Self harm

This was sent to me today by a self harmer who did this to her leg.



It catches the emotional core of the Borderline personality. A mixture of anger and fear.

She makes an interesting distinction between ‘playing” self harm and ‘punishing’ self harm. This is playing self harm where the cuts a quite superficial but with punishment self harm the cuts are significantly deeper. And it is the bleeding that has the most psychological significance.



In my book - Working with suicidal individuals - I propose 8 possible motivations for self harming:

1. Self harming as part of gang tattooing behaviour.
2. Self harming to make self feel real which can be found in those who dissociate.
3. Self harming to make self feel something.
4. Self harming used as a means of tension relief and to release pressure build up.
5. Self harming as a physical expression of emotional pain. Self harming is seen as providing concrete evidence of the pain.
6. Self harming as a means to self nurture. It allows the person to care for self as can be found in Munchausen Syndrome.
7. Self harming as a means to punish self and an expression of self hatred.
8. Self harming as a means to manipulate others or as a cry for help.

It would seem that reason number 7 is part of the motivation to self harm. As for seeing the blood and bleeding one would need to enquire as to what it means for the self harmer. It could be a variety of things such as found in reasons # 2, 3, 4, 5 or 6.

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Expressing internalized anger

The internalised anger transaction can take two forms.



Firstly the person receives information of some kind. It is disturbing information to which the person reacts in an angry fashion. The person may have been criticised at work, they may have got a “B” for an assignment when they expected an “A”, they may have been rejected by someone or many, many other possibilities.

Once the information has been acknowledged by the Adult ego state the internalised anger can be expressed in two ways which are indeed quite different in their origin and indicate two quite different psychological processes.

The person can express such anger at the Child ego state from the Critical Parent ego state (CP). This person can be said to have a large internal critic inside their head which at times actively scolds and derides them. The origin of this comes from an introjection in childhood of the parent figures around them.

The child may have observed mother and father being critical of others and themselves and he copies that. However the more potent source of an active internal CP is when the parents have expressed criticism of the person when they were a child. The young child is criticised directly by mother and father. This criticism is then internalised by the youngster and stored in their Parent ego state through the process of introjection.



Often the words the person says inside their head as an adult are exactly the same words that were expressed to the person as a child by mother and father. Or the self criticism is about the same kind of things mother criticised the about child as a youngster.

This type of self directed anger is the least pathological and the easier of the two to treat. As with all treatment contracts it is better to look at increasing some behaviour rather than decreasing behaviour. One would not want the contract to be - “I will decrease my Critical Parent comments”. Instead one would want the contract - “I will increase my Nurturing Parent comments”. If one increases their Nurturing Parent ego state then the Critical Parent will naturally go down. One focuses on the Nurturing Parent rather than the Critical Parent.



Interestingly if a person has a high internal critic directed at self then there is always the potential for it to be directed at others as well. If one is working with a client who has a high CP for self then one also wonders if there are high CP thoughts about the therapist as well.

Some with a high CP for self can also have a high CP for others. Those critical thoughts of others may be openly stated or they may never be stated and just remain internal thoughts. But the potential is always there compared to the individual who does not have a high internally directed CP.

Child ego state anger
As the diagram shows the other type of internally directed anger comes from the Child ego state and is directed at the Child ego state. As a consequence these angry statements are not introjects from our parent figures. Instead they result from decisions that the Child has made about itself. These represent more serious psychopathology and thus the person can be seen to be more ‘damaged’.



The nature of the CP statements tend to be; “I am bad because...”

The Child ego state angry statements may also be precipitated by an event and thus one gets statements like: “I am bad because..... and there is an inherent badness in me anyway”. At other times there may be no precipitating event and the person simply expresses anger at self for no obvious reason. At times this can result in self harming type of behaviour.

Whilst an internal directed CP is common, almost every one has an internal critic of some kind. The internally direct Child statements are far less common. It requires the person to believe and feel there is something basically and intrinsically bad about self. This probably represents 5% of the population. As a result it is much more difficult to treat as one is looking to remediate a basic belief about self and not simply encourage NP statements to counter the CP statement from the Parent ego state.

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Emotional dysregulation

I was recently reading an article on emotional dysregulation. Sounds impressive eh?

