In gathering data for our new book, The Tender Cut (NYU Press), we realized that most of the literature on self-injury suggested that women are more frequent cutters, burners, branders, etc. than men. Some studies noted as high a figure as 85 percent women. Yet we suspected that there were more men out there than that, and that the male population was growing. Our data, gathered over the last ten years and based on more than 135 in-depth life history interviews with self-injurers located all over the world and tens of thousands of Internet messages and emails including those posted publicly and those written to and by us, offered an excellent vantage point to see if these gendered assumptions were valid.
One of the problems with the existing research is that it has been so heavily based on inpatient hospital and clinic populations. Yet sociological studies of health show that men are much less likely than women to go to the doctor, to go to the hospital, or to seek medical care.
Men who self-injure, then, are probably more inclined to manage their behavior by "free ranging" it on their own, thereby being underrepresented in doctors' and psychiatrists' samples. Our research, did, indeed, find a wider range of self-injurious behavior in the everyday world. In observing this broader swath of self-injurers, we discovered a few things about the gendered nature of the phenomenon.
First, it is certainly true that women self-injure more than men. They self-injure in larger numbers partly because their gender role socialization inclines them toward it. When women get upset, they are taught to turn their feelings inward and take it out on themselves. Connie (pseudonym), a 19-year-old college student who had a lot of familial conflict, told us, "This was the only thing that would calm me down when I was just so angry. And I wanted to punch walls and stuff like that but I didn't want to be so loud about it. So, it was taking anger out on myself." Penelope noted that, "Like with my dad, I feel, like, all my anger at him but I can't take it out on him 'cause he'll kick me out of the house, so I just take it out on myself instead."
Women are also socialized to lodge their self-identify heavily within their bodies, since so much of their value and self-worth in the relationship marketplace resides in their looks. Being a woman of any age in today's society means struggling to meet cultural appearance norms (i.e., be thin, be pretty, be fit but not too muscular). For people who fail to live up to the standards of fashion models, this may create anxiety, depression, and feelings of failure. This excessive focus on embodiment leads women to think that if they can control their bodies, they can control their selves. Injuring their bodies gives them a feeling of control over their emotions. This is the same sociological impulse that leads so many of them to engage in eating disorders.
Men, on the other hand, are socialized to externalize their upset. They see male role models turning their upset and frustration into anger by yelling at people, punching walls, and getting into fights. So when faced with the same feelings of emotional upset, which is what leads most people to self-injure, they take it out on others, not on their bodies.
Second, the male population of self-injurers is undoubtedly growing. Adolescent and adult men who live ordinary middle-class lives are venturing into this behavior in greater numbers because they are seeing other guys doing it, and the behavior is extremely contagious. This includes men who self-injure because they have serious psychological problems as well as those brought to it by the typical stresses and strains of growing up or dealing with romantic relationships (and everything in between). Young men are also self-injuring more as an expression of their affiliation with alternative youth subcultures, from their desire to experiment and be rebellious, and by the fact that they gain peer status through their demonstrated ability to withstand pain.
Beyond these types, we are seeing an explosion of male self-injury in groups of people who might be considered structurally disadvantaged: homeless youth, youth in juvenile detention centers, and adults in prisons. Self-injury has evolved into a popular coping mechanism where life is harsh and people see little hope for the future. Finally, evidence suggests that self-injury is spreading in the military, where stress can also be high. Sam, a former Marine, told us,
I self injured when I was 20 and an active duty Marine. I cut my left wrist over thirty times in response to finding out that while I was in boot camp my girlfriend had cheated on me with another guy and was now pregnant with his child. I was hospitalized for three days after which I returned to full active duty immediately. Less than three months later, I was stationed in Okinawa where I self injured again by cutting myself with a razor blade and also by taking an overdose of pills requiring an afternoon stay in the hospital. I knew of two other Marines in Okinawa who cut themselves with razor blades. I watched another Marine take a cigarette lighter and burn the flesh off of his arm right in front of me.
So, although women still self-injure more than men, the practice is spreading into wider groups of men, and, over time, we should expect to become aware of more boys and men engaging in it.
Third, our research suggests that there are distinctly "feminine" and "masculine" ways of self-injuring. Women tend to make smaller cuts in hidden places with sharp implements (such as exacto blades, straight-edge blades, and broken razor cartridges) and to hide their behavior.
Men are more inclined to make larger, deeper cuts and burns on their chests, their upper arms and more noticeable locations with rough, serrated knives or rusty nails and to be open about their injuries.
When men and women conform to these gendered ways of injuring, they are (relatively speaking) more accepted. Lisa told us that she went inward toward self-destruction, "Probably because I didn't want people to know. I didn't want to ruin my future because I wanted to show people that I could be okay, eventually, but I wasn't at the time." Guys who follow their gender norms seem able to self-injure more openly without reprimand. Ben struggled with an abusive father, and everyone knew that he was beaten regularly. So when he made large, bold cuts on his arms and didn't try to hide them, nobody asked him about these; it was taken as an understood response. In fact, committing violent acts upon one's body is a more acceptable and manly behavior (like some masculine rites of homo-social bonding behavior such as getting drunk with a group of friends and branding themselves), and many women noted that male self-injurers whom they knew seemed to be able to "pull it off better." Sam, the former Marine, agreed, saying, "In a sense, the more you could tolerate, the more 'manly' you were. I knew of a sergeant who shot up Jack Daniels intravenously and everyone thought that was 'hardcore." I don't remember feeling like the Marines thought I was unmasculine for SI."
When people deviate from these masculine and feminine ways of self-injuring, however, they are more likely to be negatively sanctioned. Penelope, quoted above, reflected that she turned her anger inward precisely because she feared the reaction of others if she (like guys) turned it outward, or against others. Women who flaunt their injuring too openly may also be chastised as "posers," "emo cutters," or condemned for "crying for help" (even if they need it). If they make larger cuts or burns, or if they do these to their faces, chests, or arms, they may be considered unfeminine and be more highly stigmatized.
Kyra, who cut herself on her face, her arms, and other visible places, said that this impacted significantly on her ability to have a relationship, to have friends, and to keep a job. The way she was treated made her withdraw from the world even more. "I feel like an alien. I don't like, I'm not interested in making new relationships. I'm not interested in even talking with people."
Men, on the other side, who make smaller and hidden cuts, who seem too vulnerable or emotional, are decried as "fags" and cast out from the company of other guys who may view their degraded status as socially communicable. Sam noted that he deliberately avoided cutting himself on his right wrist because he thought it would be "gay" to cut on both wrists.
There is, thus, a highly gendered component to the causes, population, and manner of self-injuring that is shifting in some ways and not in others.
We would encourage doctors, therapists, and friends to be aware of these trends and to try to avoid the trap of reinforcing some of these gendered stereotypes in dealing with self-injuring individuals.