Suicide And Self-Mutilation

Carving an Image of Society: A Sociological Approach to Self-mutilation

Kelly L. Faust


“It is society which, fashioning us in its image, fills us with religious, political, and moral beliefs that control our actions.”
٭ Durkheim in Suicide, trans. 1951 p.212

Introduction

Self-mutilation is the act of intentionally inflicting harm on oneself. One of the most important things to note about self-mutilation is that it is not an attempt at suicide. In fact, a common theme in much of the research on self-mutilation is that self-mutilation is the opposite of suicide (Favazza, 1996; Strong, 1998; Hodgson, 2004). Favazza (1996: 225), author of one of the most comprehensive works on self-mutilation, Bodies Under Siege, offers the following definition of self-mutilation: “the direct, deliberate destruction or alteration of one’s own body tissue without conscious suicidal intent.”
Self-mutilation has long been of interest to psychologists. Research exists on the detection, diagnosis, possible causes, and treatment of self-mutilation, though it is limited. Self-mutilation is often studied as a psychological phenomenon. As a result, the existing research is conducted with the individual as the primary focus. Psychological factors need to be examined; however, no one has attempted to explain what role society plays in the detection, diagnosis, cause, and treatment of self-mutilation. In this paper, I examine existing theories on self-mutilation, and combine Durkheim’s theory on suicide (another psychological phenomenon) with available information on self-mutilation. This is done as an attempt to determine what part, if any, society plays in the occurrence of self-mutilation. I begin by looking at the existing research on self-mutilation to develop a model. I then review Durkheim’s theory on suicide.

A Model of Self-Mutilation

Self-mutilation includes many behaviors such as nail biting, piercing, burning, cutting, hitting, or punching. The actions involved in nail biting and piercing are self-explanatory. Burning includes burning oneself with cigarettes, lighters, and matches. People who engage in these behaviors are commonly referred to as “burners”. Cutting refers to slicing or scratching the skin to the point of bleeding. People who engage in cutting behaviors are commonly referred to as “cutters”. Cutters utilize a variety of tools, often razor blades, pieces of glass or plastic, needles, and even their own fingernails. Though the labels are common, those who participate in self-mutilation may not identify themselves with the label. Hitting or punching entails physically striking oneself either with one’s hand or a blunt object. Another common behavior among self-mutilators is carving. In this action the individual may use any of the tools for cutting to carve words or pictures into their skin (Favazza, 1996).

Classifications of Self-mutilation

Favazza (1996) classified self-mutilation into two categories: culturally sanctioned self-mutilation and deviant-pathological self-mutilation. The first category, culturally sanctioned self-mutilation, refers to rituals and practices. In certain cultures, body piercing is an example of culturally sanctioned self-mutilation, as are rituals thought to rid the body of demons or satisfy angry gods. Deviant-pathological self-mutilation, the second category, has three sub-categories: major self-mutilation, stereotypic self-mutilation, and moderate/superficial self-mutilation (Favazza, 1996). Major self-mutilation refers to, what are most often, single occurrences or infrequent events typical of persons suffering from schizophrenia. In these cases, the individual is often in the midst of a hallucination in which they believe that their actions (burning, cutting, hitting, and even amputation) are demanded of them. An example of such behavior would be a person with schizophrenia hearing voices telling them to cut off their finger as punishment for their own actions or possibly even society’s actions. Stereotypic self-mutilation is most common among those persons with severe mental impairments and Autism. This type of self-mutilation presents itself in actions such as repetitive head banging and is also referred to as self-injurious behavior (SIB) (Favazza, 1996).
Superficial/moderate self-mutilation is the most common type of self-mutilation. This type encompasses the remaining, previously mentioned, behaviors of nail biting, burning, and cutting. Favazza (1996) further classifies superficial/moderate self-mutilation into three variations: compulsive, episodic, and repetitive. Compulsive self-mutilation is the variation that includes behaviors of nail biting and hair pulling. These behaviors occur repeatedly throughout the course of one’s day. Episodic and repetitive self-mutilation include the same type of behaviors, such as burning, cutting, and carving but with different frequencies. The episodic self-mutilator does so occasionally as the response to stressful, overwhelming situations or emotions. People who engage in episodic self-mutilation typically do not identify themselves as “cutters” or “burners” (Favazza, 1996). Repetitive self-mutilators mutilate for the same reasons as episodic self-mutilators; however, they are more likely to identify themselves as “cutters” or “burners” and are overcome by their preoccupation with these behaviors.

