Sociology of Health & Illness Vol. 33 No. 5 2011 ISSN 01419889, pp.

777791
doi: 10.1111/j.1467-9566.2010.01322.x

The non-display of authentic distress: public-private

dualism in young peoples discursive construction of
self-harm
Jonathan Scoureld1, Katrina Roen2 and Elizabeth
McDermott3
1

School of Social Sciences, Cardiff University

Psychology Department, University of Oslo, Norway
3
Department of Social Policy and Social Work, University of York
2

Abstract

This article draws from focus groups and interviews investigating how young
people talk about self-harm. Some of the research participants had personal
experience of self-harm but this was not a prerequisite for their inclusion in the
study. Thematic coding was used initially to organise and give an overview of the
data, but the data were subsequently analysed using a discourse analytic
approach. The article focuses on the young peoples constructions of deliberate
self-harm such as cutting. Throughout the focus groups and interviews, a
dichotomy was set up by the young people between authentic, private self-harm
which is rooted in real distress (and warrants a sympathetic response) and public,
self-indulgent attempts to seek attention. This dualistic construction is discussed
in some detail and located in various socio-cultural contexts. It is argued that the
dualism illustrates contemporary ambivalence about mental health and youth.

Keywords: self-harm, youth, mental health, discourse analysis

Introduction
Much of social life depends on display; the public show of behavioural and stylistic signs
through which identity is claimed and ascribed (Finch 2007). In the west, display is perhaps
especially associated with youth. Youth can be a time for spectacular display of belonging to
a particular social group (and not to others), for example, as seen in sub-cultural fashions,
and can also be a time for displays of excess. We expect spontaneity and vitality from the
young, but also recklessness (Hall 2002). Youth is seen as a time of emotional drama the
storm and stress of adolescence (Hall 1904) being a truism of a universalising pop
psychology. As expressed by one of the young people we quote elsewhere (Roen et al. 2008:
2093), its sort of like the right of every teenager to be dramatic. Drama can involve
pretending to be something you are not. It is not inevitable that a performance will be found
authentic by an audience. Young people are given licence to be dramatic, but may regard one
anothers dramatic outbursts with disdain. If the drama is not thought to be authentic, it can
be seen as monstrous. In a similar way, the eld of mental ill-health is fraught with struggles
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Jonathan Scoureld, Katrina Roen and Elizabeth McDermott

