Dr. Stephen Lewis knows firsthand the value of lived experience when it comes to academic research. It was his own journey with self-injury that led him to study the behaviour.
A psychology professor in the College of Social and Applied Human Sciences at U of G, Lewis has co-authored a new book, Understanding Self-Injury: A Person-Centered Approach. Released Feb. 28 from Oxford University Press, the book is available the day prior to Self-Injury Awareness Day, a global observance to destigmatize and foster understanding about self-injury.
With longtime colleague Penelope A. Hasking of Curtin University in Perth, Australia, Lewis moves the discussion around self-injury forward, an action he believes is critical in the advancement of the field.
“In some ways the book is a paradigm shift,” Lewis said, offering alternative ways to think about and address self-injury.
What makes Understanding Self-Injury: A Person-Centered Approach such an important book is that it takes a person-centered, strengths-based approach. People with lived experience of self-injury are centered and priority is given to topics they feel are most important, including to stigma, social media, resilience, recovery and advocacy.
“The book is unique because it gives needed voice to people’s concerns,” Lewis said. “It places emphasis on their lived experience and adopts a strengths-based approach to understand and address self-injury. Part of this approach involves explicit recognition of individuals with lived experience as experts in their own right.
“In order to best support people who self-injure and foster recovery, we need to prioritize what is important to them. This is essential to propelling the field forward.”
Lewis and Hasking devote a chapter to re-thinking how people with lived experience can play vital active roles in moving the field forward, as research participants, informing the focus of study and knowledge dissemination. They also write about how people with lived experience can play key roles in enhancing treatment and in advocacy.
“I’d like to think the book validates the many experiences of people who self-injure by shedding needed light on them,” Lewis said.
1 in 5 people self-injure, behaviour can be indicative of suicidal risk
One in five people globally report self-injury; contributing factors include mental health difficulties such as depression, eating disorders, anxiety and trauma. Research has shown that while self-injury is not engaged in for suicidal reasons, it represents the most reliable predictor of later suicidal thinking and behaviour.
A large obstacle in promoting self-injury recovery for many people is the complex stigma that surrounds it. “Its impact is profound,” Lewis said. It perpetuates myths that people who self-injure are manipulative, attention-seeking, or weak and unable to cope. That can leave people feeling hopeless, without value and isolated.
“A major driving force behind the book was to tackle a lot of these issues head-on, and to ensure our field is maintaining a connection to larger movements in broader mental health that emphasize strengths-based approaches,” he said.
Traditional research has often focused on people’s vulnerabilities, taking a deficit-based approach, Lewis explained. A strengths-based approach is founded in the belief that everyone who self-injures, regardless of their experience, possesses strength of some kind. These strengths can initiate and fuel recovery, which helps people to develop resilience and meaning in their lives, he added.
Taking an approach that emphasizes people’s strengths can also help foster a more compassionate understanding of self-injury among people who can play key support roles. “If we don’t have a dual focus – one that acknowledges that individuals with lived experience may need help in some areas but still possess strengths – we’re doing them a disservice,” he said.
Language perpetuates stigma, shame
A large part of the book tackles stigma with the goal of enhancing how self-injury and people who have lived experience are understood. This involves addressing language and its role in stigma. “We know that language is obviously a very powerful form of communication,” said Lewis. “It shapes and frames how we see the world and the people in it.”
Many terms historically used to refer to self-injury and people who self-injure can unintentionally create and foster shame, he continued. People who have lived experience are very much aware of these framings and are consequently less likely to come forward, talk about their experiences and seek support.
The initial interaction someone has when talking about their lived experience is pivotal, Lewis said. If responded to inappropriately, people can feel unvalidated, unaccepted, and misunderstood, ultimately believing they are alone in their experience. “This may further silence them and contribute to greater reluctance to reach out,” he added. “Given what we know about the impact of self-injury, including its association with suicide, that’s highly worrisome.”
The book also contains background and foundational knowledge about self-injury that puts the behaviour into context and eliminates misunderstanding and stereotyping. Self-injury is often a “cardinal signal of distress,” Lewis said. “There are so many complex and intersecting factors that account for self-injury – no two experiences are identical, which is why a person-centered approach is needed to understand each person’s unique set of experiences.”
Many people who self-injure do not tell anyone and actively work to hide it (counteracting the “attention-seeking” myth), disclosing only very selectively when they feel ready or safe to do so.
Lewis hopes the book helps individuals who self-injure and the people in their lives who can play different supportive roles, including mental health and medical professionals and trainees, medical professionals and trainees, school professionals, families, friends and partners.
“This book is really a culmination of the research and advocacy that we and many others have been involved in over the past several years,” said Lewis.
“Writing about self-injury in a way that helps to destigmatize the behaviour and people who self-injure are critical steps toward situating individuals’ experiences within an appropriate context,” he said.
“This, in turn, allows those who can play key support roles to adopt a more understanding and compassionate lens when not only thinking about self-injury but ultimately when responding to and supporting people with lived experience.”
Dr. Stephen Lewis