Abstract
Although previous studies have considered shame to be a significant emotion in making sense of self-injury, the connection is still not fully understood. Drawing on sociological ideas on shame, this communication contributes to a theoretical understanding of actions of self-injury by demonstrating how shame operates and unfolds in social interaction. It argues for how shame and self-injury may reproduce and amplify each other, hence turning into a self-perpetuating cycle of shame and self-injury. It shows how shame is triggered in social interaction, how shame leads to self-injury, and how self-injury may turn into more shame. Self-injury is used to fend off shame by upholding social and cultural commitments and maintaining social bonds with others. However, self-injury may also threaten social order and social bonds and, consequently, trigger more shame. The most important reason that self-injury does not fully work as emotion work, and internalized social control, lies in the interactive cycle of shame, that is, you feel shame and cut, you cut again and are (a)shamed, you are shamed and cut, and so on. It is proposed that people who self-injure do not necessarily lack the ability to self-soothe or regulate emotions or that they suffer from a clinical psychopathology.
Personal Reflexive Statement
For many years before writing this article, I have been intrigued by, and have tried to understand, the link between self-injury and shame. My interest can particularly be understood as a response to my own experiences having used self-injury on and off during several years. In the present theoretical communication, with empirical examples from the literature, I explore the reasons why one may feel the urge to cut or in other ways hurt their bodies, and what may be the driving force of self-injury. I have examined different kinds of literature and come to an understanding of how shame may explain why some people self-injure as well as why self-injury continues to trigger shame in a self-perpetuating cycle of shame and self-injury.
From as early as the 1960s and 1970s and up to the present time, self-injury has been dealt with in the psychomedical world as a feminized psychopathology, particularly affecting white, middle class, often young girls, who self-injure especially by cutting themselves (Brickman 2004; Grunebaum and Klerman 1967). Definitions of self-injury vary but in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5th ed.; American Psychiatric Association 2015) in the United States and in Sweden, self-injury is defined as a nonsuicidal self-directed behavior that through various means leads to direct damage to body tissues (Favazza 2011; Nock 2009). Most psychomedical studies investigate self-injury from an individualistic “objective” (i.e., outsider) perspective and have largely focused on questions of what may be “wrong” with the suffering individual, together with reasons for why the individual may self-injure (Chandler, Myers, and Platt 2011). A growing body of subjective reports and studies, with a focus on broader social and cultural functions and meanings of self-injury, however, have challenged the psychomedical and individualistic representations by arguing that self-injury should be understood as having multiple meanings and functions (Chandler 2016; Steggals 2015). Self-injure, for example, is presented as a mechanism to manage emotions and different difficult and often social situations, including what one does in terms of identity/emotion work, survival, and control.
An important recurrent aspect in the literature about self-injury is its connection with shame. Shame is viewed frequently to figure in what is known and told about self-injury. In psychomedical research, shame is typically studied as one of many other possible variables involved in self-injury, or indirectly, for example, through self-hatred, low self-esteem, self-punishment, and self-dissatisfaction (e.g., Gilbert et al., 2010; Ivanhoff, Linehan, and Brown 2001; Victor and Klonsky 2013). Twenty years ago, Linehan and Brown also showed how shame, but no other emotions, predicted the increase in urges to self-injure and that the existence of high levels of shame before starting therapy increased the odds of self-injury within the first four months of therapy (referenced in Ivanhoff et al., 2001). Schoenleber, Berenbaum, and Motl (2014) revealed how proneness to shame was associated with more frequent bouts of self-injury and, in turn, that self-injury could reduce the individual’s feelings of shame. Further, Xavier, Gouveia, and Cunha (2016:583) found how self-criticism in the form of self-hatred was strongly associated with self-injury and that adolescents with a “persecutory and hatred self-attacking” were more likely to engage in self-injury. Other studies have disclosed how HBQT (Homosexual, Bisexual, Queer, trans) youths who self-injured and youths who had tried to commit suicide talked about their actions as a strategy to avoid or escape shame (Fullagar 2003; McDermott, Roen, and Scourfield 2008).
The significance of shame in literature about self-injury is hard to ignore, but there is still a lack of empirical and theoretical insight as to how shame is part of the cultural, psychological, and phenomenological sense making of self-injury (see also Steggals 2015). Steggals emphasizes how objectivist (what is here referred to as psychomedical perspectives) representations of self-injury fail to consider self-persecution as a fundamental reason for why people self-injure. Steggals (2015:163) considers what he calls self-persecution to be significant in self-injury, and which he conveys is “strangely underplayed, marginalized or even completely ignored by more objectivist representations and texts.”