for authenticity (McPherson and Armstrong 2009). This is partly because diagnoses of
mental health problems are more contested than with physical illness and partly because
mental illness is bound up with judgements about morality (Foucault 1967). The central
concern of the current article is the struggle for authenticity, in relation to youth and mental
health. The topic is young peoples self-harm and its cultural context. The specic aspect of
the cultural context at the core of the article is the dualism wherein private self-harm is seen
as a sign of authentic distress but the public display of scars to peers is thought to undermine
a claim of distress.
The denition of self-harm is a major topic in its own right and to debate denitions is not
an aim of this article. Nonetheless, it is worth setting denitional limits for the behaviour the
article is addressing. Self-harm can potentially refer to any kind of damage caused to ones
own body, regardless of intent, along a continuum that could range from heavy drinking to
immediately life-threatening acts. While the question of intention is often unclear, this article
is concerned with behaviour meant to injure the body but not cause death; behaviour which
in medical terms tends to be labelled as deliberate self-harm. The data we discuss from
young peoples talk refer overwhelmingly to cutting, that is, self-wounding with a sharp
implement such as a knife or razor blade. The label self-injury is sometimes used for this
specic form of self-harm (e.g. Chandler 2008), effectively excluding diverse forms of
behaviour such as tattooing and anorexia. We use the term self-harm, however, because it
was the term most frequently used by our research participants. It is the social and cultural
meanings of self-harm that concern us in this article.
There is considerable literature on self-harm within psychology and psychiatry, where the
emphasis is often on individual pathology. Social analysis is mostly limited to the
epidemiological evidence base, which suggests that deliberate self-harm is much more
common in young women than young men, with 11 per cent of girls aged 1516 and 3 per
cent of boys having self-harmed in Hawton et al.s (2006) study. It is also more common in
lesbian, gay and bisexual young people than heterosexual young people. Skegg et al.s (2003)
research comparing 26-year-olds who had experienced same sex attraction with those who
had not found odds ratios of 5.5 for men and 1.9 for women for reports of ever having
deliberately self-harmed. Hawton et al.s (2006) study of 1516 year olds also found selfharm to be associated with alcohol misuse, with those having more than 20 drinks in a
typical week, compared to those who never drink, having odds ratios of 6.70 (girls) and 8.22
(boys) for deliberate self-harm, although the relationship between alcohol and self-harm was
mediated by other factors. Other associations with self-harm noted in the same study
included problems with school work and peer relationships, experience of sexual abuse and
bullying, as well as having a friend or family member who self-harms. Hawton et al. (2006)
note that in contrast to the picture for adults, where rates of self-harm are elevated in lower
socio-economic groups, the social class status of children and young people who deliberately
self-harm is unclear.
Within the eld of suicide research, attention is often drawn to the strong association
between self-harm and increased suicide risk. For example, Owens et al. (2002) found suicide
risk among self-harm patients to be hundreds of times higher than in the general population.
In the light of this, concern is expressed about the level of knowledge of clinical staff who
encounter self-harm. Pejorative judgements are noted among medical and health care staff,
especially in Accident and Emergency settings (see for example, Jeffery 1979, Crawford et al.
2003), and some studies show that clinical staff have understandings about self-harm that are
in contradiction to epidemiological evidence (e.g. Friedman et al. 2006).
Cresswell (2005) has charted the emergence of self-harm survivor testimonies in an
attempt to challenge a clinical framing. These testimonies have had a powerful impact on
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mental health and social care elds where user perspectives tend to be taken seriously. In
particular, two assumptions professionals have previously made have been contested. First,
the idea that people cut themselves because they want attention from professionals has been
disputed by those who say that for them cutting is a private act which helps them cope with
distress (see the myths and accurate statements in Warm et al. 2003). Second, the
assumption that self-harm indicates risk to life has been questioned by those who say their
cutting is almost the opposite of this it is a life-preserving strategy; a way of coping (see
testimonies in Cresswell 2005). These discussions have tended to relate to cutting rather than
other kinds of self-harm such as overdosing.
Despite the challenges, however, the idea of self-harm as attention-seeking or at least as
communicative cannot be dismissed (Chandler 2008). Hawton and colleagues (2006) study
was one of the largest community-based studies of self-harm in young people. They sampled
6020 young people aged 1516, of whom 784 reported self-harm at some point in their lives.
Their data reveal the responses from those who reported they had cut themselves (see
Table 1). So it seems that communicative intentions are indeed part of the picture. Not all
self-harm is meant to be kept secret.
This issue of attention-seeking is important in what follows. The main focus of the article is
the private-good public-bad dualism which our research participants set up in relation to
self-harm. In order to develop our argument and lead to a coherent conclusion, we present
the main research ndings and then pause for a discussion section before returning to the
data to show how the public-private dualism is challenged by one interviewee. Before moving
on to give a thematic overview of the data on public and private self-harm, the research
strategy will now be summarised.

Research methods
The empirical basis for the article is a qualitative research project conducted in South Wales
and the North of England in 20052006. This projects title for participants was the On the
Edge project and it was presented as being about young people in distress. One of the main
research objectives was to identify and analyse the discursive frames through which young
people make sense of suicide and self-harm. This article in fact deals specically with the
discursive construction of self-harm and not suicide. Our analysis of the discursive frames
through which young people make sense of suicide has been presented elsewhere (Roen et al.
2008).

Table 1 Reasons for self-cutting in 15-16 year olds

Questionnaire response

Percentage of
self-cutters

I
I
I
I
I

37.6
27.8
21.7
18.6
12.5

71
52
39
35
23

wanted
wanted
wanted
wanted
wanted

to
to
to
to
to

show how desperate I was feeling

nd out whether someone really loved me
get some attention
frighten someone
get my own back on someone

Note that multiple responses were permitted

Source Hawton et al. (2006: 53)
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Jonathan Scoureld, Katrina Roen and Elizabeth McDermott

