Self-Harm behaviour; Cutting among Kenyan Adolecents
The first time she walked into my office she was smiling widely, her youth and exuberance reflected in beautiful brown eyes. Her mother stood beside her, looking anxious and tense. I asked Wema some questions as I waited for her mother to relax and tell me what had brought them to the clinic.
Over the next weeks I got to know Wema well. She gradually allowed me to look at the various parts of her body that held both big and small, straight and jagged, healed and raw scars. She said the scars inside were worse than those I could see. During those first few weeks, she spoke in a monotone and answered questions automatically, emotionally detached from herself, me and my clinic. As we spoke, she caressed her scars as if they were long-time friends. The smile that she had learnt to plant on her face haunted me each time she left, and I knew almost without fail, that the next time she returned, there would be a fresh cut. Slowly and over time, as we talked about issues around her cutting, her smile diminished. I did not mind that she looked sad because as we snuffed out the facade, the cutting reduced and ultimately stopped.
Wema started cutting when she turned 12. She told me that after the first cut, she could not stop. She did not want to stop. The sense of relief was too good, she said. The pain made her feel alive, like she mattered. Her bottled feelings of inadequacy, hopelessness, anxiety and sadness were dulled by the pain and flowed out with the blood. Her parents were too engrossed in their own lives to notice and she so desperately wanted to fit in with her peers she did not dare speak about cutting. Her teachers were overworked and did not have time to notice her except when she did not do well in class. She was surrounded by so many people on a daily basis but was so alone, she said. She cut because she wanted to feel, she reported.
Non-Suicidal Self injury (NSSI) or self-harm behaviour is defined as the intentional destruction of one’s body tissue without suicidal intent & for purposes which are not socially sanctioned. It is more common among adolescent girls but is also found among boys. The behavior is usually preceded by feeling down, empty or anxious, a period of thinking about release from the low feeling and an intense urge to cut. The child will then subsequently purposeful cut anticipating relief from the negative feelings. The act of cutting will usually induce positive feelings. NSSI may be done to control emotions, punish oneself, revenge on someone or even to fit in with others who are cutting. The cutting cycle may escalate as long as the underlying cause is not addressed.
Usually, children with NSSI have issues that need to be addressed. Many children have difficulties stemming from the home and/or school. Some adolescents may also have emotional difficulties related to the transition between adulthood and childhood, especially in families that have little or no social support systems. Children in families that experience high rates of discord, where there is inter-parental violence, abuse, or absentee parents are usually at higher risk of self-harm behavior.
Many adolescents who cut suffer depression and/or anxiety. Feelings of helplessness, hopelessness and worthlessness associated with depression exacerbate self-harm. The fact that a child appears normal within her circle of friends and does most things other teenagers do does not mean that there is no self-harm behavior going on.
Caregivers and Parents need to know that cutting usually starts between approximately 12 and 15 years although it may start earlier or later. The causes may not be obvious to the caregiver. Professional help from a Psychologist may be required. While most adolescents cut, self-harm behavior is not limited to cutting. Adolescents may cut, scratch or burn on any part of the body including the arms, thighs and stomach. There may also be burns on the back from very hot showers, hot metal, cigarettes, etc.
When looking for self-harm sites, please check the whole body. One may assume that a child is just being an adolescent when he or she withdraws emotionally and physically and is moody. Self- harm can be caused by stress that is unknown to the parent, even in homes that appear otherwise happy. It is important to note that although most children are not necessarily suicidal at the onset of cutting, depression and anxiety are underlying causes. Suicidality may increase as depression progresses. Successful suicides may also occur.
Liz A. Khaemba is a Clinical Psychologist who specializes in children and adolescent behaviour and learning. She is a psychotherapist and conducts learning assessments and provides learning interventions. You may reach her on +0710262393 (message/whatsapp only) or Liz@transformativelearning.co.ke.