Self- Mutilation There are a number of different ways to define what self-mutilation entails. It is one of the most commonly used phrases, but researchers and mental health professionals have not been able to agree on one specific definition to explain self-inflicted injury. Hence, self-harm, self-injury and self-mutilation are the common phrases used to refer to this type of behavior ( Zila & Kiselica, 2001).
Many people tend to associate self mutilation with suicide, when in fact they are very different. Therefore, when attempting to understand self-mutilation it is important to recognize the distinct differences between self mutilation and suicide. Suicide is an attempt to depart from pain through ending one’s life. While self mutilation is an effort to create relief from a negative affective incident, it differs for each person. It is used as a means for a person to temporarily deal with the pain, rather than abort it all together. In suicidal patients, pain is viewed as everlasting, which makes them feel hopeless. While, on the other hand self-injurers often portray an optimistic attitude (Walsh, 2006). Hence, there is a big difference between the behaviors and intent, which is why it is important to recognize these differences. Self-injurious behavior tends to be separated into two general categories: culturally sanctioned and deviant self mutilation. Culturally sanctioned rituals and practices comprise of ear piercing in the modern U.S culture, sacrament dances amongst Native Americans that entail self-mutilation, and the genital circumcision of Jewish offspring. These practices are commonly approved as standard traditions within in that they occur without question. They frequently are recognized as a rite of passage or to communicate with a higher power( Stone & Sias, 2003). The second category is deviant self mutilation or self injurious behavior. “ Self-injurious behaviors(SIB) are those in which an individual inflicts harm to his or her body purposefully, for reasons not recognized or sanctioned socially and without the obvious intention of committing(Whitlock, Eckenrode,& Silverman, 2003,p.1939).” The second category has been broken down into three major forms of non-socially approved methods of self- mutilation. They include: major, stereotypic and the superficial type. Major self-mutilation is an extreme form in which considerable amounts of body tissue is damaged. Castration of body parts or limbs is seen here. It is most common among psychotic clients. Stereotypic self mutilation is behavior that is rhythmic, has no symbolism and tends to be repetitive. It includes behaviors such as head banging or arm biting. It is commonly seen in individuals with mental retardation, autism, Rhetts disorder, Tourrette syndrome, deLange syndrome and Lesch Nyhan sydrome. The most common form of self mutilation is called moderate or superficial. It is broken down into three smaller categories which are: compulsive superficial (unconsciously pulls out own hair or picks skin), episodic (cuts or burns themselves deliberately) and the repetitive type. A client is labeled the repetitive type when they have created an identification dependent upon his or her behavior( ie: addicted to cutting or burning)( Stone & Sias, 2003). Some typical acts of self mutilation comprise of: cutting of the wrists/forearms (most common), scratching, self burning (usually with matches or cigarettes), heat and/ or chemical burning, obstructing the healing of wounds, confinement of air or blood flow to parts of the body and hitting the self. Other types of self mutilation include: cuts to the face, genitals, thighs or breasts, injecting objects under the skin, along with many other types of harm to the individual. The instruments most commonly used for these types of behaviors are: needles, fingernails, food bones, razors and knives (Zila & Kiselica, 2001). Individuals who self-injure usually have suffered from emotional, sexual or physical abuse from a person who has a significant connection to them, such as a parent, sibling or family member. They tend to be emotionally speechless and insensitive. They often have problems feeling and expressing their emotions (Stone & Sias, 2003). This act of self mutilation may be a means to transfer invisible emotional pain into real physical pain. This may be a way that self injurers self-medicate themselves or communicate their emotions. Individuals who partake in episodes of self mutilation have described that each episode follows a fairly expected script. Before an episode individuals encounter stress, which involves many negative emotions to emerge. These individuals usually detach themselves before they commit the self injurious act. The act creates instant relief and reduction of emotional distress. This relief may be accredited to the pain, the vision of blood or other evidence that they are still alive. Any positive feelings that exist after the episode are quickly replaced with guilt, embarrassment, self hatred and anger. These feeling then stimulate the next cycle, continuing the vicious pattern (Woldorf & Kuntz, 2005). The onset for SIB in clinical populations tends to occur in middle to late adolescence and then decline in early adulthood. The incidence of self mutilation tends to be increasing in our society, with 4% of individuals in the general population having engaged in this behavior. In the adult clinical population, 21% have participated in this behavior as well. There is a wide concern that self mutilation is increasing during adolescence. In a community sample, 14%-39% of adolescents experienced type of behavior as well. (Nock & Prinstein, 2005). The onset of self mutilation usually occurs is late childhood or early adolescence, generally identified in females. If a person continues this, behavior they can become a chronic self mutilator. Researcher has classified a person as chronic self mutilator if she is female, tends to be in her mid 20’s to early 30’s and has continued hurting herself since her teenage years. This female is generally middle or upper-class, smart and educated. She most likely has experienced some abuse as a child (Stone & Sias, 2003). Additional factors that may contribute to self mutation include: eating disorders, parental alcoholism or depression, sexual identity issues, borderline personality disorder, antisocial disorder or obsessive compulsive disorder. Since, white, middle class, young females are overrepresented, many groups are excluded. Demographically, individuals who partake in self injurious behavior are actually a very diverse group. Hence, gender, age, and ethnicity are major issues when discussing this problem. Self mutilation is reported more