Sinderlie Prankard asks: has Facebook highlighted the problem of self-harm or exacerbated it?
The death last year of actor Robin Williams once again brought mental health problems to public attention. Preliminary results of the forensic examination revealed that Williams’s life ended from asphyxia due to hanging, however he was also found with acute, superficial wounds on the inside of his left wrist. It is hard for many of us to imagine why someone who appeared to have it all would cause themselves harm but sadly Williams isn’t an isolated case. Other celebrities such as Johnny Depp, Megan Fox, Angelina Jolie and Russell Brand are known to have self-harmed through cutting. Disorders of the mind such as bi-polar and depression can lead to self-harming and often seem to go hand in hand with creative genius.
Although we may struggle to understand depression in those who have achieved the level of success most of us can only dream of, we do seem to have a collective sympathy. There was a massive outpouring of grief across social media following the death of Williams. We seem to understand the stress of those whose lives are constantly scrutinised. So why can we not be as kind to people who aren’t in the public eye? Depression isn’t unique to the rich, successful, the funny or the geniuses; those who are considered public property. It can strike any one of us at any time.
Most of us aren’t comedians, famous or intellectual masterminds and yet depression and self-harm appear more prevalent now than in earlier generations. Is it simply that with improved communications and immediate access to the news we are more aware of the existence of mental illness? Or could it possibly be that the curse of the famous is raining down on us through the power that is Facebook? We know that depression is nothing new. Stress is also nothing new but the current epidemic of self-harm amongst the young seems to be the blight of this generation.
Dr Diane Carpenter, a Mental Health Lecturer at the University of Southampton and a member of that university’s ethics committee suggests, ‘actual incidence of depression and self-harm probably isn’t any higher, but because it’s played out in social media we know more about it now.’ She adds, ‘It’s a bit like issues with sexual abuse. It has always occurred, but when Esther Rantzen did her media coverage and developed Childline, suddenly sexual abuse seemed to have increased to epic proportions.’ However, according to figures obtained by BBC Newsbeat recently, there is a 20% rise in the number of adolescents aged 10 to 19 who are admitted to hospital because of self-harm injuries across England, Wales and Northern Ireland. This suggests that the number of young people experiencing mental health problems is on the increase. Dr Carpenter explains, ‘There are probably some groups where it has become less of an issue and others where it has become more of an issue. Young people are a particularly vulnerable group. Social websites could well be an influence.’
Like the famous, our own lives are increasingly played out across the public arena of social networks. There is an attempt by most of us to showcase our lives as idyllic; an edited montage of happy ‘selfie’ snaps, fun gatherings and excitement. Author, journalist and television personality, Will Self, describes social media as ‘an arena which is inherently psychotic.’ We give others a false impression of our lives and they in turn provide a false impression of theirs. Relentless displays of optimism such as the posting of holiday snaps, whilst still on holiday, begs the question, how good a time is it if you feel the need to constantly update your status? We are by nature, competitive, but this has taken ‘keeping up with the Jones’s’ to another level. Dr Carpenter suggests that these demonstrations are masking some underlying issues such as low self-esteem. We are putting unrealistic expectations on ourselves and if that can be considered unkind to us, then we are being equally unfair to our children in allowing them access to such sites
If mental illness and self-harm amongst young people are no more of a problem than in previous generations, and only in the public consciousness due to broader communication offered by online sites, why then does cutting seem to be a more of a issue in recent times? ‘Self-harm amongst adolescents has always been a concern,’ says Dr Carpenter, ‘but the means of self-harm seem to change.’ According to a 2007 survey by the National Institutes of Health, cases of anorexia and bulimia escalated during the 1970s and 1980s. Young people, particularly girls, were more likely to self-harm by these methods. If someone within your peer group was anorexic then it was more likely others would try it. It is the same with cutting. The most common form of self-harm currently is cutting and, as with anorexia in previous decades, if someone within your peer group, either physically or online, ‘cuts’ then others are likely to follow suit. Unfortunately, the online community means the number within your peer group is much higher than in previous generations, and therefore young people are more likely to come into contact with someone who ‘cuts’.
It does seem to have become almost the norm for young people who self-harm to talk about it on social media, and even upload photographs of their ‘injuries’. Pictures of limbs uniformly sliced by razor blades are all too common. Surely social media sites such as Facebook and Twitter have an ethical duty to protect their members from exposure to posts such as these, but as it is so difficult to police, and the question of who would pay for that policing remains unanswered, inappropriate statuses and photos, remain all too common. Offensive material can be removed, but it doesn’t appear to be as effective as it could be. Neither do they seem to be focusing in the right areas. Recently there have been reports of women who have been discussing breastfeeding, or pictures where they might have been breastfeeding their baby, and those items have been thought to be offensive and removed. Yet children and young people can talk about their self-harming behaviours, and that isn’t addressed.