The person who is capable of emotional regulation can initiate, maintain and modulate the occurrence, intensity and duration of internal feeling states. Impressive eh? In other words they are capable of self soothing.



In Transactional Analysis terms one could describe emotional dysregulation in the following ways



The child begins life in a symbiosis with mother. It has to do this or it will die as it has no Adult or Parent ego states to keep it alive. The child will use mother’s Parent and Adult ego states to get food and water and all the psychological needs it has for love and human contact.

As the child grows in its early days it learns that at times it will experience distress of various kinds. It has hunger, thirst, wind, a need to be changed and so forth. It learns or is programmed to let mother’s Adult and Parent ego states know of its needs by crying. When mother hears the cry she swings into action and sets about solving the child’s distress and thus the child is emotionally regulated as the distress eases.

When this happens the child learns four things
It learns that it is important, it has worth and people will help it out
It learns that it can get its needs met
It introjects a soothing Parent ego state into its own Parent ego state
It learns the experience the feeling satisfied and calmed down



Sometimes this does not happen. For instance mother may be suffering post natal depression. She begins to find herself isolated in the house, lying in bed for long periods of time during the day. When the new-born cries she finds it very hard to get out of bed to deal with the child, at times she does not even recognise the child is crying. As a result the child has to cry for long periods before it is dealt with and sometimes the help never comes and the child just gives up crying.

When this happens the child learns
That it is of little worth
It develops the injunction, “Don’t get your needs met”
It does not introject an internal soothing parent figure
It has no experience of the feeling of being soothed

Combine this with certain inborn natural temperament qualities and the young person can be set up with a life of emotional dysregulation. Consider this list of temperament qualities.



If the child is born with a negative quality of mood and an intense level of reaction combine this with a lack of internal self soothing ability, a “Don’t get your needs met” injunction, that it is of little worth and has no experience of what it feels like to be soothed then it is likely to suffer emotional dysregulation.

Should this happen then the person will develop other ways of coping with the dysregulation. Three common ways are:

Self harming. This is common with the borderline personality. As I mention in my book on working with the suicidal there are eight main reasons for self harming

1. Self harming as part of gang tattooing behaviour.
2. Self harming to make self feel real which can be found in those who dissociate.
3. Self harming to make self feel something.
4. Self harming used as a means of tension relief and to release pressure build up.
5. Self harming as a physical expression of emotional pain. Self harming is seen as providing concrete evidence of the pain.
6. Self harming as a means to self nurture. It allows the person to care for self as can be found in Munchausen Syndrome.
7. Self harming as a means to punish self and an expression of self hatred.
8. Self harming as a means to manipulate others or as a cry for help.



People who self harm as a way to cope with emotional dysregulation would most often be doing it for the reason cited as number 4.

Drug use. Some cope with emotional dysregulation by self medicating with drugs weather they be licit or illicit



Comfort eating. One way to soothe self is to eat good tasting food. When this happens the person is said to engage in what is called comfort eating. They deal with ongoing painful emotions by self soothing using eating.

Therapy with such people is not all that complex. The therapist simply soothes the client when necessary. Of course this is easier said than done but the overall direction of treatment is quite clear. This soothing can range from lending a sympathetic ear and a soothing voice, to holding work, to the client learning methods of self soothing such as using a pacifier and so forth.

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Self harm in a wider context **

The 8 most common motives for self harm

1. Self harming as part of gang tattooing behaviour.

2. Self harming to make self feel real which can be found in those who dissociate.

3. Self harming to make self feel something.

4. Self harming used as a means of tension relief and to release pressure build up.

5. Self harming as a physical expression of emotional pain. Self harming is seen as providing concrete evidence of the pain.

6. Self harming as a means to self nurture. It allows the person to care for self as can be found in Munchausen Syndrome.

7. Self harming as a means to punish self and an expression of self hatred.

8. Self harming as a means to manipulate others or as a cry for help.

In dissociation the Free Child aspect of

the personality is split away from the rest of the personality

Some self harmers will report an addictive quality to their self harming. They find it hard to resist these actions as does one who has an addiction to drugs. In these cases the self harming serves some important psychological function for the individual. This is mostly found in those who self harm to:

Make self feel real which can be found in those who dissociate.

Make self feel something.

As a means of tension relief and to release pressure build up.