In the present communication, shame is defined in concurrence with H. Lewis (1971) and Scheff (2000), as a threat to the self and to the social bond or to the self-other relationship (Retzinger 2002). Shame is a highly unpleasant emotion that psychiatrist and shame researcher Nathanson (1987) described as the Cinderella of unpleasant emotions. It reminds us that we are separate from the other(s) and that we are both individuals and social beings. Moreover, shame guards the boundaries between the self (the private) and the other (the shared; Retzinger 2002). As shame always involves both the self and the other and concerns how others see the self, the threat to the social bond may play out, not only in physical interactions but also intellectually in one’s mind (H. Lewis 1971), hence, “in response to actions in the inner theatre, in the interior monologue in which we see ourselves from the point of view of others” (Scheff 2000:95). However, since people also internalize the moral ethics of a society as contained in the generalized other (Turner 2006), shame is not only a threat to social bonds, it also arises when an individual experiences that she or he has failed to live up to cultural ideals and values.
Moreover, shame stems from deficient behavior and inept presentation of what is referred to as a general self (Turner 2006) or a global self (M. Lewis 1995). Thus, an individual experiences the self as failed not just in the particular situation (i.e., situated self) but especially in general, and even minor situations and slight happenings may evoke extreme emotions and negative thoughts about the self (Scheff 2000). However, shame is not simply an individual self-feeling; rather, according to Elias (1991) and Scheff (2000), it is the most social of all emotions. As shame involves the relationship between the self and the other, it has to be understood and investigated in a social context. Concurring with Brossard (2014:559), self-injury needs to be considered in social interactions and perhaps particularly in how it relates to the “inner conversations with which people anticipate and think about what they do.” In the present communication, it is argued that shame and self-injury reproduce each other in social interaction, through the role-taking process of seeing the self as one thinks others see him or her (Lundgren 2004). Furthermore, shame has the ability to reproduce itself in an inner self-feeling trap (H. Lewis 1971) or a triple shame loop (Scheff 2000), which not only occurs within an individual but also between people, as in being ashamed, being ashamed of being ashamed, and being ashamed of causing further shame in others. Similarly, Brossard (2014:572) wrote about an accumulation of embarrassment that becomes a “sort of emotion/interaction loop” as in “some interactions generate embarrassment, which generate embarrassing interactions and so forth.” It is viewed as an interactional loop that makes the individual perceive a need to self-cut. The objective of this communication concerns the more intense shame states, which are not easily disregarded and which may turn into self-injury. It is not argued that shame always turns into self-injury, individuals may also redirect the need to cut by using other means, as in Brossard’s (2014) example by writing about the urge to cut. However, the concept argued for in this communication draws on the idea of shame as an often-disguised emotion and when shame is hidden from the self and others, it easily leads to more shame (Scheff 2000).
Congruent with H. Lewis (1971) and Scheff’s (2000) argument, namely, that people, as emotional agents, are often poor subjects when testifying on their own emotional state, especially when it comes to shame. These authors emphasize that shame has to be identified and analyzed in texts and discourses. Consequently, in the present communication, a range of published texts, discourses, and writings have been analyzed, which in various ways explore the individuals’ subjective experiences and accounts of self-injury and shame, including research articles/publications, popular literature, professional and clinical literature, and self-injury autobiographies. Shame is highlighted explicitly and communicated and argued to be a possible “a priori” experience, and how many of the emotional, cognitive, and bodily experiences that individuals emphasize are possibly intertwined with shame, hence with a “pre-self-injury state.” The aim is to demonstrate how shame may operate and unfold in and through social interaction and argues for how shame and self-injury may be intertwined and how they may reproduce and amplify each other, hence turning into a self-perpetuating cycle of shame and self-injury.
A Social Definition of Shame
In the western world, shame is considered a repressed emotion, which may result in a collective denial and silence that renders shame almost entirely hidden in interactions and relationships (Elias 1991; Scheff 2000). Thus, an individual who experiences shame will have difficulties in acknowledging emotional reactions such as shame. Shame is considered by Scheff and Retzinger (2000) to be a family of emotions with common aspects, ranging from mild embarrassment, and social discomfort (“ordinary shame”) to intense and penetrating shame. Although ordinary shame experiences are highly unpleasant, they are usually a brief experience in everyday life (Retzinger 2002). Shame experiences, however, can be much more intense and turn into a more persistent and relentless emotional state (Nathanson 1987; Scheff and Retzinger 2000). Individuals with emotional and mental difficulties or illnesses are known to experience such as intense, painful, and at times unbearable shame (e.g., Retzinger 2002).
Furthermore, shame becomes easily intensified when repressed. It often transforms into many other kinds of feelings (Turner 2006) and symptomatic behaviors that may make little sense to others; however, it manifests itself, as Retzinger (2002) maintains, in thwarted actions to try to salvage lost or failed social bonds.
According to H. Lewis (1971), and expanded by Scheff and Retzinger (2000), there are two kinds of unacknowledged shame states: the bypassed (covert) and the overt undifferentiated shame. In bypassed shame, painful feelings are avoided and may be expressed simply by rapid speech on topics that do not fit with the dialogue. In overt shame, the individual feels and expresses emotional pain, but the feelings are confused and undifferentiated and the individual is unable to identify them as shame. Emotions are felt strongly (intense) but are (miss) labeled, which lead the experiences of shame to become disguised.
