Similarities should not lead us to conclude equivalence. There are ways in which some forms of self-harm (particularly cutting) can resemble attempted suicide. Yet, the two behaviors are quite distinct and unique and warrant different counseling approaches. Attention to the unique motives behind self-injurious behavior allows for more effective counseling.
There is an understandable reason that people often assume self-harm is attempted suicide. Cutting, of example, can be practiced by people struggling with both temptations. So, some people do indeed cut themselves as an attempt to kill themselves. Furthermore, the idea that pain can be used to draw comfort is so foreign to many that it seems impossible. We seem designed to avoid pain, resist damage, and run from harm. It’s a built-in defense mechanism, and therefore many cannot understand self-injurious behavior. It seems the only logical reason to harm oneself intentionally is because you wish to die. Drawing this conclusion, however, can be more discouraging to those who self-harm, and can increase the sense that they are misunderstood and alone. Good Biblical counselors want to patiently seek to understand individuals and distinguish individual motives for behavior. Self-harm has significantly different motivations than suicide.
Proverbs 20:5 teaches us that it takes wisdom to truly draw out the heart of another person. So the author of the proverb writes:
The purpose in a man’s heart is like deep water, but a man of understanding will draw it out.
The language here conjures up imagery of a deep well and the idea of a man intentionally and carefully drawing up the bucket out of the bottom. Far too often we see a person’s problems or circumstances and we draw immediate conclusions about what is happening. We assume that we know what is in their heart because of the surface level symptoms. Proverbs 20:5 warns us that a man’s motives are like “deep water.” To plumb those depths you will have to be a “man of understanding.” We will need to do more drawing out than simply noticing presenting problems and surface level symptoms. That is particularly true in cases of self-harm.
While self-harm may look like other problems, it has its own logic and good counselors must seek to understand it. In helping to counsel others we must ask questions about the motives that drive behavior. Suicide has the clear intent to end life. Self-harm, however, is a maladaptive coping behavior that is intended to help someone live. So, for example, self-harm is often used as a means of attaining emotional relief. Unwanted, intense negative emotions may begin to overwhelm someone and self-harm is viewed as a means to escape those feelings. The intent is clearly very different from suicide. One has the goal of ending life, the other has the goal of coping with life. While they may share similar symptoms the goal is entirely different.
Treating self-harm and suicide as the same will result in a failure to plumb the depths of man’s heart. That deep water must be drawn out with care and patience. A failure to understand the reasons behind a behavior not only result in discouraging the person who struggles, but it results in deficient help too. For, a failure to understand the reasons, indeed a failure to understand the problem, means we are attempting to offer counsel and care that has no direct bearing on the issue at hand. Drs. Kim Gratz and Alexander Chapman offer a careful warning to caring professionals:
So, please remember that self-harm and suicide attempts aren’t at all the same. In fact, these behaviors are very different. People who try to end their own lives are generally in a state of extreme hopelessness and may have pretty much given up on themselves and the world. People who self-harm, on the other hand, are trying to cope with their problems in the way that seems best to them at the time. Although they might be experiencing incredible emotional pain, they’re not trying to escape all of life’s problems forever. They’re attempting to cope. And, we believe that this is very different from a suicide attempt. (Freedom from Self-Harm, 27)
They’re right. Attempted suicide and self-harm are two very different problems that share some surface level similarities.
This is not to suggest, of course, that self-harm can’t result in suicide. In some cases accidental death may occur. The longer someone engages in a destructive behavior the more tolerance and comfort that they develop with that behavior. So initially, someone may be very careful about how they harm themselves but overtime they get used to their process and lose focus and carelessness may set in. At other times, tolerance to a behavior means that greater risk is needed to receive the same result. Increased risky behavior also increases the chances of accidental death. It is also the case that prolonged involvement in self-harm can increase personal shame and despair, which may then lead someone to shift motives from coping to actual suicide. Still, however, we should not immediately assume that self-injurious behavior is an attempted suicide. Draw out the water carefully and seek to understand the purposes of a man’s heart.
In our counseling training at Cornerstone we often state that we don’t treat problems, we care for people. There is a big difference between those two mentalities. Treating problems means using formulas to address issues. Caring for people recognizes the unique features of a person’s situation and motivation. Caring for people means recognizes that while their symptoms may look similar to a specific type of behavior or struggle, wisdom says I need to understand their heart. The purpose’s of an individual’s heart are like deep waters, Biblical counselors must be men and women of understanding to draw out those purposes.