In each of these cases the self harming provides some kind of psychological gain which the person can not obtain by other less damaging means. To feel something and reduce a sense of numbness, to reduce the dissociation and to provide a way of releasing a sense of tension or pressure build up. They achieve these through self harming and thus become addicted to it as it is their only way they know how to.

Take a minute to reconsider self harm. To cut self or burn self one could say is an intense physical, emotional and psychological experience. It slaps the person in the face and they have strong physical feelings, possibly a sensation of adrenaline and often feelings of secrecy, shame, and a sense of what will happen to me in the future and so forth. The person certainly has a sense of aliveness. It seems reasonable to suggest that this physiological state would counter a sense of numbness or dissociation and possibly provide a sense of release from tension when the experience subsides.

If self harm is seen in this light one finds that humans can achieve this same kind of intense physical, emotional and psychological experience in a whole variety of ways. Indeed any activity that creates such strong emotions and psychological experience could be psychologically equivalent to self harming for the three reasons cited above.

Activities which create intense fear would include dangerous sporting pursuits such as BASE jumping, caving, mountain climbing, race car driving, surfing huge waves and so forth. Such fear could be achieved in the business world when one risks everything in a business deal or on the stock market. When one makes brazen political decisions. Involvement in criminal activity could also result in the same intense emotional and psychological experience. Involvement in some sections of the military or police could also serve the same function.

All these will result in an intense physical, emotional and psychological experience, just as cutting self can. Indeed the other human activity that can create such intense feelings and experience is sex. It seems plausible that the sex addict maybe doing the same as the ‘cutter’ who reports a sense of addiction to the self harming. The intense feelings allow a reduction in tension build up, reduces the sense of numbness or allows the dissociation to be temporarily relieved.

When viewed in this wider context those who self harm by cutting or burning are not all that odd after all. In fact a significant section of the normal community may be doing exactly the same using more socially acceptable means than by cutting ones arms with a razor blade. Indeed our friend Tiger who is purportedly a sex addict may psychologically be doing the same as the 20 something girl who burns herself with cigarettes.

Through the intensity of the sexual experience he could have found a way to relieve a sense of dissociation or numbness temporarily. Of course I have no idea if our man who put his putter where he shouldn’t have is doing this. However it seems that some could use sex for such a psychological purpose and hence the addiction.

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Self harm blog (Editted)

For an interesting blog on self harm have a look at Sarah's Blog

She was kind enough to answer some questions I had and came up with some interesting material that provides more insight into this area.

I have made some comments about it but I will not post them until she has given approval. So this maybe editted later.

Case study 4.

Stone (2009) states, “I started to deliberately injure myself when I was in my mid teens.... When it came to my last year of Uni it really reared it’s ugly head as an addiction, one that came with an almost unbearable amount of emotion. I was so stressed out because of the pressure of my studies that I was thinking up ways to harm myself, but I couldn’t face the thought of someone else finding out that I had actually done this to myself.” (Paragraphs 11 - 12)

A follow up interview of the individual which was placed on the internet. “T” is myself and “S” is part of the response from the interviewee

Stone (2010) states, “T = Can you describe the type of self harming that you did , was there a ritual involved and so forth?

S = No there wasn’t a ritual that I followed, they were all separate events with sometimes weeks or a couple of months in between them as the stress built up. I felt in a very particular kind of mind set each time though and one which I came to recognise over the years. I didn’t self harm in the stereotypical way that one hears about these days, as I’ve said in my original post I’d never heard of the term or knew that anyone else did anything at all similar. I certainly considered hurting myself with blades etc but always wussed out! Now that I think about it punching or inflicting pain with a blunt tool such as a hair brush or edge or a piece of furniture was by far my preference. This created bruising rather than cuts as I felt it easier to do to myself. Twice I created a scene that appeared as though I’d passed out and made sure that I was found by someone. This had a similarly good feeling as it caused people to be really concerned for myself and give me some attention. Other times I created bruising and lied about how I had got them, pretending that I’d been beaten up or similar.

T = How the actual relief came. Was it before, during or after the actual act of self harming? And was their thinking about the self harming going on in your head at that time of self harming and if so what was it?