Focus groups and interviews were conducted with young people aged 1625. There were 13
interviewees and 66 young people took part in 11 focus groups. Most of those interviewed
had already attended focus groups, so the total number of individuals taking part in the
research was 69. Around twice the number of focus groups and interviews took place in the
North of England as in South Wales. A purposive sampling strategy was used in an attempt
to reect diversity of ethnicity, social class, sexual identity and rural and urban location.
There was no targeting of young people with direct experience of self-harm or suicide, as the
intention was to speak to a more general population of young people. Despite this, some
young people did seem to have volunteered to take part in the project because of personal
contact with self-harm or suicide and this is more or less inevitable. The majority of
interviewees and focus group participants had known someone who had attempted suicide.
This was the phrase used on a short demographic questionnaire participants completed at the
end of the focus group or interview. We did not specically ask in this questionnaire about
participants relationship to self-harm but instead draw our analysis from the participants
discussion of this topic.
Participants were recruited via schools, colleges, universities, youth clubs and social welfare
organisations. We ensured that a trusted support worker was available on site for
participants and provided information on sources of support following interviews and focus
groups. Ethical approval was granted by the research ethics committee of the Lancaster
University Institute of Health Research. To protect the identities of research participants, all
names used in this article are pseudonyms.
The article is structured into three empirical sections. First, there is an overview of the data
on non-fatal self-harm which were retrieved by thematic coding. Coding using Atlas-ti
software enabled all references to non-fatal self-harm to be identied. These were
subsequently analysed for thematic content and the results of this analysis are presented in the
rst empirical section. In the second and third empirical sections we present more detailed
discussion of two specic passages of talk, to examine the discursive strategies employed in
relation to self-harm and describe their effects. In using the terms discourse and discursive,
we refer to an interpretation which is culturally authoritative and constrains what can be
thought and what can be done (Foucault 1980). Our approach to discourse analysis is
consistent with that found in critical psychological research (Hollway 1989, Wetherell and
Edley 1999), and more specically, we use the strategies outlined by Willigs (2003) account of
discourse analysis, as well as those of Hook (2001) who offers a critical engagement with the
possibilities of Foucauldian discourse analysis. To explain the process of collaborative
analysis, all three authors contributed to initial coding, though most was done by Liz
McDermott, who was the researcher employed full-time on the project. Some specic passages
of talk, including those discussed in later sections of this article, were then identied as fruitful
for more detailed discourse analysis and these were the subject of lengthy discussions at
research team meetings, with notes being typed up to record the emerging analytic ideas.

Thematic overview of young peoples views on self-harm

The key nding addressed in this article is that self-harm was taken by the young people in
our study to mean different things depending on whether it is private or public. There was a
clear dualism underpinning their understanding of self-harm. Cutting was the form of selfharm they most frequently cited. The idea was that, if kept private, cutting suggests serious
distress and real psychological and emotional pain. On the other hand, any public display to
peers was thought to undermine its credibility. If you can see it, the reasoning went, the
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person concerned must have meant you to see it, and this means their behaviour must
therefore be attention-seeking a highly negative term for them which suggests demanding
more attention than is deserved or more attention than is warranted by the distress
experienced. The following excerpts are illustrative of comments that appeared across the
focus groups and interviews.
Eric: They tend to show it off more, you know, like you said there, showing off
the cuts and that, if someones depressed they try and hide it as much as
possible you know they try and isolate themselves from the world (Focus
group lesbian, gay, bisexual and transgender [LGBT] project, small
town, North of England1).
Gwen: But like if youre addicted you sort of try hiding. Youre like in denial.
Oh Im, Im not doing that. I dont know why [] But like if you show
it, like not show it off but you know like making people aware, I think its
sort of like, I, I think it is attention (Focus group comprehensive school
in South Wales town).
Rachel: Thats true because in my rst year I lived with a boy and he obviously
used to cut himself but he used to walk around with like you know like
um sleeveless tops and things and I could see like scars all down his arms
and youd just like, if hed done it as a way to cope or as Rita said trying
to forget something painful then why would he want everyone to know
that hed done it? Just seemed weird (Focus group university in the
North of England).
Jack: Ive just nished doing this course called the [name edited out] and early
on in the course there was a girl who got kicked off um and she cut her
wrists and everything just to try to get back on to the team and it was just
so pathetic but she did it and um
Liz (researcher): How did, sorry?
Jack: At least I could see now it was for attention (Focus group LGBT
project, South Wales).
So people who are addicted to cutting or depressed or who need to forget something
painful will want to hide their behaviour and keep it secret, whereas to make sure that ones
cuts are seen is to show off. Often the accusation of attention-seeking was made and not
elaborated on, suggesting the speaker presumed there was a shared meaning. However, in the
following data excerpt, Christopher is more explicit, telling us that attention-seeking implies
the exaggeration of symptoms to achieve the desired result something we have all done.
Christopher: I mean I think weve all done, not cut our wrists maybe but weve all
done, you know, made our problems seem a little bit worse to try and get
people to just look after us you know (Focus group Further Education
college, town, North West England).
Both public and private self-harming are gendered in the young peoples accounts. They are
associated with girls in particular, and (less often) with feminised men, and an example is
presented later in the article of an account where self-harm is associated particularly with
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Jonathan Scoureld, Katrina Roen and Elizabeth McDermott

