CW: self-harm and substance use
There's this whole trend of "breaking the stigma" around mental health, but sometimes I wonder what stigma people think they're talking about. Everyone talks about and promotes mental health; social media feeds, large organizations and businesses, small organizations and businesses. People loooove talking about mental health and mental wellbeing on social media or at corporate wellness days. So what is this "stigma" that the endless media barrage is trying to break? What happens when mental illness doesn't look tidy or inspirational?
This piece is a reflection on the contradictions we live with, the ways we respond (or don't) to each other's pain, and the stories we hide when mental health stops being marketable.
Don't get me wrong: "ending the stigma" around mental health is a nice trend, kind of like when reusable water bottles were super trendy. I'm all for it. But what does the stigma actually look like? Sure, there's the occasional jerk who rolls their eyes or belittles it, but most people aren't like that.
How much of the stigma is internal? Because really, nobody thinks about our personal mental health more than ourselves. It's not really other people's business anyway.
I started self-harming when I was 12 and continued through my mid-20s. I started by pinching in visible places but, after realizing nobody was "coming to the rescue" and it wasn't worth bothering people anyway, slowly moved to cutting in less visible places. I knew it was a lousy coping mechanism (everyone does), but it's one that works for its intended purpose. No mental health expert I've ever mentioned this to has ever been that interested in the cutting itself because it isn't suicidal; they want to address the underlying issues. So why did I develop such a strong urge to hide them? Other than the default "it makes others uncomfortable to see them," I feel like my answer to the stigma question is tied up with it.
To be frank, I don't actually care much about my cutting either. Without it, I would have just replaced it with something else to cope, probably something even less healthy. A few years ago, a close friend of mine was a heavy substance user while her home life was breaking down. I tried to be there for her, sitting with her and bringing food and water, but it was difficult. While at her lowest, she said to me "Don't you dare judge me - I'm not the one digging a blade into my own skin. It's the same fucking thing." She was right - it is the same fucking thing. The substances and the cutting aren't the real problem until they are out of control.
So the question still remains: why hide the coping mechanism? Why are people ashamed of their cutting or their addictions if everyone is jumping on the "mental health" bandwagon? Would people be as supportive if they were face-to-face with the ugly face of low mental health?
It's one thing to say "mental health matters." But would you lay awake beside your friend at 5am, listening the cackling sound of the crack pipe as it's scarring her lips? Would you stand beside her as she screamed at you, staring helplessly into her gaunt, pasty, hollow face and wild eyes? Would you bring food to eat with her (not just give her) as her body shriveled to skin and bones? Could you look at the scars on my waist without cringing? Could you have a conversation with me about them without delivering pity and piety? Could you see that she and I are just the same?
Why did I hide it? It wasn't about others judging me negatively - frankly, I'd said worse things to myself.
I think there are 3 important differentiations here regarding the stigma of self-harm in particular: (1) cutting as a child, (2) cutting as an adult, and (3) the relationship between self-harm and suicide.
(1) What Cutting Teaches a Child About Being Taken Seriously
I'm not a pediatrician; just someone who self-harmed from Grade 8 into her mid-20s, and had loads of time to reflect back. This one makes me the most upset actually because, looking back, so many things could and should have happened. Because the responsibility here is different from in adults, the stigma here is fucking enraging while also the most noticeable.
I had a prof in undergrad who mentioned society's pre-occupation with mocking, devaluing, and de-legitimizing adolescent girls. At the time I kind of laughed to myself; "Okay but that was also the time I adored Edward Cullen - pretty sure the mocking's valid." Undergrad was when I was still internalizing the devaluing of little girls. It is so socially acceptable to shit on adolescent girls: the vapid chick flicks and romance movies, the fashion tastes, the music they listen to, the books they read, the hobbies the chose. Everything. And the fact that it's so socially acceptable to mock is disgusting because it gets internalized. Little girls are mocked and devalued mercilessly for the things the find important by people they see as important. So no fucking wonder when they stop trusting their own perceptions of what is important.
On top of all this utter nonsense stigmatizing young girls, it is incredibly common for people to have the audacity to write off NSSI in young girls as mere petty attention-seeking just because it is visible. These people can, once again, fuck right off with that perspective. Even if it were for attention, why do you think a child might be looking for this kind of attention to begin with?? Jesus fucking Christ. These adults are the ones complicit in both creating the problem and now dismissing the problem they created. Here is a quotation from Dr Muehlenkamp, licensed clinical psychologist: "Do not assume that self-injury is always undertaken for attention-seeking, which is another common myth. The most common reason is emotional regulation, when people are trying to cope with overwhelming distress or self-punishment, which has its origins in self-hatred... [occasionally, people] try to get others to understand the seriousness of their distress as an outward sign to communicate how much pain they are in" with key risk factors being shitty communication skills, negative thoughts/feelings, hostility and criticism at home. In essence: We devalue little girls, blame them for internalizing that devaluation, and then have the gall to confirm their lack of value by writing them off as attention-seeking. We're talking about children; why are grown-ass adults perpetuating this awful way of thinking?
