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Some forms of pain defy language. When words fail, the body steps in — sometimes violently — inscribing on the skin what the mind cannot articulate. In its most visible form, self-harm appears as deliberate injury: cuts to the arms or wrists, cigarette burns, scratches, bites, bruises. But beyond the physical act lies something deeper — a silent cry expressed through the body.
Once treated as a fringe concern in psychiatry, self-harm has become far more visible in recent decades. Clinical and epidemiological studies agree that it primarily affects adolescents and young adults, with a marked prevalence among girls and young women. It appears in hospitals, schools and prisons, but also across digital spaces. On platforms like TikTok and Tumblr, online communities form, sometimes rooted in empathy, but often spiraling into a troubling form of glorification.
Self-harm is not the same as a suicide attempt. The goal is not to die but, paradoxically, to manage pain that feels otherwise overwhelming. Some hide their wounds under long sleeves, others expose them, consciously or not, as a signal. In all cases, self-harm reflects a fractured relationship with the body and with expression itself.
What drives someone to inflict such wounds on themselves? Self-harm is more than a behavior, it’s a symptom, a compromise, a message, a kind of stutter. When language breaks down, the blood from a self-inflicted wound becomes a form of expression. It is not simply a cry for help. More often, it is an inner cry, concealed and marked by shame. It’s rarely about wanting to be seen. More often, it’s an unconscious hope that someone, somewhere, will understand — without needing to ask. In that sense, the symptom acts as a bridge between inner experience and the outside world, between what can’t be fully processed and what demands expression.
According to psychoanalyst Donald W. Winnicott, self-harm often signals a rupture in the early bond with the mother, a failure of the environment to provide sufficient “holding.” Left alone with their anxiety, the child learns to self-soothe, sometimes through injury. The body becomes the only tangible boundary between a chaotic internal world and an indifferent external one.
Other psychoanalysts speak of a “blank” in mental representation: for some individuals, words never fully developed. Physical pain then fills a gaping psychic void. In cases of depression, objectless anxiety or borderline states, pain becomes proof of existence: “I suffer, I feel, therefore I am.”
Eating disorders, particularly anorexia and bulimia, are also closely linked to self-harming behaviors. In such cases, the body is shaped, constrained and damaged not out of aesthetic pursuit, but to express something deeper: the sense of inner lack, the impossibility of love, the emotional void.
Françoise Dolto once said that the body speaks when speech is blocked. What the body expresses, in these cases, is often an early, unprocessed pain, something that never found symbolic form. The act of cutting becomes an attempt to release pressure, to return to sensation, to feel something real. In a world that has grown abstract, unstable and unmoored, the wound provides a kind of certainty.
For psychoanalyst Joyce McDougall, self-harm is a “pre-symbolic” form of communication, as the body stands in for words that cannot be found. She described certain patients as “psychosomatic,” meaning they somatize psychic conflicts because they lack the internal tools to process them. In some cases, unconscious guilt, rooted in fantasies of an original wrongdoing, compels the person to self-punish. Here, self-harm becomes an expiatory ritual, a form of self-flagellation, driven by an archaic and unrelenting superego that demands punishment.
Still, these actions can also be read as an attempt to reassemble the self and to give shape to something internally fractured. Self-injury is not inherently destructive. It can serve as a desperate, if flawed, effort to create internal cohesion. As psychoanalysis has long emphasized, symptoms are never random or meaningless. They are unconscious formations and coded responses to inner conflict. From this perspective, self-harm is a genuine symptom: it communicates something, though in a distorted, masked form that resists immediate interpretation. What matters is not the wound itself, but the need to inflict it. The act belongs to a realm where doing takes over from thinking, where the body steps in to speak when language falls silent.
Self-harm can also be seen as an effort to reclaim the self. The anxiety is unbearable, it is vague, unformed and overwhelming. In contrast, physical pain is specific, grounded and containable. It becomes a way of trading an inexpressible psychic pain for something that can be felt and localized. In that moment, the wound becomes an anchor, a sign that something real exists. The repeated nature of the act, often ritualized with precision, suggests a containing function. In the midst of internal chaos, self-harm takes on the shape of ritual, even of survival. It imposes rhythm on the void, gives form to what cannot be said. To understand this, one must listen to the person’s own logic — a language that is not rational or linear, but metaphorical and driven by instinct.
In the face of self-harm, the point is not to judge, condemn or normalize it. What’s needed is to listen and to search for meaning where society sees only pathology. The person is not asking for their wounds to be patched up, but for them to be acknowledged as traces, as something to be explored and understood. Psychoanalysis offers a space where words can gradually begin to take the place of action. The steady, containing presence of the analyst helps rebuild a sense of trust — enough for the experience of absence or lack to no longer feel like total collapse. Transference becomes a space where early relationships are replayed — those that often failed to provide security. The goal isn’t to eliminate self-harm as one would a virus, but to make sense of it, to integrate it into a life story, to bring it into the realm of thought. When a person begins to speak, to dream, to give symbolic form to what they once inflicted on their body, something shifts.
Let us turn, as we often do, to art, and ask whether there’s a shared thread between artistic creation and psychoanalysis. Neither shies away from pain. On the contrary, both confront it: art sometimes head-on, psychoanalysis through interpretation. In art, self-harm, as a boundary act, has been explored in works where the body becomes both medium and message, the surface onto which psychic distress is inscribed.
In Thirteen, Catherine Hardwicke captures, with chilling clarity, the emotional drift of a California teenager navigating self-injury, drugs and identity breakdowns. The film doesn’t try to explain, much less moralize. It simply shows. The camera adopts the adolescent’s point of view, pulling the viewer into an emotional chaos that only the body seems able to articulate. In this context, cutting becomes both an act of resistance and a silent scream.
Black Swan (2010), directed by Darren Aronofsky, explores another facet of self-harm: the kind that stems from a tyrannical ideal self. Natalie Portman plays a ballerina trapped under the weight of a sadistic superego, driving her to injure herself in pursuit of absolute purity. The body becomes the stage for fragmentation, the space where the impossible merger between the real self and the idealized self plays out.
In the 1970s, artist Gina Pane took a more radical approach, staging acts of self-harm as part of her live performances. She would cut, pierce and injure herself in carefully choreographed rituals — performances that bordered on the sacred. These weren’t meant to provoke. They were a way to confront the violence of the world, and of womanhood, by making pain visible, etched directly onto the body as a form of social and political expression.
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