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The paradox of self-harm in prison: psychopathy or an evolved coping strategy?

©2013 Textbook 87 Pages

Summary

Deliberate self-harm (DSH) refers to intentionally self-inflicted injuries, and is mainly explained by abuse or neglect, severe psychopathy or at least a trait of a mental disorder. Most functions of DSH serve intrapersonal motives but interpersonal reasons are also found. These range from seeking for attention, pity and sympathy, to benefits like care, help or avoidance of unpleasant tasks or persons. To the latter belongs the deterrence of assaulters, a benefit, especially desirable for prisoners due to the hostile and brutal environment of prisons. This book scrutinizes two hypotheses of avoidance of attacks in prisons by the use of episodes of DSH as costly signals building upon the signaling theory developed in economics and biology. The first hypothesis is that DSH is an honest signal of fearlessness intended to repel other inmates from attacking. The second deals with the avoidance of assaulters by signaling madness via DSH to achieve relocation into an asylum. The underlying motive in this case is the need of protection, and thus, DSH serves as a cry for help to prison authorities. All necessary requirements of both hypotheses are examined, provided with evidence from existing research and analyzed with the help of mathematical models.

Excerpt

Table Of Contents


able environmental conditions. Although the phenomenon of DSH is common, it is
nearly exclusively seen as a dysfunctional strategy for dealing with emotional problems
or disturbed perception. Whether DSH is used due to inability to handle these problems
otherwise because another method was never learned, or the self-harmer shows serious
disturbances in emotional perception and handling, or it is induced by the environment,
is irrelevant to this view of DSH as a bizarre way of problem solving or alleviation. This
and the signicance of this phenomenon seem to be the only agreements across discip-
lines researching DSH (Mangnall and Yurkovich, 2008).
However, there are also some studies that view DSH as a behaviour that can be
motivated by interpersonal reasons. These can be social-positive, which means that
they are reinforced by presentation of an armatory stimulus. This includes attention,
help and getting other people to change their behaviour. Social-negative reinforcement
of DSH means that an aversive stimulus is removed, for example by avoiding unpleasant
tasks (e.g. work, punishment) (Nock and Prinstein, 2004) or shocking others (Brown,
Comtois and Linehan, 2002) and thereby avoiding their presence. The need to meet
these interpersonal motives by usage of DSH is also widely considered a maladaptive
coping strategy. It is thought that self-harmers use DSH to inuence or manipulate
other persons because of their decits in social problem-solving abilities (Nock and
Mendes, 2008) and thus lack of alternatives to convince social partners with other
means. The usage of DSH to achieve interpersonal goals can be both intentional and
subconscious (Osuch, Noll and Putnam, 1999). As already seen there exist various
interpersonal reasons for self-harm including emotional states. This means that in
some cases the self-harmer wants pity or sympathy whereas in others he wants benecial
relationship changes (Shearer, 1994). These can, however, be accompanied by emotions
as DSH most likely evokes feelings in social partners. They can range from sympathy
and concern to anger and hate if the social partner feels blackmailed and still has to
give in to the self-harmer's demands. If DSH is actually used in a manipulative way
to obtain interpersonal benets, then the behaviour is not as irrational as previously
thought. It might possibly even be necessary under certain conditions to resort to such
drastic and costly behaviours like DSH. This might be the case when cheap signals (e.g.
crying, begging) are not sucient to achieve interpersonal benets.
The research of costly and seemingly irrational behaviours began in economics with
the work of Akerlof (1970) and Spence (1973). They showed that in conict situations
private information, meaning information that is solely known to one party, can be
credibly conveyed by usage of costly signals. Costly behaviours count as costly signals,
in case of Spence's model of job market signalling this is the acquirement of educa-
3

