ABSTRACT
Traumatised people who attack, poison or mutilate their own bodies do so as a defence against a set of impulses that might otherwise result in them attacking the bodies of others and also to preserve themselves from internalised threats to their own minds, which, unopposed, they fear would cause the `insurrection' that would drive them mad. The phenomenon that is self-harm is made all the more complex by widespread and pervasive attitudes within modern mental health, social care, education and criminal justice systems to the effect that people who do harm or neglect themselves do so deliberately. Consequently, societal and professional attitudes, rooted in paradigms of rationality, are too often judgemental and derogatory ± and therefore also harm-full. The quasirational strategies, policies, procedures and clinical models that are then put in place to respond to the problem of `deliberate self-
harm' frequently become thoughtless and, at times, actively punishing. Patients who `deliberately' attack their own bodies are therefore experienced as `deliberately' manipulative, `deliberately' attention seeking and `deliberately' refusing to be well and to conform to societal ideas about what `being well' entails. These attitudes serve only to humiliate the person with the mutilated body and to further reduce their self-esteem; and so exacerbate the `presenting problem'. At this point, the parallel violence between the individual and the system of care has become reciprocal and the question about who, or what, started it becomes moot as each party becomes locked into a vicious cycle rooted in a mutual attribution of malign intent. Sufferer and carer alike ®nd themselves locked in reciprocal and identical complaints: `why do you treat me this way?'.