Empirical Research on Self-mutilation

In a study by Ross and Heath (2002), four hundred and forty high school students from two different high schools were surveyed. The research shows that 13.9 percent of the students surveyed report engaging in self-mutilating behaviors, the most common type of which was cutting. An overwhelming majority, 77 percent, was Caucasian. Ross and Heath (2002) also found that 59 percent of those who participate in self-mutilating behavior have parents who are married, while only 36 percent come from homes where the parents are divorced or separated. Yet another finding is that “girls are significantly more likely to self-mutilate as compared to boys” (Ross and Heath 2002:10).
These findings support some of those discussed by Favazza (1996). He cites work by Graff and Mallin (1967; in Favazza, 1996: 164) when stating that the typical self-mutilator is “an attractive, intelligent, unmarried young woman.” Favazza (1996) also clearly states that self-mutilation is not an attempt at suicide and is often referred to as the opposite of suicide. Reasons for this assertion are that self-mutilators often do not want to die; but rather, they want to live. This is the only way they know to deal with feelings that could otherwise lead to suicide (Favazza, 1996).
Psychological Research on Self-mutilation
The Diagnostic Statistical Manual (DSM-IV, 2000) addresses self-mutilation as a diagnostic criterion for Borderline Personality Disorder or Impulse-Control Disorder Not Otherwise Specified (NOS). The DSM (2000: 292) defines Borderline Personality Disorder as: “A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts.” The diagnosis of Impulse-Control Disorder NOS is applied when the individual’s behavior does not fit one of the specific Impulse-Control Disorders. This includes behaviors such as persistent picking at one’s skin.
A common theme in the existing psychological research on self-mutilation is that this behavior is correlated with abuse (White Kress, 2003; McLane, 1996). Much of this literature asserts that adolescents engage in this behavior as a way of dealing with the trauma of abuse. Not every person with a history of abuse self-mutilates. A large percentage of those who self-mutilate, however, do have histories of abuse (White Kress, 2003). As a result, the behavior of self-mutilating may serve to unite those who have similar histories with abuse. McLane (1996) points out that there are a multitude of other self-destructive behaviors such as smoking, eating disorders, and unhealthy relationships, which serve a unifying purpose for those who engage in them.
Even within a psychological context, it is possible to find social aspects of self-mutilation. Applying social factors to psychological phenomena is not an effort to discount the psychological research that already exists. Rather, the intent is to gain a more complete understanding and explanation of a behavior.

Durkheim’s Theory and Classifications of Suicide

If self-mutilation is often referred to as the opposite of suicide (Favazza, 1996; Strong, 1998; Hodgson, 2004), why compare it to suicide? By proposing a sociological theory on suicide, Durkheim (1897) paved the way for more open thought on the implications of sociology as a discipline. Durkheim’s approach seems to form a precursor to psychological aspects of suicide, rather than eliminating psychological aspects altogether. Social forces are viewed as general causes of suicidal behavior that are then internalized and individualized, resulting in the act of suicide. Durkheim’s theory on suicide is chosen not because it details an action similar in some ways to self-mutilation. Instead, it was chosen because it is the only extensive theory of its kind.
In his discussion of suicide, Durkheim (1897) distinguishes between psychopathic states and normal psychological states. Within the psychopathic state, he identifies four types of suicide: maniacal suicide, melancholy suicide, obsessive suicide, and impulsive or automatic suicide. Maniacal suicide is most common among those suffering from hallucinations, usually schizophrenia. Mechanical suicide corresponds with Favazza’s (1996) classification of major self-mutilation. Melancholy suicide is characterized by extreme depression, created or imaginary, and often unrelated to a person’s circumstances. Obsessive suicide usually lacks authentic motive. A person may be fixated with the idea of suicide, and thus for them, committing suicide becomes an instinctive drive. Impulsive or automatic suicide also frequently lacks motive, and is characterized by an irresistible impulse to commit suicide. Obsessive and impulsive, or automatic, suicide correspond to Favazza’s (1996) classification of stereotypic self-mutilation. Within normal psychological states, Durkheim (1897) classifies suicide into three types: egoistic suicide, altruistic suicide, and anomic suicide.

