The Psychology of Self-Injury: Exploring Self-Harm & Mental Health

Manga are comics or graphic novels originating from Japan. Not only do manga reveal and reinforce cultural values, beliefs, and norms, particularly in Japan, but they can also be used as a teaching tool and source of information. Manga and other comics can be used in medicine to learn and teach about illness and to build empathy. They also have the power to shape public understanding of mental health issues, even nonsuicidal self-injury (NSSI).

In this episode, Dr. Yukari Seko explains how self-injury and the characters who engage in the behavior are portrayed in Japanese manga. She also discusses the importance of manga within Japanese culture. Below is a reference (with a link) to her research paper along with a breakdown of common genres of manga and, based on her study, just how many characters within each genre engage in self-injury and self-harm:

GENRES OF MANGA (& the number of characters depicted who self-injure, based on Dr. Seko's study):

1. shōjo: comics for girls 18 and younger (written for girls, by girls) - depicted 10 characters who self-injure

2. shōnen: comics for boys 18 and younger (written for boys, by boys, about boys) - depicted 0 characters

3. seinen: comics for young males age 18-30 - depicted 6 characters, portrayed as menhera (a derivation of "mental health-er," a person with mental instability or "mentally vulnerable damsels in distress")

4. josei: comics for young females 18-30 - depicted 1 character

5. Boy's Love: a subgenre of josei manga featuring erotic relationships between male characters - depicted 1 character

6. seijen: comics for grownups - depicted 0 characters

7. redicomi: "Lady's Comic" for adult women - depicted 0 characters

8. slice-of-life: genre that features realistic depictions of everyday life.

Seko, Y., & Kikuchi, M. (2021). Self-injury in Japanese manga: A content analysis. Journal of Medical Humanities, 42(3), 355-369.

Seko, Y., & Kikuchi, M. (2022). Mentally ill and cute as hell: Menhera girls and portrayals of self-injury in Japanese popular culture. Frontiers in Communication, 7.

To learn more about Dr. Seko and her work at Ryerson University, visit https://www.ryerson.ca/procom/people/yukari-seko/.

To learn more about graphic medicine and novels referenced in this episode, see Williams, I. C. M. (2012). Graphic medicine: comics as medical narrative. Medical Humanities, 38(1), 21-27.

Follow Dr. Westers on Instagram and Twitter (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter (@ITripleS).

The Psychology of Self-Injury podcast has been rated #5 by Feedspot in their "Top 15 Clinical Psychology Podcasts You Must Follow in 2021" and by Welp Magazine in their "20 Best Injury Podcasts of 2021."

How can schools appropriately respond to students who engage in nonsuicidal self-injury (NSSI), whether the behavior occurs at home, on school grounds, or elsewhere? What protocols exist to support schools to better respond to students who self-injure? What role does liability play? In this episode, Dr. Nancy Heath of McGill University in Montreal, Canada explains how schools can support students who engage in self-injury and self-harm.

Learn more about Dr. Heath's work here, and learn more about her work with the Development and Intrapersonal Resilience (DAIR) Research Team here. Learn more about the International Consortium on Self-Injury in Educational Settings (ICSES) at http://icsesgroup.org/.

Self-injury Outreach & Support (SiOS) offers resources for schools here and a list of do's and don'ts here. Visit SiOS at http://sioutreach.org and follow them on Facebook (www.facebook.com/sioutreach) and Twitter (https://twitter.com/sioutreach).

Below are links to some of Dr. Heath's research as well as resources referenced in this episode:

1. Hasking, P. A., Bloom, E., Lewis, S. P., & Baetens, I. (2020). Developing a policy, and professional development for school staff, to address and respond to nonsuicidal self-injury in schools. International Perspectives in Psychology: Research, Practice, Consultation, 9(3), 176.
2. Berger, E., Hasking, P., & Reupert, A. (2015). Developing a policy to address nonsuicidal self-injury in schools. Journal of School Health, 85(9), 629-647.
3. Lloyd-Richardson, E. E., Hasking, P., Lewis, S.P., Hamza, C., McAllister, M., Baetens, I., & Muehlenkamp, J. (2020). Addressing self-injury in schools, part 1: understanding nonsuicidal self-injury and the importance of respectful curiosity in supporting youth who engage in self-injury. NASN School Nurse, 35(2), 92-98.
4. Lloyd-Richardson, E. E., Hasking, P., Lewis, S.P., Hamza, C., McAllister, M., Baetens, I., & Muehlenkamp, J. (2020). Addressing self-injury in schools, part 2: how school nurses can help with supporting assessment, ongoing care, and referral for treatment. NASN School Nurse, 35(2), 99-103.
5. Lewis, S. P., Heath, N. L., Hasking, P. A., Hamza, C. A., Bloom, E. L., Lloyd-Richardson, E. E., & Whitlock, J. (2019). Advocacy for improved response to self-injury in schools: A call to action for school psychologists. Psychological Services, 17(S1), 86–92.
6. De Riggi, M. E., Moumne, S., Heath, N. L., & Lewis, S. P. (2017). Non-suicidal self-injury in our schools: a review and research-informed guidelines for school mental health professionals. Canadian Journal of School Psychology, 32(2), 122-143.
7. Whitlock, J. L., Baetens, I., Lloyd-Richardson, E., Hasking, P., Hamza, C., Lewis, S., Franz, P., & Robinson, K. (2018). Helping schools support caregivers of youth who self-injure: Considerations and recommendations. School Psychology International, 39(3), 312-328.
8. Hasking, P. A., Heath, N. L., Kaess, M., Lewis, S. P., Plener, P. L., Walsh, B. W., .Whitlock, J., & Wilson, M. S. (2016). Position paper for guiding response to non-suicidal self-injury in schools. School Psychology International, 37(6), 644-663. Open access here<...