working class girls. One of the reasons that public visible self-harm is not generally seen as
denoting serious distress is that the young people described it as being glamorised. It is
fashionable; it gets copied. Jane, an interviewee from South Wales, was worried by the
approving reactions some people had shown when they noticed her scars. She said she had
done some modelling and the make-up artist had said oh, nice scars! When asked why such
positive reactions occur, Jane said she thought some people thought the scars hard core and
some people nd it quite fascinating and kind of macabre. She went on:
Jane: Just certain people are denitely drawn to fucked up-ness, and drawn to well just
things which are a little bit weird, a little bit odd, a little bit different, or, or which
clearly states that youve been through shit of some sort (Interview, South Wales).
As evidence of its contagious glamour, Jane gave us an example of how self-harm does
spread in institutions. She spoke of having lived in a hostel where 15 out of 31 of us were
self-harming. She regarded this as copycat behaviour. Another recurring theme in relation
to the fashionable status of self-harm was its association with particular sub-cultures,
especially Goths and Emos.
The dichotomised understandings of self-harm, as being either for genuine reasons (and
hidden), or for attention (and visible in front of peers), have also been highlighted in other
qualitative research with young people. Crouch and Wright (2004) interviewed young people
who had personal experience of self-harming, and who were living in a mental health unit at
the time of the study. According to their data, the non-secret self-harmers were despised
(2004: 193) by other young people on the unit because they were viewed as being attentionseeking and as somewhat pathetic (2004: 194). This structuring of understandings about
seeking attention may lead to a sense that there is a competition to be the most genuine selfharmer (2004: 195). Spandler (1996) also engages with this dichotomy and the conicts it
presents for young people who self-harm. Specically, these are conicts between wanting
someone to listen but not feeling able to communicate that, and wanting attention but not
feeling one deserves such attention. Clearly, the need to communicate about emotional
difculties the need to ask for help is complicated by dichotomous understandings of selfharm.
In our data set there were only two ways in which the private-good public-bad dualism was
undermined. First, there was a suggestion that those who make their self-harm visible may
genuinely be in emotional difculty, with participants asking but why does she need that
attention? Second, some self-harmers themselves justied public viewing of cuts and scars,
and challenged negative interpretations of attention-seeking. An example of the latter strategy
is seen in the data from Cherie in a later section of the article (Alternative discursive strategies).
Despite these attempts to undermine the dualism, it was very resistant to challenge and a
morally loaded public-private dualism ran right through our interviews and focus groups. To
illustrate how the dualism played out in young peoples talk and to identify its effects, we
present an analysis of discursive strategies. We discuss two data excerpts from young women.
One of these interviewees has self-harmed; the other has not. After the rst excerpt there is a
break in the empirical material for a general discussion of the public-private dualism.