As shame is often hidden in social interaction, in order to analyze unacknowledged shame, Scheff and Retzinger (2000) claim that it has to be identified in the discursive elements of a text or a discourse. Accordingly, there are hundreds of different code words therein, that is, other terms that are used for labeling shame experiences without calling it by name (Retzinger 1995). Code words are composed of both verbal and nonverbal cues. An example of the latter is paralinguistic and visual gestures. A list of such cue words is presented in Retzinger (1995, 2002), and these may be used to analyze shame in texts and discourses. It includes, for example, verbal cues of abandonment, separation, and isolation, ridicule, foolishness, and inadequacy, as feeling stupid or worthless (i.e., as failed). Shame cues are also found in verbal hiding behaviors, often used in combination with other verbal cues or preceding them (Retzinger 1995), and can serve to distance a feeling from the self or be an attempt to affirm the bond with others. The occurrence of verbal and nonverbal cues, however, cannot alone account for the occurrence of shame. It is the position of the self in relationship with the other, the situation, and the verbal statements used by the different party (parties) that determine the shame context (Scheff and Retzinger 2000). Also, the strongest evidence of any emotion is when cued categories occur in combinations and can be identified within the same situation (Retzinger 2002). In the experiences and accounts of individuals who self-injure, other vernacular variants (i.e., using freak instead of peculiar) can also be repeatedly detected. These are often much stronger emotionally valenced words than the listed cues entail, such as referring to oneself as disgusting, crazy, a monster, or dirty (e.g., Åkerman 2005; Törnström 2004).
It will be suggested in this communication that it is especially the overt and intense shame state, which H. Lewis (1971) foregrounded that is essential in understanding self-injury. Although such shame is noticeable (i.e., overt) and painfully felt, it is still not easily recognized by the self (or the other). The overt shame reactions may also be experienced and expressed, in terms of other kinds of emotional experiences (e.g., anxiety, anger, and numbness) and mental/bodily states, which people who self-injure say is the reason for why they feel the urge to physically injure their bodies (e.g., Chandler 2016; Huey, Hryniewicz, and Fthenos 2014; Le Breton 2018). It is thus suggested here that many of the emotional, cognitive, and bodily reactions and situations that individuals present as “triggering” or initiating self-injurious behaviors are intimately linked with that of living with intense shame but without fully knowing it. McDermott et al. (2008) pinpoint how their participants did not often mention shame explicitly, but it became evident that shame was an “unspoken emotion” of the young LGBT (Lesbian, gay, Bisexual, trans) participants’ accounts. Shame furthermore may be triggered when one is cutoff from others and the world, as in feeling “a personal, emotional, social or existential estrangement” (Steggals 2015:126). Following the social definition of shame, it may be identified as a cognitive and embodied disruption of the connection between the self and others and between the self and the world.
Self-injury in Psychomedical Perspectives
The psychiatrist Favazza (2011) classified self-injury as an impulsive type of self-injury without suicidal intent that consists of acts of cutting or burning the skin, pin sticking, interfering with wound healing, and smashing hand or foot bones and excludes other means of harming the self like, overdoses, anorexia, or other risky behaviors. However, others have argued that many acts of skin cutting, for example, are not impulsive but rather well prepared and organized (Chamberlain et al., 2017). Explanations are put forward in terms of individual biology as well as inner emotional and psychological characteristics (Nock 2009). Interpersonal and social factors are also linked with individual deficiencies often as a result of childhood abuse and other traumas (Favazza 2011).
These individualistic representations are well accepted and widespread in professional and public discourses (Brickman 2004) and among self-injuring individuals themselves (Steggals 2015). The “typical female self-injurer,” for instance, may be described as deficient in intra- and interpersonal skills, being attention seeking or manipulative, unable to take on personal responsibility, (passive) aggressive, lacking the ability to self-sooth, lacking effective communicative and emotional regulating skills, and being unaware of the impact they have on others (Favazza 2011; Nock 2009). The function of self-injury has been discussed specifically in terms of affect regulation, as in directing anger, disgust, and loathing toward the self (Klonsky et al., 2011; Xavier et al., 2016).
Although studies have shown that boys, non-white populations, homeless women, and people of different ages also self-injure (Chandler et al. 2011; Huey et al. 2014; Le Breton, 2018), the white, middle-class woman continues to be in the sample majority, especially in “objective” psychomedical research but also in subjective studies (e.g., Adler and Adler 2011; Chandler 2012). Thus, it is difficult to know whether the majority of individuals who self-injure, although not exclusively, are to be found among the white, middle-class women, or rather, if other individuals and populations are simply overlooked.
