Stephen P. Lewis, PhD is an Associate Professor in the Department of Psychology at the University of Guelph. His areas of expertise are self-injury and youth mental health. He has co-authored a book on self-injury and his research has been featured in national and international media outlets, including The New York Times, Time, USA Today, ABC, CBS, The Globe and Mail, and the BBC. Dr. Lewis is an invited member of the International Society for the Study of Self-Injury (ISSS), where he currently sits on the Executive Board. His work in the area of self-injury led to him co-founding Self-injury Outreach and Support (SiOS), with his colleague Dr. Nancy Heath (McGill University). SiOS an international non-profit initiative providing current information and helpful resources about self-injury to those who self-injure, those who have recovered, as well as their caregivers and families, friends, teachers and the health professionals who work with them.
In addition to his professional work on self-injury and mental illness, Dr. Lewis has lived experience in these areas. His personal experiences with self-injury, depression, and suicidal thinking motivated him to work toward helping others who have similar experiences. In 2015, he gave a TED Talk in which he shared his story and how he overcame these past challenges to embark on the career he has today. The motivation behind his talk was to challenge the stigma and various myths attached to self-injury but, most importantly, to give hope to those who may presently struggle.
What can a young person do if they know a friend is self-harming?
Understandably, finding out a friend self-harms can be stressful and often upsetting. It can also be a very confusing time. Sometimes, it’s hard to understand why a friend self-harms and what you, as a friend, can do. Some young people feel conflicted. On the one hand, you may want to tell someone about it; on the other hand, you may think this could impact your friendship. Other common reactions include feeling sad, worried, shocked, or even frustrated and angry.
It’s very important to know that each of these reactions is completely normal.
Our outreach team has developed a detailed guide to help youth who are concerned about a friend’s self-injury.
An important thing to remember is that if your friend self-injures, it’s not your responsibility to fix things or make them stop. You can, however, be a good support for your friend. It can start by talking to your friend about what’s going on and about their self-injury. When talking to your friend, it’s important to carefully listen to what they have to say and to be honest with them about your concern. For many youth, talking about self-injury (even to a close friend) can be incredibly difficult so responding with understanding and without judgement can really help. It’s okay to ask questions to better understand what’s going on for your friend but don’t put pressure on them. Your friend may not be ready to talk and that’s okay. Simply knowing that you are there can still be very helpful.
It’s very important to encourage your friend to seek help from a trusted adult (e.g., a parent, relative) or mental health professional. If your friend is at immediate risk or hurting himself or herself in a life-threatening way, it’s important that you take your friend to the hospital.
Sometimes youth think they are betraying their friend by telling an adult about their friend’s self-injury. This is very understandable. But, it’s important that your friend gets the support they need. It may help to talk to an adult that you know your friend trusts. Choose someone who you know can help your friend or get your friend to talk to a professional about what’s going on. It may even help to talk to your friend about who you can tell. In some cases, it can be quite helpful to be there with your friend when talking to an adult. This is again a way that you can show your support for your friend.
There is a lot of confusion around self-injury and suicide. How do they differ?
Unfortunately, self-injury and suicide are often confused. However, there are a number of ways that self-injury differs from suicide.
First, the underlying reason for each is quite different. Self-injury is not used to end one’s life. In fact, there are many different reasons that youth give for self-injury. For example, some use self-injury to cope with difficult emotional experiences (e.g., sadness, distress, anger, feeling overwhelmed). Some use self-injury to punish themselves. Some use self-harm to feel something when they feel emotionally numb. Some use self-injury to avoid acting on suicidal thoughts. Some may use self-injury to express feelings they can’t verbalize or self-injure to communicate a need for help. These are just some of the reasons youth may have for self-injury. Suicide is different in that it involves the intent to die. In addition to this, self-injury tends to occur much more often, whereas suicide occurs much less often. Finally, self-injury tends to involve methods that do not pose a significant threat to one’s life (e.g., cutting, burning, hitting); in contrast, suicide tends to involve more lethal methods.
Although self-injury differs from suicide, this does not mean that we shouldn’t take self-injury seriously. We should. Self-injury is often a sign of distress or an underlying mental health difficulty (e.g., difficulty coping with stress; having low self-esteem). Sometimes, though not necessarily, it may signal the presence of mental illness (e.g., major depression, an anxiety disorder).