S = When I was inflicting the bruising at first it hurt but after a few minutes it almost became easy as I guess I became used to the pain and managed to block it out. This allowed me to continue inflicting this injury on myself long after I otherwise could have beared I think. It felt good to actually hurt myself like that, in doing it I felt some form of relief, but with it came a huge chunk of guilt knowing that what I was doing wasn’t good, but the ‘need’ to do it was far stronger than any feelings that tried to make me feel bad about doing it. Having created the injury I then liked telling people about it, lying all the time obviously, but their compassion made me feel good so the more people I told the better I felt about it. I certainly don’t go by ‘the end justifies the means’ ideas at all on the whole but in this case that went out the window! It was a completely cold calculated decision that I made each time. I didn’t consider the long term effects of what all the deception was doing to me or others, or whether this was a long term solution, it just went round and round my own head as I didn’t let anyone in on any of it.” (Paragraphs 10 - 13)

“T = I assume you don’t self harm now, so what changed?

.....So I have no need to hurt myself any more. When I’m stressed about something I talk it through with my husband, Mum, sister or close friend before it becomes a big issue. I look at the issue as objectively as I can, ask their opinions about it, weigh them up, ask God for His opinion on it and act from there. If it’s something that needs resolving that can be then I act in the way that I consider best, but if it’s just one of those things that you’ve got to just grin and bear it knowing that there’s an end in sight then I just get on with it. If I find that I’m still getting stressed I talk more about it, eat some chocolate, have a long bath, do some exercise – in fact anything rather than just sit and stew about it!” (Paragraphs 15 & 17)

This case study has some interesting clinical features. The most common methods of self harm tend to be cutting, burning and perhaps wound interference. In this instance we have an example of hitting self such that one bruises. As with other types of self harm there is an addictive quality reported thus indicating that her Child ego state is obtaining a significant psychological benefit from the activity. She reports the benefit as a sense of relief and she is using the self harm mainly as a means of tension relief.

Excluded Child ego state

Also reported is a particular kind of mind set prior to the punching and bruising. From a counseling point of view this is important as it indicates the build up period prior to self harm and one would enquire as to what that mind set was. Once defined one can then use it as an alarm system such that the individual can develop a Plan B to be used at that time with the hope of avoiding the self harm. Plan B being alternative ways to relieve tension and stress. Also from a counseling point of view she reports being able to block out the pain which means that she is capable of significant exclusion of the Child ego state as is shown in diagram 2. Treatment would need to include at some point an opening up of the Chile ego state feelings again. However they have been repressed for some time and for some good psychological reason if she agrees to open up the feelings again then she may come across some feelings which may be quite painful.

This case study also demonstrates how the different motives for self harming are not mutually exclusive. As indicated she self harmed as a means to reduce tension and she also mentions that she self harms as a way of obtaining attention from others. In addition to this we see that she self harms as a means to get nurturing in this instance from others. She reports liking the concern and compassion shown by others and reports regularly seeking these responses from others.

This shows the possible initial development of a condition like Munchausen Syndrome. By self harming she can adopt the sick or injured role with others then giving her nurturing and compassion. In this instance, as she matured she subsequently developed other means of seeking compassion and nurturing from others. If that had not happened then she may have developed fully fledged Munchausen Syndrome symptoms. In her last paragraph she explains how she now deals with stress and distress in ways other than self harming. She seeks out family and friends to talk to and get support from which is the psychologically healthy way to deal with stress and thus any Munchausen Syndrome symptoms have no need to develop.

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Self harm as self punishment

One of the eight reasons why some people self harm is because of a self hatred or as a form of self punishment. As a result of childhood experiences some people end up with a self hatred or with a sense of self loathing. This may be because they were told precisely that. They were told they were useless, worthless, not wanted, hated and loathed by the parent figures.

In other circumstances the child may have been physically and sexually abused. When this happens sometimes the child has faulty thinking and believes the reason why they were abused is because there is something wrong with them. It was because of their inherent badness that the parents physically abused them. The child thinks that it is their fault and thus a sense of self loathing and hatred can evolve in their perception of self.

If a person has a basic sense of self hatred that does not mean they are going to be suicidal. A person will be suicidal if they have made the suicide decision and thus see suicide as a viable solution to their problems. There are plenty of people who have a basic self dislike who do not see suicide as such a solution.

