From surveillance to resistance: two adult women’s accounts about self-injury

“Medicalization” refers to the social process by which issues once considered nonmedical are redefined and treated as medical problems (Conrad and Slodden, 2013, p. 62). This process, evident in psychiatry and known as the “psychiatrization of society” (Beeker et al., 2023), is explored in Lavallee and Gagné Julien’s (2024) study, focusing on the pathologization of emotion. The authors introduce “emotion pathologizing” as a form of affective injustice, arguing that this phenomenon, driven by the biomedical model and the discrimination of “sanism,” (discrimination against those labelled with psychiatric conditions) distorts emotional experiences. This leads in turn to hermeneutical injustice, where individuals lack adequate interpretive tools to understand their emotions outside the pathological framework, thus marginalizing alternative narratives and perpetuating systemic injustice.

Self-injury is currently under investigation in the DSM-5 (APA, 2015) as a potential standalone diagnosis, rather than being categorized solely as a symptom of other disorders. Thus, it may become yet another way by which this social practice, linked to emotional pain, is framed within a biomedical model and how the pathologizing of people suffering from emotional pain is made.

Self-injury, or non-suicidal self-injury (NSSI), is a complex and often misunderstood behaviour characterized by the deliberate infliction of harm on one’s own body without suicidal intent (Lengel et al., 2022). It typically manifests in various forms, such as cutting, burning or hitting, and is commonly used as a coping mechanism to manage emotional pain, distress or overwhelming situations. Although self-injury is often perceived as a deviant or abnormal act, it is increasingly recognized as a response to deeper psychological and social influences (Steggals et al., 2022). To fully understand self-injury, it is essential to examine its sociocultural underpinnings, including family dynamics, societal pressures, stigma and cultural narratives surrounding mental health (Chandler et al., 2011).

A major component of self-injury is the need for emotional release in the absence of other more socially acceptable coping mechanisms. Many individuals who engage in self-injury report feelings of isolation, overwhelmed emotions and emotional suppression, often, but not always, rooted in adverse family environments or traumatic childhood experiences (Kaess et al., 2013). Cultural expectations that frame the family as a source of support can exacerbate these feelings when the family unit is dysfunctional. In such cases, individuals may turn to self-injury to exert control over their bodies and emotions, especially in environments where expressing emotions is stigmatized or suppressed.

The social stigma surrounding self-injury is another critical factor in its development and persistence (see Gunnarsson and Lönnberg, 2022; Long, 2018). Western societies often promote ideals of emotional regulation, strength and self-sufficiency, leaving little room for public displays of vulnerability or emotional distress. Self-injury, which externalizes inner turmoil, contradicts these cultural norms and is often misunderstood as attention-seeking or deviant behaviour. This stigma contributes to the secrecy and shame many individuals feel, causing them to hide their behaviour, further isolating them from potential support systems (Chandler, 2018). The gendered and age-based perception of self-injury—frequently associated with (white) teenage girls—ignores the reality that self-injury occurs across all genders, ethnicities (Bhui et al., 2007) and age groups compounding the challenges for individuals who do not fit these stereotypes (see Gunnarsson, 2023).

Additionally, societal pressures to achieve, conform and “fit in” play a significant role in the emergence of self-injury. The pressure to meet academic, professional and social expectations can create a sense of failure and inadequacy, driving individuals to self-harm to cope with the perceived inability to conform to these societal ideals (Gunnarsson, 2021a, b; Kokaliari and Berzoff, 2008).

There has been a cultural shift in mental health care toward harm reduction, which views self-injury through a more compassionate and pragmatic lens, at least in the UK (NICE, 2022). Rather than focusing solely on stopping the behaviour, harm reduction emphasizes managing self-injury safely and addressing the underlying emotional issues (NICE, 2022). This approach challenges the traditional view of self-harm as something inherently “wrong” and instead seeks to understand the sociocultural context in which individuals turn to these behaviours as coping mechanisms. Woodley et al. (2021) argues that individuals who self-injure often take an active role in managing the risks associated with their behaviour, such as reducing physical harm, scarring and minimizing the impact on others, therefore suggesting that health services should involve individuals more meaningfully in the processes of risk assessment and management. Inckle (2020) furthermore suggests that user-led approaches to research and social justice allow individuals to articulate their lived experiences, contributing to the development of harm-reduction interventions for self-injury.

