Relating to Self-Harm by Incarcerated Women

Self-harm by women prisoners can be a sign of hope, communicating private pain.

Reviewed by Abigail Fagan

Key points

• Women in custody have high rates of self-harming, often related to histories of complex trauma.
• Self-harming is a meaningful behaviour that expresses pain and communicates experiences.
• Clinical work with women in custody can reveal their resilience and enhance their hope for the future.

This is Part 1 of a series.

For many women, particularly those who have suffered abuse that is too traumatic to put into words, marking pain through their bodies can offer release and comfort. In the prison system in the United Kingdom, self-harm is a major issue, particularly for women. Overall, women in prison are much more likely than men to self-harm. In the United Kingdom in 2021, women made up 22% of all self-harm incidents despite making up only 4% of the prison population.

It is important to understand self-harm as a form of communication, and sometimes, a kind of currency with which to purchase care, making visible invisible pain. There is an expressiveness, a visceral directness and an urgency to marking and maiming the skin, conveying truths about grief, shame, pain and trauma that the spoken or written word cannot. It can be painful and distressing to hear patients talk about the harm they inflict on themselves and to witness the labyrinthine scar patterns on their arms or legs. They often describe it as a chosen means to express themselves.

Self-harm can also be a compulsion to a means of release that is very hard to give up. It is not always a public expression or call for help. Many patients I have worked with outside custody have disclosed secret rituals of self-harming with no outward signs of disturbance or violence. Though this can be shameful, it can feel like their only lifeline. It can communicate emotional states with an immediacy, at a visceral level, as psychologist Gillian Straker describes as 'signing with a scar.'

I illustrate this with a young woman I worked with in custody, whom I call Skye. She was well known in the prison as being one of the women who harmed herself most days. Although she was 24 when we met she appeared far younger wearing, shabby prison-issue clothing and a ponytail. At first, she was loathe to discuss her past. Like so many of the women in prison she had experienced disruptions in her early life, spending time in and out of the care system, witnessing violence at home and getting involved with drugs as a teenager. Despite this, she showed a real wish for relationships and quickly became attached to staff, including me.

Eventually, she began to tell me more about the origins of her self-harm during her adolescence in care. She had no one to turn to or trust, and when she confided to a residential care worker that his colleague had handled her roughly and called her names she was not believed. When another child sexually assaulted her, she tried to tell staff and was told that she had exaggerated. She felt she was going crazy and wanted to tell her mother, but she did not visit her as she had promised to. Out of desperation at having been so hurt and ignored, she cut herself on the leg with a razor blade, her way of proving that something bad had in fact happened. Now that she had marked it on her skin no one could deny it, herself included. At that time she told no one and tended to the wound herself. Her pain was unspoken, but this was real. She recalled that even having the blood come out felt good, like a release of tension and a feeling of poison being drained.

This confession was a turning point in our therapeutic relationship. Skye started to use the sessions to trace the history of her self-harming, and revealed that it was not just the currency of communication with others, crying out for care, but also a kind of ‘memory map’ for herself, a way of ensuring that she marked significant events. She painted a picture of a little girl, alone in brutal institutions, who became both the perpetrator of her abuse and its nurse as she then tended to her wounds. She would use anything she could get hold of to cut herself: shards of glass, coat hangers, bra wires. Skye felt in control of her body when she cut herself, as though proving it was hers and hers alone. Although she didn’t like her scars, some of which were in private places, like her breasts or inner things, she respected them because they proved her pain and validated her existence. Sometimes she showed me the scars, now healed, on her wrists or ankles. Although it was hard to look at these I understood that she needed me to bear witness to the memories these encoded and pain endured.

She had a private, secret way of relating to herself, to keeping her important truths and memories preserved, encoded on her body. At the same time, cutting was becoming too violent, and when she was 15 or so she wanted to replace it with something that was less ‘ugly’. At 16 Skye had a butterfly tattooed on her wrist, a delicate image in vibrant colours that she said she would touch whenever she wanted to cut, imploring the pain to ‘fly away’.

Over the course of therapy Skye gradually reduced her ligaturing, and only rarely cut or scratched herself, increasingly using our sessions to talk about the urges to harm herself, rather than actually acting on these. She took on a job helping other prisoners to read, and made one or two friendships with women she trusted. She learned that she could express her feelings and pain in other ways and that her voice was as important as her skin in communicating to others when she felt sad, angry, alone or tormented by memories. She did not give up self-harm altogether but felt that, little by little, she could relate to herself and others without hurting herself in this way, and that she too had hope, as her tattooed butterfly symbolised.

I have described the work with Skye in more detail in If Love Could Kill, where I discuss the traumatic roots of women's violence, against themselves and others.