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The walls within: working with defenses against otherness

Online Conference 5-11 July 2021

Why do you treat me this way?': reciprocal violence and the mythology of deliberate self harm

Traumatised people who attack, poison or mutilate their own bodies do so both as a defence against a set of impulses that might otherwise result in them attacking the bodies of others and to preserve themselves from internalised threats to their own minds which, unopposed, they fear would cause the insurrection that would drive them mad. This phenomenon is made all the more complex by widespread and pervasive attitudes within modern mental health, social care, education and criminal justice systems to the effect that people who do harm or neglect themselves do so deliberately. Consequently, societal and professional attitudes, rooted in paradigms of rationality, are too often judgemental and derogatory and therefore harm-full. The quasi-rational strategies, policies, procedures and clinical models that are put in place to respond to the problem of deliberate self harm can then become thoughtless and at times actively punishing. Patients who deliberately attack their own bodies are experienced as therefore deliberately manipulative, deliberately attention-seeking and deliberately refusing to be well and to conform to societal ideas about what being well entails. These attitudes serve only to humiliate the person with the mutilated body and to further reduce their self-esteem; and so exacerbate the presenting problem. At this point the parallel violence between the individual and the system of care has become reciprocal and the question about who, or what, started it becomes moot as each party becomes locked into a vicious cycle rooted in a mutual attribution of malign intent. Sufferer and carer alike find themselves locked in reciprocal and identical complaints: why do you treat me this way?