Social Constructs and Self-Injury

A recent post about double standards on Ballastexistenz inspired a very insightful comment by Julian^Amorpha about self-injury:

When autistic people self-injure it’s seen as a "co-morbidity" or as something intrinsic to autism and a reason to "find a cure," but if, for instance, a teenage girl considered "normal" in all regards begins cutting, or starving herself, people blame the culture, rather than talking about cures for normalcy.

Feminist psychologist Mary Pipher discusses the cultural roots of self-injury by teenage girls in her book Reviving Ophelia, which deals with how social constructs of femininity are related to emotional and behavioral problems in girls. The book includes case studies of a girl who regularly cut herself after being abused by her boyfriend and another cutter who became depressed when she thought about all the war and violence in the world. Pipher writes:

In my experience, behaviors that arise independently and spontaneously in large numbers of people often suggest enormous cultural processes at work. Eating disorders, for example, are related to the pressure that our culture puts on women to be thin... Self-mutilation can be seen as a concrete interpretation of our culture's injunction to young women to carve themselves into culturally acceptable pieces.

Pipher explains that self-injury is a reaction to feelings of being overwhelmed and helpless to control one's own life. In therapy sessions, she teaches her clients to identify their feelings of emotional pain and to develop healthier ways to deal with their stress and assert control over their environment. For example, the girl who despaired over the state of the world was encouraged to volunteer at a soup kitchen for the homeless, which helped her to believe that she had the ability to make positive changes in society.

There is no solid scientific proof establishing that autistics self-injure for any different reasons than anyone else. I am not aware of any research studies comparing the prevalence and severity of self-injury in autistics vs. non-autistics, with appropriate controls for age, gender, education, income, etc. (If any readers know of such a study, please post a link in the comments.) And even if someone were to do such a study, there would be no way to control for the most significant variable—the horrendous psychological effects of growing up excluded and abused by a society that deems an autistic person's very existence to be a tragic misfortune.

Despite the lack of evidence regarding the reasons for self-injury in autistics, many professionals make the unwarranted assumption that it is caused by neurological flaws rather than cultural processes. As a result, autistics who engage in self-injurious behavior often are treated in ways that cause them to have even less control over their lives. They are forced to take medications that often have distressing and/or physically harmful side effects such as extreme weight gain, they are placed in helmets and other types of restraints, and they are watched constantly for the slightest signs of emotional agitation. That news article I've been ranting about in my last few posts had a picture of an autistic boy being sent to school with a helmet strapped on him and his hands wrapped up in mitts. Does anybody really expect him to learn how to deal with stress (or to learn anything at all) when he is being treated like that?

Mary Pipher's book was written over a decade ago. Even before that, psychologists knew what sort of therapy would help the millions of non-autistic young people struggling with self-injury. It's about time for our society to stop treating autistics as less than human and to work toward empowering autistics to have more control over their lives, too.