Sociocultural Perspectives of Self-injury
One salient function in the sociocultural studies is individual (self) control expressed as staying in control, feeling, or taking control over one’s emotions, the self, and the situation (e.g., Daley 2015; Harris 2000; Leaf and Schrock 2011; Rao 2006). Another understanding is self-injury as a form of “silent scream” and refers to what cannot be formulated (e.g., Solomon and Farrand 1996). Emotional pain and distress are then communicated throughout the body (i.e., physical pain, the wounds, and scars; e.g., Daley 2015). They are thought of as being a manifestation of the experience of self that is not fully understood (e.g., Hills and Dallos 2011) and that cannot be communicated to others or managed in other ways. Self-injury to stay alive and opposite of suicidal intent is mentioned in several studies (e.g., Alexander and Clarke 2004; Daley 2015; Le Breton 2018) and thus comprehended as a “life- and self-sustaining behavior” used to survive unbearable emotions/situations in the moment and/or of the past (e.g., Rao 2006).
Furthermore, two frequently explored perspectives are self-injury as emotion work and/or identity work and/or as a deviant practice used to manage a deviant behavior and/or a nonnormative self/identity (e.g., Adler and Adler 2011; Chandler 2012, 2014, 2016). When framed as a deviant practice, self-injury is often linked with individual agency (e.g., Hodgson 2004). Adler and Adler (2011:201) recognize how people, who turn to self-injury but lack experience of severe traumas, use self-injury as a “means of self-expression, comfort, affiliation, identification, sexuality and rebellion.” Studies on body markings and self-injury focus on how tattoos, brandings, and self-injury transgress normative gender and sexual identities, and the binary categorizations of normal and abnormal, sick, or ill, but also how these body practices challenge the body–mind dualism (Chandler 2012) and the normativity of gender and bodily appearance (Inckle 2007). Some publications emphasize how the act of cutting is used to evoke authenticity, to feel real and as a true self (Leaf and Schrock 2011; Steggals 2015), or to position the self as an authentic cutter, hence both “normal” and “ill” (Gradin Franzén and Gottzén 2011). Several of the above perspectives embed the practice of self-injury in the modern western society’s civilization process and its function as internalized social control (e.g., Kokaliari and Berzoff 2008; Steggals 2015).
Finally, in the above studies, another pattern emerges (although it may not always be a study focus). This points at how individuals engage in self-injury, especially when experiencing troubles, stressors, and traumas that somehow relate to other people. This includes abuse carried out by others, or experiencing rejections, ridicule, or criticism in interactions and relationships with significant others (Alexander and Clarke 2004; Hodgson 2004: Huey et al. 2014). Hence, they develop in situations and interactions that threaten the self and the social bond (Rao 2006).
The sociocultural meaning of self-injury is clearly framed around similar emotional, mental, and bodily experiences and interpretations (Chandler 2016). However, the meanings and functions of self-injury may also vary depending on the individuals’ emotional experiences as well as from the situation and relationship between the individuals involved (Chandler 2016; Steggals 2015). Moreover, variations regarding the function and meaning of self-injury in terms of gender (e.g., Leaf and Shrock 2011), class, ethnicity, and age and the context in which self-injury occurs have been documented. For example, boys tend to “show off” their self-injury and use it to “demonstrate their virility” (Le Breton 2018:45). Moreover, it is suggested that women in prison are particularly susceptible to self-injury because of past traumas, like domestic violence and sexual abuse (Liebling 1994).
The Self-perpetuating Cycle of Shame and Self-injury
The theoretical framework argued for in the present communication and conceptualized as “the self-perpetuating cycle of shame and self-injury” suggests that taking the perspective of the other would result in a cycle of shame and self-injury, and further that shame has the possibility of arising in any small or trivial situations and ordinary interactions and becoming highly self-perpetuating, leading to simply more self-injury. Unacknowledged or unspoken shame (McDermott et al. 2008) has the capability to continue indefinitely as one interacts with significant others, friends, and different professionals faced by those who self-injure. Moreover, it also includes the judgments that one makes of oneself as failing to live up to the moral yardstick of society, that is, the generalized other (Turner 2006). Thus, in connection with others, there is always the likelihood that shame leads to more shame, and that it leads to self-injury, but also the opposite that self-injury eventually also triggers more shame and so on.
Becoming “An Unattractive Social Agent”: Triggers of Shame
Shame is triggered not in isolation within the individual self but derives particularly from how one believes that one appears to others (Leeming and Boyle 2013). According to Leeming and Boyle (2013), shame can be “understood as a sense of an inferior position in relation to a critical, powerful others, whether this is related to an actual experience of being shamed by another person or to a more general sense of an internalised critical other” (p. 4). Situations and interactions may generate shame, for example, anytime one may have become as Gilbert (2007) states “an unattractive social agent” in the eye of the other. It may be real or it may be as simple as one anticipates or imagines the others’ view of the self (Scheff 2000). It may be about having done something wrong and feeling ashamed of it, but it is foremost about “being” wrong (Gilbert 2007; Leeming and Boyle 2013), regardless of whether any wrongdoings have occurred or not.