Shame is also connected with self-injury. Gunnarsson (2021a) demonstrates how shame, often triggered by social interactions, can lead to self-injury, which in turn intensifies feelings of shame, creating a self-perpetuating cycle. This cycle suggests that self-injury is not solely a personal coping mechanism but also a response shaped by social pressures and cultural expectations.

Steggals et al. (2024) further argue that self-injury, beyond its intrapsychic functions, can serve as a form of recognition-seeking. They challenge the dismissive label of “attention-seeking,” suggesting that some self-harming behaviours are better understood as efforts to gain social and self-recognition. The authors highlight two key forms of recognition: (1) Self-recognition: Self-injury allows individuals to validate their internal emotional pain, offering a way to see their suffering manifested physically, (2) Social recognition: Self-injury can also serve as a call for recognition from others, expressing the need for their pain to be acknowledged and taken seriously. Their article emphasizes that while recognition may not be the only factor driving self-injury, it is a significant social dimension in many cases. The authors conclude that viewing self-injury through the lens of recognition can help destigmatize self-injury and facilitate more empathetic responses in social and clinical contexts.

In conclusion, self-injury is not merely an individual issue but one deeply rooted in sociocultural factors. By examining the societal norms, family dynamics and cultural pressures that contribute to self-injury, we can gain a more holistic understanding of the behaviour and work toward more effective and empathetic approaches to care and intervention.

This study analyses the self-injury stories of two women, tracing their experiences from adolescence into adulthood. The focus is on the sociocultural factors influencing why they began self-injuring and why they continued throughout their lives. This study emphasizes the sociocultural processes that shaped the self-injury behaviours of these two women as they matured but also connect this with the aspect of power, discipline, social alienation and control of individuals lives and emotions.

Foucault’s (2017) Discipline and Punish explores the dynamics of power, control and resistance. He explains that power is not just held by institutions or individuals but is spread throughout society and tied to knowledge, which defines what is considered “normal” and “deviant.” In the context of self-injury, societal knowledge often labels such behaviours as pathological, leading to stigma.

Foucault (2003, 2017) discusses the shift from overt sovereign power to more subtle disciplinary power, exercised through institutions like schools and hospitals. This power focuses on regulating behaviour and making people conform to societal norms, such as emotional control. Individuals internalize these norms, leading to self-surveillance, where they monitor their own behaviour out of fear of judgment. Roberts (2005) critiques this, arguing that mental health professionals should promote understanding and respect for individual differences rather than reinforcing these power dynamics.

Foucault also highlights surveillance, where constant monitoring leads individuals to hide their self-injury due to fear of being judged. However, he notes that where there is power, there is resistance. Self-injury can be seen as a form of resistance against societal control, allowing individuals to reclaim agency over their bodies in situations where they feel powerless.

The concept of social alienation, as outlined by Seeman (1959, 1983, 1991), includes dimensions like isolation, self-estrangement and powerlessness, which are relevant to the experiences of women who self-injure. Isolation means that the individual experiences a disconnection from social groups, whether family, peers or larger communities, leading to emotional or social loneliness. Self-estrangement is a feeling of disconnection from one’s own desires, goals and sense of self, often due to societal pressures. Powerlessness is when individuals feel they have little control over the forces shaping their lives, often due to systemic issues or societal structures. These feelings of disconnection and lack of control reflect the broader societal forces shaping their struggles.

Feminist psychology, such as the work of Lafrance and Wigginton (2019), emphasizes the importance of acknowledging power dynamics in research. It highlights how intersectional factors like gender, race and class shape women’s experiences of self-injury. Language plays a crucial role in representing these narratives authentically, avoiding the reinforcement of oppressive stereotypes. The narratives of adult women who self-injure are not merely personal; they are shaped by broader societal discourses surrounding mental health, self-injury and femininity. Feminist psychology extends beyond understanding these narratives to actively advocating for social change, ensuring that research contributes to addressing inequality and promoting justice.

This study sheds light on the experiences of adult women who self-injure, challenging societal stigma and advocating for more inclusive and supportive approaches to understanding and addressing self-injury.

A case study is a qualitative research method that involves collecting and analysing detailed accounts or stories from individuals to understand their experiences, perspectives and contexts (Simons, 2009). According to Sturman (1997), “[a] case study is a general term for the exploration of an individual, group, or phenomenon” (p. 61). Thus, a case study involves a detailed description and analysis of a specific case, which includes characterizing the case and its associated events. This also encompasses the process of discovering these characteristics, which is an integral part of the research. The case in this study encompasses two adult women’s way of describing and narrating their experiences of how self-injury unfolds over the years. The aim in this study is to explore how two individuals make sense of their engagement in self-injury, considering cultural, social and emotional factors. By focusing on the whole story in two single cases we were able to capture the complexity of the women’s experiences and the ways they construct meaning of their engagement in self-injury practices over their life-course.

