Self-harm and children – hidden terrors

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There is a growing awareness in academia of the phenomenon of self-harm, particularly self-harm among children, primarily girls under 18 and some as young as ten. Papers detailing the phenomenon in Pakistan began to appear in 2009, but there has been no sustained attempt to record or quantify the scale of the problem and most reporting in the public domain remains anecdotal and uncollated.

The harm usually takes the form of cutting of the forearm with a razor blade or other sharp object, typically the arm opposite to that which is used to write. Other sites are the inner thighs and genitals. The cuts are generally superficial but frequently of sufficient depth to draw blood.

Occasionally stitches are required but this is reportedly rare. Most who self harm cease in their 20’s though there are reports of women of all ages harming themselves post-partum. It is important to note that those who self harm almost never do so with suicidal intent.

This is not the place for a forensic examination of self-harm, but it is a place where awareness in mental health professionals, educators and parents may be raised. Self-harmers are naturally reticent about displaying their scars and in a culture where modest attire from an early age is the norm in both men and women, the chances of a teacher or even a parent seeing evidence of harm is much reduced.

An increasingly significant factor in self-harm is the use of the internet to display marks and scars and instruments anonymously and graphically. There are anecdotal reports of this happening in Pakistan, and with the ubiquity of the internet and the connectivity enjoyed especially by young people there is a problem that is – like the internet itself – extremely difficult to regulate.

What is possible, and there are now models which can be replicated, is the integration of self-harm awareness into teacher training curriculum and social work degree courses. Given the parlous state of mental health services nationally there is little chance of making much of a difference via that route, but there are mental health NGO’s – few, but present – which could also take on an awareness-raising role.

This is a problem that is only going to get worse, and as pressures, especially on middle-class children, mount educationally schools and colleges are where the phenomenon is most prevalent. Stress and the urge to achieve are sometimes more than a young person is equipped to deal with, and self-harm is the cathartic release which eases inner tensions. Parents are unaware or dismissive or ashamed, teachers are confused and helpless there being no referral route by which they can seek help for a child or themselves as first responders, and society generally will tend to stigmatise those that harm themselves. There is a role for the popular media to play, both print and televisual and increasingly online – because that is where young people spend an increasing amount of their time. There may be a role for the so-called ‘influencers’ who have social media presences sometimes in the many millions, virtually all of them in the demographic most vulnerable to self-harm. Now is the time for pro-active thought and action, and the putting aside of the national malaise of learned helplessness. Addressing the issue of self-harm, especially among children and girls in particular can be done. Starting now.