Whilst delivering a conference workshop on the topic of self-harm yesterday, a colleague stated that her school had a policy that all self-harm injuries and scars must be covered. She asked whether I agreed with the policy.
It’s a very good question and not one I’m sure I have a clear answer to – in fact, I’m not sure there is an easy ‘one size fits all’ solution, but having cast around for the opinions of others, I’ve come up with blanks so I thought it would be helpful to write a blog post exploring my own opinions on the topic in order to start the discussion and enable me to develop some guidance to include in the book I am currently writing on the topic of supporting self-harm and eating disorders in schools.
Please take a moment to leave a comment if you have a view on this, I think it would be helpful to have as many voices as possible included in the conversation. If you’d rather share your opinion in private, please email me: firstname.lastname@example.org
First of all, I think it’s important to acknowledge that there are different scenarios which might underpin our decision about whether a student’s injuries and scars should be covered at school. For some young people, group identity relies on self-harm – i.e. those young people who actively self-harm together, (this is sometimes associated with goth or emo communities, or Justin Bieber fans). For these young people, self-harm injuries may be worn almost as a badge of honour and there can be a degree of competition over the severity of the injury. This can also be the case if you have a self-harm fad doing the rounds at school (e.g. ice and salt, aerosol burns or chicken scratching). Young people may compete to see who has the biggest or deepest injury.
In these instances, having injuries on show is very likely to trigger further incidences of self-harming behaviour and I would almost always advocate covering injuries.
Whilst some of the young people who participate in this type of behaviour may be using self-harm as an unhealthy coping mechanism, the majority are simply participating in an activity that makes them feel like they belong as part of a group and the behaviour should be actively discouraged (whilst taking care to follow up with the more vulnerable individuals who may need more specific support).
I would advocate a rather different approach to those young people for whom self-harm is a genuine coping mechanism and who are dealing with emotional and psychological distress. These are the young people I have in mind for the rest of this post.
The risks of exposing injuries and scars
In a school environment, there are some good arguments for covering self-harm injuries and scars. The most often used one is that it may be distressing for other people and this may be true. There is often a conflict between the needs of the individual and the needs of the wider student and staff body. Educating staff and students about self-harm can help to demystify it and begin to address the stigma and fear that often surrounds it. However, one might argue that encouraging young people to actively wear their wounds may normalise, and if handled inappropriately glamorise, self-harming behaviour which could have negative consequences and lead to a rise in copycat incidences.
Another argument against allowing a young person to keep their injuries on show is that the attention they may receive as a result could act as a positive reinforcer for the self-harming behaviour, making it harder for them to break the self-harm cycle. They may also begin to actively identify with the label of ‘self-harmer’ or ‘cutter’ and find it hard to identify themselves another way if having their injuries on show means that this is the behaviour people most often associate them with. This can make it hard to move on, especially if their self-esteem is very low and they do not have other facets of their personality which they feel they can promote.
Finally, young people may find themselves isolated or bullied or constantly questioned if their wounds are not covered. Unless they are taught how to support a friend who is self-harming, many young people (and old people) do not know how best to support and may have all sorts of false beliefs about self-harm which play out in their actions. Being bullied or ignored by peers will exacerbate the low self-esteem of the young person concerned and is likely to act as a maintaining factor for their self-harm.
The risks of NOT exposing injuries and scars
By this point you may feel that I strongly advocate the covering of wounds, and I certainly think that in a school environment there are some strong reasons to consider this approach. However, I also think there are some compelling arguments for enabling a young person to expose their injuries whilst at school.
Self-harming is not a behaviour that a young person should ever be made to feel ashamed of. It is a coping mechanism and for many young people, each scar or injury has a specific meaning or trigger. To insist on covering these can further fuel the low self-esteem of the individual and make them feel ashamed or embarrassed about their behaviour. It can make them feel less willing or able to seek support when they need it as they may feel that their behaviour is being punished. This may encourage them to undertake more secretive forms of self-harm such as harming hidden parts of the body or taking non-lethal overdoses. More secretive behaviours are harder to track and respond to which may prevent the young person getting the help they need when they need it.
Young people who self-harm will often be left with multiple scars that they will need to live with for the rest of their life. These scars can have a huge emotional impact and learning to live with them is an important part of the recovery process. Insisting that such scars should be covered can delay recovery and can result in anxious or obsessional behaviours surrounding their scars as time goes on. Enabling a young person to begin to feel safe and more confident about exposing their scars within the school environment can help them to find a route forwards within wider society whilst they still have the back up of supportive staff who know them and care for them at school.
A possible way forwards
I think that to propose a one size fits all solution would be foolhardy and that each individual case needs to be taken on its own merits bearing in mind what we know about the individual, their peers and the type and extent of injury. However, the closest I think I would be happy to come to a universal solution is to suggest that newer injuries which are still in the process of healing should be covered, both to reduce the impact of exposing such injuries on the individual and others and to promote healing; whilst wounds which are older or have formed scars should not be kept hidden unless the individual chooses to do so. In this case, I would look to work with the individual to help them feel more confident in exposing their scars if this felt like a realistic goal – in much the same way we might work to enable a young person who had been scarred as a result of an accident to come to terms with their appearance.
I hope my thoughts have proved helpful. Please feel free to add your thoughts and experiences by commenting. You are more than welcome to disagree – this is a topic which causes much debate. If you would find it helpful I could write a follow up post about preparing a young person who wishes to expose their scars. Please let me know if this would be of use.