The two women’s stories were selected as part of a previous autoethnographic study of five women’s accounts about what is special about self-injuring as an adult/middle-aged woman (see Gunnarsson, 2023: the entire project has been approved by an ethical committee). Fictive names were created for both women, Wera who identified as a white heterosexual woman and Rita who identified as a white non-binary (they/them) woman. These two women’s accounts were chosen because they elaborated on their entire history of when they started self-injuring, why they did it and how they understood and made sense of their self-injury at the time of the interviews and during the 20- to 30-year period they continued to self-injure. One of the women still self-injured at times, while the other had not self-injured for over a year. One was 41 years old, and the other was 35. One was from the UK, and the other was from the US. Both had some extent of university education; one was a licensed counsellor (but did not currently work), and the other had attended university but did not complete a degree (but worked full-time).

The interviewer, and thus the researcher, is a white, middle-aged woman from Sweden who has personal experiences with self-injury as an adult. The autoethnographic approach referenced in the article involves analysing and integrating my experiences with self-injury as part of the empirical analysis (see Gunnarsson, 2023). The interviews, therefore, became a collaborative production of five women’s experiences, which naturally influenced the interview dynamics and our conversations. This shared foundation of experiences established common ground. While this approach may introduce biases, it also enhances the ability to understand complex phenomena such as self-injury (see for example Adams et al., 2022). The initial four women involved in the project, as well as the two whose accounts are used in this study, approached me through a social media platform within a group I was also a part of. They expressed great interest in being interviewed, emphasizing the importance of discussing self-injury among women who are no longer teenagers or young adults.

The interviews were carried out on the digital platform zoom, lasted about an hour and were recorded and transcribed verbatim. Zoom interviews provide the advantage of ensuring a degree of privacy, enabling participants to speak more openly in the comfort of an environment they select. However, many of the subtle nuances of in-person interviews may be lost in the virtual setting (see Oliffe et al., 2021, on benefits and limitations). Zoom interviews were the only feasible way to conduct these interviews, as the participants and the interviewer were in different parts of the world, including the USA, the UK and Sweden. The use of Zoom provided a practical and efficient solution to overcome geographical barriers, enabling real-time conversations despite the distance. Additionally, the platform offered a sense of immediacy and personal connection that might have been lost in asynchronous communication, such as email.

The use of video during the interviews fostered a level of engagement and non-verbal communication that contributed to the depth and quality of the conversations. This format ensured that logistical challenges did not hinder the exploration of sensitive and complex topics, making it the most suitable choice for this study. Nuances such as non-verbal language are not entirely lost in video communication; in some ways, they may even be enhanced. Video calls highlight facial expressions and gestures, enable recordings for deeper analysis and reduce environmental distractions. While some in-person interactions may be missing, video technology offers a focused and practical medium for capturing non-verbal cues, particularly in research contexts.

The analysis of these two interviews involved reading and rereading each one multiple times to become familiar with their individual accounts. Then, the complete interview of each woman was analysed considering the social and emotional processes that initiated their self-injuring activities, what transpired over the years and how they understood these actions in adulthood. Qualitative methods like Braun and Clarke’s (2021) reflexive thematic analysis are rooted in the understanding that subjectivity is an inherent and unavoidable aspect of data interpretation. The coding of each of the two interviews was first carried out independently. Then, these codes were grouped into potential themes, and all relevant data corresponding to each theme in each interview were focused upon. In the next step, the coherence of these themes was evaluated in relation to both the coded extracts and the overall dataset. In the fifth phase, the themes were further refined, developing a cohesive narrative that captured shared meanings and formulating precise definitions and names for each theme (Braun and Clarke, 2012, 2021).

It is important to note that these are stories from two educated (middle class) white women living in a Western (northern), neoliberal political context; therefore, their experiences are limited in terms of generalizing to coloured, working class, the global south experiences (developing world) of self-injuring women. In fact, research shows that socioeconomic and cultural factors, such as poverty and the inability to meet basic needs, significantly contribute to the risk of self-injury among those living in developing countries (Mannekote et al., 2021).

