Self-harm is still a taboo all over the world, as is mental health in general. Yet in English-speaking countries such as the United States and especially the United Kingdom, self-harm is discussed and researched, even if the general public often misunderstands it. In France most people do not understand it either and French research about non-suicidal self-injury (NSSI) is relatively rare and behind American and British studies. This could be explained by the fact that, for a very long time, self-harm was either seen as extremely serious forms of self-mutilation of a body part by a “mad” person – someone suffering from psychosis and who lost touch with reality – or as malingering, that is as an intentional injury to the self for financial gain, to escape work or to get attention for example. During World War I some soldiers mutilated themselves in a desperate attempt to avoid fight, which contributed to perpetuate the misconception of self-harm being pretense. As the United States only became involved in the war later and was less affected by it, American studies about self-harm developed, unlike in Europe where “psychiatry was totally mobilized to support the war effort” (Trybou, Brossard, & Kédia, 2018). Trybou writes that several cases of self-harm were described between the 1950s and 1980s but that they were either serious injuries associated to psychosis, madness or autism, or factitious disorder or malingering. He also suggests that unlike in the United States where self-harm became understood as a symptom of borderline personality disorder, French psychiatrists “closer to psychoanalyze and its distinction between neurosis and psychosis, remained for a long time skeptical to American psychiatry and therefore only later considered the diagnostic category of ‘borderline states’.”
Nowadays misconception about self-harm persists in France and the French language shows how little our perception evolved through time. The French word for “self-harm” is “automutilation”, which is not representative of the average NSSI. With NSSI, the injury is usually not serious, but the term “mutilation” suggests the mutilation of a whole body part. “Automutilation” is more representative of extreme psychosis cases of self-harm but not of what we now understand as NSSI. The word “scarification” is also often used incorrectly to refer to self-harm in general, which is reductive and suggests that self-harm is only cutting. The term “automutilation” never changed and was already used in the early 20th century in France. In English-speaking countries however, the naming changed throughout time in order to be more representative of the new findings and understandings of research: it was first called “self-mutilation” or sometimes “automutilation” and became then referred to as “self-injury”, “self-cutting”, “delicate self-cutting”, “self-harm” and finally is now known as “self-injurious behavior” (SIB) or more commonly “non-suicidal self-injury” (NSSI). This evolution in naming testifies to the evolution of research.
This ignorance about NSSI in France can have serious consequences on those who suffer from this behavior. Self-harm is not understood by the public as a coping mechanism or a symptom of uneasiness or mental health issues. It is usually seen as something done by young teenagers – usually female – to get attention or express their excessive admiration to their idols. Their motives are considered illegitimate and self-harm is seen as futile and immature and is associated to teenage years. Most French papers studying self-harm are also centered around adolescents.
Therefore, this behavior is not taken seriously and help is rarely sought as it is assumed that teenagers will grow out of it. The stigma can also encourage people who self-harm to keep this behavior secret and not reach for help from fear of judgment. They may also feel guilty and ashamed if they think the misconceptions are true and wrongly blame themselves for not having legitimate issues or being immature, especially if they are adults. Moreover, the lack of resources about NSSI in the French language makes it more difficult for people who do not speak English (especially children and teenagers) to get help and access information on their own. Self-harm is never discussed in the media and no prevention is done in school and college about it (except for some self-destructive behaviors such as drug and alcohol consumption, smoking or unprotected sexual intercourse).
Improvements about the understanding of mental health by the public are slowly being made but further information and talk is needed in order to raise awareness of self-harm in France and end the stigma and taboo of NSSI and mental health in general.
Trybou, V., Brossard, B., & Kédia, M. (2018). Automutilations: Comprendre et soigner. Odile Jacob.