Editor's note: This post contains some disturbing information.
“We don’t bleed / When we don’t fight.”
- The National
I was visiting with some of my grad school friends, talented counselors who work in schools, agencies, and in private practices. They’re a colorful group, and I miss them. When we get together, one subject that always surfaces is ‘What are you seeing in your practice?‘ This time, almost without exception, we’re seeing cutting. This correlates with what I’ve been reading. Pediatrics Digest estimates that “14% to 24%” of youth, adolescents and young adults self-injure, and the Journal of Mental Health Counseling reports that self-injury is increasing
The increase in self-injury is thought to be, in part, attributed to Internet use. A New York Times article as far back as 2008 notices the rise. The article paraphrases Dr. Janis Whitlock, an expert in adolescent self-injury, as saying, “...the Internet is spreading the word about self-injury, prompting many to try it who might not otherwise have known about it.” The increase in self-injury is underscored by Tumblr, a blogging website that’s used by many teens. According to PC Mag, Tumblr changed its content policy in March to ban blog content that “...actively promotes or glorifies self-injury or self-harm.”
I’m seeing Internet use associated with self-harm in my practice. The Internet can be a source of support for people who self-injure and a source of positive reinforcement or social contagion for self-harm. It’s difficult to discern between content that provides support and content that encourages self-harm. Before examining this, let me provide some background information on self injury.
“And it feels so damn good for the moment.”
- MadSinCinema, YouTube
Self-harm or self-injury is defined by The American Academy of Child and Adolescent Psychiatry as “...the act of deliberately destroying body tissue, at times to change a way of feeling.” Child and Adolescent Psychiatry and Mental Health adds to this definition “...in the absence of suicidal intent.” The most common form of self-injury I see is cutting, but burning, scratching, pulling out hair, and hitting are also forms of self-injury. People who self-injure generally don’t want to kill themselves when engaging in the behavior. They self-injure to relieve emotional pain, to punish, to gain a sense of control, because they are addicted to it, to manipulate, and because others are doing it. It’s the last reason that seems most relevant when discussing the Internet and self-harm, but a word about judgement and self-injury.
Self-injury evokes strong reactions from others. It strikes a visceral chord because it violently contradicts our instinct for self-preservation. Some react in horror, condemnation, or explain the behavior as plain stupidity. I would ask that the person without a dysfunctional coping strategy cast the first stone. Could the above quote from a cutting video also apply to emotional eating? Having a couple drinks after a tough day at work? Yelling at your kids because you’re frustrated with aging parents? I’ve found it’s not helpful to judge others because their brand of dysfunction isn’t yours.
Back to the discussion of the Internet being used as a support or as reinforcement for self-injury.
“I hope that you will some day get better, find another way out other than cutting."
- harmonysmith, 'Experience Project,' a message board website
Dr. Janis Whitlock, in a study for the Journal of Clinical Psychology examines the Internet and self-injury. She notes that adolescents are increasingly using the Internet to fulfill their social needs. She finds that the Internet has “...overtaken malls as the primary socializing venue for teens.” It makes sense to seek support on the Internet if it’s the primary source for social engagement. For self-injurors, it makes even more sense. Kids who self-injure feel isolated and desperately lonely. Often, they hide the behavior. Most kids want to tell someone about their behavior but are afraid they’ll be judged or rejected. Dr. Whitlock maintains that the Internet can provide a community where teens feel supported.
Further, Dr. Whitlock states “...informal support and discussion of proximal life events that trigger self-injury were the most common types of exchange.” From my own experience, I agree. Most people visit message boards, don’t post comments, but just follow discussions. When commenting it’s usually supportive - affirming and understanding someone else’s experience. The Internet sends the message, ‘You’re not alone’ which is an incredible relief to anyone in emotional pain. However, where is the line between ‘You’re not alone’ and ‘You belong here?’
“I started cutting because my friends were doing it and I wanted to fit in. But when they stopped, I wasn’t able to.”