The empirical analysis was supported by examining how both external and internal control—self-control and social control—contributed to explaining the women’s experiences of self-injury, which began in their teens and continued into adulthood, spanning a period of 20–30 years. Foucault’s framework of discipline and punishment, feminist psychology and the concept of social alienation according to Seeman (1959, 1983, 1991) was applied here.

Interviews in the original study was made by four women who had experience of self-injury in their adulthood. Besides their accounts, my own account as a researcher and a middle-aged self-injurer were used (see Gunnarsson, 2023). The entire project has been approved by an ethical committee (Swedish: etikprövningsmyndigheten, Dnr 2020-00462) and informed consent was obtained from all four participants. While securing informed consent is essential, it is equally important to respect the stories shared and recognize the privileged narrative position I hold as a researcher. I have the authority to shape the narrative we co-create and to present my own story as I choose—a privilege these four women do not share. Although they had the agency to decline participation, withhold responses or challenge my interpretations, an inherent power imbalance remains in the researcher-participant dynamic. While this power imbalance cannot be entirely eliminated, the women willingly shared their stories and even expressed that they believed this aspect of adult self-injury was important to share with others.

The sociocultural analysis of the interviews with the two women reveals how societal norms, family dynamics and cultural stigmas shape their experiences with self-injury, emotional regulation and identity. Their accounts highlight the impact of cultural expectations around family support, academic achievement and perfectionism, which exacerbated their feelings of isolation and self-hatred. Lacking emotional support, they turned to self-injury to regain control over their lives. Rita saw it as a form of self-care, while Wera used it as an alternative to suicide.

Themes developed were family dynamics and childhood trauma that contributed to the onset of self-injury, followed by a growing sense of social alienation and feeling different. As adults, the women navigated their social identity as “different” and began resisting the dominant discourse that frames self-injury as merely pathological or immature behaviour. They now advocate for a broader understanding of mental health that recognizes self-injury as a complex coping strategy.

Both women describe growing up in environments where family dynamics played a significant role in their emotional distress. Rita dealt with abusive, alcoholic parents and dangerous family associations and was burdened by academic pressures at school while dealing with the turmoil in the family having to realize and deal with what they say: “the pressure of not having a good childhood”:

Family is typically expected to be a source of emotional and social support. However, in both cases, the family environment became a source of trauma and dysfunction, highlighting how sociocultural norms surrounding familial support can break down in dysfunctional environments. This breakdown created a profound sense of powerlessness within the family dynamic, leaving them with little control over their lives. Traumatized children often express their emotions through their behaviour, with impulsive actions being particularly common (Malizia, 2017). Impulsivity tends to channel feelings and tensions directly into action, bypassing cognitive processing or emotional reflection, thereby offering an immediate sense of escape from perceived danger. As such, self-injury becomes a way to manage trauma and cope with the lack of control over one’s life.

For Rita, self-injury continued because it was something they could control over the years. Rita describes it as a form of self-care—the only care they could provide for themselves during their upbringing (see Simopoulou and Chandler, 2020, on self-care). Also, Rita states that: “and so it just became this coping mechanism that was default for me, and I just never really, I never found anything else that gives me the relief and the release that self-injury does, so I just carried on”. Rita, who identifies as a non-binary woman, explains that they have struggled with being acknowledged and recognized both as a full partner in social interactions and in their gender and sexual identity. These aspects intersect with their mental health in ways that perpetuate a sense of powerlessness. In this context, self-injury serves as a means of empowerment for Rita, as it allows them to take control of the overwhelming emotions arising from their unsafe and traumatic family situation.

For Wera, self-injury began because of feelings of isolation and being overwhelmed (powerlessness) by everything happening around her chronic illness, lack of family support due to a sick sibling and the responsibility of caring for her younger brothers. In the following extract she explains her situation and why she started self-injuring as a young girl:

For Wera, self-injury began at an early age, around eleven, when she no longer wanted to live. She had specific plans for taking her own life, which she openly shared with her aunt, including the methods she intended to use. However, instead of following through, she turned to self-injury to stay alive: “seemed like a better idea than killing myself” as she says in the extract above. The response from her aunt, which dismissed her suicidal thoughts without offering meaningful support, exemplified the social alienation Wera experienced. This lack of validation or understanding contributed to her internal struggle, where self-injury became a private means of managing her distress. The act of self-injury, hidden from others, underscored the alienation she felt—seeking relief in solitude rather than through social connections, which seemed unavailable or inadequate.