The discursive construction of a public-private dualism

This section shows how the dualistic construction of self-harm is accomplished and
describes its effects. While our data are from research-contrived talk in interview and
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focus group discussion, we argue that such data provide insight into the routine
discursive construction of the topic at hand. We start with an excerpt from an interview
with Rosie, a university student who has not self-harmed, but has encountered self-harm
in others.
Rosie: Theres been so much on TV about this self-harming. I dont claim to
know a great deal about that. I mean obviously its sort of supposed to be
people who kind of internalise their problems and take it out on
themselves to make it feel, they get some kind of release from it, so I
mean we hear an awful a lot about that. I really dont know that much
about that.
Liz: No no
Rosie: I have encountered it at school but at school it was almost like it became
a fashion it was, I mean you hear about self-harming being done in secret
and people wearing you know long baggy clothes to conceal what theyve
done. People in my school would sit there openly with a rusty compass in
the back of the classroom.
Liz: Seriously?
Rosie: Yes
Liz: And do what?
Rosie: And cut themselves. You know carve things into themselves. And it just
became like a badge um.
Liz: And how were those people viewed in school? I mean
Rosie: For the people on the outside of that you werent involved it was kind of
viewed with disdain. People thought it was attention-seeking behaviour
and its quite difcult to look at it as anything other than attentionseeking behaviour when its been done in public like that [...] It tended to
be more girls in fact I cant think of a single lad who did do it, I think
there were a couple but it was denitely a female thing.
Liz: Right and what sort of, what sort of girls were they, you know, was there
a perspective on what they were like you know in schools people you
know?
Rosie: They did tend to be like the more working class um that sounds really
snobby I dont mean it to um
Liz: God thats fascinating isnt it
Rosie: But the ones from you know more from the sort of council estates that
kind of thing and they would, they tended to be um the ones who did,
would be in like a group it wasnt isolated they would be friends and they
would see each other outside of school as well [] Thats the only time
Ive ever directly come across self-harm.
Liz: What if what if um one of you know your close friends at University you
found that she was for example or he um was cutting themselves how do
you think youd feel about it?
Rosie: My girlfriend actually has got a bit of a history with this but doesnt do it
anymore. I think she cut herself once, and its just something that makes
me feel powerless, cause I dont understand it where as I understand
alcohol abuse a lot more.
Liz: Yes
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Rosie: Thats the problem if you dont understand something its very difcult to
know how to help someone I think to get some out of it. To me its just
an alien concept.
Liz: Yes and just so, yes you if you, what kind of reaction do you have though
do you think of it as attention-seeking behaviour?
Rosie: Not with her it wasnt no
Liz: No
Rosie: No because it was done in private and it wasnt something that she was
happy about or displaying or sort of wearing as a badge of honour or
anything (Interview North of England).
Willig (2003) prompts us to examine how the same discursive object is constructed in
different ways. Rosie is, among other things, clearly contrasting public and private self-harm
in this passage. It is worth noting that Rosies account does not emerge in an interactional
vacuum. The interviewer (Liz) works to collaborate with her account, rendering some aspects
as remarkable (e.g. Seriously?, God thats fascinating). However, the interviewers
interjections have not introduced new material. The connection between self-harm and social
class, for example, is clearly introduced by Rosie without any specic prompting.
Rosie begins with reference to the discourse of self-harm as private self-directed distress,
perhaps implying a degree of sympathy with this discourse but distancing herself from it by
claiming to know nothing about it. She then goes on to show that she does know something
about public self-harm. In connection with this she uses terms such as badge, fashion and
carve, using these terms to suggest a negative judgement of public displays of self-harm.
This is cutting for public consumption, not for private release from distress (which is
concealed and internalised). When asked who the public cutters (or carvers) were, she
claries that it was girls and in fact working class girls from the council estates who were in a
friendship group. Following Willig (2003) again, we consider what is gained from
constructing the discursive object in this particular way and what subject positions are
offered by these constructions. Rosie positions her self-harming classmates as Other (De
Beauvoir 1972 [1949]), and as lacking authenticity. She positions public acts of self-harm as
not serious and as not deserving of sympathy. She identies working class girls who engage in
public self-harming as being together in a social group (of which she, herself, is not a part).
She precludes any engagement with these girls. In a dichotomous relation to public cutting,
she attempts to understand private self-harm and, ultimately, to sympathetically account for
her girlfriends self-harm. She positions her girlfriends cutting as deserving sympathy and
support and as being a genuine expression of distress. At this point we pause to consider the
implications of the public-private moral dualism that is evident in Rosies interview and
evident throughout our data. We then return to the data to consider possible challenges to
the public-private dualism.