Those who do have a very low self perception will self harm in some form but maybe not in the usual sense of the word. That is they will not self harm by cutting, burning or stabbing self but will self harm by the lifestyle they live. For instance a woman may prostitute herself at least partially because she hates herself. This could be seen as a type of self harm in terms of the life style she lives.

Any person who has a sense of self loathing will somehow live a life style where they treat self very badly either physically and/or psychologically. For instance the drug addict type of drug user can be taking drugs in such a way that it amounts to physical self harm. Such as with intravenous drug use where they share dirty needles with high risk others and so that their veins eventually become essentially mutilated.

Most drug addicts also hate themselves for being an addict. They know society views a junkie as being at the lowest level of society. They are seen at least by some as the useless crap at the bottom of the pile and often view themselves in a similar light. This can amount to psychological self harm. Thus the drug addict may hate self and that is expressed by self harming physically and psychologically.

Despite this there are a group of self harmers such as ‘cutters’ who harm self as an expression of their self hatred and self loathing. They cut self as an expression of these thoughts and feelings about self. Some self harmers will talk of bloodletting as a way to getting rid of some of their badness. As the blood flows out they see their inherent badness also flowing out.

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Family systems and illness

Family systems theory as described by Haley (1980) provides further insight into how people can display suicidal behaviour and not necessarily have made the suicide decision. In any relationship with two or more people there is a ‘system’ that develops between them. When the two (or more) personalities meet, over time they work out how to be in the relationship for them. For example one party will take over some roles and the other party will take over other roles.

This can be described in terms of ego states. In a relationship between mother and son the mother may take over the Parent and Adult ego states in the relationship and the son may respond primarily from Rebellious Child ego state. Over time they will work this out often with both parties not even being aware of it. In a family of five members each one will also work out their various roles and positions in the family.

All families develop a system that works for them

Some family systems operate such that one party needs to be ill. If the daughter of the family is ill then all the other family members know what to do in terms of their roles and responsibilities. Examples of types of illness that can originate from a dysfunctional family system can be self harming, drug use, depression and panic attacks eating disorders and suicidal behaviour.

In such circumstances if the daughter is making suicidal statements, gestures or attempts then that is how that family functions. For instance mother and father may start to co-operate and unite against the common cause of the daughters suicidal ‘illness’. It allows them to focus on the daughter and thus they can put to the side their own marital problems.

If the daughter stops making suicidal gestures then mother and father are again confronted with their own relationship so there can be subtle pressure on the daughter to remain suicidal. Having worked in drug rehabilitation this is not an uncommon scenario when one hears the drug user refer to himself as the black sheep of the family.

In such situations when working with the suicidal daughter one can encounter resistance from other family members because if the daughter changes (ie stops being suicidal) then the whole family system has to change. Every person has to alter to some extent and systems will resist change as they strive to achieve homeostasis. Some only have to alter slightly and those who have considerable psychological investment in the daughter being suicidal may be quite resistant to the change.

Treatment of such suicidal people is thus complicated as it involves the person restructuring their relationship with the other family members and that maybe difficult especially if the child is living at home and cannot move out. This also provides an extra avenue of investigation when making a suicide risk assessment.

As is common in the field of psychology often the different approaches whether they may be psychodynamic, organic or systems all tend to take the stance of one size fits all. In this instance all suicidal people are a result of a dysfunctional family system. It is indeed unfortunate how the alternative theories do this as with the human psyche, rarely one size fits all. From my experience of working with the suicidal sometimes the family system is very important and at other times it is only a minor influence. However in assessing and understanding the suicidal person it is very wise to make an assessment of how the suicidal thoughts and behaviour fit for the family system that the person currently lives in.

It is also possible for the individual to have made the suicide decision in childhood and be in a family system where they take the sick role of being suicidal. If that is the case then the risk level of a suicide attempt would certainly increase.

In systems theory every system is naturally homeostatic and will seek to balance itself. Thus it will also avoid or resist change as the balance is disrupted and it is not homeostatic.

So if family member number two changes then that forces all other members to change in some way as well. That change can be anything such as becoming depressed, stop being bulimic, start taking drugs, winning the lottery to becoming assertive. If you change then the system becomes unbalanced and all others have to change so that they system can become homeostatic again.

