One reason self-injury remains hidden is the commonly held view that those who self-injure are ‘attention-seeking’. Prejudice in the health service and the media can brand people as wasting professionals’ time and resources. Shame is compounded by visible scars and fear of being labelled ‘mentally ill’.

Maggie Long is sceptical about whether self-injury is the individual’s ‘fault’. In a study published in Health Sociology Review, she takes a closer look at how “labelling, stereotype, prejudice, and discrimination”, shaped in social interactions, can leave individuals feeling ashamed. Face-to- face interviews were carried out with 10 clients and 10 counsellors.

Counsellor participants were professionally accredited and experienced in working with self-injury, while client participants were; aged over 18, reporting a past history of self-injury, and engaged in counselling. Five clients had been involved with formal psychiatric services.

Three key themes were identified through grounded theory analysis: First, stigma and rejection in the community and society. One counsellor explained: I think there’s not a lot of understanding about it. I think that they’re all tarred with the same brush, you know that whole ‘pull yourself together, behave, there must be something wrong with you, why would you do that? You must be nuts’(Rachel), while a client (John) described how; I was in that psychiatric hospital when I was 14 and I felt people treated me different afterwards, that didn’t give me a chance to actually heal. Ironically, fear of being labelled and misunderstood can cause frustration among counsellors struggling to understand self-injury.

Fear and the need to rescue in counselling services comprises the second theme, whereby counsellors attempt to stop or pathologise individual behaviour rather than heal the deeper emotional wounds. One counsellor (Kevin) referred to the need; to be aware of…our own fears, our own need to sort the person out, to want to be a sticking plaster, epitomised by one client as treating people from a textbook (Ruth).

The final category, secret shame and self-stigma, is encapsulated by Rosie’s insistence that; there has been a terrible stereotyping…of people who self-harm, and it’s something that you know, we’re not ugly, we’re not monsters, we’re not psychotic, we’re just really sad sometimes, and sometimes we just really hate ourselves for it, although strategies to avoid detection can be sophisticated; wearing bracelets and passing off the injury as a ‘minor accident’, to be seen as normal to the rest of the world.

Taken together, Maggie Long says her results are consistent with the idea “that people who self-injure experience moral stigma on the basis of perceived mental illness and physical stigma because of “visible scars on their body. People marginalised within society are already more prone to self-injure. Further, the media’s negative portrayal of self-injury, may leave clients feeling ashamed, preventing disclosure and help-seeking.

While thought-provoking, this study is not free of limitations. Clearly, the biggest drawback lies with the ethical requirement that participants be engaged in counselling during the research project. The assumption that people engaged in self-injury and not receiving counselling don’t have the capacity to participate in research, could indicate structural stigmatism.

So, more research is evidently needed. But if self-injury stigma really does affect capacity to seek help and prospects for recovery, then this could have major implications for service providers and policy makers.

Long, M. (2018). ‘We’re not monsters…we’re just really sad sometimes’: Hidden self-injury, stigma and help-seeking. Health Sociology Review. 27(1): 89-103. doi:10.1080/14461242.2017.1375862