Discussion
When we consider the social importance of display, there is something of a puzzle here. Janet
Finch introduces the concept of display in relation to families. She writes:
By displaying I mean to emphasize the fundamentally social nature of family practices,
where the meaning of ones actions has to be both conveyed to and understood by relevant
others if those actions are to be effective as constituting family practices (Finch 2007: 66).
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As was noted in this articles opening remarks, display could be thought to be especially
relevant in youth. Young people in the West are generally meant to be conspicuous at least to
each other. But in relation to self-harm it is important not to convey to others the signs of
distress in order to prove that your distress is authentic. In suggesting an authentically
distressed subject, we are drawing on an understanding of authenticity as uid and
intersubjective (Taylor 1991, Mendez 2008). Thus, the self-harming subject is constructed as
potentially more or less authentic according to the extent to which their signs of distress are
displayed to others.
In fact it is not feasible for private self-harm to be wholly un-communicated. Arguably,
self-harm often involves some form of display, whether via physical signs or via discussion
with other self-harmers in support groups or on-line. Here lies the puzzle. Why do young
people believe that only self-harm that is not physically displayed is authentic and suggests
genuine distress? To suggest some possible answers, we need to consider the contemporary
discursive context of mental health and illness.
While serious mental illness with a diagnosis is usually stigmatised (Hayward and Bright
1997), it could also be seen as deserving sympathy and concern, because it causes suffering
and is regarded as beyond the patients control. In contrast, lower level difculties may well
be seen as not so serious and as more within the control of the patient, therefore evoking less
sympathy (see McPherson and Armstrong 2009). That people whose emotional distress is
regarded as less serious may then be subject to a moral imperative to pull themselves together
chimes with Foucaults (1967) argument that denitions of madness regulate morality. It is
perhaps especially acute in relation to young people because the idea that youth is a time for
emotional drama (Roen et al. 2008) sets up an expectation that symptoms of distress might
be exaggerated.
The dualistic approach that the young research participants drew on resonates clearly with
some clinical interpretations of self-harm. There are numerous studies which show pejorative
judgements from clinical staff on time-wasters who repeatedly present with self-inicted cuts
and overdoses (see, for example, Jeffrey 1979, Crawford et al. 2003, Friedman et al. 2006).
Crawford et al. (2003) have specically studied attitudes towards self-harming adolescents
and there may well be a more widespread assumption among clinical staff that time-wasters
are likely to be young, given the association between youth and drama. We might conclude
that the splitting of self-harmers into good and bad categories could relate in some way to
this clinical culture. There are at least echoes of medicines general approach of categorising
people according to the severity of their condition and treatability. It is also possible that
stories of self-harming time-wasters have become common currency because they are good
stories (Carter 2008). However, it is equally credible to make sense of the well known
pejorative judgements of self-harmers in Accident and Emergency departments, for example,
as not so much as about the power of medicine to categorise people as about the inuence of
lay moral judgements on medical practice (Jeffery 1979).
This may be understood as a double hermeneutic process, whereby knowledge spirals in
and out of lay and expert realms (Giddens 1993). One example of making a connection
between lay and expert knowledge on health is Chandlers (2008) discussion of the disdain for
attention-seeking self-harm with reference to Williamss (1998) work on the individual
moral imperative in late modernity for us to have healthy bodies. Chandler notes that selfharm transgresses this moral imperative in most peoples eyes, although she also notes that
her own research and other studies have in fact shown people who self-harm tending to
describe this behaviour as life-preserving and healing rather than as being associated with
death or illness.
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But why the public-private dualism? To address this question, let us work with the
concepts of rationality, intelligibility and stigma. Rationality is important to the neo-liberal
self as responsible and emotionally contained (Rose 1989). One way to understand
participants disdain for public displays of self-harm would be to consider them as
contravening our ideas of the responsible and rational self. Further, deliberately harming
ones own body is likely to be unintelligible. It does not typically make sense to others, or at
least is hard for others to read. It is the very unintelligibility of self-harm that leads to its
denition as irrational (Foucault 1967).
We need to consider the interplay between irrationality, unintelligibility, mental illness, and
morality. In Greek, stigma initially referred to marks cut into the body to expose something
unusual and bad about the moral status of the signier (Goffman 1968: 11). Here, the cut
represents some kind of moral decit, something shameful; something that one might
sensibly want to hide. Given that mental illness is stigmatising, there is no surprise that
intense emotional distress may draw some sympathy from others, but they are unlikely to
want to rub up against it. They would probably prefer it to be kept private. Distress becomes
a private shame and the cut is potentially a way of displaying that shame and forcing others
to acknowledge ones distress. And such public display of ones own stigma is surely going to
be misread by others, and not met with sympathy or understanding by many.
The gendered and classed construction of self-harm in the passage from Rosie above
warrants some brief comment, although a full discussion is beyond the scope of this article.
The gender prole of self-harm in the data excerpt above from Rosies interview may be
stereotypical but is in fact a reasonably accurate impression, according to the epidemiological
research, and therefore perhaps not surprising. There is also clearly an important cultural
dimension to the association, however. Canettos (1997) research on the gendered cultural
scripts operating in relation to young peoples suicidal behaviour notes the common
associations of successful suicides with masculine decisiveness and failed suicide attempts
with manipulative femininity. Although Rosie is talking about behaviour which is not so lifethreatening, we can see connections between the moral judgement of feminised suicide
attempts described by Canetto (1997) and Rosies gendered construction of manipulative selfharm. Less clearly connected to the epidemiological evidence is the association by Rosie of
self-harm with girls from working class backgrounds. We could perhaps usefully relate this
association to regulatory class discourses which represent the working class through excess
and overt display, while the middle classes are represented by associations with restraint and
modesty (Skeggs 2004). However, a dedicated and sustained investigation of the relationship
between young people, social class and self-harm is largely missing in published research to
date, so we also note this as an important issue for exploration in future studies.