Over the past few years, we have learned that although self-injury differs from suicide, they can sometimes be related. Specifically, youth who engage in self-injury are at higher risk for suicide relative to those who have not self-injured in the past. In other words, self-injury may (in some cases) increase suicide risk. Because of this, self-injury should never be swept under the rug or dismissed as unimportant or not serious.
Would you describe self-harm as a coping strategy?
For many people self-injury is used as a coping strategy. At first, this may seem a bit counterintuitive (hurting yourself to cope); however, this is what most (though not all) youth report. In my own experience, I used self-injury as a way to get relief from very strong negative emotions. This wasn’t the only reason I self-injured but it was one of the major ones.
Unfortunately, self-injury has often been viewed as attention seeking. This is a myth. Most youth who self-injure do so in private; they either tell very few people about it or no one at all. The view that self-injury is attention seeking only adds to its stigma and misunderstanding. And, this can make a young person less likely to talk about it with others. For this reason (and many others!), I think awareness about self-injury is critically important. It’s very important that a young person struggling with self-injury feel understood by others. This can go a long way in facilitating recovery.
There have now been a number of studies (including some by our team), which have shown that people report high levels of negative emotions prior to self-injury and lower levels of these emotions after self-injury. There is also evidence to indicate that it’s not just psychological relief that people experience after self-injury. They also experience physiological relief.
By saying that self-injury is a coping strategy, by no means am I saying that it is the only way to get relief from difficult emotions. That’s certainly not the case. There are many ways to cope with difficult emotions without hurting yourself.
Recognizing that self-injury is used to get relief from difficult emotional experiences helps to shed light on why some youth may do it. Importantly, this also sheds light on how to help those who struggle with self-injury. Specifically, if self-injury is used to cope with negative emotions, then one part of treating self-injury is helping a young person find other (and healthier) ways to cope with these emotions.
While it is certainly the case that many young people who self-injure do so to get relief from negative thoughts or feelings, this does not mean that this is always the case. As mentioned earlier, there are various reasons that youth may give for self-injury. It’s also important to recognize that reasons may change over time. So, what prompted a young person to self-injure the first time may not be why they keep doing it.
You have talked about your own difficult experience of being bullied and using self-injury as a coping mechanism and outlet for your painful emotions. You also describe the shame and stigma that you felt and that although self-harm provided you with an outlet it seemed to also take away your voice. What do you want to say to a young person who self-harms?
I would first want them to know that they are NOT alone – even if it feels like they are. Many young people (and adults!) have self-injured. It’s much more common than many people think.
I decided to share my experiences with bullying, depression, suicide, and self-injury in an effort to let others know that it can get better, even when it seems like there is no chance it ever will. When I was very depressed, I believed there was no way out of the hole I was in; I thought that my life would always be filled with self-injury and emotional pain. I couldn’t have been more wrong. I’m not saying that recovery is quick or easy – I’m saying it is possible. It will take effort. It will take some patience. And, it will take a willingness to change (or at least a willingness to try). I can say though that the path to recovery is completely worth it.
Sometimes, even at our absolute lowest points, we can actually learn a great deal about ourselves if we take a moment to ask for help, accept it, and talk about our difficult experiences. I learned how strong I was by taking that moment. I learned that I could help others. I learned that I could have a life with purpose.
I would not be where I am today without having taken those risks. There is absolutely no shame in talking about self-injury, depression, suicide, or related difficulties. In fact, I would say there is only strength in being willing to do so. Even if self-injury has been happening for years, you can still stop. Self-injury is not a life sentence nor is it a signal that you are destined to feel a certain way. There is hope. There is life after self-injury. You CAN recover.
Self-injury and mental health issues in general actually, are typically thought of as something that affect more females rather than males. But we know that that is not true. We place an almost added stigma to mental health issues for males. What can we do to further change these myths?
I think we’re doing something right now – we’re talking about it. We need to have more of these discussions and involve more young men in the conversation. They need to know that they are NOT alone and that there is nothing wrong with them if they self-injure or struggle with any form of mental health difficulty. It’s important they know that they can talk about these topics. Talking (and even asking for help) is by no means a sign of weakness nor does it say anything negative about who you are.
