensationalised headlines. You don't have images that are really provocative.
Professor Penelope Hasking (20:31):
So I think we're probably one of the first countries to have those guidelines in place. They're not always followed. One of my PhD students has actually just finished a project looking at news media and how self-injury's portrayed in Australian news media. And yeah, there are some unhelpful ways that it's still being portrayed. Within the International Society [for the Study of Self-Injury], we've also just put out new guidelines specifically on portrayal of self-injury in media and they're much the same. Don't sensationalise it, not putting out graphic descriptions of different methods.
Professor Penelope Hasking (21:06):
And I guess one of the things that media tends to pick up on is when celebrities engage in self-injury or self-harm and there has been a tradition for some of that to sort of been sensationalised or glorified. I think we're seeing a shift towards more recovery stories and providing messages of hope and optimism, but it's a fine line to tread. I think, news want to sell what they're selling and one of the easiest ways to do that is to have something that's big and glossy and sensationalised, but we need to be responsible in conveying messages that are not going to be harmful.
Amelia Searson (21:45):
Yeah, definitely. As someone who is hopefully graduating this semester with a journalism degree, that is something that is so important for budding journalists like myself to have such a grasp on for future reporting. And well ... talking about the future, what changes do you hope to see, Penny, for people going through self-injury?
Professor Penelope Hasking (22:09):
Ultimately, I'd like to see the stigma reduced. I'd like to see increased awareness, increased understanding, less judgement, I guess, less assumptions being made. And I think that comes with increased awareness and understanding among the general public. But also, as I was saying before, that willingness to sit with someone, have a conversation, find out what's going on and offer that more empathic supportive kind of ... support, I guess, rather than going in with assumptions and judgements.
Professor Penelope Hasking (22:43):
And I think that will help people who self injure be able to talk about it, be able to seek help if they want to, to be able to seek that support rather than remaining silenced or feeling afraid to seek support because they're afraid of how someone will react. And I think it will help people who are in that supporting role to not be frustrated or be less frustrated and to feel like they're doing something valuable in supporting other people.
Amelia Searson (23:08):
It's such a complex topic but it's so great to have researchers like yourselves who are so involved in it and working to see real change. So thank you so much, Penny, for sharing your knowledge on this topic. I'm sure many of our listeners will have more questions for you that we didn't get time to cover today. Where can they connect with your research?
Professor Penelope Hasking (23:31):
If people have questions, the easiest thing to do is probably to email me. So it's just Penelope.hasking@Curtin.edu.au. The International Society for the Study of Self-Injury is itriples.org. So that's one place that has some resources available and I think we have some other resources available, as well, but emailing me is always ... I can direct people where they want to go, I hope.
Amelia Searson (23:55):
Yeah, great. Thank you again. We'll add those details into the show notes, along with our email, if anyone would like to reach out.
Jessica Morrison (24:04):
And again, if this episode has raised any issues for you, please call Lifeline on 13 11 14, if you live in Australia. And wherever you're located in the world, please visit checkpointorg.com/global to find crisis hotlines and mental health resources based in your region. You've been listening to The Future Of, the podcast powered by Curtin University. Leave us a comment wherever you find this episode. We'd love to hear from you. Bye for now.