Whose Planet Is It Anyway?

Tuesday, August 22, 2006

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.

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10 Comments:

  • I agree, self harming is allways assumed to be just part of autism, rather than from eternal pressures.

    By Blogger Nathzn, at 9:02 AM  

  • I stand corrected. The female gender is medicalized to a significant extent still.

    JBJr. says you can just give a child vitamin C for self-injury. Poor kid. Who knows what he must go through.

    By Blogger Joseph, at 11:06 AM  

  • gabfh wrote:

    "Despite the lack of evidence regarding the reasons for self-injury in autistics, many psychologists make the unwarranted assumption that it is caused by neurological flaws rather than cultural processes."

    I'd like to add that psychologists make unwarranted assuptions that certain behaviors are *meant* (by the SIB-er) to be self-injurious or even *are* self-injurious (as in, "causing pain") when they are not. Here's an article from Web MD:

    http://www.webmd.com/content/article/118/112873.htm

    I find that article kind of crappy because that's not why I pick at myself and "trich."

    I used to "trich" because I found it really fascinating and hypnotizing. It never hurt me at all. I pick at scabs and other things I find on myself because it relaxes me and makes me feel cleaner.

    In an article on "habit disorders," head-banging is called a "habit disorder" because the artice is not talking about *autistic children*:

    "In some cases, the onset of head banging has been associated with teething or otitis media and has been hypothesized to serve a **pain-relieving function**."

    http://www.emedicine.com/ped/topic909.htm

    Oh, so in nonautistic children head banging relieves pain, but in autistic children it causes pain. Hmmmmmmm.

    The behavior and the interpretation of the behavior seem to have little to do with each other depending on who is doing the interpreting and why (intended audience of the article?), the context in which the behavior is occurring, the population exhibiting the behavior, whether or not the population can be interviewed about the reasons behind the behavior, etc.

    In this article on trichotillomania...

    http://www.emedicine.com/PED/topic2298.htm

    ...the word autism doesn't even appear. But if an autistic does this, it is marked down as an SIB, which is "obviously" a direct outgrowth of autism. Something seems wrong about this.

    By Anonymous autiemom, at 9:42 PM  

  • autiemom: I have an uncle who, when he was younger, had a habit of bumping his head against a wall. He never did it hard enough to injure himself; apparently he found it relaxing, just like any other stim. I'm sure you are right that such harmless behaviors are often mistaken for SIB in autistics and others who have psychological labels.

    By Blogger abfh, at 8:10 AM  

  • Just to let anyone who is interested know, my blog now uses haloscan, which apparently means its easier to post comments. However, the shift seems to have wiped out all the earlier comments on the posts.

    By Blogger Redaspie, at 4:01 PM  

  • Bravo for this post.
    My teenage daughter has a friend who was a "cutter" as they are called by the other HS kids. It's not uncommon and is considered to be fairly typical in some social circles. Her friend has been through some really bizarre and painful things in her life (won't go into any details here, would take a long time and a lot of space). She has been in therapy and on medication(?) and the cutting has been reduced, if not eliminated. She probably does feel a little more in control of events and cicumstances in her life now.
    My son was a serious headbanger when he was smaller (between 2 and 3 years old). It pretty much subsided when we got him sleeping better and he wasn't operating on only a few hours sleep. He would have big bruises and knots on his forehead. We did not necessarily attribute it to his autism, though that was one of the "signs" that indicated a possibility of it. Ultimately, it was more indicative of his sleep deprivation than of his autism.

    By Blogger Soapbox mom, at 10:19 AM  

  • Just blogged on the UN disability rights convention for those interested.

    By Blogger Redaspie, at 2:06 PM  

  • I agree the SIB in autism is often due to masking the pain just like in nondisabled population. My Autistic son has periods where pain comes on, he cries while he is hitting himself on the temple and legs. Just as quickly the SIB behavior stops.

    So although it's nice that you all are debating the differences in SIB..... the real question is, how to get a doctor to take SIB behavior seriously in an Autistic person and treat the PAIN which is causing the SIB in the first place.

    I am very frustrated in extreme prejudism that is found in the medical profession which refuses to properly investigate health concerns for a person with Autism. Any of you know a good doctor that looks at the person first?

    By Anonymous Anonymous, at 5:13 PM  

  • Hi Anonymous. Here's a link to a recent post by a mother who is dealing with this issue with her young son. I hope it's helpful for you.

    By Blogger abfh, at 5:59 PM  

  • "There is no solid scientific proof establishing that autistics self-injure for any different reasons than anyone else."

    That may be true but I can tell that there IS a difference. I have Asperger's and I'm a regular cutter, BUT I'm not depressed or anything like that. I've always liked blood and the sensation of cutting, and I do it pretty much recreationally. In search of people who were like me, I posted this on several forums:

    "Okay. I cut myself more or less regularly, but not for those reasons people in general cut for. As I've heard on cutters' forums, for other people, there is much sadness/pain/dissociation/trauma/depression/self-deprecation involved. For me? None of these. When I cut it can be a celebration, a fun thing to do, a thing like masturbation (as in a tool to stimulate myself in a strong way for physical enjoyment), a routine activity (as I need to get new wounds when the old ones can't be picked anymore, as it has became my morning ritual to pick them and eat the covers), and a technique to make me more energized (as it raises dopamine levels). I also gained inspiration for my creative writing from cutting. Of course, I'm strictly careful not to endanger my life (with an usual max. depth of 0,5 cm, and not anywhere near visible vessels), it's not a suicidal thing for me.

    Most people say self-injury is "damaging yourself". I never thought of it as causing damage, mainly because it's not life-threatening (well, if you're careful, of course), or because it doesn't feel like damage. (Overheat [there are times I cannot sweat, like my brain doesn't realize it's hot], for example, feels like damage, and also dehydration. Though I sometimes have a hard time recognizing what kind of damage it is... but a great clue is that if my palms are hurting like the skin could break, then it's a case of forgetting to drink, which happens very frequently...) My experience of pain is quite peculiar, sometimes tremendous pain signals a minor bump into something that doesn't even cause a visible injury, and sometimes I get black and blue without having a clue where I got that.

    Another thing about my cuts is that clotted, but not yet healed wounds, which I pick open whenever I lose the feeling that they're there, provide a "presence" perception of my limb, or at least the part of the limb they're located on.

    So, I wonder, is it just me, or others as well? Are any other recreational cutters here?"

    And guess what? Only on the WrongPlanet autie messageboard did I get positive replies. On dyscalculiaforum and on some "general" or "normal" sites I got
    banned, on SI-Friends I got irrelevant comments and then dead silence.

    So what?

    By Blogger Meredith, at 6:55 AM  

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