Another important part of addressing the stigma is awareness. We need to increase society’s understanding of self-injury and mental illness. Doing so can help debunk the misconceptions that men do not self-injure or that men do not get depressed or experience mental illness. They do. In fact, some studies suggest that there is no difference in the rate of self-injury between men and women.
One critically important thing I’ve learned from my own experiences is that it’s okay to show vulnerability. It’s okay to reach out and it’s okay to ask for help. I firmly believe that these are signs of strength. Too often young men are socialized into thinking that they should not show feelings like sadness or anxiety, or even talk about them. I strongly disagree with this. Talking about my own experiences, as difficult as it was at the time, has only made me a stronger person. I have absolutely no regret for having taken these important steps and neither should any young man who has self-injured or who has struggled with any form of mental health difficulty.
There is only strength in vulnerability so let your voice be heard.
Did you ever struggle with tendencies to self-injury after you started recovering? How did you or how do you currently cope with those urges?
As mentioned in my TED Talk, recovery did not happen over night. I had good days but also bad days. Even as I worked on recovery – and even after long periods of time – there were moments when I self-injured again. Recovery is definitely a process and it’s not always straightforward. It takes time. Knowing this, I think, is key.
Those moments that I acted on an urge to self-injure or had the thought that I was ‘back to square one’ became less and less frequent. In time, those moments became farther and farther apart. I saw this as a sign of hope – a sign of me getting better and me getting stronger. I was able to look back on how far I had come and could say to myself that I’ve come a long way from where I was. I had improved. And, importantly, I was not going to look back - only forward.
So, yes, I certainly had urges to self-injure again – even quite some time after I stopped doing it. To this day, I still think about self-injury sometimes. I think this is a very normal part of recovery and a very normal experience for those who have stopped. For me, and for many people, self-injury was for the longest time a “go-to act” to help cope with what I had no other way of coping with at the time. If you do something enough it’s only natural for you to think about it, even after you stop doing it and especially in situations that remind you of when you once did it. For me, this would happen if I felt very distressed, depressed, self-critical, etc. However, I learned that an urge to self-injure was just that – an urge. It was an urge and it would pass. It wouldn’t last forever and it would go away. It didn’t mean I had to do it. As I found other ways to cope and other ways to express what I felt inside, I learned that I didn’t need to self-injure. I could resist the urge. The more I came to that realization, and the more I made the choice to not act on those urges, the easier it became and the better I felt.
What helps you to cope in positive, healing-focused or constructive ways today?
This will most likely differ from person to person but for me, I found that writing helped tremendously. As I started my recovery journey, I started to keep journals to express all the feelings and thoughts I was having. It didn’t have to always make sense, but I kept writing and writing. I still write to this day. For me, it’s one of the most powerful ways I’ve learned to express difficult thoughts and emotions; I also really enjoy it.
In addition to writing, I find that spending time with others helps. To this end, I have made sure to have quality time with family and friends. They have also proven to be great supports. Related to this, talking to others has been immensely helpful. For the longest time, I thought I had to keep things bottled-up; this was very isolating and unhelpful. I have since found that talking about my thoughts and feelings helps a great deal.
Another very helpful strategy for me was exercise; it is to this day. There’s actually a lot of research showing that exercise can be quite helpful when coping with difficult emotions. For me, I started to run. I found that this worked very well to let out a lot of what I felt inside; in some ways it felt like I did after I self-injured. I used this quite a bit and started getting involved in other physical activities like ultimate Frisbee and basketball. More recently, I started Crossfit and Yoga.
For some youth, writing is not their thing; some may hate running. In the end, I think it’s important to find what works for you. The good news is that there are plenty of healthy and positive activities that can be used in place of self-injury! It may take a few tries to see what works but the possibilities are endless.
Do you have a favourite quote or any words to live by?
Good question. Many quotes and words come to mind. Reflecting on my experience and what I’ve learned from it, I guess I would say the following:
Adversity has the effect of eliciting talents, which in prosperous circumstances would have lain dormant. - Horace