Alternative discursive strategies

At this point we return to our data, taking a discourse analytic approach to another specic
passage. The data below move the argument on from the dualism discussed above and lead
us to consider implications for practitioners in health and social care.
Chandler (2008) describes some of her research participants, who have personal experience
of self-harm, clearly positioning themselves as having self-injured to get attention and
justifying that this was necessary at the time (and not just done to be cool), although in all
cases this behaviour was rmly in the past and (with the possible exception of one
interviewee) was spoken of in generally negative terms or at least contrasted with more
genuine private or secret cutting. The interview excerpt below from Cherie conrms that the
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The non-display of authentic distress

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possibility of using public self-harming to draw attention may resonate with the actual
experiences of some people who self-harm. Aspects of the young peoples discourse about
public and private self-harm do in fact tell us something about the diverse social functions of
self-harming. This excerpt from Cherie, who has self-harmed, is notable for its attempt to set
out an alternative discourse on public self-harm. Cherie directly confronts the moral disdain
of attention-seeking:
Cherie: Some people, I do know people who do it to attention-seek but they do it because
people dont [tails off]. Right I have a friend who does it and I know why she
does it, she does it because people dont understand how she feels and she puts on
this act and shes dead happy all the time but shes not at all. And shes got a lot
of things going on at home, so she cuts herself so people ask her whats wrong
because its easier for that to happen rather than her actually going up to them
and saying you know, I need to talk to you. Um, I know people who cut
themselves to the point where they have to go into hospital, I know a girl who
drinks bleach, just so that she has to go into hospital and thats another attention
fact. They actually need to go into hospital to feel loved and cared about because
they feel like they are not getting it from anywhere else. And then theres the
people who say they are attention-seeking but they are really not and cutting is
something, a lot of people are ashamed of so why would they, people who really
have issues going on deep down, why would they want people to know they were
cutting themselves because its not something, its not really, I hate using the word
but its not really the normal thing to do, you are not supposed to hurt yourself.
And a lot of people get this sort of psycho nametag because you harm yourself.
[] Yeah because um, one of the people who do it so people ask them whats
wrong um, she was being beaten up at home by her dad, but nothing visible. So
her way was that if I cut myself people are going to notice that there is something
wrong. The problem is nobody noticed for a long time and it got out control to
the point where it was just clear she was not coping at all. People do it for
different reasons and I cant stand people who criticise and say like, oh why do
you self-harm, take up smoking, get a hobby or you know, cry for a while
because sometimes, like I said before, that feeling doesnt go away and crying and
whatever else doesnt help, so youve got to nd some way of getting it out.
Cherie constructs self-harm as a legitimate strategy for coping with emotional difculties. She
refers in the middle of this passage to the idea of self-harm as a private method of self-care,
but she also talks of self-harm as a means of connecting with others. She validates self-harm
as a way of getting attention from others, for people who are legitimately distressed and nd
it hard to talk about what is wrong and therefore need alternative ways of seeking help and
being loved and looked after by others. She is arguably making the irrational (publicly selfharming) self rational by reconstructing it as a legitimate call for help. She is constructing the
attention-seeking self-harmer as a reasonable individual making choices about how to cope
with distress (Rose 1989).
She also talks about emotional build up and release, suggesting that one has to nd some
way of getting it out. This is psychodynamic discourse; the idea that emotions well up inside
and one needs to nd a way of letting them out. Just crying does not work, but self-harm
might work. Cherie offers possibilities for self-harmers to be taken seriously without their
reasons being judged and without the validity of their distress being evaluated. She closes
down possibilities for judging and pathologising self-harmers. Self-harm is, however, not
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Jonathan Scoureld, Katrina Roen and Elizabeth McDermott