Brossard (2014:561) makes reference to triggering events that may turn into self-injury as being an “interaction that disturbs the person in question.” Brossard pinpoints that such situations are not unusual ones, but such that “creates a feeling of misunderstanding, uncertainty, or injustice.” One of these are what Brossard calls embarrassing situations, which he declares will usually not lead to any direct reaction from the individual experiencing them. What is striking in this context is that such situations are described in a way that would imply a relation to shame, as embarrassment is considered by H. Lewis (1971), Scheff and Retzinger (2000) as a mild form of shame. Brossard’s notion of embarrassing situations is particularly concurrent with the shame state that H. Lewis (1971) calls the covert, bypassed shame. In comparison with the overt, undifferentiated shame state argued for here, in bypassed shame, painful feelings are simply avoided (H. Lewis 1971) and therefore remain largely unconsummated.
In terms of self-injury, there are a number of situations that can be suggestive of shame. The following are some examples: hurting someone else, disappointing others (Törnström 2004; Åkerman 2005), being rejected or feeling rejected by others (real or imagined), feeling isolated, being alone, being put aside by others (Johansson 2010; Karlsson 2013; Van Gelder 2010), feelings of worthlessness, being unlovable, evil, or a fake (Åkerman 2005; Johansson 2010; Steggals 2015; Strong 1999; Törnström 2004), and feelings of being a failure and inadequate, a person who cannot amount to anything, including a failure to live up to social and cultural commitments such as relationships and work (Karlsson 2013; Leatham 2006; Törnström 2004). Shame may also be generated when social bonds are broken or merely threatened, when breakups happen, when one has had arguments with loved ones and particularly feeling that it is one’s own fault (Johansson 2010; Leatham 2006; Steggals 2015; Törnström 2004). Shame particularly involves judgment and blame, and a person experiencing shame often feels a strong self-blame (Hartling et al. 2000).
In McDermott (2014) and McDermott et al.’s (2008) findings, shame has a prominent position, particularly in considering self-injury as shame management, for example, by avoiding shame. Shame in their study, however, is mainly linked to individuals’ nonnormative identity and with widespread homophobia (see also Alexander and Clare 2004). It is therefore difficult to actually pinpoint how shame relates to self-injury in such a context and what may instead be shame as a consequence of a nonnormative identity. Mayrhofer (2011:168) acknowledges how shame in self-injury “carries the potency to threaten social bonds and jeopardies social integration/reintegration.” The presence of shame is assumed in her study, and it is not stated in what way shame carries the power to threaten social bonds and to risk social integration/reintegration. Steggals (2015) mentions how self-persecution, which includes judgments of the self and a deep sense of a failed self, is found in a profound and relentless negativity about the self. It is connected with how individuals constantly must assess and discipline the self to conform to cultural expectations.
Although previous findings indicate that shame may initiate self-injury (e.g., one cuts because of shame), and used as shame management, most studies never mention or investigate shame directly (e.g., Horne and Csipke 2009; Solomon and Farrand 1996). When mentioned directly, shame is seldom defined; it is perhaps considered as an effect of self-injury (or a nonnormative identity), which is evoked because of the social stigma resulting from the self-injurious behavior or a nonnormative identity (e.g., Hodgson 2004; Inckle 2007; Rao 2006). More importantly, the literature about self-injury are enmeshed with shame and imply the presence and activity of shame but often surprisingly without discussing its implications as to why people self-injure. Rao (2006), for instance, writes about how the interview subjects are: convinced of her inherent badness, or at least of some unidentified deficiency, she finds others justified in their ill-treatment of her. Feeling acutely alone, she absorbs as fact their offensive comments (real or implied)—she believes she is crazy, stupid, worthless, rotten, bad. (p. 47)
Implicit in many self-injuring individuals’ experiences is the negative view of the self, which seemingly also defines the situation that triggers shame and self-injury (e.g., becoming an unattractive social agent). Believing one is “inherently bad” and thinking it is justified is an undeniable cue for shame (Hartling et al. 2000; Retzinger 2002). For example, in Mayrhofer (2011:131), a respondent Samantha talks about her sense of worthlessness and how she self-injured to punish herself “because I deserved it.” In her mind, the damage to the skin validates how she feels inside “like I was kind of worthless, and not good.” When someone says they hate themselves or that they feel worthless in an interview, this also hints at how it may play out in their mind (i.e., in their inner monologue/dialogue).
The perception of the self is unfolded and cocreated together in social interactions, as one takes the others’ attitude, which, according to Cooley (1902), results in a self-feeling of either shame or pride. The theorizing about shame and self-injury in the present communication builds specifically on the logic of the role-taking process—as one becomes “unattractive” somehow in the others’ eyes. It follows in the track of Lundgren’s (2004) arguments that taking the others’ perspective is foremost about how we imagine what others think of us. Thus, if a person imagines that the other thinks badly about him or her, then shame reactions will be easily triggered.