Egoistic Suicide/Egoistic Self-Mutilation

Egoistic suicide occurs when an individual’s ties to society and morality are too lax. Egoism is commonly defined as self-centeredness, thus people in this state are concerned with themselves over anything else. The first consideration in egoistic suicide is religion. Durkheim spent a great deal of time focusing on the study of religion and its purposes. Morality was also an important term for Durkheim. Morals are a set of rules or codes that people adhere to in any given society (Spaulding and Simpson, 1951). Durkheim believed that religion is a creation used to assist the reinforcement of these morals. High levels of collectiveness characterize certain religions. Durkheim (1897) proposes that these religions experience fewer suicides than others, which encourage free thought. If individuals do not subscribe to the higher beliefs of a religion, they are left to make sense of the world on their own. When individuals cannot make sense of the world in which they live, they may simply loose the desire to live (Spaulding and Simpson, 1951).
Religion is not the only way individuals can be tied to society. Durkheim (1897) also cited family, education, beliefs, and politics as forces that influence egoistic suicide. Families, if large and close-knit, can also provide the necessary ties to society through their own traditions and common beliefs. Politics can be another source for common beliefs that serve to connect individuals to the society in which they live. Beliefs or philosophies such as existentialism can lead to depression, which in turn, may cause suicide. Existentialism is the belief that “man is born into a state of nothingness, out of which he/she creates meaning” (Furman and Bender, 2003:126). Again, we see that the individual is left to create meaning on his or her own. Education, according to Durkheim, may increase the occurrence of egoistic suicide. Lax ties to society cause extreme individualism and individualism leads to a desire to learn. Often, in the course of learning, common beliefs and traditions of a given society are called into question (Spaulding and Simpson, 1951). Once again, the individual is left to make sense of the world on his or her own.
After examining the research on self-mutilation, it is evident that the typical self-mutilator often falls into the egoistic category. Many self-mutilators report that they harm themselves as a way of coping with feelings of loneliness, anxiety, anger, or depression (Ross and Heath, 2002). Egoistic self-mutilation is done to serve the individual’s needs. Individuals self-mutilating to alleviate the feelings of loneliness, anxiety, anger, or depression would be one example of this. Using self-mutilation as an attention seeking behavior such as cutting or burning after a breakup or argument is another example of egoistic self-mutilation. There is no literature, however, that addresses the frequency of instances of self-mutilation used for this purpose.
In further support of an egoistic approach to self-mutilation, there is some evidence that instances of self-mutilation are increasing (Ross and Heath, 2002). At the same time, the breakdown of morals and an increasing emphasis on individuality is noticed. Information on the religiosity of adolescents, who make up the majority of self-mutilators, is needed to fully assess this logic. The average family size, however, has decreased in recent years. According to Durkheim, family traditions cannot be established as easily in smaller families. At this point, little data exists regarding self-mutilators’ religiosity or family size. Future research is necessary to fully integrate the sociological model.