spoken about as something that is resolvable. Rather it is a kind of solution in itself. She
closes down consideration of other coping strategies and undermines the value of crying and
talking.
What becomes possible through this discursive framing of self-harm and of self-harmers is a
stand-off between us and them, where we are the people who are suffering and are using
self-harm as a legitimate coping strategy, and they are the people who do not understand
what we are doing. In this context, alternative suggestions from them can be read as
criticism, not understanding, and can be rejected as annoying. Furthermore, any self-harming
behaviour can be legitimated and defended as a valid expression of distress, without alternative
ways of seeking help or making pain visible being considered. Within this framework of
understanding, it might be possible to feel determined to use self-harm as a means of expressing
and coping with emotional distress. It is possible to not be able to stand people who try to
suggest alternative coping mechanisms. This framing of self-harm, if taken to an extreme,
might make it impossible to conceive of other coping mechanisms once self-harm has begun.
This analysis goes some way to extend the ideas put forward by Crouch and Wright
(2004) and by Spandler (1996). In these previous studies, it was noted that a paradoxical
situation was being set up, because of constructions of attention-seeking, whereby selfharmers did not want to be thought of as attention-seeking but did acknowledge
themselves to be needing some attention from others (Crouch and Wright 2004: 196).
Crouch and Wright noted that participants wanted people to notice and care about them
but hid their self-harm from others (Crouch and Wright 2004: 197). The present analysis,
however, demonstrates how an alternative subject position may be set up as a way of
dealing with these contradictions. Cheries talk, for instance, offers a subject position that is
about defending self-harm and self-harmers against criticisms, effectively positioning selfharm as a viable and rational means of coping. Such an approach is consistent with other
reports from those who self-harm (Cresswell 2005), even though it works against popular
understandings of self-harm in terms of the public private dichotomy suggested in much of
the data presented in this article. On a general level, Cheries approach has echoes of the
pro-anorexia movement, which also involves positive reframing of behaviour which is
stigmatised and problematised. As in the pro-ana website studied by Fox et al. (2005),
there is an emphasis on the problem behaviour as a symptom of underlying disturbance
and as a legitimate sanctuary from emotional pain.

Conclusion
We conclude with some comments about the implications of our data and discussion for
health and social care. Some working in the health and social care eld have attempted to
reject what they see as the dominant medical framing of self-harm and remove pejorative
moral judgements, rst by asserting the role of self-harm as coping with life rather than
threatening it, and second by asserting the private nature of most self-harm. Although this
challenge may have been necessary in care contexts with traditional formulaic responses, it
does not take account of the reality that some self-harm is not intended to be wholly private
but does seem to be communicative and appropriate responses are therefore needed. It is
important for practitioners to acknowledge that self-harm may have a variety of social
functions. It would be wrong to replace one orthodoxy (self-harm is attention-seeking so
should be ignored) with another one (self-harm is a private coping strategy) when in fact the
picture is complicated and the same behaviour can mean different things to different people
at different times. So perhaps most important of all for practitioners is an acknowledgement
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that self-harm is a complex and multifaceted phenomenon and therefore it is useful to

consider multiple ways of understanding self-harm. This is consistent with what is already
known about self-harm having diverse functions (Skegg 2005).
Moral judgements about public self-harm are met by some of our research participants
(and perhaps especially those who self-harmed) with the challenge to others to consider why
do they need attention? This may perhaps be a useful construction for practitioners in health
and social care, as a respectful approach which does not stigmatise a particular behaviour.
Cherie, in the passage above, explains why people take the extreme measures of self-harm so
they can be loved and cared about when they nd it difcult to ask for help. She is
effectively accepting that there is a communicative aspect in some self-harm and arguing that
this should not be denigrated.
It is worth noting that there are also risks for practitioners in taking at face value the idea
of self-harm as a way of communicating distress, as this could potentially be seen to reinforce
the idea that self-harm is the defensible way to deal with distress, thus closing down
alternative ways of coping. Here, work could usefully be done to examine what it is about
constructions of self-harm that enables and supports self-harming behaviour, where the
points of resistance are in discourses that frame self-harming as a (or perhaps the) valid way
of coping with distress, and how alternative methods of coping with distress might become
discursively possible.
While health and social care practitioners cannot wish away the discursive tension inherent
in the public-private dualism in the construction of self-harm, there are opportunities to work
creatively in relation to this discursive framing. One approach to consider is acknowledging
this dualism in working with people who self-harm and making it explicit on the grounds that
it will be around anyway. Crouch and Wright (2004) recommend using therapeutic
groupwork with self-harmers. Using groupwork to make dualistic constructions explicit and
to question them may be a sensible approach. If the dualism is left implicit, there is a risk that
those who self-harm will compete for authenticity through inicting more serious injuries and
keeping them secret, as Crouch and Wright (2004) note.
Address for correspondence: Jonathan Scoureld, School of Social Sciences, Cardiff
University, Glamorgan Building, King Edward VII Avenue, Cardiff CF10 3WT
e-mail: scoureld@cardiff.ac.uk

Acknowledgements
We would like to thank the research participants and the funders (ESRC grant RES-000-22-1239). The
article beneted from the very helpful comments of the anonymous referees.

Note
1 The research project had a particular focus on sexual identity (see McDermott et al. 2008)

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