What is the prevalence of self-injury among adults over age 40? And what differentiates those who report having stopped self-injuring from those who continue to self-injure? How do they differ from those under age 25 who self-injure, including related to suicidal thoughts and behaviors? In this episode, psychologist Dr. Sarah Swannell from Australia discusses the prevalence of self-injury and self-harm among individuals over age 40 and stigma around the behavior.

Learn more about Dr. Swannell and her work at https://sarahswannell.com.au/. Below are links to some of her research referenced in this episode:

1. Martin, G., & Swannell, S. (2016). Non-suicidal self-injury in the over 40s: Results from a large national epidemiological survey. Epidemiology, 6(5), 266.
2. Martin, G., Swannell, S. V., Hazell, P. L., Harrison, J. E., & Taylor, A. W. (2010). Self-injury in Australia: a community survey. Medical Journal of Australia, 193(9), 506-510. (Australian National Epidemiological Study of Self-Injury [ANESSI])
3. Troya, M. I., Dikomitis, L., Babatunde, O. O., Bartlam, B., & Chew-Graham, C. A. (2019). Understanding self-harm in older adults: A qualitative study. EClinical Medicine, 12, 52-61.

Follow Dr. Westers on Instagram and Twitter (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter (@ITripleS).

The Psychology of Self-Injury podcast has been rated #5 by Feedspot in their "Best 20 Clinical Psychology Podcasts" and by Welp Magazine in their "20 Best Injury Podcasts."

A lot of therapies address the context in which nonsuicidal self-injury (NSSI) and self-harm may occur, but only a few treatments have been designed to address NSSI specifically. In this episode, we dive into one of these treatments: Treatment for Self-Injurious Behaviors (T-SIB). Dr. Peggy Andover, its lead developer, walks us through the 9 sessions of T-SIB, including the personalized modules of sessions 7 & 8.

Learn more about Dr. Andover and her work in the Mood and Behaviors Lab at https://www.fordham.edu/info/23638/mood_and_behaviors_lab and reach her at [email protected]. Follow her on Twitter @DrPeggyAndover. Below are links to some of her research and the resources referenced in this episode:

Moderators of treatment response to an intervention for nonsuicidal self-injury in young adults (2020)

An intervention for nonsuicidal self-injury in young adults: A pilot randomized controlled trial (2017)

Development of an intervention for nonsuicidal self-injury in young adults: An open pilot trial (2015)

Follow Dr. Westers on Instagram and Twitter (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter (@ITripleS).

Does it matter where on the body someone cuts, whether on typically more visible sites such as the forearm and wrist, or in typically more concealed areas, such as the upper arm and torso? Is there a relationship between where someone cuts on their body and their likelihood of continuing to engage in the behavior? In this episode, Dr. Gardner discusses her research on the psychology of self-injury location and where on the body one chooses to self-injure as well as intrapersonal (emotional) reasons and interpersonal (social) reasons for engaging in self-injury and self-harm.

Learn more about Dr. Gardner and her work at https://www.uclan.ac.uk/academics/dr-kathryn-gardner, and follow her on Twitter @KathrynJGardner. Below are links to some of her research referenced in this episode:

1. Gardner, K. J., Bickley, H., Turnbull, P., Kapur, N., Taylor, P., & Clements, C. (2020). The significance of site of cut in self-harm in young people. Journal of Affective Disorders, 266, 603-609.
2. Gardner, K. J., Paul, E., Selby, E. A., Klonsky, E. D., Mars, B. (2021). Intrapersonal and interpersonal functions as pathways to future self-harm repetition and suicide attempts. Frontiers in Psychology, 12, 688472.

Follow Dr. Westers on Instagram and Twitter (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter (@ITripleS).

The Psychology of Self-Injury podcast has been rated #5 by Feedspot in their "Best 20 Clinical Psychology Podcasts" and by Welp Magazine in their "20 Best Injury Podcasts."