Self-Injury, Black Youth, and the Perils of Cultural Stigma

White painted fence displays shadow of teen boy taking adult's outstretched handCultural stigma related to African-Americans and therapy attendance is well known. Seeing therapy attendance as a sign of weakness, believing that personal information should not be shared outside of the family, and preferring spiritual resources instead are among common reasons some African-Americans refrain from seeing mental health professionals. Additionally, a history of misdiagnosing African-Americans and a limited number of therapists of color are impediments to African-Americans entering therapy.

Discrimination, bias, and minority stress increase the mental health vulnerability for many African-Americans (USHHS Office of Minority Health, 2016), including African-American youth. As an attempt to cope with overwhelming stress or emotions, some African-American youth engage in self-injurious behavior, such as cutting. As defined by the International Society for the Study of Self-Injury (ISSS, 2016), self-injury is “the deliberate, self-inflicted destruction of body tissue without suicidal intent and for purposes not socially sanctioned.” Parents often feel at a loss for understanding these behaviors or accessing appropriate services for them.

According to information from ISSS, 12% to 24% of young people engage in self-injury; however, much of the attention related to cutting focuses on the experiences of white youth, while only a small amount of research on self-injury explores the experiences of ethnic minority youth (Gratz, Latzman, Young, et al., 2012). Consequently, cutting may seem like something done only by white youth. In fact, many of the African-American parents I see in my practice express surprise at their child’s self-injurious behavior, believing cutting was not something in which black youth engaged.

Viewing cutting and other acts of self-injury (hitting, burning, scratching, biting) as a “white thing” is problematic for a number of reasons. First, African-American parents may be in denial of the seriousness of their child’s emotional well-being and thus delay seeking treatment for their child. Second, African-American parents may feel embarrassed about their child’s behavior, seeing their cutting as a reflection of their parenting, which can also promote delayed entry into mental health services. Third, African-American youth are faced with consolidating their identity, including integration of their racial/ethnic identity. A challenge faced by some African-American youth is being accused of “acting white” or “not being black enough.” Viewing cutting as a white issue adds unnecessary challenge to the already stressful process of ethnic identity development.

The idea of strength within the African-American community has been effective in persevering through historical and present-day hardships. However, the idea of perpetual strength provides little space for African-American youth to express the distress they feel; hence cutting becomes a viable option.

Unknowingly, African-American parents can also promote stereotypes that get in the way of getting effective help for their children. Comments such as, “You are better than this” and “You don’t have any reason to do this” are meant to motivate changed behavior in their child. However, such comments unintentionally communicate the expectations that African-American youth should be stronger and that negative internal or external stressors should not affect them. The idea of strength within the African-American community has been effective in persevering through historical and present-day hardships. However, the idea of perpetual strength provides little space for African-American youth to express the distress they feel; hence cutting becomes a viable option.

Punishing youth for their self-injurious behavior can also backfire. Again, well-intended parents may use punishment as a means for curbing cutting behavior. But punishment also runs the risk of their child becoming better skilled in hiding their self-injury. If parents are aware of cutting, they can talk with their child about it and seek solutions. However, if an adolescent or teen becomes skillful in hiding their cutting, precious time is lost in addressing the real needs of their child. Furthermore, the child is likely cutting because they feel bad; punishing them or inducing guilt or shame is likely to only make them feel worse.

Fortunately, there is a growing push to end cultural stigma associated with mental health services, making counseling services more accessible to African-American families. Research is better extending to the specific needs of African-American youth. In fact, one study in the United Kingdom found that young black females were more likely to engage in self-injurious behavior than other groups (Cooper, Murphy, Webb, et al., 2010).

To support African-American youth engaging in cutting:

  • Accept that African-American youth engage in self-injurious behavior. Cutting is not a “white issue,” but rather a very real concern within the black community. Moving from denial and shock to a place of acceptance regarding cutting can aid in finding the best resources for your child.
  • Look for warning signs. This includes marks on wrists, arms, legs, the abdomen, or other areas of the body. This also includes changes in behavior such as wearing long sleeves in warm weather, isolation, and poorer functioning at home, school, or with peers.
  • Address the issue. Talk directly to your child about your observations and concerns. Talking will not encourage the behavior, and it is faulty to think your child will just “grow out of it.” Addressing the issue can help your child express stressors they are experiencing. Avoid shaming, yelling, blaming, or punishing the behavior, which can result in secrecy or continued self-injury.
  • Seek treatment. African-American youth face numerous stressors that can lead to the development of self-injury. Among others, stressors include bullying, racial harassment, depression, anxiety, discrimination, and vicarious trauma. Mental health treatment can facilitate the development of safer strategies for handling emotions, as well as targeting systemic issues that impede on your child’s mental well-being.

