From the outside in, it can be very hard to understand how people overcome the natural and inbuilt desire to live and avoid injury and deliberately inflict physical pain on themselves.
Nothing illustrates this more shockingly than the two recent self-immolations in the Australian run detention centre in Nauru. What drives people to these acts?
Deliberate self harm is as old as humanity, and in modern psychiatry considered a symptom of mental illness.
It is frequently misunderstood and people who self harm are often met with stigma, suspicion and judgement. It can be hard for health professionals to comprehend, especially when repeatedly treating people who frequently self harm, sometimes quite severely.
In the mental health system, people who self harm will likely be diagnosed with "borderline personality disorder" a condition marked by impulsive behaviour, being highly emotional, frequent experiences of extreme anger, low mood, chaotic unpredictable relationships, and chronic suicidality.
It is a controversial diagnosis, with the overwhelming majority of people receiving the diagnosis being women, and many therapists believe it is really just an outcome of childhood trauma and abuse.
Studies suggest anywhere from two thirds to eighty percent of people with this diagnosis were sexually and/ or physically abused as children.
Self harm though is just a symptom, and even though it is commonly associated with borderline personality disorder, deliberately harming oneself is not indicative of this condition on its own.
In fact we frequently see that in periods of extreme deprivation, torture or being held in dehumanising conditions, the rates of self harm and suicide attempts soar. Prison, concentration camps and more recently so called "detention centres" are examples of this.
It's also true that rates here in New Zealand for "intentional self harm hospitalisation" are higher in lower in socio-economic groups: it's a behaviour more common in poverty and deprivation.
Simply put, if you treat people badly enough, many will resort to harming themselves. Causing ourselves physical injury works to help regulate intense emotional pain, it shifts our psychological and biological resources to pay attention to the injury and away from the distress.
It has obvious long term physical consequences, and frequently emotional consequences of shame and self loathing, but in the short term it works.
People suffering from the ongoing affects of childhood abuse feel tormented and imprisoned: refugees in Nauru are psychologically tormented and imprisoned and suicide is the logical solution for those who feel trapped and devoid of hope.
These are acts of desperation, borne of suffering. However if these acts are not caused by an illness, but by suffering, then it falls on the rest of us to not only make sure people are safe, but to also do what we can to alleviate the suffering.
But in Nauru, and in much smaller ways here in New Zealand - with the current crisis in our Mental Health System and more generally growing inequality - we are told alleviating suffering carries too higher cost.
Can we afford not to care?
Where to get help:
• Lifeline: 0800 543 354 (available 24/7)
• Suicide Crisis Helpline: 0508 828 865 (0508 TAUTOKO) (available 24/7)
• Youth services: (06) 3555 906 (Palmerston North and Levin)
• Youthline: 0800 376 633
• Kidsline: 0800 543 754 (available 24/7)
• Whatsup: 0800 942 8787 (1pm to 11pm)
• Depression helpline: 0800 111 757 (available 24/7)
• Samaritans: 0800 726 666 (available 24/7)
If it is an emergency and you feel like you or someone else is at risk, call 111.