often in females than males. Although, there is no information on what the actual gender distribution is. In the past, self mutilation has been considered a female issue, which has discouraged males from seeking mental health assistance with their problem (Woldorf & Kuntz, 2005). Self injurious behavior is often associated with cutting. Research has indicated that women were more likely than men to cut, which may be a reason that people believe that self mutilation is a female phenomenon ( Whitlock,Eckenrode,& Silverman, 2006). Due to these generalizations there is a good chance that more males than reported do engage in these behaviors, but do not receive the proper help because they are too embarrassed to speak up. Age is another factor that must be addressed. Since many people associate self mutilation with younger individuals, they do not question it when working with elderly people(60 +). In fact, when dealing with the elderly populations there are many more risks. Deliberate self harm is strongly connected to suicide. This pattern is seen through suicidal intent and repetitive suicide attempts. Many of these individuals engage in self poisoning, pill overdoses, self cutting, attempted drowning, jumping from a elevated height and excessive use of alcohol (Hawton & Harriss, 2006). This is a prime example of how something such as self mutilation can not be placed in a specific age group. At any age, a person can be a self mutilator. Therefore, it is overly important to assess each age group properly, so they can get the appropriate help that is needed. Since self mutilation tends to be a secretive act, it is harder to identify, so many people of all ages probably remain unnoticed. Ethnicity is an issue that must be addressed. Earlier in the paper, culturally sanctioned self injurious behavior was discussed. In our society there are many different cultures that engage in a number of different rituals. Who is to the person that is able to determine what self mutilation is and what is an acceptable custom of their religion or culture? There may be individuals who come from a culture that uses self mutilation for a rite of passage, but Americans are not familiar with the custom. Since it is not a regular custom in our society, they may be viewed as a deliberate self injurer. Before making the assumption that people are self mutilation, it is important to examine their ethnic origin. . All of the issues discussed are considered “diverse” when discussing self mutilation. They do not fit into the group that is generally represented as self mutilators. Since we now understand that this is a problem that affects all people, attention needs to be given to all clients regardless of age, gender, or ethnicity.
Ecological and strengths perspective In order to successfully engage and assess an individual or family with this problem, one must understand different perspectives that are applied. The ecological or ecosystem perspective conveys that a sensitive equilibrium occurs between individuals and their current environment. It believes that this mutuality can be improved and sustained. A fundamental element of this model is the concept of “person-in- environment- a person is involved in constant interaction with various systems in the environment. The systems include family, friends, work, social services, politics, religious systems, goods and services and educational systems( Fong & Furuto, 2001, p. 13).” The individual is depicted as being involved with all of the outer systems. The ecological perceptive has created a model to help social workers understand and analyze a clients circumstances. It focuses on the connections involving the individuals, systems and environment ( Fong & Furuto, 2001). The strengths perspective has a bit of a different approach, but utilizes ideas from the ecological perspective. Hence, they seem to compliment each other. The strengths based perspectives main goal is to identify the factors which affect a person or families life. Then support the client in a way that the factors can be changed. Although, while doing this the social worker is recognizing the positive elements and strengths of the client. Initially, they are empowering the client to recognize and improve their abilities (Fong & Furuto, 2007). Once a client’s own strengths have been identified, a social worker provides the client with adequate resources to resolve their own problems. By doing this, the client is able to accomplish their own goals and satisfy their own needs (YIP, 2006). The engagement and assessment process with a family or individual, who is dealing with self mutilation issues, may be very challenging. In order to help a client who self mutilates, it means that the social worker needs to understand all of the underlying reasons and what the behaviors actually mean. I strongly believe that self mutilation needs to be thoroughly researched before a social worker can work with a client or family. When working with clients who are self mutilators, the initial stage is going to be very challenging. As explained, many of these clients have experienced some type of child abuse, which has caused trauma to be a factor that dominates their life. Due to these experiences, many people in this population have a hard time expressing their feelings. Some clients will understand why they are seeing a social worker, while others may be sent by a family member, a close friend or possibly their school. Clients that recognize they have a problem will be easier to work with, and possibly more open with the social worker. On the other hand, the clients who do not understand their problem will probably be much more difficult, especially when family members are involved. If a client was sent by a family member or close friend, I would start the engagement process by meeting with the family members individually. This would allow me to find out what type of concerns they have, what they hope will happen from these therapy sessions and it will also give me an opportunity to educate them on what self destructive behavior entails. In order for this to be a successful experience, family members and close friends need to understand that therapy is not a “quick” fix. When working with clients who self mutilate, there are usually many underlying problems that need to be dealt with separately before the destructive behavior may stop. As explained earlier, this behavior is a coping mechanism. Therefore, the client needs to be taught how to express and deal with their emotions before there will be any behavior changes. Hence, the underlying issues (abuse, trauma) are major contributors to these behaviors, so they need to be dealt with first.