References:

  1. Cooper, J., Murphy, E., Webb, R., Hawton, K., Bergen, H., Waters, K., & Kapur, N. (2010). Ethnic differences in self-harm, rates, characteristics and service provision: three-city cohort study. British Journal of Psychiatry, 197, 212-218.
  2. Gratz, K. L., Latzman, R. D., Young, J., Heiden, L. J., Damon, J., Hight, T., & Tull, M. T. (2012). Deliberate self-harm among underserved adolescents: The moderating roles of gender, race, and school-level and association with borderline personality features. Personality Disorders: Theory, Research, and Treatment, 3(1), 39-54. doi:10.1037/a0022107
  3. International Society for the Study of Self-Injury (ISSS, 2016). Fast facts. Retrieved from http://itriples.org/redesadmin15/fast-facts/
  4. U.S. Department of Health and Human Services Office of Minority Mental Health. (2016). Mental health and African Americans. Retrieved from http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=24

© Copyright 2016 GoodTherapy.org. All rights reserved. Permission to publish granted by Kimber Shelton, PhD, therapist in Duncanville, Texas

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • lanna

    lanna

    October 6th, 2016 at 6:38 AM

    I am not sure why there is this stereotype against those who seek treatment with therapy within the black community. Just because you seek out help does not mean that you are weak, it means that you are smart enough to understand that this is not something that you can handle alone.

  • Genevieve

    Genevieve

    October 6th, 2016 at 9:12 AM

    All parents and grand parents need to be aware of how kids can be hurting themselves without anyone ever knowing it, and keeping secrets. We have to be diligent and keep our eyes wide open.

  • dan

    dan

    October 6th, 2016 at 1:57 PM

    People all over the world just need to get over this stigma thing. It doesn’t matter if you think that something will make you look weak, it won’t. It only makes you look weak when you refuse help when you could have used it. And to refuse that for my child to me is unthinkable. I would love it if everything could always be handled in house but it can’t and sometimes you have to be willing to let someone else do some of the heavy lifting for you.

  • Russell

    Russell

    October 7th, 2016 at 10:34 AM

    This is something that is probably way more prevalent than we often think and it is not just limited to one specific community. There are many families who would never think that look for mental health care because this would be something that you just don’t do.

    I say all of that is old school thinking to me, that there have been way too many advances in this field over the years to ignore the good that it can do. But you know, it can be hard to change someone’s mind when this is something that they have always thought and believed.

  • anonymous

    anonymous

    October 7th, 2016 at 2:39 PM

    yeah I would never admit that I am cutting because my dad would skin me alive. i’m trying to work on it myself

  • Lorraine

    Lorraine

    October 9th, 2016 at 1:48 PM

    Dear anonymous,

    You are not alone, as a parent we make mistakes, as a nurse you are not alone. If you can’t talk to your parents PLEASE, talk to a friend, school nurse, counselor someone. You Are Important

  • Lorraine

    Lorraine

    October 9th, 2016 at 1:50 PM

    Thank you, Dr Shelten for addressing the issue.

  • Christa

    Christa

    October 10th, 2016 at 8:27 AM

    I never remember anyone doing things like this when I was a teenager but now it seems like this is the thing that so many kids do.
    I would be afraid to not talk to my children about it because this behavior could very easily morph into something else without paying attention to it.

  • Jayne

    Jayne

    October 11th, 2016 at 10:29 AM

    The more concerned we are about what we think that someone else is going to think of us then the greater the likelihood is that we are never going to get the help that we need because we are too scared to ask for it.

  • Phyllis

    Phyllis

    October 15th, 2016 at 1:12 PM

    I guess that it is true that there are certain issues that we tend to think of as only a problem that certain races pr groups have to deal with, ignoring the fact that mental health issues do not discriminate based on race or color.

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