Disclosing Self-Harm and Mental Health Issues
By: Patricia Christabel Jovita Toha
Staff Departemen Kajian dan Aksi Strategis BEM FEB UI 2018
When you’re sure you’ve had enough
Of this life
Well hang on
Don’t let yourself go
‘Cause everybody cries
And everybody hurts sometimes
- “Everybody Hurts”, a song by R.E.M.
Life certainly isn’t always about rainbows, butterflies, and all the joyful things. One time you can be extremely buoyant, but that does not simply last long. You just can’t predict what the future has in store—then series of bad omen somehow starts to haunt your happiness. Shocking occurrences are not easy to handle; every person has his own way of dealing with his problems. However, there are people who cope with their problems through a destructive behavior—take self-harm as an example.
General Facts about Self-Harm
According to the National Alliance on Mental Illness (NAMI), a US-based mental health organization, self-harm is hurting yourself on purpose—but anytime people hurt themselves deliberately is also classified to as self-harm. The self-harm practice that is widely recognized by people is through cutting flesh with knife and other sharp things. But behavior such as an impulse to burn themselves, to pick at wounds in order to prevent healing, pulling out hair, are also considered as an act of self-harm.
Hurting yourself, or even considering to do so, is a sign of emotional distress. In this case, sometimes a person uses self-harm as a way to cope with his or her emotional distress. Self-harm is sometimes perceived as a suicide attempt since they are similar—but they actually are not. Self-harm is don e without an intention to die but rather to express their feelings, to punish themselves, or to relieve unendurable tensions—even the combination of those three things. Whereas, a suicide attempt is done with an intention to die and the severity of the practice causes much more critical—even lethal—damage.
Although self-harm is not always a suicide attempt, self-harm can escalate into suicidal behaviors. Self-harm is closely associated with elevated emotional and interpersonal distress (Klonsky & Olino, 2008; Klonsky et al., 2003; Klonsky & Muehlenkamp,2007), which increases the likelihood of suicide ideation (i.e.,desire), and facilitates habituation to self-inflicted violence and pain, which increases the ability to attempt suicide (i.e.,capability) (Nock et al., 2006). Self-harm leads to suicide when it is no longer an effective coping method as it ceases to offset the feelings caused by stress (Whitlock & Knox, 2007), also in a crisis situation, self-harmers who have become desensitized and habituated to pain through repetitive harming acts, may view a suicide attempt as less frightening (Stewart, 2014).
Figure 1: Relations between the history of self-harm and suicidal behavior
A study done in 2016 to patients with eating disorders to have a better understanding about reasons to the high comorbidity (including self-harm and suicidal behavior) among those patients. And the result, as stated above, shows that in the self-harm group with a total patients of 23, there were 17 patients with suicidal behavior (73.9 %); whereas in the group without self-harm with a total of 24 patients, there were 11 patients with suicidal behavior (45.8%). The difference, as we can see, is statistically significant. Thus, this research also supports the argument saying that self-harm can lead to suicidal behavior.
People doing self-harm are usually based on these several reasonings. First, to make the doers feel better as it may repress feelings such as anger and anxiety, or people who feel numb to actually feel ‘something’—or to be ‘alive’ again. Second, to communicate their emotional distress—using this reason, self-harmers usually show their scars as a signal to reach out for help. Third, to feel a sense of control; people who self-harm might be feeling powerless, even lacking self-esteem—in this case, self-harm may be used as a way to ‘regain control’ and common to those who have suffered abuse. Fourth, to punish themselves especially those who lack of self-esteem then thinking that it’s actually their fault for feeling that way. (CSP, 2014; Klonsky and Muehlenkamp, 2007; Hasking, 2010). While those four things are considered general, there is also depression that can trigger the act of self-harm—as the source of depression varies (loss of someone important, abuse, childhood trauma, et cetera).
