2019 Aug 15
Trigger warning: Sections of this article contain information on self-harm that may be sensitive to some readers.
A “choice”, an “addiction”, “a way out” out of crushing emotional pain. This is the reality of self-harm in Sri Lanka – a problem that many young people struggle with, and one that parents and loved ones find hard to comprehend. This commonly disregarded problem implores an urgent call-to-action and increased awareness on the issue.
What is self-harm and why do people do it?
‘Self-harm is when a person directly inflicts damage to their own body tissue with or without the intention of suicide.’
This is often seen as an impulsive response to intense emotional stimuli and is carried out for complex reasons. Emotions that are too painful to manage can prompt a person to engage in self-harming behaviour and the difficulty in expressing certain feelings like rejection, failure and loss can also lead to someone harming themselves as means of communication.
A feeling of ‘numbness’ or disconnection is likely to arise when faced with situations of extreme distress. Self-harm, then, is seen as a way to counter this feeling of numbness by translating emotional pain into a physical one. This harmful practice is seen as either punishing oneself, creating an outlet to express unbearable pain or can be a cry for help. Most times, it is all three.
Self-harm is not always visible.
As Nivendra Uduman, counselling psychologist and member of The Ohana Project points out, “the common stereotype linked to self-harm is cutting, which is widely portrayed in the media. But there is a tendency for us to miss other signs – both physical and psychological – because we naturally look for signs of cutting, as that is ingrained in our minds as the physical manifestation of self-harm.
Extreme dietary restrictions, binge eating, using recreational substances and alcohol in a reckless manner, and emotionally punishing one’s self by engaging in pervasive, negative self-talk can also be seen as acts of self-harm even though it is often referred to as ‘indirect self-harm’ as it does not directly cause injury to body tissue.”
Who is at risk?
- While people of all ages self-harm, teens and young adults are reportedly more vulnerable. At an early stage in life, distressing situations can leave them feeling confused and unable to deal with overwhelming situations.
- Those who have experienced past trauma– in the form of abuse, neglect or having grown up in an unstable environment.
- Teens and young adults who struggle with their identity. Those who question or are confused with their sexual orientation or gender identity, for example.
- Peer pressure or, on the contrary, social isolation can increase a person’s inclination to self-harm.
- Self-harm can also be a sign of a mental health condition such as depression, emotional dysregulation, severe anxiety and psychosis.
6. A person is more likely to self-harm if they are under the influence of drugs or alcohol
Common myths and misconceptions
- “Only women self-harm.” – Wrong. Several findings reveal that self-harm is evident in men as much as in women.
- “Self-harm is attention-seeking behaviour.” – Wrong. People who self-harm often deal with shame and guilt over their actions. This is common, especially in Sri Lanka, where there is heavy social stigma surrounding issues of mental health. If someone confides in you about self-harming, it means that it took a long time for them to decide to come out and seek help.
- “People who self-harm are violent.” – Wrong. Those who self-harm can come from different backgrounds and has no indication, whatsoever, of tendencies to be violent.
- “Self-harm is so emo ” – Wrong. Self-harm is not a lifestyle choice and does not have any connection to a particular culture.
Self-Harm in Sri Lanka
The lack of awareness on self-harm and the stigma attached to seeking help for mental health conditions is often the case for Sri Lanka. Not only are there inadequate attempts to understand this behaviour, but a lack of communication, tolerance and coping skills as well as the drawback of such issues being left out of mainstream education add to the problem. Self-harm is also romanticized and popularized in some peer groups and the media, thereby conveying a false, much less unhealthy way to cope with distress.
This type of peer pressure can be seen through efforts to assert one’s identity in a group and to feel a sense of belonging. This is upsettingly common in Sri Lanka. Commenting on this, Nivendra adds that “the scars left behind both physically and emotionally help them connect with people who may have had similar experiences, therefore giving rise to a sub-culture within a system. Peer group behaviour is also seen to be linked to self-harm, especially in the school system where the need to belong may lead a person to use self-harm as a primary option in coping with pain.”
Engaging in self-harm can also help someone ward off suicidal thoughts by diverting attention to self-injury or self-poisoning.
“In Sri Lanka, there are a great deal of young people harming themselves due to not having the necessary tools to deal with intense emotional experiences like a breakdown of a relationship, experiencing domestic violence, problems around sexuality, neglect or abuse. It may also seem like a form of release, almost like a pressure cooker releasing pressurized air,” says Nivendra.
What is more, a spike in admissions of pesticide self-poisoning incidents relates a completely different picture in the more rural parts of Sri Lanka. A deeper look into this alarming practice relates that most rural households constantly battle with financial and social difficulties. While pesticides are easily available in these areas, alcohol consumption also apparently aggravates the situation. A recent pesticides ban in 2008-11 has however, contributed to a reduction in fatal pesticide self-poisoning.
Recognizing the signs
- Frequent reports of accidental injury
- Wearing inappropriate clothing even in a warm country like Sri Lanka (i.e. long sleeves)
- Unexplained scars/bruises
- Fresh cuts, scratches, bite marks, etc.
- Difficulties in interpersonal relationships
- Statements of helplessness, hopelessness and worthlessness
Initial response to someone who has self-harmed
- Look for serious injuries (heavy bleeding/ signs of poisoning). If he/she appears to be lethargic, confused, or experiencing a loss of consciousness, call 1990 immediately and request for an ambulance
- Be calm. Do not scold or criticize the person
- Respect their privacy and dignity
- Ask them about how they are feeling
Important: When bringing up the topic of suicide, do so in a non-judgmental, caring manner. E.g. ‘Sometimes when people hurt themselves, they are in a lot of pain. When people are in pain, they can sometimes feel like life is not worth living anymore. Have you felt this way?’
- Ask how you can be of help
- Be prepared to listen
- Encourage the individual to seek professional support
Helplines for anyone seeking support:
- The Ohana Project – firstname.lastname@example.org
- CCCline – 1333 (24 hours)
- NIMH toll free hotline – 1926 (24 hours)
- Shanthi maargam – 0717639898
- Sumithrayo – 011 2696666 (9am to 8pm)
Self-harm is a lot more common than we realize. It is something that people do not pay enough attention to, and is therefore left unaddressed. Measures like restricting access to harmful substances and more innovative and culturally appropriate preventive strategies are needed to address this increasingly unsettling problem. And with the right measures and a collective social commitment of looking out for one another, this can be accomplished.
*This article was written with help from The Ohana Project; a community of mental health professionals who aims to ‘leave no one behind.’