In Making Sense of Self-harm: The Cultural Meaning and Social Context of Nonsuicidal Self-injury, Dr. Peter Steggals slowly and carefully circles around self-harm as a social construct. His book gathers up the underlying meanings and contradictions inherent in the practice and inspects them in turn. He makes a case that self-harm as we see it today in the form of skin cutting, picking, and other related phenomenon is unique to our time period and is not universally present across cultures— regardless of other mutilation, cutting, or piercing practices that may exist. And importantly, he starts by addressing our aversion to discussing it.
The monograph begins with the compelling story of “Fiona,” an inmate Steggals confronted early in his career at a prison in England. Fiona had managed to scrape nearly all of the skin off of her face, and Steggals describes his sense of bewilderment, exposure, and being out of his depth in meeting her. He presents this example, perhaps to invite the reader to experience his or her own form of disgust, distress, or confusion.
This monograph will explore a set of behaviors that many of us struggle to make sense of or cope with, whether as witnesses or bystanders, never mind as clinicians. Steggals states: “Perhaps this is why I felt so utterly confounded by Fiona; the frustration of unconventional communication mixed with the difficulty, the almost primal anxiety, of witnessing another human being and treating her as such” (p. 10). The importance, then, of this contribution is evident: to unpack the taboo of self-harm.
Throughout the book, there are short vignettes of patient stories and popular press events that provide anecdotes, evidence, and explanations of this philosophical foray into the meaning of self-harm. After introductory materials and definitional work, the book is divided into three main sections: The Ontological Axis, The Aetiological Axis, and The Pathological Axis. These sections in particular rely on patient reports and interviews from 30 interlocutors, which were carried out in person, over the phone, and by email.
Twenty-nine of the participants were women, which unfortunately neglects male perspectives and may contribute to the false belief that self-harming is exclusively a feminine phenomenon. The bulk of the work relies on philosophical considerations of meaning-making and the struggle to define and explain the phenomenon at hand, bookended by a historical analysis of self-harm, and an analysis of its fit within a consumerist capitalist society.
There are many useful components to highlight. Among them is the strength of The Pathological Axis for reconsidering health communication and care. This chapter reimagines that self-harm might be understood as “a letter that has been written, but not sent, set aside in a safe place with the possibility that it may be sent in the future and with the hope that by then the recipient will be able to understand it” (p. 160). In other words, self-harm, though frequently done in private, is currently conceptualized by care providers as a distressing social practice.
By reconceptualizing self-harm in more philosophic terms, providers may find a way to engage around the internalized social norms, values, and beliefs of patients. The wounds themselves might be better understood as an incomplete attempt at communication rather than an as attempt at manipulation or causing distress in others.
The shortest chapter of the book, “The Belaboured Economy of Desire,” provides powerful insights, pointing the reader to an explanation for why self-harm is uniquely present at this social moment. A critical depiction of consumer capitalism, and how it facilitates a culture of striving toward self-actualization, begins to explain self-harm. Steggals argues that our consumerism has become less focused on owning things and more focused on becoming a certain kind of authentic, satisfied person. He proposes that persons who self-harm are canaries in the coal mine, victims of internalized normative wants, wishes, and cravings that cannot be achieved. He suggests that those who self- harm have more than internalized social values of comparison and achievement and have taken on the task of self- punishment for their failure to successfully achieve them. In this chapter, this monograph is elevated from a rigorous philosophical exploration of culture into an incisive analysis of modern society and the literal wounds that it leaves on the bodies of its inhabitants.
As readers, we are invited to engage with a stoic expression of pain that we have culturally defined as deeply unsatisfying, inexplicable, and disturbing. Reading this book is an act of confrontation, and a rewarding one. While there may not be a simple and easy sense- making to engage in, and perhaps self- harm is intended to be so ungraspable, nonetheless Steggals does a wonderful job of walking the reader around the glass shards. Underneath are thoughtful and sympathetic insights, with a more-than- competent review of Foucault, Derrida, Geertz, and others who can assist us in understanding what precisely self-harm means. I recommend this book particularly for graduate-level courses in medical anthropology, cultural studies, and the sociology of knowledge. It would also be helpful for clinical psychologists in training as they gain skills in working with patient populations who self-harm. Selections, including the pop-culture references to the music industry, may also be well suited to undergraduate lectures on culture, mental health, and social constructionism.