tion. The idea of signalling also developed in other elds, for example in biology. The
equivalent to Spence's signalling theory is Zahavi's handicap principle (Zahavi, 1975)
and it emerged independently, although the idea could have been immediately adopted
from the eld of economics (Hammerstein and Hagen, 2005). Handicaps are charac-
ters (e.g. colourful plumage of male birds in certain species) that develop through mate
preference and signicantly impair the corresponding individual in his ability to survive
(e.g. colourful birds attract more predators). A colourful male therefore signals that
despite the higher predation risk he is able to survive and hence of better quality. In
contrast, low quality males would not be able to aord such a costly signal. Translated
to DSH behaviour, the signalling eect of DSH could most likely be applied to humans,
although the behaviour itself also occurs in non-human primates like rhesus monkeys
(Novak, 2003), chimpanzees (Walsh, Bramblett and Alford, 1982) and gorillas (Bowen,
1980).
The occurrence of DSH in humans is, as already mentioned, mostly explained by
the presence of at least a trait of a mental disorder or troubling or traumatic events
in the past. Interpersonal motives for DSH are considered but DSH is still mainly
labelled as a maladaptive strategy to obtain social benets due to lack of other means
to convince social partners. The explanation of such an irrational behaviour consists
of psychological disturbances of the signaller because of the diculty to imagine this
self-harming behaviour as a rational device. In terms of signalling theory it is, however,
possible that DSH could indeed serve as a costly signal to transport private information.
There is no doubt that DSH is costly due to the wounds, scars or even disabilities
induced by its usage. In fact, the approach of comprehending DSH behaviour as a
costly signal to credibly signal private information (Hagen, Watson and Hammerstein,
2008) has already found its way into the literature of psychology (Nock, 2008). But
what could be the private information signalled by this behaviour?
As the many dierent reasons for interpersonal functions of DSH suggest, there are
most likely several possible messages. In case of social-negative reinforcement DSH is
used to remove an aversive stimulus. This includes unpleasant tasks and obligations
as well as repelling other people. Regarding the deterrence of others, Diego Gambetta,
a sociology professor at the University of Oxford, develops the hypothesis that DSH
can be used as a method of choice under certain conditions. Based on signalling theory
Gambetta suggests that self-harming behaviours in prisons might, amongst other func-
tions, also serve a rational goal, namely the deterrence of assaulters. Furthermore he
claims that DSH can provide hard-to-fake information on unobservable traits of those
who engage in it (Gambetta, 2009, p.114). The sent message in this case is fearlessness,
4

meaning that attackers cannot harm the signaller more than he already did to himself.
This resilience or indierence to pain is according to Gambetta the private information
conveyed by the costly signal of DSH. Gambetta states further that the usage of DSH
to deter assaulters by signalling fearlessness discriminates between inmates possessing
this trait of character and those who do not, or more precisely that DSH is an honest
signal of fearlessness.
The choice of regarding DSH behaviour as an honest signal among prisoners results
most likely from the specic eld in which Gambetta works, namely organised crime
and trust. But apart from this reason prison populations are a promising candidate for
research of strategic DSH behaviour due to the various restrictions in this environment.
Prisoners cannot choose where and with whom to spend their time, nor are they in
control over their living conditions. These limitations are assumed to make the possible
gains of DSH especially attractive and thus DSH behaviour is expected to appear in
prisons more frequently with manipulative components (Haycock, 1989). In case of
DSH as a signal to deter assaulters, prison might even be the only setting in which
such a costly signalling strategy would be used because of the inmates' general rates
of aggression and willingness to resort to violence (Lahm, 2008). Also the connement
of a lot of antisocial people might add to it. DSH behaviour suspected of manipulative
components has also been researched in other environments but none of them yields
benets that high for the self-harmer. An environment that can closely relate regarding
the restrictions are boarding schools because there pupils also cannot freely decide
about where and with whom to spend their time. Research about strategic usage of
DSH in boarding schools indeed reveals interpersonal reasons as motivations to commit
DSH (Lumsden Walker, 1980). But the majority of DSH research is done in schools
(Evans et al., 2005) showing that also there manipulative motivations are common
(Laye-Gindhu and Schonert-Reichl, 2005). Another population in which DSH behaviour
is intensively studied are mental institutions. Although strong support for strategic
functions of DSH is found (Brown, Comtois and Linehan, 2002) it has to be considered
that the participants suer from severe psychopathy which could possibly be the reason
for their behaviour. All in all, each of these environments might bear the necessity
to deter attackers or bullies but prisons are the ones with most pressure regarding
prevalence and severity of assaults. This is the main reason why costly signalling via
DSH is seriously considered to be a valid strategy to deter assaulters in the environment
of a prison.
Gambetta states that several conditions have to be valid for this hypothesis, these
include, amongst others, requirements of the signaller as well as of the signal itself
5

