Warning: This story discusses suicide and self-harm, and could be distressing for some readers.
Wellington hosted the 20th annual conference of the International Society for the Study of Self-Injury in June. Not only is it a big deal because it’s the 20th one, it’s the first time this conference has been held outside of Europe or North America.
This year, the conference was preceded by a clinical preconference for folk wanting to learn a bit about working to support people who hurt themselves. Apart from me giving people the wrong directions to the room, it went off.
The main facilitators were Professor Jennifer Muehlenkamp, from the University of Wisconsin at Eau Claire, and Professor Stephen Lewis, from the University of Guelph in Canada. That’s a long way to come but, as Lewis told me, it’s given him an appreciation for the experience of people Down Under who have attended the other 19 conferences.
As well as being an all-round good egg, Lewis has pioneered several areas of research. They include some of the most influential analyses of self-injury on the internet and social media, championing an appreciation of lived experience, and investigating the stigma associated with self-injury. In his workshop, he posed a question: everyone in the room is focused on helping people recover, but what does it mean to “recover”?
The dictionary is both helpful and not helpful: “The process of becoming well again after an illness or injury” is a fairly common characterisation. In medical literature, a common characterisation is when the problem stops, goes away or ceases.
Lewis’s work focuses on self-injury, when people deliberately hurt themselves without any intention to die. Often, people hurt themselves as a way of coping with what’s going on for them, so the first definition might be taken to mean they go back to whatever was happening for them before they started hurting themselves. That’s not necessarily a return to good, just a return to whatever preceded the now.
As for cessation, it sounds reasonable, but people hurt themselves for a reason. If you “just stop”, what does that mean for other aspects of your mental health? I’ll illustrate this with a paradox.
Non-suicidal self-injury involves hurting yourself without suicidal intent, but it’s also one of the single best predictors of suicidal thoughts and acts. Some people hurt themselves to avoid doing something more serious.
Research shows that if self-injury works to reduce whatever tension, emotion, pain or distress is at the root of what’s going on, they’re less likely to think about suicide or act on it. If you tell someone to “just stop”, that could be stopping something that is helping, albeit problematically.
So, Lewis asks, what do people who have hurt themselves say constitutes “recovery”? The answer is many things. It’s iterative, and back and forth, with relapses and remissions. It might be harm reduction, rather than stopping entirely. It often doesn’t mean striving to be “well”, because we also know that self-injury often occurs in the context of other forms of psychological distress, so “stopping” self-injury doesn’t mean you’re not going to be depressed, anxious, etc.
It sounds like common sense, but Lewis’s position is to not go into the room assuming you know what recovery is, to find out what it means for that person, and collaboratively work towards that. It means being open with that person in accepting they are an expert in their own experience, without placing the burden for “recovery” solely on them. By necessity, Lewis says (in his 2023 book with Penelope Hasking, Understanding Self-Injury), therapy must be person-centred, and that might mean colouring outside of the lines if you’re a clinician trained in particular ways. As self-injury guru Barry Walsh says, clients don’t fail therapy, therapists fail clients.
It’s been lovely hosting international visitors – Lewis waxed lyrical about Zealandia, among other things. Oh, Lewis also has a well-viewed Ted Talk you can easily find online to learn more.
WHERE TO GET HELP:
•Lifeline:0800 543 354 (available 24/7)
•Suicide Crisis Helpline:0508 828 865 (0508 TAUTOKO) (available 24/7)
•Youthline:0800 376 633 or text 234 (available 24/7)
•Kidsline:0800 543 754 (available 24/7)
•Whatsup:0800 942 8787 (12pm to 11pm)
•Depression helpline:0800 111 757 or text 4202 (available 24/7)
•Anxiety helpline:0800 269 4389 (0800 ANXIETY) (available 24/7)
•Rainbow Youth:(09) 376 4155
If it is an emergency and you feel like you or someone else is at risk, call 111.