Facebook has an age restriction, however I’ve discovered that my own children lied about their ages and, as no proof was required, it was all too easy for them to set up accounts. So to what extent should parents be responsible for their children’s use of, and the content they upload, to such sites? Parents could be demonised by their offspring should they impose restrictions on the use of social media but if the use of them increases the risk of self-harm do we not have a duty of care? According to Dr Carpenter parents have a responsibility to talk to their children about the problems associated with living your life on line but suggests that schools do as well.
According to the National Association of Head Teachers and the Association of Teachers and Lecturers, spending cuts to local services have left schools without as much expert medical help as in the past. As a result schools are struggling to cope with the vast numbers of pupils who self-harm or are affected by cyber-bullying. Dealing with the problem once it has occurred is probably the emotional equivalent of putting a ‘there, there’ plaster on a child’s cut. To be of any real help, schools need to educate pupils on the negative side of social media and the long term consequences of self-harm.
Despite there being an increasing number of adolescents self-harming or taking their own lives due to cyber-bullying, NHS spending on children’s mental health services has been cut. The mental wellbeing of the young should be a priority. Without the help they need, the risk of ongoing problems throughout adulthood increases, which in the long run, could cost the tax payer even more. The Government has responded to these concerns. Care Minister Norman Lamb said, ‘It is crucial that young people get the help they need so we are investing £150m over the next five years to help them deal with issues of self-harm.’ According to Dr Carpenter the Government is piloting an NHS scheme called IAPT which provides cognitive behavioural therapy. This is a talking therapy which can help manage problems by changing the way a person thinks and behaves. It has proven to be a successful treatment in cases of self-harm in adolescents. However, we still need to address the underlying issues which incite young people to hurt themselves.
Facebook does have a Code of Conduct but given that more than 500 million people subscribe to it, it is virtually impossible for it to be regulated thoroughly. Parents, schools and social media need to be jointly proactive in tackling the problem. So has the internet exacerbated or just highlighted a pre-existing problem? According to Dr Carpenter, ‘It’s probably a bit of both.’
On Thursday 27 February 1986 the focus of an episode of the BBC soap opera EastEnders was the tempestuous relationship between publican, ‘Dirty’ Den Watts and his alcoholic wife, Angie. Having discovered her husband’s affair, a distraught Angie swallows a cocktail of aspirin and gin. Following the airing of this episode it was reported that there was an increase in the number of parasuicides. (A parasuicide is an apparent attempt at suicide or suicidal gesture, in which the aim is not death). Contagion suicide, or copycat suicide, is as the name suggests, the process whereby one suicide or suicidal act within a school, community, or geographic area increases the likelihood that others will attempt or complete suicide. In the wake of the EastEnders episode, someone tried, unsuccessfully, to sue the BBC, suggesting that they were influenced by the programme. It was impossible to prove that any increase in suicide attempts was the direct result of that one episode. However, it is the reason the BBC now adds disclaimers at the end of certain episodes, offering advice and contact numbers, should anyone have been affected by what they’ve viewed. Evidence suggests that cutting is the self-harm equivalent to suicide contagion.
Stephen, aged 18 from Portsmouth, had become involved with a girl who had a history of depression and self-harm and who regularly displayed evidence of both across social networking sites. Before long Stephen too became depressed and began self-harming. When the relationship came to an abrupt end, he was the victim of a cruel online assault from members of the girl’s family and as a result, took a significant overdose and ended up in hospital. ‘I didn’t want help,’ Stephen said. ‘I just wanted to be allowed to die.’ After three days on an IV drip, Stephen was interviewed by one of the hospital’s psychiatric team and deemed fit enough to be discharged. The interviewer, it turned out, was a social worker, as the hospital had a very limited psychiatric team, and could not afford a psychiatric doctor.
Stephen was referred by his GP to a crisis team. Despite Stephen’s determination to make another suicide attempt he wasn’t hospitalised. Phil, a member of the acute care team who doesn’t wish to be fully identified, said ‘the reason Stephen wasn’t admitted to hospital was that there were no beds available.’ According to Dr Carpenter, ‘a lot of acute admission wards are over subscribed so the bed capacity is something like 110-120%, which means that at any one time a proportion are on home leave or weekend leave and their bed is used until they come back. They just hope there will be enough going out on leave to accommodate those who need beds. As you can imagine, that doesn’t always work. With young people, there is Children and Adolescent Mental Health Services (CAMS), community and residentially based, however, the beds available are even fewer.’
The acute team initially visited Stephen every day, reducing their visits when he was considered ‘safe enough’. Acute care only lasts approximately four weeks, and each visit, due to the pressures on their time, was relatively short. It was very much down to Stephen’s family to keep him safe. Phil said, ‘Unfortunately, like everything else, it’s all down to cost.’
Photography by Sarah Cheverton.