During the client and social worker’s first meeting, it is vital that all aspects of the client’s life is examined. These include: recent life experiences, past traumas, current life stressors, and many other aspects. By identifying current life stressors it may provide some insight on what types of events trigger self injurious behavior (Kress & White, 2003). In order to gather information and engage with the client, using an assessment tool such a eco-map could be very beneficial. An eco-map is a detailed picture that shows the ecological context of the clients system. It identifies significant environmental systems and portrays the nature of the relationship. It helps the client see where the supportive relationships in their lives are, along with the stressors in their lives. This is a device that promotes collaboration and engagement between the worker and client. Due to the application of the eco-map, a solution focused dialogue could be applied. This is because the eco-map allowed the client to look at many different aspects of their lives, which gave them an opportunity to see what changes they want to make. The social worker was able to act as a support, help them indirectly create goals for themselves, implement a plan of action and help provide the client access to needed resources. This tool, also helped identify the strengths in the client’s lives. Therefore, the strengths perspective, along with the ecological systems model was incorporated (Miley , O’Melia,& DuBois, 2007).
When engaging with the client, it is vital to be an empathic listener. When the worker listens empathically, the client feels valued and understood which helps to create a trusting environment (YIP, 2006). Since prior traumatic experiences are major issues that these clients need to overcome, it is important for social workers to encourage the discussion of the prior distressing events that have occurred in their life. By using proper responding skills( Validation, clarity, questioning of feelings) the social worker can help the client come to terms with the events that have lead to self destructive behavior. When discussing these types of events, it is important to continue empowering the client, which is accomplished by using a strength oriented approach (Miley, O’Melia, & DuBois, 2004). For example, when a client discusses what they do to express their inner feelings (cutting), it would be a good time to commend them on finding a way to cope with their past traumatic experiences. As the social worker a possible statement I could say is: it is unfortunate that you have experienced these traumatic events ( abuse), which has caused you to engage in self destructive behaviors. But you are still alive and have found a way to cope with your problems. By taking an extremely negative situation and helping the client realize they are dealing with their problem, it may empower them to talk about how they feel, instead of physically acting on their problems. Through these in-depth discussions with the client, I will be continuously assessing if abuse seems to be occurring. During the assessment process, I will also be looking for indicators of suicidal risks to ensure that the client has not developed these feelings due to the discussion of events (Froeschle & Moyer, 2004). As indicated, self mutilation is a problem that can be hard to identify at times. Recently, individuals have been engaging in this behavior due to peer influence. In the past 15 – 20 years self destructive behaviors has become a new trend (Walsh, 2006). Due to this trend, schools and communities have been using prevention tactics to try and decrease this behavior. Creating awareness campaigns and educating students on how to deal with their emotions are good ways to decrease this behavior. Froeschle & Moyer( 2004) have provided some prevention methods that are implemented in schools as a means to avoid these types of behaviors. One method is conducting classroom presentations that include related issues to self destructive behavior. They include; drug/alcohol abuse, violence, and self- esteem. “Modeling, assertiveness training, and showing appropriate ways to voice negative emotions have all proven effective in handling those who self mutilate( Froeschle & Moyer, 2004, p. 234).” This seems like a good way to try and get students to express their negative emotions, rather than physically acting on them. When trying to include family members into the engagement/ assessment process of self mutilation, a dilemma tends to occur. Abuse tends to be implemented by family member or person close to the client. Therefore family counseling becomes difficult. There are instances when one family member joins the session. Although, their has been limited research conducted on the family and client process with individuals who are self destructive. Hence, due to abuse and traumatic experiences from a family member, engagements and assessment process regarding a family does not occur very often. Race and gender are two issues that need to be considered in the engagement and assessment process. Being a young, Caucasian female may present some challenges that I need to overcome. Since I am part of the dominant society, people of other cultures or races may feel intimated by me. This may result in their lack of cooperation, because they do not want me to be their social worker. “Historically, African Americans have experienced less power than those in the dominant society. As a result, they