Awareness of Mental Health, Self-Harm, Suicidal Behavior in Indonesia
As the facts have been stated above, we now know that many things, such as depression, might trigger someone’s urge in doing self-harm. In our country itself, the rate of people suffering from depression as of 2017 is 3.7% of the total population—meaning that 9 million out of 250 million suffer from depression. With such a high number, we should keep in mind that depression is also the main reason why people commit suicide in each year. The World Health Organization reported in 2015 the number of suicides in Indonesia as 2.9 cases per 100,000 population. At first glance, this is much lower than other country such as Thailand (16 suicides per 100,000 population), but the problem is that there are many unreported cases. In my past experiences, I have encountered several people who are deeply inflicted by personal matters and secretly self-harm. Sadly, these people did not simply open up and discussed their problems. But it is no surprise if they did so—as I remembered the fact that we all live in Indonesia.
To be frank, talking about mental health issues, self-harm, and suicide is not easy, especially in Indonesia. Although as we face the reality, we’re starting to see that those things are actually inevitable to not be discussed. The sad truth is, cases relating to self-harm and suicide are usually left unreported because the appearance of social stigmas and taboos that hinders people from talking uninhibitedly about those—especially in a country where most of its citizens have a religion, since ending own’s life is considered as a very shameful sin; thus making someone even more reluctant to report a suicide case.
Not only the stigma that hinders someone from opening up—the deeply conservative beliefs of masculinity and feminine are very entrenched in society. The ideas then make it even more difficult for men to open up and talk about their issues. Men mostly are asked to ‘man-up’ every time they are not feeling fine. Not to mention the fact that many Indonesians have the tendency to bully those who express their depression, even labeling them as exaggerating (or lebay in Indonesian)—aggravating the situation and perhaps causes harmful consequences. Sad truth indeed.
The first recommendations are intended for yourself, and for you to help others. Starting from preventing yourself to do self-harm if you happen to feel depressed and currently encountering some problems. You can refrain yourself from doing self-harm by opening up to people you trust the most and just communicate all of your feelings to them. Then, surround yourself with people in order to avoid the feeling of loneliness that can trigger negative thoughts—fill your days with positive activities (such as taking internships, joining competitions, being a committee to a certain event, et cetera), and you can even exercise. If those things only reduce your sadness in a small amount, you should never be afraid to seek help from professionals.
If you happen to encounter people who are facing problems and shown depressed, it is crucial for you to be a good listener and try to understand what they are sharing to you —cause most of the time, all they need is a set of listening ears. While we are listening, we also must not judge—as they have put their trust in you by sharing their pain through stories to you. Finally, you can always suggest an aid from professional if they are not feeling any better.
I hope that society in Indonesia may be able to change their stigma toward such cases. Government and other NGOs must also take part in building awareness on how important mental health is and the fact that mental issues are not to be taken lightly. There should be an increase of suicide hotline numbers where people can seek help directly from professionals. Perhaps, an online website that has an easy access for everyone to share their personal matters to other people—or if plausible, professionals. And as a step of early prevention, there should be an additional counseling relating to the mental health issues (take sex education as an example, but in this case, it talks about mental health issues).
It is time to open up our eyes and realize that there may be people out there, perhaps one of our friends, who reach out for your help. Stigmas have to be eradicated, therefore people will not hesitate to share their feelings—so that no self-harm is needed. After all, mental health should be everyone’s top priority.
– Centre for Suicide Prevention. (2016). Self-harm and Suicide. Retrieved from https://www.suicideinfo.ca/resource/self-harm-and-suicide/
– Dudova, Iva & Koutek, Jiri & Kocourkova, Jana. (2016). Suicidal behavior and self-harm in girls with eating disorders. Neuropsychiatric Disease and Treatment, 12, 787. DOI: 10.2147/NDT.S103015.
– Klonsky, M. May, & Glenn. (2013). The Relationship Between Nonsuicidal Self-Injury and Attempting Suicide: Converging Evidence From Four Samples. Journal of Abnormal Psychology, 122(1), 231-237. DOI: 10.1037/a0030278
– Mustikasari, Indah. (2017). Let’s Talk Openly about Mental Health. Retrieved from http://www.thejakartapost.com/life/2017/08/02/lets-talk-openly-about-mental-health.html