Those little girls learn that cutting works. And when they attempt to communicate (cry for help, validation, whatever) fails, the cutting still works. We can be disgusted with it or shut it out as much as we want but the reality remains true: cutting provides a physical release from emotional/psychological pain while reassuring the cutter "this is real. I'm real. What's in my head is real because it's right there on my skin." We can still easily help the ones who cut in visible places, but the kids who hide their scars have already given up on us as adults being willing, able, or even interested in helping. They've accepted they don't deserve help. But the cutting still helps. And yes, this is obviously Adult Anneke reflecting back on Child Anneke.
(2) Unspoken Rules of Adult Self-Harm
The issue here, I think, is more that people don't know how to react. Because self-harm scars can look like a big flashing "PROBLEMS" sign and it makes people uncomfortable in a culture where people don't like being uncomfortable. Usually (at least my own early adulthood), adults self-harm in less visible places so as not to draw any attention. Perhaps the self-hatred has gone down, but the self-harm still provides an effective coping mechanism in periods of low mental health.
Good, kind, and well-meaning people just don't know how to respond and putting them into that situation is kind of lousy. As a result, the self-harm is usually in places only a close friend might see when living/hanging out in close proximity. This stigma isn't about negative judgements; it's just ignorance and well-meaning discomfort. Which is fine. Just a bit of an annoyance.
So what would "ending the stigma" look like here?
- It's a-okay to ignore self-harm scars. In fact, please do ignore them if I don't know you. To you, it's as relevant as any surgical scar on a stranger's body.
- Even if I do know you, you still don't have to bring it up. Being a friend does not mean you have to take on my emotional burdens. I am not expecting you to.
- If you are a friend and you do want to bring it up, it's also okay to ask. I'm probably also okay to talk about it, but will probably keep at an emotional distance for a while. If I don't want to talk about it, I'll probably say that too. On occasion, I might also lie about them depending on the social situation and what I anticipate your reaction to be. "Just a bike crash" is a convenient go-to. Similar to #2, my emotional burdens were and are not others' responsibility, and I will decide to end/change the conversation topic if I want to.
- Don't. Bloody. Overreact. I swear to God. This is the big one, be it friends, strangers, anyone. At the time I was cutting in early adulthood, I knew it was a problem and, rest assured, I was active on the case. You do not need to stand aghast and burst into sobs and utter devastation about how I could possibly do this to myself. Now I am going to comfort and reassure you. "Oh don't worry, it's probably only temporary" or "Yes of course I'll tell you immediately if it ever happens again" (lol I absolutely will not). The priority is now to make you feel better about this awful horrid thing I am doing. And considering the state I was in at the time, would you really trust someone like me to therapize you? If you can't cope with the answer, don't. This kind of response was 100% the main reason I would lie about the scars to a friend or loved one. Now, after the last scar was added a few years ago and I have a safe level of emotional distance (unless we're talking about the adolescent girls - THAT still pisses me off), I'm significantly less likely to lie about it to anyone. Both because there's no longer the shame of being an "active" cutter and because maybe the topic is important enough that some people should be made uncomfortable.
(3) Why Self-Harm Isn't the Same as Being Suicidal
I won't say there's no link, but I think a lot of people completely misunderstand the link. NSSI is deliberately non-suicidal; I would argue it actually brings a suicidal person away from suicide. Self-harm is a way to cope; suicide is a solution (albeit a bad one obviously). Someone who's decided on a solution has no more need to cope.
Someone who uses NSSI may very well also be suicidal (re: the self-worth stuff). But if they are actively self-harming, the self-harm is to avoid suicide. Self-harm is a way to feel; it's self-validating; it's relieving; it's a reminder that you are alive. In a way, it's a desperate quest for the hope that suicide gives up on. In a weird way, self-harm protects an otherwise suicidal person.
Final Word
With this piece, I'm trying to name what many of us have seen but rarely say: that not all coping mechanisms are tidy, and that awareness without discomfort is just branding. There's no clean ending to this kind of topic, and I'm not offering solutions. But maybe we could stop pretending that talking about mental health means we're done with the hard parts. If we really want to "end the stigma," we have to be willing to sit with discomfort - not fix it, not sanitize it, just sit with it. The reality of mental illness doesn't come in the form of a wellness app or an Instagram post (or in this case, a blog post); it looks like scars, like addiction, like a kid who's stopped asking for help.
Maybe learning to sit with that is where the actual work begins.