Altruistic Suicide/Altruistic Self-mutilation

Altruistic suicide is often seen as the opposite of egoistic suicide. When an individual commits egoistic suicide, they do so because his or her ties to society are lacking. On the other hand, an individual who commits altruistic suicide does so because his or her ties to society, or a particular group in society, are too strong. Altruism means for the good of the group. In this case, the individual is placing the group’s agenda above his or her own. In Suicide, Durkheim (1897) identifies three types of altruistic suicide: obligatory, optional, and acute.
Obligatory altruistic suicide occurs when common beliefs in a society require individuals to kill themselves. This type is more commonly associated with cults or primitive religions (Spaulding and Simpson, 1951). A person usually commits obligatory altruistic suicide when they believe they will be punished, religiously or otherwise, for failing to do so. In the case of optional altruistic suicide, the society or group does not force the idea of suicide. They merely recommend it. To the society or group in question, suicide is seen as honorable. Acute altruistic suicide occurs when one is motivated by beliefs of what he or she will gain after death. Suicide bombers are an example of this in that they believe, through their religion, they will be rewarded in the after-life.
The idea of altruistic self-mutilation explains primitive self-mutilation or what Favazza (1996) refers to as culturally sanctioned self-mutilation. This is somewhat different from the typical types of self-mutilation discussed so far. In these instances, self-mutilators either allow themselves to be disfigured, or disfigure themselves in an attempt to please society, gods, or other immortal beings. For example, female genital mutilation is considered altruistic self-mutilation, as well as acts required of an individual before entering into the ancient healing art of shamanism. The belief is that one must endure intense physical and mental pain in order to then be able to heal others (Favazza, 1996).

Anomic Suicide/Anomic Self-mutilation

Anomie is a term used by Durkheim to refer to a state of normlessness or conflicting norms; this is where anomic suicide gets its name. In the instances of egoistic or altruistic suicide, the individual’s relationship to society is the cause. With anomic suicide, it is an individual’s interaction with society that is the cause. Every human has basic needs such as food and water. In modern society, however, “the more one has, the more one wants, since satisfactions received only stimulate instead of filling needs” (Spaulding and Simpson, 1951:248).” Thus, individuals set unattainable goals and produce for themselves a constant state of discontent and possibly even depression. States of anomie can be brought on by changes in society. Economic changes, such as depression or inflation, cause individuals to re-examine their needs and adjust accordingly (Spaulding and Simpson). This change can lead to an internal struggle regarding what one can afford versus what one desires. Occupational change, another type of economic change, affects the individual in the same ways and, therefore, can also cause anomie. Becoming un-employed is a prime example of such anomie.
Furthermore, when an individual commits murder before committing suicide, the situation is classified as anomic suicide. Often, the anger associated with this combination of actions is a result of the individual’s inability to internalize societal norms or reconcile the conflicting norms that individuals is are faced with.
Anomic self-mutilation is caused by the individual’s inability to deal with stress or frustration caused by changes in society or in the individual’s social groups. Because self-mutilation is more common among adolescents, the social groups in question are often school-aged peers. Any type of teasing, bullying, or general lack of acceptance also creates a state of anomie. In these cases, the unattainable goal is often popularity or acceptance. Self-mutilators then participate in mutilating behaviors as a way of coping with this anomie.

Conclusion

Having now examined both the research on self-mutilation, as well as Durkheim’s sociological theory of suicide, I can begin to identify the new model’s successes and failures. The existing classifications of self-mutilation seem to fit within a Durkheimian approach. There are, however, a few shortcomings. These shortcomings are a direct result of the lack of empirical research on self-mutilation. In order to completely integrate a sociological approach to self-mutilation, more information on individuals who engage in this behavior is needed. It is necessary to know their religious affiliation, as well as their degree of religiosity. Additionally, more information regarding family size and peer group structure is needed.
In Suicide, Durkheim (1897) writes that instances of suicide are more common among men. He argues that women need less from society and, therefore, are less likely to experience any of the identified types of suicide. This argument seems to contradict the existing research on self-mutilation, which says that females are more likely to self-mutilate. This discrepancy actually serves to support the integration of a sociological model of self-mutilation. If one accepts the notion of self-mutilation as being opposite to suicide, then it would make sense that more males commit suicide while more females engage in self-mutilation. Further empirical research is needed to form a continuum of the sociological approaches to suicide and self-mutilation. A sociological approach to self-mutilation opens the door for a psychosocial understanding of many phenomena affecting society today such as eating disorders, depression, and even low self-esteem.