For this month’s column, I spoke with Patricia A. Adler, Professor of Sociology at the University of Colorado, Boulder. She and her husband Peter Adler, Professor of Sociology at the University of Denver, co-authored a new book that offers an ethnographic perspective on a controversial health topic. The Tender Cut: Inside the Hidden World of Self-Injury (NYU Press) invites readers to go beyond predominant medical and psychological perspectives by offering a nuanced analysis of self-injury as a sociological phenomenon.

Their book is the culmination of 135 in-depth, life-history interviews conducted over ten years with self-injurers from across the world, as well as analysis of tens of thousands of emails and Internet messages. Their participants were engaging in self-injury, the intentional non-suicidal harm of one’s own body, including but not limited to include cutting, branding, burning, branding, and scratching. 

AN: In your book, you describe a broad range of motivations for self-injury. Can you explain the most typical reasons?

PA: Most of the people we interviewed saw it as a way to cope, to function when they were facing tough times. Many started in their teens when they were trying to cope with negative life circumstances.

AN: Did you find that sex and gender made a difference – did the self-injury types or reasons differ between men and women?

PA: Yes, men and women differed in the ways that they self-injured and their motivations. Men were injuring their bodies because of feelings of rage and anger and were more likely to use dull or rusted instruments to make bigger injuries on parts of their body that would be easily visible. If a man did small self-injuries and tried to hide them, then other guys would be likely to ridicule him. Women were more likely to use sharp, small blades on parts of their body that they could easily conceal because society judges women’s bodies, and they wanted to be able to hide it. They tended to self-injure because of negative feelings about themselves.

AN: It’s fascinating that sex and gender factors into others’ reactions to the self-injurers: that those who acted in ways that matched their gender norms – who were seen as being appropriately masculine or feminine – received less ridicule. Do you think mental health and medical practitioners understand self-injury as a gendered phenomenon?

PA: I think that mental health practitioners probably regard self-injury as they do eating disorders, as a generally female behavior. They may see a guy here and there, but I doubt that any practitioner sees enough to recognize this pattern. And some of the books I’ve read from the clinic people who do see larger numbers have presented cases of men who injure in ‘feminine’ ways. So I don’t think they’re attuned to this gendered pattern.

AN: Most media coverage of self-injury approaches it as a psychological problem, often as a physically dangerous type of addiction. Can you explain the sociological perspective you present on self-injury?

PA: It is common for self-injurers to be told that they have a mental disorder and that it is an addictive practice. We looked at a range of people who self-injure and found that their motivations did not necessarily reflect mental illness. A lot of regular teenagers and adults who were structurally disadvantaged were using it to find relief. Then there are those who have severe mental disorders before they start self-injuring. Some of the people we interviewed were mentally ill, but our research suggests that many of them are not. We intentionally chose the word “tender” in the book’s title because cutting may be a coping mechanism that makes some people feel empowered with a sense of control over their pain. The self-injury gave some people relief from emotional pain that they needed to get through challenging times. Our book is nonjudgmental, providing a “voice” for the experiences of a broad population of self-injurers: comprising people who have genuine mental disorders, as well as those who just have temporary situational life troubles, and everything in between.

AN: From the medical and psychological perspectives, a key focus in on how to help self-injurers stop “dangerous” behaviors. So, what did you learn about the ways and reasons why self-injurers stop?

PA: Many self-injurers stop when they are able to escape from the circumstance that caused them to initially start. So, transitioning from high school to college can be a time when young people stop. For others, it takes getting a good job, finding a partner who will not tolerate it, or becoming a parent and not wanting their children to see them self-injuring.

AN: In other published interviews, you’ve made the somewhat controversial point that not every self-injurer will need to invest in professional medical and mental health treatment in order to quit. What are some of the other ways that those you interviewed found to be helpful when they decided they wanted to stop self-injuring?

PA: Solutions from the medical-psychological community include everything from specialized clinics, which can be very expensive, to outpatient therapy, and drugs. Those who found therapy to be effective were those whose therapists addressed the reasons the person began self-injuring in the first place, rather than those who focused on self-injuring as the problem to be treated. Most of the people who self-injure are not trying to self-destruct; they’re trying to self-soothe. And, we also found many turning to free online support groups to connect with people like themselves who had either stopped self-injuring or could give advice on how to better manage the negative aspects of self-injury. In addition, some people just stopped on their own or with the encouragement and support of friends.

AN: As experts on deviant subcultures, would you say that the Internet has helped to create communities of self-injurers?

PA: Yes, the Internet has helped to build a kind of self-help community for self-injurers. Peer support groups have emerged organically, and people are sharing their experiences with each other in cyber-communities. These online relationships help them manage stress so that they function better in their daily lives.

AN: What role do you think the media played in transforming self-injury into a sociological phenomenon?

PA: It was initially shocking but not necessarily more shocking that the many other ways the people try to relieve their pain. The stories often showed that self-injury was not a suicide attempt and wasn’t necessarily because the person had serious psychological problems. Once the media started to cover self-injury stories of celebrities, then it became more acceptable because young people could relate to these people. Now, it’s so common in high schools that teens are more willing to disclose their self-injuries to their friends, and their friends often see it as “that thing that people do” if they’re unhappy, as a temporary coping mechanism. We see this behavior as highly “socially contagious”—the media, along with word of mouth, has contributed to its spread.

In The Tender Cut, we describe how media coverage of celebrities who self-injured, the accessibility of the Internet, and shifts in cultural norms made it possible for loner deviants to join Internet self-injury subcultures. These subcultures represent a range of levels of acceptance of self-injury and often help people to realize that their behaviors do not necessarily mean that they are mentally ill or bad people. This helps them manage the stigma of society judging people negatively for relieving emotional pain by inflicting physical pain on themselves. Our longitudinal data shows that many who began self-injuring as teenagers eventually outgrow it and lead functional lives.