- SarahNicole182, 'Experience Project'
When a behavior spreads in a significant way throughout a social cluster, it’s thought to be a social contagion. Like suicide, self-injury can attract copy-cat behavior or become a social contagion. The Internet allows millions to access information on self-injury and following, the Internet allows millions to copy. In Child and Adolescent Psychiatry and Mental Health, a recent article reports on YouTube self-injury videos. The top 100 videos have over 2 million views combined. The article states that watching self-injury videos “...may lead to reinforcement of the behavior for some individuals when this material is repeatedly accessed.” The images and the information become normalized after repeated access. Add to this the amazing artistic aesthetic that some self-injury posts create and copying becomes more compelling. Music, celebrities, raw emotion, and graphic images combine to make cutting look...cool.
(I showed one of the blogs to my kids, 13 and 15 years old. Keep in mind, their mom is a mental health counselor. They’re bright kids and well-informed. Their first reaction at seeing the post filled with multimedia whistles and bells was, “That’s so cool!” It took my bright, well-informed kids about a half second to be taken in by the imagery. I asked them to read the post. After reading, their reaction was, “Oh, that’s so sad.” The study was too small of a sample to draw any academic conclusions, but it gave me something to think about.)
“Tempt not a desperate man.”
-Shakespeare, 'Romeo and Juliet'
Both Tumblr and YouTube seem vigilant about investigating blogs and videos that are flagged for promoting self-injury as they attempt to strike a balance between publishing content that supports and banning content that promotes. In researching this article, I came across a number of posts and videos giving advice on how to hide cuts from parents and showing images of kids cutting themselves. After one day, the posts weren’t available. Both Tumblr and YouTube work to reinforce their content policies, but can content that supports and affirms also be triggering? I think yes, but I also think this isn’t the biggest issue regarding self-injury and the Internet.
“They told me that the ends / Won’t justify the means.”
- The Roots
I’m not sure it’s possible to know what content will support and what content will trigger because it’s too relative of a question. Graphic images can help honest confrontation of pain but can also trigger others to self-harm. Most articles I read to determine what content is helpful and what is harmful offer the ‘...more research needs to be done in this area...,’ so while I’m hedging, I do so in scholarly company.
What I can say for certain is that even at its best, the Internet is inadequate support for addressing self-injury. Dr. Whitlock’s study in the Journal of Clinical Psychology states “...ongoing and active participation in Internet communities may effectively substitute for the real effort required to develop positive coping and health relationships.” I find that kids who self-harm have trouble forming sustaining, healthy relationships. They fear rejection and have trouble regulating their emotions. This makes it tough to navigate in any relationship. Blogs, message boards, and videos provide a comfortable distance to interact without investing much that’s real. The Internet compensates for skills that the kids lack. This can be helpful but also enabling. Healthy relationship skills won’t be developed online at a comfortable distance from others, but they’ll still be needed offline. Further, I wonder if the support offered online draws teens further away from life offline, especially as another aspect of offline life isn’t emphasized - recovery.
Most of the content on blogs and YouTube emphasize the role of the victim. The message seemed to be ‘These are my cuts; these are my scars; I’m in great pain; I’m alone.’ This is a powerful, hard-hitting message, and there is little variation from it. Discussion about recovery or resources that would help stop self-injury are difficult to find. Tumblr and YouTube content policies give the numbers of crisis lines, and Tumblr has public service announcements attached to self-harm searches. However, after watching one of YouTube’s P.S.A.’s on self-injury, still shots of related videos came up with more of the artistic, victim-centered imagery.
When treating teens who self-injure, exploring Internet use is part of our work together. I’ve seen kids use the Internet as a source of support, sometimes for years, because no one else knows. The use has positive and negative ramifications. While the Internet provides a sense of community for kids who self-injure, it also provides a sense of community for kids who self-injure. I think this upshot. The community affirms and validates feelings, and the community might make it difficult to leave, trigger more self-injury behavior, and compensate for deficits in life skills offline. Online support can’t replace offline action. Watch how much time you and your kids spend online. Challenge and engage kids offline - even those kids who are ‘bright and well-informed.’
Where to go for help:
- S.A.F.E. Alternatives (Self-Abuse Finally Ends): http://www.selfinjury.com/ 800-DONTCUT
- Cornell University Information on Self-Injury (Dr. Janis Whitlock): http://www.crpsib.com/userfiles/mediafactsheet.pdf
- Common Ground Sanctuary: 800.231.1127