Sabotage of A Perfect Life: An Existential Interpretation of Self-Harm
Written by Natalie Fraser, 2018
Coursework for The Existential Academy
What does it mean to self-harm, is it madness or natural, and are more people susceptible than society perceives?
The NHS defines self-harm as 'when somebody intentionally damages or injures their body' (nhs.uk, 2017). While previously listed as symptomatic to a number of psychiatric disorders, self-harm was categorised as an independent disorder, Non Suicidal Self-Injury (NSSI), in the updated diagnostic manual currently used by health professionals, the DSM-5 (American Psychiatric Association, 2013). The DSM-5 criteria refers to 'any premeditated, self-directed actions that leads to direct damage of body tissues' (Kerr, Muehlenkamp, & Turner, 2010).
While it is noted that many cases of self-harm go unreported (Klonsky et al., 2011), an estimated 300 out of 100,000 people are affected each year (Comtois & Linehan, 2006) with statistics demonstrating a high prevalence of 5- 17% of the general population and 15% of adolescents having reportedly self-harmed (Suicideinfo.ca, 2016; Whitlock et al., 2006).
The importance of addressing this behaviour lies in the distressing affect it has on those suffering and the dangerous potential for it to lead to suicide (Rodríguez, Salvador, & García-Alandete, 2017). Research demonstrates that self-harm is strongly related to low self-esteem and has a distressing impact due to self and public stigma surrounding the behaviour (Hasking et al., 2010; Corrigan, 2004). Studies show that suicide caused by self-harm may occur when the purpose of self-harm changes, for example, when it ceases to be an effective coping strategy (Whitlock & Knox, 2007). While self-harm is associated with suicide in the intentional cause of pain, the intent to die differentiates it. However, if not addressed the intent to die can change over time and can escalate to suicidal behaviours (Klonsky et al., 2011). Over half of those who self-harm have been found to make at least one suicide attempt (Klonsky et al., 2011).
Current understanding and the resulting stigmatisation of behaviours considered as 'disorders' provoke unhelpful attitudes within society which may prevent those suffering from seeking help or guidance (Corrigan, 2004). If the prevalence of self-harm is so high, is it really a disorder that should evoke such stigmatisation, shame and guilt or can existential interpretation provide an alternative understanding about this behaviour?
While considered 'disturbing and dangerous behaviour' to those who may not understand it or consciously participate in it (Alderman, 1997), contemporary existential research suggests that self-harm may merely be a natural method of seeking a deeper connection with their self and their meaning in life. Searching for meaning lies at the forefront of existential psychology (Frankl, 1967). Studies suggest that low levels of meaning in life are directly related to psychopathology such as mental disorders, addictive disorders, depression and hopelessness, all of which self-harm is a prevalent symptom of (e.g., Kleiman & Beaver, 2013). In a one year follow up study baseline NSSI, high levels of hopelessness and low levels of meaning in life were found to directly predict increased frequency of NSSI (Marco et al., 2015), while high levels of meaning in life was a protective factor against NSSI (Kress et al., 2015). Studies looking at NSSI in relation to meaning of life have found that self-harm may in fact be used as a method of enhancing feelings of being alive (e.g., Muehlenkamp & Gutiérrez, 2007).
Medical professionals may be aware of this meaning-based research, yet self-harm may continue to be viewed as a medical 'disorder' due to not being deemed ’socially sanctioned' (Klonsky et al., 2011). This medical criterion of 'unwanted' behaviours fundamentally shapes social understanding, constricting people whether they wish to be or not. Until society rejects the enforced categorisation by the medical profession, stigmatisation and misconception of 'normal' behaviours such as self-harm will prevail (Szasz, 1997). Furthermore, while the medical bodies focus on self-harm consisting of any deliberate self-inflicted damage to the physical self, does this categorisation fully encompass the potential areas of harm that human beings can and do inflict to their selves?
As early as 1943, Chesterton noted that the medical-based branches of psychology were destroying our understanding of human nature (Van Deurzen, 1997) and it seems alarming that decades later the governing bodies continue with this notion, neglecting the diversity of dimensions of self within their diagnostic criteria. According to the existential perspective, human beings are bio-socio-psycho-spiritual organisms (Van Deurzen, 1997). Interpreting self-harm from an existential perspective may highlight the necessity to be aware of the potential harm humans can do to the social, personal and spiritual dimensions of self, and elaborate on the physical.
While inducing bleeding, bruising, or pain to one's physical body is currently understood as self-harm, is this the full capacity of harm possible to the physical self? For example, when considering the necessity to attend to our physical needs (Van Deurzen, 1997), contemporary research into the fast-paced lifestyle of the western world has returned to examining ancient understandings of physical care. An example of this is the basic process of breathing. This physical action that we do to survive has become an automatic process that we pay little or no attention to on a day to day basis. For centuries philosophies have valued controlled breathing, or pranayama, as a method of promoting concentration and improving vitality. Contemporary research has found evidence that neglecting to attend to this physical need is harmful to our physical self and in turn has an effect on our other dimensions. Studies demonstrate, for example, that breathing practices such as integrative body-mind training (IBMT) can help reduce symptoms associated with known pathologies (Tang et al., 2007).