A Shame-ridden Self: The Reproduction of Shame
When constantly imagining and seeing oneself as being negative in the eyes of the other(s), a self that is prone to attacks on one’s body and self may take form. The degree of negativity one has about the self may vary between different individuals and situations/contexts. Regardless of the degree to which one sees oneself as flawed and unworthy, this is the fundamental building stone for understanding the formation of a failed self, conceptualized here as a shame-ridden self. The shame-ridden self is reproduced because shame, when unacknowledged and undifferentiated, fosters simply more shame because the voice of failure as confined in the “imagined other” is corroborated when taking the others’ perspective. Despite the shame-ridden self being more temporary for some individuals, for many others, it may become a deep-rooted self-state that eventually drives the individual to repetitive self-injury over many years or develop into a self-injury identity (Adler and Adler 2011; Favazza 2011).
To illustrate how a shame-ridden self is confirmed and reproduced in a specific situation, an example from Sofia’s autobiography (Åkerman 2005) illuminates how her inner monologue of seeing the self from the point of view of the other operates and unfolds through especially the imagined other(s). In Sofia’s memoir, we are given admittance to a Swedish 18-year-old girl’s pain and despair, frequently managed through self-injury as well as her experiences with inpatient psychiatric care. In the account below, Sofia has recently been released from psychiatric care and once again tries hard to be a “normal” schoolgirl. The situation that evokes her shame is that of a seemingly ordinary one, learning to play the guitar. Sofia feels that she cannot keep up with her classmates during their performance, and in an instance, an everyday seemingly minor situation turns into a possible threat (to the self and to the social bond) that awakens her critical inner monologue.
There are several verbal shame cues in Sofia’s example: “I can’t,” “I am worst of everyone in here,” “I am stupid and bad,” and “I am hopelessly dull.” There are also several accounted for changes in her manner, that is, paralinguistic and visual gestures (Retzinger 1995) such as wanting to flee, a lowered gaze, wanting to hide her eyes, and mumbling to herself more verbal shame cues such as “stupid, fat, crazy, and selfish.” The account shows how the shame-ridden self is reproduced as shame fosters simply more shame and how it intensifies and also transforms into other emotional, bodily, and mental responses (e.g., flight response, emptiness, fear, and anticipated rejections), which continue in an endless cycle and subside only when she makes three cuts on her arm. The guitar grew in my arms, my fingers became flaccid and uncontrollable and the only thing I heard was: I can’t! I am the worst of everyone in here! I can’t, I can’t! I am stupid and bad! I am hopelessly dull! It was time to turn back-give up and flee. I came out on the schoolyard. Gazing at the ground so nobody would notice the fixed stare and emptiness in my eyes. The healthy appearance was gone, and the only thing left in my eyes was the sick clutter and emptiness. I knew how such a gaze looked like because I had seen it on so many people in the psych ward. I felt how it had also crept over my face. I wish I had had a cap to drag down over my eyes and hide behind. My steps were short and fast, and each time I put my foot down I mumbled something about myself: - stupid, fat, crazy, ugly, nuts, selfish, idiotic, bad, weird, wrong… I was filled to the brim with hatred toward myself. Where should I go? What should I do? How should I get Lucifer to loosen its grip on me and go away? In sheer desperation, I rounded the school, and I became even more burdened with thoughts of fear, hatred, and insecurity. Was I in the way now? Did the school want me to disappear somewhere else now when I was not the good student they wanted to see? But where should I go? I was not welcome at the psych ward, and didn’t want to go there anyway. I could not go home, because in front of mom and dad I put on the iron-mask even though behind it I still hurt just as much. // I stayed out for another hour. Then I went to the school bathroom and made three cuts on my arm, which I then wrapped with toilet paper. As soon as the cuts opened up and the yellow bubbles underneath the skin became visible to the eye, Lucifer fell asleep. My body became completely soft, like conditioner in a newly showered hair. (Åkerman 2005:63, 64, 66)
The passage from Sofia’s autobiography shows how shame tends to bind to the core general self of the shamed individual and to the self-other relationship, especially because it is highly difficult for ashamed individuals to fully recognize their emotional experiences as shame (Scheff 2000). When shame is overt and painfully felt, it nevertheless communicates loudly with the individual (H. Lewis 1971), particularly as shame is known to both intensify and transform to other kinds of painful emotional states (M. Lewis 1995; Turner 2006) and does so particularly when shame is not acknowledged and communicated (Lynd 2014). For example, shame may be blended with anger, anger that has not been consummated (i.e., shame rage; Scheff 1997). When shame appears indistinguishable from other emotional and bodily reactions and experiences, the individual may instead understand and express experiences of shame as anxieties, depressions, or as a turmoil of different emotions, suffering, and emotional pain (Le Breton 2018). Sofia, for example, articulates emotional experiences of the situation in a number of other ways and wordings than in terms of shame, fear, hatred, and insecurity.