(Gambetta, 2009). In this thesis all of Gambetta's assumption are discussed in de-
tail, supported with evidence from existingresearch, and several are altered, specied
or expanded. Furthermore additional criteria are suggested, especially regarding the
assaulters. Subsequently all of these assumptions are used to develop a simple mathem-
atical model capturingGambetta's hypothesis of DSH as an honest signal of fearlessness
to deter attackers. While analysingthe model it is shown that it does not depict reality
due to problematic denitions and exclusions regarding the assumption of dierential
costs between fearless prisoners and those who do not possess this trait of character.
Subsequently it follows that DSH is most likely not suitable as an honest signal of
fearlessness and thus not reliable to deter attackers.
Although DSH does not qualify as an honest signal of fearlessness, this does not
mean that it cannot be an honest signal at all. The approach from Hagen, Watson
and Hammerstein (2008) refers to DSH as a potentially rational bargaining strategy by
which the signaller credibly signals unmet needs and hence convinces social partners
to change their behaviour. This can be by giving the signaller attention, help or other
benets and thus the reinforcement of DSH behaviour would be social-positive. In
case of prevention of assaults, help could mean that the prisoner is transferred by
prison authorities and thus avoids attackers. If the signaller is actually hospitalised,
he not only escapes permanently his assaulters, he also escapes the dangerous and
hostile environment of a prison. Assault rates are signicantly lower in asylums and
hence a transfer implies successful avoidance of attacks. Hospitalisation of prisoners can
solely be carried out by prison administration, makingthem the receiver of signalling
strategies to obtain help in form of transfer into a mental institution. Hence signalling
the need of hospitalisation via harmful and costly DSH behaviour might be an honest
signal of need for help. It has to be noticed that although DSH behaviour is intended
to lead to relocation into a mental institution, it is not meant as an honest signal of
madness or severe psychopathy. However, the message of DSH is madness as otherwise
prison administration cannot be convinced to hospitalise the signaller but the underlying
interpersonal motivation is need for protection from assaulters.
To analyse the hypothesis of DSH as an honest signal of need for protection, again
several conditions and requirements have to be fullled. To dene them, Gambetta's
assumptions are used and altered accordingto the hypothesis. This allows a com-
parison between the conditions and thus simplies the recognition of similarities and
dierences between both hypotheses and their respectively underlyingmotives. After
establishment of the conditions they are supported with evidence from existingresearch
and a simple mathematical model based on them and the approach of Hagen et al. is
6