tend to protect themselves from power brokers in the dominant society, and analyzing the power dynamics becomes a critical survival skill( Fong & Furuto, p.122). Overall, if the client did not have a good experience with the dominant society, chances are I will have to work extra hard to assist the client and show them that I am here to help them, regardless of their past experiences. Gender is another issue that needs to be considered. Being abused is a hard topic to discuss, along with self destructive behaviors. Since males may be embarrassed of this situation, they may not feel comfortable talking to a female social worker, especially if the abuser was female. Overall, both race and gender are issues that may bring challenges that I will need to help the client overcome, before I will be able to help them. My beliefs and values regarding self mutilation Each person has a set of individual values and beliefs that affect their understanding or attitude about certain issues. Hence, this was true when I was learning about self mutilation. My parents have instilled a number of values in me, which has helped shape me into the person I am today. I was raised in a very supportive and loving family, who always required that my brother and I were very open with our feelings. Therefore, we were taught to express our feelings verbally, rather than physically. In all aspects of my life, I tend to use my words due to this value that was instilled in me. In most cases an individual who uses self destructive behavior, did not have the same positive environment that I did. Before, learning about this population I always assumed that most people coped with their feelings verbally as well. Due to this assumption, it was challenging for me to understand this population at first. I did not know why a person would physically harm themselves. Although I had a harder time understanding, how a parent/family member could live with themselves, knowing that they were the main reason for their child’s destructive behavior. Due to the values I live by, this type of behavior seemed morally wrong to me. Although, after recognizing that my values and way of thinking is different than people in this population, I was able to understand that they live by different values due to their past experiences. Learning about this population gave me a chance to realize that people who self mutilate are just like everybody else. They are trying to find a way to survive and cope with their emotions. This is the only way they know how to. Before, writing this paper I thought that self mutilation was a call for attention, because I did not understand why somebody wouldn’t verbally ask for help. Now, I understand that all people have different values, meaning all people have different ways of coping with situations.
The social work code of ethics has helped to incorporate additional values in my life. The code of ethics main purpose is to offer social workers a concise guide to deal with ethical issues or dilemmas (Miley, O’Melia, & DuBois, 2004). When working in the social work field, it is important to always act in an ethical and professional manner. The code of ethics is based on six core values which are: values of service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence. When I became familiar what these core values, it seemed as if they corresponded with some values that were already instilled in me (dignity & worth of person and importance of human relationships). Although, having a complete understanding of these values has made me a better person and has helped me understand how to interact with vulnerable populations. When working with clients who self mutilate, their may be times that I feel myself becoming to emotionally involved with the client’s situation or encounter an ethical dilemma. The code of ethics will be able to act as a guide in dealing with this situation in a professional manner. Overall, the various values/ beliefs that have been instilled me, have impacted my understanding of myself and this population. Since I have a better understanding of how I feel, new values and attitudes towards individuals who self mutilate will continue to be developed. Overall, this paper has given me the opportunity to demonstrate my understanding of the engagement and assessment process when working with clients who self mutilates. Looking at different perspectives such as: the ecological, strength based and solution focused dialogue has prepared me with adequate skills to engage with this population. By constructing a literature review, looking at diversity issues, examining empirically supported social work approaches and theory guided practice, I feel confident working with these individuals. I am very grateful that I chose to learn about this population, because I found myself very challenged and learned new things about myself. Before this paper, I never thought I would want to work with a population such as this. I imagined it would be too upsetting and that I would not be able to relate to them because I have never engaged in self destructive behavior. By the end of this paper, my perspective was very different. I suddenly realized that I am a strong enough person to work with these individuals and would be a positive asset as well. Through writing this paper, I have empowered myself to continue learning about diverse populations in which I never pictured myself working with.
References
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