If it is shame that activates and organizes the role-taking and the feedback system so that a failed self is reproduced in actual and fictive interactions and dialogues, it is not unlikely that extreme reactions and actions follow from seemingly ordinary interactions and circumstances (Scheff 2000). Shame-induced reactions may include running away, anger rage at others or the self, isolating oneself, or thinking like Sofia that she was not welcome back to school. These reactions may appear irrational to others, but they are in fact a rational response from someone who is experiencing intense shame (Scheff and Retzinger 2000). It is often difficult for an intensely shamed individual to evaluate whether she or he is “reacting to a trivial or significant event” (H. Lewis 1971:39). It is the kind of shame which, even when acknowledged, cannot be reasoned with. Additionally, shame is also known to derail higher cognitive functions (Nathanson 1987); therefore, it is possible that the mental processes of a shamed individual are greatly confused. The ability to reflect on one’s own and others’ minds and actions, hence, taking the (actual) attitude of the other, may prove to be very difficult for a shame-ridden individual. This may be another reason for why it is not enough to talk about or describe self-injury as a mere individual and pathological symptom or disorder (Favazza 2011) or as a fully conscious and deliberate act (Adler and Adler 2011).
To Uphold Social Order and Maintain Social Bonds: Fending Off Shame
Previous studies have discussed self-injury and suicide as a way to manage shame, for example, by avoiding or escaping shame (Fullagar 2003; McDermott et al. 2008). Here, it will be argued that it may rather be about fending off shame than avoiding it. If overt shame is what drives individuals to self-injure and one is caught in a shame-ridden self, it cannot be that easily avoided or escaped. Shame will still continue underneath the surface, but it can be fended off temporarily if one cuts and consequently manages the emotional, cognitive, and bodily reactions connected with shame. As shame is here hypothesized to underlie the emotional distress and pain experienced by those who self-injure, when one cuts because of shame the cutting also concurrently works as a form of internalized social control (see also Brossard 2014; Kokaliari and Berzoff 2008). When experiencing the self as deeply failed (i.e., living with a shame-ridden self), the act of cutting one’s body becomes a way to try to uphold the social order and maintain (or mend) social bonds with others. Self-injury makes it possible for the individual to get control over the self, and one’s painful emotions and experiences of disconnections, and as one restores the bond to the self, one can again function in everyday life, just like any other individual, and to continue to meet social and cultural expectations and obligations. Self-injury thus functions to make an ashamed individual reconnect with others and with “society,” as one may be able to “get up and get through the day” for the moment, hours, and sometimes for days (Caroline 1999).
In the example below, Caroline’s (1999) story line is about her 12-year-old self who works hard to uphold her cultural commitments and social obligations, especially in being an ambitious American pupil and responsible daughter. Caroline explicates, as many others do, how she was “made paradoxically whole” by the cutting, which made it possible for her to interact, perform, and function in everyday life in the way she was expected to: Cutting was my deliverance, my knight errant riding in on a bag of disposable Bics. I cut myself, and just like that the itching, anxiousness, and restlessness were gone. I cut myself and was paradoxically made whole. I cut, and then I could get up and get through the day, eat my dinner and complete my homework because that’s what you do. It was expected of me. It was what I expected of me. I could never fail that duty, even if I wanted to. I would not have ventured the temerity to believe that my troubles justified a failure to meet my obligations. Those obligations drove me like a bus I couldn’t get off; cutting was the fare that made it possible for me to stay on the bus that I couldn’t get off of (Caroline 1999:62).
A Threat to the Social Order and Social Bonds: Self-injury Triggers More Shame
Just as using skin cutting may make it possible for the individual to reconnect with the self and others and to engage in social and cultural activities, the cutting may also be the very thing that challenges and threatens the social order and social bonds, and this may in turn trigger more shame. There are at least three reasons for this: (a) Shame cannot be fended off more than temporarily (a new situation can always arise, which may then again trigger shame) and (b) many people who self-injure eventually lose control over their strategy to survive, as it often careens out of control by, for example, becoming dangerous (as in cutting deeper than what one intended, or more frequently with time and in more situations; Adler and Adler 2011; Rao 2016). As Caroline (1999:63) states, “almost any reason was good enough reason, almost any provocation was provocation enough. Cutting was my all-purpose solution.” Finally, (c) self-injury is far from a sociocultural acceptable survival strategy—it is viewed by others and society foremost as an individual pathology and deviant practice (Adler and Adler 2011; Favazza 2011).