Wera’s description of self-injury as a survival mechanism highlighted the ways in which coping strategies, even harmful ones, could be forms of resistance against oppressive societal structures. Self-injury was not merely a symptom of individual pathology but could be a response to the systemic pressures and inequities that women faced (Inckle, 2020). By engaging in self-injury, Wera navigated the emotional toll of these expectations, reclaiming some sense of control over her body and emotions in an environment that offered little other recourse.

Both women were expected when they were just children to assume responsibilities beyond their years. Rita was exposed to unsafe situations and neglected by their parents, while Wera was expected to care for her siblings and meet academic and extracurricular expectations. These family roles reflect the social expectation that older children or individuals in difficult circumstances must “step up,” even if it comes at the cost of their mental health. Both Rita and Wera express feelings of self-estrangement, that is, alienated or disconnected from their own identity and their sense of self. For Rita it manifests as a feeling of dissonance between an expected “ideal” self and their actual self-image (Seeman, 1983, 1991) as in the following citation: “there were a lot of people, kind of telling me how I should behaving and how I should be feeling and none of that really matched up to how I WAS feeling, how I was behaving”.

Both Rita and Wera expressed feeling isolated and “different” from their peers, partly due to chronic illness and emotional struggles. Weras chronic illness made her feel disconnected from typical teenage life, while Rita’s emotional turmoil and social alienation further isolated them. This reflects broader societal discomfort with chronic illness and mental health, as these conditions often lead to social exclusion due to stigmatization, ignorance or fear of engaging with individuals who are perceived as “different.” Women’s experiences of social alienation refer to the feeling of being isolated, disconnected or estranged from their families, society, their community and even to themselves (Seeman, 1983, 1991).

Wera discusses how she hated herself, and cutting became a way to cope with that self-hatred (see also Gunnarsson, 2021a, b). In the example discussed firther in the text, I ask her why she felt this way, and she explains that her feelings of being different from her peers due to her chronic condition led to a sense of alienation from others. Wera also describes the immense pressure she felt to excel academically and live up to perfectionistic standards, which reflect societal expectations for success, particularly in Western contexts (see also Kokaliari and Berzoff, 2008). The pressure to “achieve” while managing chronic illness creates internal conflict, as Wera desire to meet societal and familial expectations clashed with her physical and emotional limitations. This contributes to feelings of self-hatred and inadequacy, demonstrating how societal pressures exacerbate individual mental health struggles.

For Wera, self-injury may provide a fleeting sense of agency in a world dominated by external expectations (Foucault, 2017). There is a clear interplay between self-control and societal control, as both Wera and Rita struggle to reconcile their coping mechanisms with the pressures of external influences and societal expectations about how to behave and manage distress. In the extract above, Wera expresses a sense of self-surveillance, ultimately placing the blame on herself, especially in her younger years—when she says, “Like, it’s my fault that I was alone.”

Wera’s self-hatred and perfectionism stem from internalized societal pressures, particularly the Western emphasis on achievement, which, when combined with chronic illness, fosters feelings of inadequacy. Feminist psychology critiques these pressures, which disproportionately affect women by expecting them to excel in all areas despite emotional and health challenges. Both women’s experiences underscore how personal struggles are connected to systemic gendered inequities, given that women are more susceptible to experiencing trauma and abuse within the family context and developing PTSD (see, for example, López-Castro et al., 2017).

Both Rita and Wera grapple with feelings of difference and self-acceptance, shaped by societal views of normality and mental health. Weras’s chronic illness and Rita’s experiences with emotional trauma left them feeling alienated from societal norms and peer groups. However, over time, both interviewees began to accept their “differences” and learned to use them as strengths, especially in their professional and personal lives. This process reflects broader cultural shifts towards accepting diverse identities and experiences, challenging the rigid expectations of what is considered “normal” in society. In a sense both women resists being a “psychiatric subject” (Roberts, 2005) and they thus also as adult women try to assert control over who they are and who they are to be labelled and identified. In engaging in self-injury Rita and Wera can reclaim agency over their bodies in a context where they feel powerless.

When asked about whether self-injuring as an adult is the same or different to when she was younger, Wera tries to explain how the self-hatred is still there but not in the same way as when she was a teenager. She is not as socially isolated and alienated any longer.

