Self-Harm as a Disengagement Strategy?

In February 2025 I invited ‘unanswered questions’ about self-harm and throughout 2025 and beyond I will be responding to these questions in a series of blogs. In these blogs I draw on my personal and professional experience, as well as survivor and academic literature. The purpose of these blogs is to bring together a range of perspectives and pose ideas and questions for further reflection. I welcome feedback and questions – thanks for reading!

The Unanswered Question(s):

Why do professionals use the self-harm-as-strategy concept against people? I have heard people say their self-harm is dismissed as a strategy/not taken seriously as a result.

A common phrase when people are talking about self-harm in clinical settings is to describe someone’s self-harm as a ‘maladaptive coping mechanism’. Although I can’t pin down the origins of this phrase (and I’d be happy to hear from anyone who can), any online search for information about self-harm will quickly return this standardised description.

I can’t deny that this neat parcelling up of such a complex, multi-faceted experience is one of my bugbears. I can see why it appeals; it sounds suitably scientific and medical, it seems on the face of it to be explanatory, a simple summing up that doesn’t require more thought and it’s othering – it’s about people being bad at something the rest of us are good at (apparently). It also leads ‘nicely’ on to wrapping up self-harm as a ‘coping strategy’, a phrase which does much the same job and keeps everyone satisfied (apparently).

A Plethora of Strategies

The concept of strategy is everywhere in relation to self-harm. You can find national, regional, local and organisational strategies for ‘tackling self-harm’. There are resources and research on management strategies, harm minimisation strategies, harm reduction strategies, risk management strategies, psychotherapy strategies, prevention strategies, strategies for care, strategies for staff. Self-harm is described as a coping strategy, a maladaptive coping strategy, an emotion regulation strategy, a survival strategy. That’s a lot of strategy, some for organisations, some for patients, some for both.

Why do strategies and describing things as strategies appeal so much? Unpicking the meaning and function of the word strategy can give some insight into this. Generally, strategy has the meaning of having a plan which is thoughtful and aiming at a longer-term outcome. But as well as the definition, strategy also brings with it a sense of things being under control. It implies there’s a plan and a thought process behind the strategy which is being enacted by the person that made it. It’s neat and tidy. Above all, it feels safe.

For something which can evoke many intense emotions in everyone involved and is very much associated with a lack of physical and psychological safety, framing self-harm as a ‘strategy’ can be a way of defusing a sense of fear and alarm. It can also be long-term a way to avoid engaging with the more complex reasons and experiences underpinning someone’s self-harm. And self-harm as strategy not to be interfered with maps nicely onto NICE guidance offering advice on longer-term management of self-harm rather than just focusing on cessation. Of course, that is not what the NICE guidance actually says, but in an overstretched service with little time for reflection it can be the path of least resistance.

Strategy or Distraction?

Of course, some (?many) people will not want to talk about and/or address their self-harm and very much see it as a coping strategy and this is absolutely valid. I have certainly seen and experienced situations where self-harm became a sole focus, sidelining things that had even further reaching effects, such as impending homelessness or domestic abuse. But equally this doesn’t mean support should lean so far in the opposite direction that self-harm is dismissed when the person seeking support actually wants to focus on it.

The thing with self-harm is that although there are many commonalities and common experiences, everyone’s individual experience with self-harm is unique. With any experience, there is a very human drive to make sense of it and over time we all develop narratives that help to shape and make sense of our experiences in some way.

The Power of Narratives

The importance of this can often be seen not so much in the narratives that develop, but the level of distress, confusion and anger that can arise when we can’t make sense of something such as experiencing a sudden traumatic event or a loss of memory. This need for narrative is so profound that in illnesses where loss of memory is a feature, confabulation (generating a narrative to fill the gap) is also common.

Likewise, we turn to broader cultural and societal narratives to make sense of things beyond our experience. Narratives develop around collective experiences such as national events or traumas – Blitz spirit anyone? They also develop around political and social issues including poverty, welfare reforms, immigration, cultural identities and societal roles, to name a few. Anyway, you get the idea, narratives are everywhere; individual and shared ones, helping us to make sense of the world.

