Illustration by Cei Willis
Self-harm among teenagers is pretty close to an epidemic in the UK. Evidence about the exact number of self-harm cases is scattered, but almost every report published in recent years has shown that it's on the rise. In 2014, figures were published showing a 70 percent increase in 10- to 14-year-olds attending A&E for self-harm—related reasons over the preceding two years. Last year, a wide-reaching survey conducted by leading civil servants found that a third of 15-year-old girls had reported harming themselves on purpose. Earlier this month, a report from ChildLine found the charity is now mostly receiving calls about low self-esteem, bullying, and self-harm. In 1986, when the 24-hour helpline began, children's top concerns were sexual abuse, family problems, physical abuse, and pregnancy—calls about self-harm were not recorded at all.
What's unclear is whether these manifestations of extreme self-hate and turmoil are increasing or simply better recognized and recorded.
Glyn Lewis, Professor of Psychiatric Epidemiology at the UCL Division of Psychiatry, believes that we aren't witnessing a new phenomenon. "Self-harm has always been a relatively common event in adolescence and I think the current increase in reporting is, if anything, a sign that these sorts of issues are being treated more seriously than before, despite cuts to mental health services."
In fact, the concept of self-mutilation first came into use in the late 19th century. Medical books tended to concentrate on more extreme acts—castration, amputation, or enucleation (removal of an eye)—though in hospital and asylum medical notes, the definition was much wider: skin-picking, hair-plucking, knocking any part of the body, cuts and other injuries, swallowing foreign bodies, inserting things like needles under the skin, and eating trash.
Unlike today, though, cutting was not common. As UCL's Dr. Sarah Chaney, author of the forthcoming book The Psyche on the Skin: The History of Self-Harm, explains: "In very few cases, patients cited bloodletting—an ancient medical practice that remained popular in some circles into the 20th century. While self-performed bloodletting was frowned upon, even some psychiatrists described self-inflicted cuts as therapeutic."
Chaney also says the connection between self-harm and young people is a modern one. "No one associated self-mutilation with children or teenagers in the Victorian era or the first half of the 20th century. Doctors did, however, link it to unmarried people, especially women, whatever their age. Being unmarried, so they thought, put you at risk of hysteria or other nervous disorder."
Fast-forward to the 1960s and self-harm, particularly overdosing, started to be considered a cry for help, a last option to communicate to a partner or friend that you couldn't cope. While it was often seen as attention-seeking, this wasn't, generally, in a pejorative way. "If you look at the political environment of the 60s, it was all about about social work and collectivity, and the role of the health worker was instrumental in getting self-harm recognized at home," explains Chris Millard of QMUL and author of A History of Self-Harm in Britain.
This change in attitude was partly down to the decriminalization of suicide in 1961 (previously, attempted suicide had been punishable by death). After that, self-harm became an issue for psychiatrists, not the police. According to Millard, it slowly became accepted that a highly stressful pathological incident in your life wouldn't have to stain your family forever. Psychiatric wards started becoming attached to general hospitals. Prior to this, if it wasn't serious enough for someone to be committed to an asylum, the vast majority of patients were patched up and sent home.
Self-harm only started to predominantly take the form of arm-cutting in the late 60s and bizarrely, it was, at the time, linked to being unable to menstruate. "Because the majority of people doing it were young women, and because it was delicate cutting that appeared not to hurt them, one explanation was that these women weren't menstruating and so were trying to find blood," says Millard.
By the 1980s, with the rise of Thatcherism and the emphasis on the individual, opinions shifted, but even then, a belief remained that women could be inherently crazy, especially regarding men. "Even in A&E, self-harm was often seen as a weapon for girls to bring back their boyfriends. It was seen as an attention-seeking act that people should just stop," says Millard.
While it seems that self-harm has always been an issue, its presentation as something that affects young people is a fairly recent development. Perhaps 90s goth and grunge culture created a sheen of "cool" around self-mutilation, but that doesn't seem to account for the most recent reports of a sharp rise in cases of self-harm among teenagers.
Psychologist Oliver James suggests that there has been an increase in mental illness in both children and adults since the 1970s as a consequence of "selfish capitalism"—of wage disparity and the high value that is placed on possessions, money, appearance, and fame. He says that capitalism stokes up unrealistic aspirations and the expectation that these aspirations can be fulfilled.
Many more, including Lucie Russell of the mental health charity Young Minds, have argued that social media is effectively super-sizing peer pressure.
"I'd been bullied for years and I always thought that meant there was something wrong with me. Social media made it a lot worse," says Nikki Mattick, 18, from Croydon. "When I put up a picture on Facebook and people commented by saying nasty things or it only got so many 'likes' I would overanalyze it. I'd go on Facebook seeing people at parties, so happy, and I'd think, why I am I not like that, why am I not normal? It definitely made things worse."
But, Russell argues, there are other pressures at work too, such as more testing in schools and an increase in families breaking down, which may also accelerate instances of self-harming. Professor Fiona Brooks, Head of Adolescent and Child Health Research at the University of Hertfordshire, says: "The challenges of the future job market have been found to put massive pressure on young people. Unpaid internships, zero-hour contracts, and schools demanding and expecting higher grades are all having an impact."
All of this comes at a time of huge financial cuts to mental health services. During the coalition government's term, mental health funding was cut by £600 million [$857 million]. A recent study found that just 14 percent of people received appropriate care for a mental health problem.
We are living in a unique time. Self-harm has gone from being misunderstood and not discussed, to common enough to be almost an accepted part of the adolescent experience. Concerns about how technology may affect teenagers' mental health are well-founded but, paradoxically, the internet might also be the answer to many of the problems around teenage self-harm.
Allie Heslop, 24, from South Shields, says communities online showed her new ways of coping, and she hasn't cut herself for nearly two months. She learned techniques such as holding an ice cube or ripping paper when you feel the urge to hurt yourself, and she credits the support she received from CAHMS (the NHS child and adolescent mental health service) and years of therapy with saving her life. "The help I've had basically kept me from killing myself," she says. "It's something I still struggle with, it's part of my mental health and there will always be that natural instinct, but I've become more resilient."
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If you are affected by any of the issues in this piece, help is available from the Mental Health America website.