Wera discusses how, in her counselling work, she has been able to use her experiences of feeling different to maintain a therapeutic distance from her clients, which allows her to support them more effectively. She has taken control of these long-standing feelings of difference, isolation and self-hatred, transforming them into strengths in her professional life.

As adults, both Rita and Wera confront cultural norms surrounding adulthood, responsibility and emotional control. Rita expresses that they felt shame about continuing to self-harm as an adult, but they also shows a healthy distance towards this today. Experience shame may be reflecting societal expectations that emotional regulation and self-injury are “teenage” problems that should be left behind (see Gunnarsson, 2023). Rita says with laughter: “You're forty and you still having to go to get stitches what is that about, you know, why can’t you grow up”.

Rita also expresses resistance towards the view of self-injury as a teenage problem and always pathological they try today to educate people around this. Here I was specifically engaging them with how self-injury is portrayed in research, media, biomedicine and the public. We had a long discussion about this, and Rita says the following:

There is a clear tension between individual mental health struggles and societal expectations of “growing up” and emotional maturity, which often disregard the complexities of long-term mental health challenges. Rita attempts to challenge the common misconception that self-injury is inherently tied to being “mentally unwell” or that it indicates something fundamentally “wrong” with them. For Rita, self-injury serves as a method to release emotions and regain control over their emotional state in the moment. The women’s experiences and narratives thus resist the pathological framing of self-injury as solely indicative of psychiatric illness and contradicts popular beliefs surrounding it (Brickman, 2004). As Rita also identified as non-binary and bisexual, they acknowledge a double stigma in the excerpt above. Emotions like shame, stemming from navigating norms related to heterosexuality, adolescence and rationality, are central to understanding self-injury in adolescents according to McDermott (2015). These norms regulate which emotions can be felt and expressed, as well as the kinds of narratives young people are allowed to share about their lives. However, compared to young people with a non-heterosexual identity, Rita, as an adult woman, regularly tries to educate others about their misconceptions. They share a narrative that authentically highlights how a self-injuring individual can simultaneously be a functional and “normal” adult woman, despite the visible scars and wounds on their body.

Rita and Wera resists above all being reduced to psychiatric categories. Their narratives reflect a reclamation of agency through self-injury, countering societal pressures and stigmas. From a Foucauldian perspective mental health care should not intensify the power dynamics that classify self-injury as a deviant or pathological act but should instead foster an environment that allows for differentiation, recognizing the unique ways individuals cope with trauma. This approach challenges conventional views, emphasizing understanding over judgment and encouraging more creative, person-centred approaches to treatment that respect adult women’s experiences of their struggles.

Foucault argued that societal norms and institutions exert control by defining what is “normal” or “deviant” behaviour, particularly in mental health (Foucault, 2003, 2017). In this context, women’s experiences with self-injury can be seen as acts of resistance against societal forces that pathologize and regulate their emotions and behaviours. For both, self-injury functions as a form of agency within a sociocultural environment that imposes rigid expectations of emotional control, behaviour and identity. Adult women are pressured to conform to norms of mental health and emotional maturity, but their self-injury challenges these norms, asserting control over their bodies against a system that seeks to label them as “mentally unwell” (Lafrance and Wigginton, 2019). Societal judgments about female behaviour exacerbate feelings of shame in women who self-injure. Therefore, this article advocates systemic change to reduce these pressures, emphasizing the need for inclusive mental health care practices and public health policies that address the underlying causes of emotional distress. This approach situates self-injury within a broader critique of societal norms and gender inequality, calling for more empathetic and supportive responses to women’s mental health challenges.

Foucault (2017) also emphasized “self-surveillance” in modern society, where individuals internalize societal expectations and regulate their own behaviour. The women’s narratives reflect this dynamic: they express shame and secrecy about self-injury, shaped by societal stigma that frames such behaviour as pathological or immature. Rita’s reflection on the expectation to “grow out of” self-injury aligns with Foucault’s notion that adults are expected to self-regulate according to norms of emotional maturity. However, their continued use of self-injury as adults resists these norms, reclaiming agency in a system that denies their complexity.

Foucault’s analysis illuminates how self-injury for these women is not just a response to personal distress but also a form of resistance against societal forces that seek to regulate their identities, bodies and emotions (see Gunnarsson, 2023). Their stories challenge dominant cultural narratives around mental health and self-control, asserting their agency within an oppressive system.