If you are feeling depressed or anxious that means all those in your ‘family system’, or your inner circle of closest people, are in some way contributing to your depression or anxiety. Indeed if you are feeling happy and joyous they are also contributing to that as well. In systems theory there is no such thing as an ill person, instead it is the system that is ill. If your partner is suffering depression then you are contributing to that in some way as part of the system.

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Is suicide an angry act? (editted)

Some time ago I would answered yes, this was the case but I have tended to change my views over time or perhaps refine them over time.

There is a view that the more a person has difficulty expressing aggression or anger then the likelihood of suicide increases as the anger gets turned in on self. In support of this such research is quoted

Horesh et al (1997)

“Anger correlated significantly with suicide risk. Higher anger contributed synergistically to the suicide risk.”

DiGiuseppe et al(2007)

“Increasing evidence indicates that aggressive behaviour may be related to suicidal ideation and attempts. Many adolescents report intense anger immediately prior to their suicidal gestures. In one study, a third of adolescents who completed suicide displayed anger as their predominant mood just prior to their deaths.”

“Prior to suicide attempts adolescents may engage in intense verbal attacks or display physical aggression towards objects or people”

DiGiuseppe et al(2007) also conclude that anger inward turned has a higher correlation to hopelessness in suicidal adolescents than anger outward turned. However the outward turned is also correlated as well.

One firstly needs to identify the possibilities with anger

It seems reasonable to concur with the research. If a person has made the suicidal decision (“Don’t exist”) and they have high levels anger then they could be assessed as being at a higher risk of making some suicide action.

This would seem to be particularly so if the anger tends to be inward turned rather than expressed outwards as is shown in the diagram but I would also concur with the last conclusion of the research that there is also a correlation with outward turned anger as well.

When one sees a client who has inward turned anger one of the treatment directions is to get them to identify a thing or person to whom they could also direct some of the anger. The anger starts to be directed at something outside the person and thus one would assume that less of it is directed at the individual them self. This is a typical scenario in the treatment of depressed people.

However whilst the correlation was higher with inward directed anger there still was a correlation with outward directed anger. Getting the anger outward directed is better but still not the full solution. Why would this be so?

I have said before that psychologically there is some similarity between the murderer and the suicidal as well as some psychological similarity between the self harming person and the person who harms others. Some seem to find this hard to understand and take it as me saying that self harmers are in some way bad people for this. I am not saying such a thing and I have sought to find a metaphor that may make it clearer. I am not too sure if I have achieved this but I will give it a go anyway.

If I capable of speaking german then I can insult and verbally abuse others in that language. Or I can choose to insult and verbally abuse myself in german. If I have no mastery of the german language I do not have the choice. I cannot verbally abuse others in german and I can not insult myself in german. The self harmer and the “others” harmer both have mastery of the same language. They have both decided that physical assault is a viable solution to a problem. The person who does not harm self or others does not speak the language so they are far less likely to do either.

Thus we get back to the diagram and the research. Anger directed at self could obviously be correlated to suicidal behaviour. However anger directed out at others could also be correlated (but less so) because they are still speaking the same language than the person who does not have such anger in the first place.

In the treatment of such a kind of depression, one would first want the inward turned anger to start being directed at an outward thing or person. Once done then one would be wanting the person to drop the anger and thus they start to loose mastery of that language entirely.

Whilst on the topic of anger and suicide one can make further assessment of suicide risk by enquiring about how a person would plan to kill self. The method chosen could be reflective of the degree of anger involved. The more destructive the method may indicate a higher degree of anger involved.

The less violent methods would be things like poisoning self, gassing self or perhaps drowning and even cutting self in a effective manner (ie not hacking away at self). The more violent methods would include shooting self in the head, throwing self under a train or jumping from a high building. However it seems that the penultimate expression of violence in the act of suicide would be self immolation. Without a doubt a very violent means of suicide and reflective of substantial angry feelings.

Thus it seems productive for a therapist to enquire about the method of suicide considered and if violent then one knows to further look into the level of anger felt by the client and how they deal with such feelings.

One also needs to consider temper tantrum type of anger. If one sees a young child have a temper tantrum one would notice how they lash out in an indiscriminate way. Temper tantrum anger is completely directionless anger. The child is enraged and expresses that rage by lashing out at anyone including itself.