As human beings we are more than just a physical entity, our existence is intrinsically related to being with others, a vast range of others. We are naturally inclined to categorise people as a way of understanding their traits, but categorisation without exploration of the deeper self leads to discrimination. By neglecting to consciously strive to see the complementary nature of the mixed characters that each being has (Klein, 2002), we harm the authenticity of our ability to be our selves, as to be human is to be with others (Heidegger, 1927). Rather than viewing others and ourselves as separate solid entities, discriminating or obsessing, rejecting or accepting other people, we must modify our relationship with them. By embracing the fluidity of our relationship with others, we can retrieve ourselves out of the inauthentic state of separation and accept both our own and other's fullness and truth (Buber, 1923).
At the centre of our physical and social world, we develop an understanding of our personal dimension of self in which we claim our personal identity (Van Deurzen, 1978). When considering the personal dimension Sartre drew attention to the deceptive nature that humans are prone to, or 'Bad Faith', existing as pure consciousness yet attempting to approximate solid objects. He believed that we harm our personal identity by living a life as actors, attempting to live as one immanent, primary role rather than understanding that we are transcendent beings, condemned to reinvent ourselves each day. According to Sartre this challenging, threatening way of being causes most humans to fail miserably at the task, resulting in the harmful outcome of self-deception and existential angst (Sartre, 1943). Only through a process of self-development in which humans must accept themselves not as a thing, but as a creation which can reshape the past and invent the future that they wish to seek, can they achieve a total authenticity and understanding of the complexity of their personal dimension (Satre, 1952).
Beyond our physical, social and personal dimensions of self lies our spiritual dimension (Van Deurzen & Arnold Baker, 2005). Our spiritual self is intrinsic to our being, often intangible, unformed and unspoken yet within this dimension we create a philosophy of life. With the tendency to desire solidity in their existence, humans are prone to develop rigid and inflexible spiritual values in their attempt to avoid confrontation with new or different views that they are exposed to on an ever-changing path of life. This neglect of embracing spiritual fluidity creates the harmful state of an inability to develop genuine and authentic meaning. By accepting the capacity to constantly re-evaluate ones values and not dogmatically accepting the comfort of a rigid personal philosophy, humans may achieve a new sense of humility, morality and purpose by accepting a state of eternal recurrence (Löwith, 1997).
While self-harmful behaviours may be a natural feature of existence and meaning seeking, the distress and suicidal potential resulting from it suggests that intervention and guidance for sufferers is required. Medical intervention focuses heavily on 'curing' pathologies with the apparent aim of a suffering-free existence. Yet existential psychotherapy offers an alternative perspective. The intention is not to 'cure' but to explore experiences, understanding suffering as an inevitable feature of existence and enabling people to have the courage and understanding necessary to face the tensions of their experiences (Van Deurzen, 1997).
Particularly relevant in his dedicated contribution to the understanding of the human search for meaning, Victor Frankl (1967) recognizes suffering as an essential piece not only of existence but of the meaningful life. Based on his philosophy that "“Everything can be taken from a man but one thing: the last of the human freedoms — to choose one’s attitude in any given set of circumstances, to choose one’s own way.”, Frankl introduced the therapeutic practice of Logotherapy which continues to effectively treat a range of 'mental disorders' and life issues including self-harm (Hannila and Purjo, 2013).
Frankl proposes that harmful behaviours are caused by existential angst due to a struggle with finding meaning which he referred to as an existential vacuum. Using the technique of Socratic Questioning, Logotherapy would reduce the harmful existential angst in a client by assisting their self-discovery. By intently listening to their dialogue, specific word patterns and word solutions can be seen by the therapist and reflected to the client, allowing them to see new meaning and enabling them to understand that they have the potential to discover the answers which lie within themselves. Without eradicating suffering from their existence which existentially speaking is not a realistic existence, Logotherapy educates clients about their own responsibility towards their self, transcending from an existential vacuum to existential fullness, " healing through meaning" (Lukas & Hirsch, 2002; Frankl, 1967).
While social views of behaviours may at present remain dictated by the governing medical literature which lives to categories and label 'unwanted' behaviours such as self-harm (Szasz, 1997), contemporary existential evidence suggests a movement towards alternative understandings of such conditions of being. Unlike medical based intervention, existential psychotherapy does not seek to 'cure illness' but rather to assist individuals through exploration in their understanding of the human predicament.
Therefore, with the intention to give space for each individual to create and find their own meaning in whichever thoughts, feelings, beliefs and behaviours that they deem favourable, an existentially lead movement towards greater awareness of the dimensions of our self and raised awareness of the available guidance to seeking meaning may reduce the risk of dangerous self-harming tendencies across the population. Therapeutically, Logotherapy may be a valuable intervention to address the wide range of self-harming tendencies by assisting the unique ability of each individual to find their own meaning in life.
Through this perspective, the understanding of 'self-harm' may be altered. Rather than categorising self-harm as a disorder that relates to pathologically unbalanced people and the abuse of their physical self, perhaps to uniquely varying extents all human beings naturally cause intentional harm to the different dimensions of their self at different moments in their search for meaning due to an innate understanding that a perfect life is not a true life. "To live is to suffer, to survive is to find some meaning in the suffering" (Frankl, 1985).
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