The women experience social alienation due to the stigma (Goffman, 2009) associated with their behaviours (Seeman, 1983, 1991). Foucault’s notion of “self-surveillance” suggests that individuals internalize societal expectations, and failure to meet these standards often leads to isolation or exclusion. Both women feel shame and secrecy about their self-injury, reflecting alienation when societal norms clash with personal realities. Their defiance of emotional control norms results in feelings of separation from the broader social group that upholds these standards.

Rita and Wera’s experiences with self-injury are clearly shaped by societal norms, family dynamics and cultural stigmas. Both women faced trauma, isolation and overwhelming expectations, which contributed to their emotional distress and reliance on self-injury as a coping mechanism. Their stories highlight the impact of perfectionism and emotional regulation, leaving them feeling alienated from their peers and grappling with stigma that enforces shame.

The neoliberal context of mental health emphasizes individual responsibility and self-management, aligning with broader societal trends that prioritize self-sufficiency and productivity. As Harvey (2005) emphasizes, neoliberalism promotes individualism and personal responsibility while downplaying the influence of broader social and systemic factors on personal success or failure. In this framework, mental health struggles, such as self-injury, are often medicalized and pathologized, reducing complex sociocultural phenomena to individual pathology.

Neoliberal ideologies reinforce the notion that individuals must regulate their own emotions and behaviours to fit societal norms, often leading to self-surveillance, as Foucault (2003, 2017) describes. In this context, self-injury can be seen as a coping mechanism that challenges the rigid expectations of emotional self-regulation. The women’s narratives reflect a struggle against these norms, illustrating how societal expectations around mental health can lead to increased feelings of inadequacy and alienation when individuals fail to conform.

The intersection of social alienation and the medicalized approach to mental health creates a scenario where individuals like Wera and Rita navigate a dual burden: the internalized stigma of their self-injury and the external pressures to conform to normative behaviours and normative emotional expressions. This article demonstrates how their self-injury served as both a personal coping mechanism and a form of resistance against the societal and medical systems that sought to control and define their identities. This resistance is critical in understanding the broader implications of self-injury, not as a mere pathology but as a socio-political act that challenges the dehumanizing aspects of medicalization and the isolating effects of neoliberal mental health paradigms (see also Inckle, 2020; Lavallee and Gagné Julien’s, 2024).

One potential harm-reduction strategy in self-injury management, particularly among adults who self-injure, is the development of safe self-injury practices. Harm reduction strategies can be divided into two main categories: the first involves substituting self-harm methods like cutting or burning with less harmful alternatives that serve similar functions, such as snapping an elastic band on the wrist or painting the arm with red colour. The second focuses on minimizing the harmful effects of self-harm without necessarily aiming for complete cessation, such as providing clean razor blades or anatomical information (see Cliffe et al., 2021; Wadman et al., 2020). This approach aligns with how the women in this study resist and challenge the pathology discourse of self-injury and the medicalization of mental health, while affirming their right to make decisions about their own bodies.

Public health initiatives could focus on destigmatizing self-injury through community awareness campaigns, promoting open dialogues about mental health. Additionally, integrating peer support programs in healthcare settings can offer individuals a non-judgmental space to share experiences and coping strategies, thereby reducing isolation and shame associated with self-injury.

These recommendations align with the study’s findings that self-injury serves as a coping mechanism and a form of agency, suggesting that harm-reduction approaches can offer compassionate support, acknowledging the complex interplay of personal and societal factors in mental health.

Although this paper includes only two case narratives from adult women who have self-injured for decades, and thus has limited generalizability, it vividly highlights how the women negotiated their social identities as adult women who self-injure, while simultaneously resisting labels of mental illness, medicalization and the pathologization of self-injury as a coping strategy in adulthood. Their stories are about reclaiming power and asserting autonomy and agency as mature adult women. Future research should be sensitive to how adult women who self-injure perceive the practice, not only as a manifestation of individual emotional pain but also as an embodied response to past trauma and abuse. It should also explore how they resist the infantilization, medicalization and pathologization of self-injury. These women want to be recognized and treated as autonomous, rational adults, regardless of their choices regarding their bodies. They assert agency over their actions and seek understanding from others without diminishing their emotional struggles or pathologizing them. Furthermore, individuals who do not fit the stereotype of a young woman cutting herself need to be explored, particularly through an intersectional analysis of class, ethnicity, sexuality, gender, age and socioeconomic backgrounds. This would provide a more comprehensive understanding of self-injury and help tailor interventions to meet the needs of various populations.