Please be aware this post will be discussing self harm so some content may be triggering.
There is a lot of thought about whether self harm is a decision or not. I know it’s a highly controversial topic and it’s something I’ve been thinking about for a while. As someone who self harms it can be a difficult thing to consider.
The definition of self harm is deliberately hurting yourself. This suggests that self harm is a choice but how much is that true? When we consider self harm as a symptom of a mental illness is it really a choice?
If you had an illness like cancer would you consider your symptoms your choice? Quite obviously the answer would be no. So is self harm any different? If you ask anyone with self harm about what happens when they need to harm most will say its an uncontrollable urge. It is something they feel forced to do. This is especially common as you go deeper down the self harm hole.
The urge to self harm, for many, is intense. It takes over. It’s hard to think clearly. The urge is made stronger by the fact that many who self harm have low self esteem and don’t feel deserving of care. Whatever has been a trigger will bring up all sorts of feelings that are hard to deal with. Everything can feel overwhelming. Sometimes we are not totally there, maybe dissociated. Then it’s not really a choice is it?
But in some ways it can be a choice. We decide to inflict the harm, don’t we? I honestly don’t know. This is where I’m hugely torn. And why I’m torn is based on how I see others and how I see myself. For others, and this is probably the most important part, I don’t think it is a true choice. There is a lot leading or pushing you in that direction. It is a symptom of an illness so is never a true choice. Then I look at myself and berate myself for choosing to hurt myself in the first place.
I don’t give myself a break on the decision making idea. I blame myself for self harming every time. I blame myself for making that “choice”. I see myself as truly being the reason I’m hurting myself. Even the name makes it seem like that. Especially when medical staff call it deliberate self harm.
And this is where the issue becomes more apparent. We are treated by medical staff, including in mental health teams, who see it as a choice rather than a symptom. Yes I may pick up the blade etc but there is something pushing me to that. I am unwell. My choices are not truly my own always. It’s not an excuse but an explanation. I’ve been told I’ve made the choice to hurt myself. This in a time when I was so distressed I couldn’t see any other choice. So surely it isn’t a true choice?
There is hope with this though and this is where it gets more into the dodgy area of being a choice. Learning through therapy of other ways to cope instead of self harming means we do start to have a choice between self harm or using our new coping methods. I start to see why they say its a choice. They’ve given us other options and we’ve gone for self harm. What they don’t seem to realise is we probably chose their new methods first but it takes time for them to be an effective choice for us. It’s all about time.