In the last section, we discussed various arguments that clients use to persuade themselves that they do not have a problem with self-mutilation. These included arguments regarding personal events, necessary emotional cleansing, and communication. We also included ways to address these arguments of the exploration of ramifications, analogies, and the "Comfortable Presence" exercise
In this section, we will examine the ways in which cultural pressures have a direct effect on the adolescent self-injurer: the idea that pain is achievement; and the "tough guy" stereotype.
2 Ways Cultural Pressures Have a Direct Effect on Adolescent Self-Injurers
♦ # 1 - 'No Pain, No Gain'
As you know, society places a large emphasis on hard work to reach success. However, hard work is soon associated with pain, resulting in the common saying, "No pain, no gain." Twelve year old Melissa, a gymnast, was used to pushing herself in all her routines. Her musculature was soon overdeveloped for a child of her age.
Her parents were notified that Melissa was in the eighth percentile for girls of her age. Her parents became concerned and wanted to lessen her involvement with gymnastics. Very soon, Melissa's parents began noticing scratches on her arms that they determined could only have been made by Melissa herself.
When Melissa was referred to me, I found that Melissa had become confused in her notion that pushing herself physically was the same as inflicting another kind of pain on herself. "My coach told me that if I ache, I tried hard enough. If I'm not hurting, I'm not working hard enough." The motto that her coach had instilled in her, that of "No pain no gain," had been taken literally. Her scratches gave her a feeling of achievement. Luckily, the behavior was discovered early and could be dealt with before it became a dangerous problem for her later in life.
♦ Technique: "Nurturing" Exercise
During a session Melissa said she had trouble nurturing herself because she felt she was reversing her training. To try and separate Melissa from her philosophy of pain, I used the "Nurturing" exercise. The purpose of this exercise is to develop self-soothing behavior which diverted Melissa from self-injury and promoted self-esteem. I asked Melissa to make a list of ways to nurture herself in the future.
Melissa's list of ways to nurture herself in the future:
1. Bubble bath
4. Play with friends not from gymnastics
5. Talk to friends
6. Play with my dog
7. Play video games
8. Watch my favorite movie
9. Take a nap
10. Go shopping with my mom
In nurturing herself, Melissa was beginning to realize that she felt more confident and more comfortable being pain free and less anxious over whether or not she was improving her athletic abilities.
♦ # 2 - The 'Tough Guy' Stereotype
Another type of culturally induced self-mutilation is typically found in males and is rooted in what is known as the tough guy stereotype. This occurs in boys who have been taught since an early age that "whining" and expressing emotion other than anger is a sign of weakness. Eighteen year old Sam was found kicking out windows in the athletic room of his high school. Sam was the star quarterback but was going to have to give up his athletic career in college due to knee injuries. His behavior was striking to his coaches who told him to try and seek help.
While in sessions, I found that Sam's behavior did not stem from anger mismanagement, but from incapacity to express the pressures of his life. Sam stated, "Next year, I'm going to be nothing without football. I could come back here and relive who I used to be. But it's really over for me. High school was a setup. I couldn't get higher grades if I wanted to. I'm one of the biggest, strongest, but definitely not the smartest."
He said that when he cut himself by kicking in the windows, it made him feel like he was strong and could take whatever pain came his way. Sam told me how his father would constantly point out heroes in movies and say, "You've got to bite the bullet. That's a real man, a hero. No whimpering and whining when he gets hurt!" The philosophy of "the tough guy" was so ingrained into Sam's conscious that he felt he couldn't deal with problems in any other way that would not make him appear weak.
♦ Technique: "Being a Man" Exercise
Negative thoughts about gender and gender identity can contribute to self-hatred and self-destruction. For Sam, not allowing himself to express his inner emotions led to a destructive path. To help Sam gain a different perspective of himself as a male, and to derail the notion of being a hero from his mind, I found the "Being a Man" exercise helpful.
I asked Sam to answer the following questions:
1. What thoughts and feelings do I have about being a man? Include thoughts and feelings about body size as well as psychological attributes.
2. What ideas of manhood do I find discouraging or hard to appreciate?
3. What ideals of manhood do I find unappreciated? Which do I find positive and rewarding?
Sam stated, "I feel like I need to have a presence wherever I am. I think guys should be well-built and muscular and I don't think guys need to talk to other guys about their problems. That's what girls do. I never bought into the sensitive guy thing. The guys that said they were sensitive were only trying to impress a girl. I think that in this day, people don't appreciate how much strength a guy has. I like feeling like I can protect somebody, like my girlfriend. I find the opportunity to be in a protective role rewarding."
By stating these thoughts, Sam was able to analyze and break down the negative preconceptions or myths he had about his gender, which was the first step in replacing them with more helpful models.
In this section, we discussed the ways in which cultural pressures have a direct effect on the adolescent self-injurer: the idea that pain is achievement; and the "tough guy" stereotype
In the next section, we will examine four aspects of a self-mutilator's ability to form a relationship which includes: a lack of a workable medium of relationship; the factor of low self-esteem; keeping friends at a distance; and the result of shame of past abuse.
Peer-Reviewed Journal Article References:
Bhugra, D. (2013). Cultural values and self-harm [Editorial]. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 34(4), 221–222.
Nielsen, E., & Townsend, E. (2018). Public perceptions of self-harm—A test of an attribution model of public discrimination. Stigma and Health, 3(3), 204–218.
Sansone, R. A., Sellbom, M., & Songer, D. A. (2018). Borderline personality disorder and mental health care utilization: The role of self-harm. Personality Disorders: Theory, Research, and Treatment, 9(2), 188–191.
Siddaway, A. P., Wood, A. M., O'Carroll, R. E., & O'Connor, R. C. (2019). Characterizing self-injurious cognitions: Development and validation of the Suicide Attempt Beliefs Scale (SABS) and the Nonsuicidal Self-Injury Beliefs Scale (NSIBS). Psychological Assessment, 31(5), 592–608.
Turner, B. J., Cobb, R. J., Gratz, K. L., & Chapman, A. L. (2016). The role of interpersonal conflict and perceived social support in nonsuicidal self-injury in daily life. Journal of Abnormal Psychology, 125(4), 588–598.
What are two ways in which cultural pressures can cause teens to self
injure? To select and enter your answer go to .