Book review: Can I Tell You About Self-Harm?

Can I Tell You About Self-Harm? A Guide for Friends, Family and Professionals. By Pooky Knightsmith, foreword by Jonathan Singer. Reviewed by the Salvesen Mindroom Centre team.

Can I tell you about self-harm book cover

Date published: 2018

Paperback price: £9.99

Link to Jessica Kingsley Publishers

Reviewer: Salvesen Mindroom Centre Team

Reviewer expertise: Directly supporting families of children with learning difficulties.

What is the book about and who is it aimed at?

The book is about self-harm from the perspective of a teenager called Asher who struggles with self-harm, mostly by cutting or scratching. The book describes itself as a guide for friends, family and professionals and we agree that it could be read by all three audiences.

According to Amazon, the book is aimed at 7 to 12-year-olds, but we feel it may be more appropriate for secondary school aged young people, young adults, professionals and parents who are supporting a young person who self-harms.  

A brief description of the book.

The book starts by introducing Asher and it looks at some of the issues surrounding self-harm. It focuses on the concept of self-harm as a coping strategy. It includes advice on what to do if someone you know is self-harming. It also gives advice on how to reduce the risk of infection of wounds and how to be aware of and reduce self-harming behaviours.

It provides a realistic representation of the services available regarding self-harm, for example, it indicates that in some areas of the UK when a young person seeks professional help to try to stop self-harming, they may encounter waiting lists for some mental health support services.

The book contains line-drawing illustrations which are lovely, because they help to make Asher’s story relevant and relatable to young people.

Is the content in line with best practice or research evidence?

The content of the book appears to be in line with current best practice in the UK, as we understand it, because it advises the person who is self-harming about how to reduce the risk of infection etc while it promotes alternatives to self- harm.

However, we note that best practice in relation to this issue varies throughout the world. Different countries vary in how self-harm is viewed and addressed. The book’s emphasis is on self-harm as a coping mechanism. Viewing self-harm in this way and not having a distinction between “serious” self-harm and less risky self-harm behaviours may carry the risk of downplaying the seriousness of it or “normalise” self-harm too much. However, it is positive that this approach doesn’t encourage panic.

Although the book’s aim is to talk about self-harm, and encourages hope that other coping mechanisms can be found, it may be problematic that the book lists the self-harm carried out by various close friends of Asher. Again, this may down-play or normalise self-harm, which could pose a risk that some people may start to self-harm because of peer pressure or because they want to experience what it feels like.

The advice we took from the book is to put strategies in place and that the first step towards this is for someone who regularly self-harms to try to talk about their self-harm with a trusted person, and for that trusted person to listen in a non-judgemental way. This can reduce the shame and the shock factor around self-harm. The book indicates that if the person who is self-harming considers what they are doing as one of a range of coping mechanisms, which they use until they find a better way to manage their emotions, then they are more likely to significantly reduce their need to self-harm and stop completely. The book’s approach made us question our own reactions and apprehensions about the subject of self-harm.

Self-harm is addressed from a realistic viewpoint. The subject is not sugar-coated, nor is the book terrifying to read. We understand that the book’s advice regarding the internet and social media is in line with best practice.

It is helpful that early in the book, the author highlights that self-harm doesn’t necessarily mean someone is suicidal. This could be reassuring to parents and others.

Who would this book be helpful for?

In our opinion, this book meets some of the needs of a friend, family member or professional who is supporting a young person who self-harms. For example, the book would help the supporter to understand and support the young person without adding to the guilt the young person may be feeling about self-harm. Also, the book could be helpful to people who are currently self-harming, because it provides practical advice in a non-judgmental way. We consider that that the book would be helpful to a younger person or anyone who is aware of someone self-harming. It addresses the shame and loneliness which someone who is self-harming may experience.

Although the subject matter can be difficult, we found this short book easy to read and unintimidating. Its brevity and simple language mean it may be read quickly.   However, the brevity of the book results in it being very general, lacking detail, and it gives the same advice regardless of the underlying reasons for self-harm.

We thought that it would have been useful to have sources of help and support grouped together at the beginning of the book, so they were easier to find when someone needs help.

In the book it isn’t always Asher speaking: the narrative switches from the first person to the third person. This does jar, but it may mean that the book provides a different voice for different groups. It appears that the language has been carefully chosen: although it reads easily it comes across more like the advice a professional might give, rather than a young person speaking to another young person.

The book is perhaps too graphic for a reader of a younger age and it may not be appropriate for someone who is vulnerable or who doesn’t have a support network. However, it could be used by youth groups or schools, in a facilitated way, as part of a discussion about health and wellbeing, as a useful piece in the jigsaw or a way of breaking the ice to discuss self-harm.

The book can encourage useful reflection on what exactly constitutes self-harm and encourage discussion about other harmful behaviours such as addiction, for example.

What is your final, overall opinion on the book?

Our final, overall impression of the book is mixed: some of us loved it, others were more critical. We found it positive that we learnt a lot from such a small book. The book could have benefited from more information or detail around the ‘toolbox’, including how and why the toolbox is effective. More emphasis could have been placed on slowing down the response time to give someone more time to think before harming, and that this can sometimes help prevent the harm from taking place. Considering the lack of services and long waiting times in the UK for interventions and treatments, we feel that this book is generally a positive resource. The subject, which can be emotive, is handled in a way which aims to remove stigma and appears to be in line with best practice in the UK.