That self-injury only works temporarily and may eventually careen out of control is something Rao (2016) states in the example below. The cutting is described by Rao as working to “get a grip” of the individual and her world, so she can “recover a sense of herself” (p. 56). However, the “healing ritual” is only “temporary, illusory,” and it may “careen out of control” as the individual finds out that the cutting may not only help her but also hurt her: The very act through which she regains control can easily careen out of control. She may be tempted to cut deeper or more often than anticipated. Or she may be unable to stop the blood flow. She is scared to find that her healing ritual can be dangerous. Her newfound sense of closure quickly becomes temporary, illusory. She is taken aback to learn that cutting does not help her. It also hurts her. Abruptly, she realizes the self-deception. But it is not soon enough. She is probably already enveloped in a cycle of self- injury. (P. 51)
Considering that a society develops sociocultural standards for people’s behavior, then a society (the others) also tends to shame those who do not match such standards (Turner 2006). One may thus be shamed by others because of one’s self-injury or feel ashamed for not managing the emotional self in more socially acceptable ways. In Victoria’s (Leatham 2006) autobiography, she writes about her self-cutting as crossing a line: if I used a knife against myself, then I would have transgressed to such an extent that everything else I did and was ashamed about would fall away to nothing. I’d be outside the normal boundaries, in a place where the rules no longer applied. (p. 1)
As a failed sense of self is not only confirmed and reproduced in the individual’s inner theater, it is also reproduced in the “actual” feedback that individuals who self-injure receive from others, and perhaps especially from “society.” Cultural values and norms in a society may induce shame in individuals who self-injure, and self-injury may thus trigger more shame. One may be shamed by others, or feel ashamed for the cutting, or as Scheff (2000) states, feel shame for making others feel ashamed as Victoria expresses about her parents in the example above. The social stigma of self-injury thus makes it hard for individuals to continue to uphold the social order and maintain social bonds with this strategy. The strategy one uses for survival and emotion regulation to avoid or fend off shame may thus become a possible threat to what one tries so hard to uphold in order to function in everyday life. Social action is about intersubjectivity, that is, a mutual understanding, and intersubjectivity that is at the basis of social order. When self-injury is involved, this mutual understanding may falter. As people have a hard time to comprehend the self-injurious behaviors, this also means that any mutual agreement in how to define the situation can be highly difficult, hence disrupting or threatening the social order.
Conclusion
In the present communication, it is argued that it is difficult to explain why people self-injure without taking into consideration shame as a significant emotion. Our identity, according to Cooley (1902), is the result of learning to see ourselves through what we perceive to be the perceptions of others. How we view the self and act are thus heavily dependent on what we believe the other(s) think of us. Cooley (1902) pinpoints how the notion of being perceived is to be socially real. This is significant for understanding the shame dynamic and process of the looking glass self of those who self-injure. As our identities are built on how we think others think of us, perhaps more so than it is dependent on the actual feedback we receive from others, shame has the ability to arise in almost any situation, when feeling inferior, incompetent, judged, or scolded.
I have argued that shame is triggered anytime the individual becomes an unattractive social agent (Gilbert 2007), and whenever there is a threat to the self-other relationship, that is, to the social bond (Scheff 2000), or when one has failed to live up to the moral yardstick of society (Turner 2006). The self-perpetuating cycle of shame and self-injury illustrates how an individual’s general sense of a failed self tends to be confirmed and reproduced in interactions with others. The constitution of a failed self and negative self-image is closely related to how individuals, who self-injure, in their interior dialogues with imagined others, conceive and anticipate how others will think and react to them. The cycle of shame is not unlike the inner self-feeling trap and the triple shame loop, which H. Lewis (1971) and Scheff (2000), respectively, describe. However, it additionally illustrates how a failed (shamed) self tends to complete and repeat itself as one takes the others’ perspective. Once a shamed self is established, it thus takes on a self-perpetuating life of its own, leading to more self-injury and consequently to more shame.
I want to propose that self-injuring individuals do not lack the ability to self-soothe or regulate emotions (they do regulate emotions in many different ways, not only by self-injury, e.g., see Brossard 2014) or that they necessarily suffer from a clinical psychopathology, but that intense, relentless shame may explain actions of self-injury and may be what is behind all the different “symptoms” people who self-injure may display. If self-injury were socially and culturally accepted as an emotion management and survival strategy, the self-perpetuating cycle of shame would not necessarily have to trigger more shame. For example, Hodgson (2004:177) has shown how self-cutters “learn that others do not approve of cutting” and also that they learn it is timely to maintain a front of “coping normalcy.” Similar to Hodgson (2004), I do not suggest that self-injury should become “normalized,” I simply propose that we should take shame into consideration, as one way to understand and explain why people self-injure and continue do so even when the act becomes a possible threat to the self and the self-other relationship. As shame is reproduced in social interaction and the combination of shame and self-injury can become highly self-perpetuating, when individuals who self-injure are shunned and we hide or disguise the experiences of shame behind notions of individual psychopathology, actions of self-injury will never be fully understood.
If we were to listen to what Scheff, Retzinger, Lewis, and Lynd say about the social emotion of shame, in order for shame to lessen, disperse, or be repaired, it has to be managed by openly acknowledging it. The individual who experiences intense shame has to acknowledge that it is shame she or he feels; moreover, shame needs to be talked about and communicated in social interactions and relationships. Perhaps by acknowledging and openly discussing shame between people and the self-injuring individuals, self-injury may become more tangible as a practice. Finally, such considerations may also help in professional encounters. Thus, it can become a tool for professionals to feel less helpless and frustrated when encountering people who self-injure (Favazza 2011). It is otherwise possible that if neglecting the role of shame in terms of self-injury, it may only further shame an already (a)shamed self and keep pushing individuals to cut or in other ways physically injure themselves.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.