As narratives develop around various issues or experiences, they don’t just help us make sense of them, they frequently shape and mould our worldview. As a basic example there are languages out there which don’t differentiate between green and blue. Conceptually this is wild if you’re used to a language and environment where the green-blue distinction matters. But where these languages are spoken, these things make sense.

Does this mean that people in places as diverse as Namibia, Korea and Australia can’t see a difference between blue and green? No, it doesn’t mean that, but it does mean that the environment and context of a society shapes the language that evolves. Factors as diverse as cloud cover and living near water have a big influence on whether a language has different words for green and blue.

Institutional Narratives

On a larger scale this development of narrative happens not just in societal or cultural groups, but also in organisations and institutions. In healthcare especially, as we saw earlier, strategy has become a big part of the narrative for institutions, staff and patients.

But with great power comes great responsibility. In healthcare, narratives about what it means to be a patient or a person in need of healthcare have been shaped and reshaped by healthcare systems over time. And these narratives aren’t always shaped for the benefit of the patient.

So, what happens when narratives are co-opted or even weaponised, however subconsciously, to fit the needs of a system or institution? Research in this area outlines a range of ways that narratives can be misused including co-option, used against you, used for a different purpose and reinterpreted for another’s benefit.

In mental healthcare over the past 20 years strategy has very much tended towards the adoption of ‘recovery’ as a narrative that everyone must fall in line with. Initially developed by patients for patients and very much focused on being patient or user-led, the narrative of recovery has most definitely been co-opted by institutions into a cookie-cutter, tick-box exercise everyone must work through. The narrative is clear, do these things to get better and if you don’t, you’re not trying hard enough.

Narratives around self-harm are equally clear.

“It’s bad. It’s abnormal. It’s a maladaptive coping mechanism. It’s about emotion regulation. It’s a strategy. You must stop.”

Before you even get as far as seeking help for self-harm, the narrative of your experience has been written for you. When your experience and understanding are shaped before you’ve even begun to explore it, you don’t stand much chance of changing the narrative.

Different Possibilities

More recently research in this area, especially in the field of sociology, has tried to unpick and examine this narrative. Amy Chandler’s work has critiqued the representation of the ‘typical self-injurer’ in clinical literature and explored how illness narratives relate to narratives of self-harm. Veronica Heney has focused on the how fictional representations of self-harm adhere to the standard narrative, with a requirement of resolution and Brigid McWade considers the role of media in perpetuating these narratives. Looking further back at historical research from Chris Millard, Sarah Chaney and Alanna Skuse only serves to emphasise how narratives about self-harm have been shaped and reshaped over time in response to the social, cultural and political environment.

So, what’s this got to do with self-harm being seen and/or dismissed as a ‘strategy’?

Tell the Right Story

As Hazel McMichael explains so well in her blog in the NSUN Limitations of Lived Experience Series, delivering an appropriate narrative of your trauma is a requisite part of accessing mental healthcare. And a system with a narrative already in place around self-harm will respond best if you shape your narrative to fit.

Aligning to the self-harm-as-strategy narrative demonstrates that you acknowledge and accept the broader narrative. For both people seeking support and people trying to offer it, the most efficient thing to do is to ‘tell the right story’.

“You are making bad choices. You are making other people uncomfortable. You just need to learn to cope better. You need to stop.”

For some people, this will be the ‘right’ narrative that makes sense of their experiences, but for others this narrative will diminish and dismiss their experiences and make it that much harder for them to make sense of their experiences.

For staff, self-harm-as-strategy can feel like a safe and tidy ‘answer’, but it doesn’t answer the fundamental question: A strategy for what?

Changing narratives is a slow and complex process and it’s tempting to lean into ‘fixing’ by delivering a ready-made story. But self-harm-as-strategy should just be the starting point of a conversation that offers space for someone to work out what it means for them, nice, neat narrative or not.

If you’re interested in work on narrative change I recommend checking out the work of the Public Interest Research Centre who run a whole host of programmes to support people working to change societal and cultural narratives.