What is meant to happen in normal child development is slowly the child learns about its anger and learns to recognise the stimuli for the anger and then its anger expression is focussed at the identified cause. Some however never master this psychological task of child development and thus you get some adults who have the temper tantrum type expression of anger where its expression is indiscriminate. Hence you can have some suicidal type of behaviours when the tantrum anger gets directed at self.

In my view this can explain the situation where a 19 year old man goes into a school, starts shooting at people indiscriminately and eventually suicides at the end of it all. A temper tantrum type expression of anger.

If a client presents as having made a suicide attempt that seems to be anger related it would be instructive to question as to the context of that attempt. Namely, around the time of the attempt did the client display other indiscriminate anger expression. If he did then one may be dealing with an individual who has a temper tantrum type of anger expression and the suicidal behaviour is a consequence of that.

I am reminded of one person who almost completed a suicide in these circumstances. When I was working in a prison there was one inmate who had a phone call with his girlfriend where she dumped him and told him the relationship was finished. His response to this in the space of about 30 seconds was to smash the phone, slit his throat with a razor blade which he obviously had on him at the time and throw himself head first off a 4 meter high landing onto a concrete floor. The medical reports showed that he very nearly died, but he did survive. Indeed after that the other inmates referred to him as “Black magic” because he was black and it was magic that he did not die.

One could say that this suicide attempt was an angry act, but technically this is not correct. I got to know this man very well as that was my job in the prison, to identify and manage suicidal and self harming inmates. This man had not made the suicidal decision in childhood, he did not have a Don’t exist injunction.

What had happened was he was abandoned by his girlfriend to which he responded with rage. He then displayed that rage in a temper tantrum type of way. He damaged property (the phone) and then attacked himself (fortunately there was no one standing nearby or they may have been attacked as well).

His goal was not to kill himself, so technically it was not a suicide attempt, he was simply enraged and he expressed that anger in a temper tantrum where at one point he attacked him self. In such instances one gets the unplanned and spontaneous type of suicide attempts and thus many of them are not completed. In this case his anger was very reactive anger.

One can have other temper tantrum type of anger that is not reactive anger but is based on character anger. Thus an event does not happen that sparks the tantrum like anger but the person has character anger deep inside that pervades over time. In these circumstances one can get well planned suicidal and murderous acts. An example of this could be Martin Bryant.

He was an Australian in his early 20s. At one point he took a number of guns and considerable ammunition to a home where he shot dead two people he knew. After that he left and went to a popular tourist resort and randomly shot dead another 33 people. Any person, man woman or child who got in his sights he shot dead. At the sentencing the judge stated in part:

“The prisoner, having had a murderous plan in contemplation and active

preparation for some time, deliberately killed two persons against whom he held a

grudge, and then embarked on a trail of devastation which took the lives of a

further 33 other human beings who were total strangers to him and which caused

serious injury, distress and grief to literally thousands more. The repercussions

of these crimes have been world-wide. His selection of victims was

indiscriminate. He killed and injured men, women and even children”. (end quote)

After he killed the people at the tourist resort he left and went to a house where he set him self on fire in an attempt to kill himself. He survived the attempt and remains alive today.

Thus we have temper tantrum type behaviour. The indiscriminate killing of others and eventually the attempt to kill self. We have an instance of firstly controlled and thought out anger directed at a distinct target and then indiscriminate directionless anger expression.

Even in murder children will display a child like quality.

As another example

The Boomtown Rats were at a US radio station for an interview when the story

of Brenda Spencer came over the news wire. A 16 year old California high

school student made headlines when she grabbed her father's gun and opened fire

on her school from a house across the street, injuring eight students and killing

the school's principal and custodian. When later asked why she'd gone on the

shooting spree, she responded "I don't like Mondays."

I Don't Like Mondays

by the Boomtown Rats

“The silicon chip inside her head

Gets switched to overload.

And nobody's gonna go to school today,

She's going to make them stay at home.

And daddy doesn't understand it,

He always said she was as good as gold.

And he can see no reason

'Cause there are no reasons

What reason do you need to be shown?

Tell me why?

I don't like Mondays”.

Hence we have apparently unexplainable behaviour which mystifies many. The temper tantrum explanation may give some insight into why such things do occur.

Graffiti