Ten per cent of adolescents may harm themselves - and it's rarely to get attention, reports Tricia Sheehy Skeffington.
'We all did it," shrugs Kate, a 22-year-old care assistant, as she describes how she and her classmates at secondary school would rub their forefingers until they were raw. One friend cut scars in her upper arm instead of getting a tattoo; another had a reputation for cutting herself more persistently and seriously. "There were degrees of it," says Kate. "I just did it because everyone else did."
Self-harm is a common but seldom talked about problem in adolescence that "fills people with dread", according to Carol Fitzpatrick, professor of child psychiatry at University College Dublin. Often people who self-harm are able to hide the fact, although others end up in hospital.
"At one end of the spectrum, some teenagers cut to see what it's like and others do it as a group bonding activity," she says. "Then there's another group of young people who do it to relieve their emotional pain, and a small proportion of those can get into the habit of repeatedly self-harming. The physical pain relieves their emotional pain."
Ways of causing that pain are as diverse as the reasons for it. They include cutting with a razor or broken glass, burning, scratching, head-banging, hair-pulling and gnawing at flesh.
"It's often seen as attention-seeking, but most who self-harm are very private about it, so it's unlikely they're particularly looking for attention. A small number of those who self-harm are truly suicidal, but most are not," says Fitzpatrick.
Recent studies show the problem is more widespread than previously thought. An Oxford-based survey of 6,000 15- and 16-year-olds looked behind the yearly figure of 25,000 young people who turn up at UK hospitals suffering from cuts, poisoning or burns they had inflicted on themselves. How many hurt themselves without the formality of looking for medical attention?
Nearly 800 of the group, or 13 per cent, had harmed themselves at some point in their lives. About half of these had done so in the past year - a tenth of whom had sought hospital treatment for their injuries. Although most self-harmers were girls, boys figured significantly also.
Similar research is under way at the Southern Health Board, whose initial findings echo the UK results.
Although the ISPCC does not keep figures on how many Childline callers self-harm, it recognises the phenomenon as a serious symptom of underlying problems. "It would not be uncommon among teenagers who are experiencing trauma and distress," says Paul Gilligan, the society's chief executive.
Teenagers are particularly vulnerable because their "huge psychological task is to come to terms with their new body, so if things start to go wrong it tends to be taken out on their body". But to see it as mere pubescent angst is too dismissive. "Something is resulting in this behaviour," he says, "so they need to find a way of expressing their emotional distress in a less harmful way."
Gilligan agrees that one in 10 teenagers is a reasonable assessment of the breadth of the problem, but he warns against panicking. "A high percentage of teenagers engage in such behaviour. It may be minor, like scratching at their wrists. It's part of being a teenager, like getting ears pierced or radical hair colours - it's part of the developmental stages." He adds, however, that if the behaviour becomes obsessive it is a serious condition that needs therapeutic attention.
Bringing up the subject of self-harm with friends is a shocking experience. Many talk of scratching themselves with compasses and stubbing out cigarettes on their arms, partly to test their pain barriers and partly, admits one, because he was a "f***ed-up teenager" who later attempted suicide.
Rachel, now in her early 20s, was one of the worst. She first deliberately hurt herself when she was 11, and although she generally reached for solvents she once took a blunt hacksaw to her wrists.
"You're not trying to kill yourself. It's more like getting out aggression and doing it on yourself. It was being on my own; I couldn't cope. I wasn't happy with my personality and stuff like that."
Trying to explain why they hurt themselves can be frustrating. People who haven't been there find it hard to understand. One tried to explain herself on an Irish Internet message board. "Sometimes you just can't feel yourself any more. You can't feel life because it's not real to your eyes. So harming oneself can be a way to get back to reality. When the blood starts to run down your body you're able to feel yourself, your soul, your mind again."
She provoked some unsympathetic analysis on the generalist website she posted her explanation on. But trying to understand is vital, according to Siobáin O'Donnell, who worked with self-harmers who were up to 35 years old as manager of a community drugs team.
"It's very difficult to understand how a mind can become obsessed or overwhelmed. But it's like when you wake up thinking there's someone in the house, and you can feel your pulse in your ears and your heart is racing. That overwhelming panic is once-off and you wake up thinking, oh my god, I was silly.
"But can you imagine being in that state for years, with your heart thumping and pulse racing, and you have to do something to release this feeling - and cutting is the way, because the body and mind can't cope? It's a survival mechanism."
People who are worried about their own or others' self-harm can ask their GPs about therapeutic services in their areas.
Although there is no dedicated support group for self-harmers, Childline and the Samaritans are available and several UK helplines will gladly talk to Irish callers.
But Katie Fousler of the UK's Self Harm Alliance sees this as far from ideal. Rather than the half-hour people normally spend on the phone, Irish callers often limit their conversations to five minutes. Money and secrecy are at issue.
"Callers from Ireland will say this is costing me quite a lot of money and there are issues with it being on their parents' bill - they might ask why they're phoning England."
That problem could leave them more reliant on the people around them rather than on specialist counsellors, which makes it all the more important to be aware of the problems they might be having and to treat them sensitively.
For support
Self Harm Alliance Helpline
00-44-1242-578820 (Tuesdays
and Sundays 6-7p.m., Thursdays 11 a.m.-1 p.m.) www.selfharm alliance.org.
Childline 1800-666666.
Samaritans 1850-609090. www.samaritans.org has links to self-harm support websites.
Bodies Under Siege www.busmail.org/phpBB is a well-moderated message board for self-harmers, family and friends.
What to do
Do
• Be patient and supportive.
• Ask if they want to talk.
• Tell them you love them deeply, even though you don't like what they're doing to themselves .
• Listen and be understanding if they tell you it's their way of coping.
Don't
• Be judgmental.
• Tell them to pull themselves together.
• Accuse them of looking for attention.
• Shout at them, blame them or say they're weird.