developed. In contrast to the work of Hagen et al., this model focuses on dierential
benets instead of dierential costs. Although Hagen et al. argue that only individuals
with little to lose, i.e., those genuinely in need, will exhibit DSH because they are the
ones who can aord to do so (Hagen, Watson and Hammerstein, 2008), their approach
still emphasize costs as the crucial factor due to the fact that for individuals in need
DSH is much less costly because although it similarly threatens one's health, there are
fewer benets to be lost (Hagen, Watson and Hammerstein, 2008). By using dier-
ential benets in this mathematical model, the problematic translation of dierential
costs between the dierent types of prisoners that occurred while analysing Gambetta's
hypothesis is averted. The usage of DSH as an honest signal of need for protection,
thereby meaning the prevention of assaults in the violent and hostile environment of
a prison, is shown to be plausible and thus could be a valid strategy in the theory of
costly signalling.
2 Gambetta's assumptions about DSH as a signal of
fearlessness to deter assaulters
In his book Codes of the Underworld - How Criminals Communicate (Gambetta,
2009), Gambetta presents the idea that, apart from ghting, also resorting to DSH is a
method to deter other prisoners from attacking. He assumes that DSH has never been
systematically considered as a signalling strategy designed to deter assaulters because
many studies are trapped in a hedonistic weltanschauung that eschews self-inicted
violence and explains any departures from pain avoidance as pathological (Gambetta,
2009, p.113). Consequently, he then starts to examine whether the styles and patterns
of DSH occurrence that one can predict from the signalling hypothesis are compatible
with the evidence (Gambetta, 2009, p.121). His predictions and requirements are:
1. Relations to conicts
2. Non-suicidality of DSH
3. Display of the non-suicidal self-injuries
4. Intended message of non-suicidal self-injuries
5. Characteristics of fearless non-suicidal self-injuries
6. Uncertainty over a prisoner's toughness
7

7. Assumptions about the assaulters
The following chapters analyse all these assumptions and predictions not only theoret-
ically but also support them with more and very detailed data. Furthermore limitations
of these conditions are identied and the assumptions are correspondingly altered. Sub-
sequently a simple mathematical model based on the discussed assumptions is developed
and analysed.
2.1 Relation to conicts
Gambetta's rst prediction is that the committed acts of DSH have to be related to
conicts to account for his hypothesis of DSH as a strategic device to deter other
prisoners from attacking (Gambetta, 2009). This is a logical criterion to make sure that
DSH is used out of interpersonal reasons which does not restrict resorting to DSH only
to manipulate other prisoners, it can still be accompanied by other motivations. The
strategic usage is not an exclusive characteristic but the linkage to conicts assures that
there are interpersonal reasons involved because the basic requirements for a conict
are the existence of other people and interactions with them.
Although the relation to conicts is thus a mandatory requirement for the function-
ality of Gambetta's hypothesis, the existence of DSH out of or accompanied by strategic
motives has still to be shown. The usage of DSH because of manipulative reasons is
a controversial topic as many researchers focus largely or completely on aect regu-
lation properties (Chapman, Gratz and Brown, 2006; Penn et al., 2003; Kemperman,
Russ and Shearin, 1997), most likely because the majority of self-injurers who engage
in NSSI report doing so for the purpose of aect-regulation. However, an analysis of
empirical studies on the numerous functions of DSH, excluding suicidality, showed that
although most studies use dierent terms and denitions, there are some functions that
are examined repeatedly (Klonsky, 2007). These functions are more or less accepted
as possible reasons of DSH behaviour and interpersonal-inuence gures among them
(Table 1). This is the function relevant for Gambetta's hypothesis and it was examined
and supported in 10 studies (Table 2).
Strong empirical support was solely found in Brown, Comtois and Linehan (2002),
where 61% of the participants endorsed reasons like to get other people to act dier-
ently or change and to shock or impress others. In Shearer (1994) only 17% of the
sample selected to seek support and caring from others and 5% chose to control the
reactions and behavior of others as one of their top three reasons. In both studies
all participants were women diagnosed with borderline personality disorder (BPD) and
8

Table 1: Functions of DSH examined in the empirical literature. Modied after Klonsky,
2007.
Function
Description of function
Anti-dissociation or
Feeling generation
To end the experience of
depersonalisation or dissociation
Aect-regulation
To alleviate acute negative aect or
aversive aective arousal
Anti-suicide
To replace,compromise with,or avoid
the impulse to commit suicide
Interpersonal boundaries To assert one`s autonomy or a
distinction between self and other
Interpersonal-inuence
To seek help from or manipulate
others
Self-punishment
To derogate or express anger towards
oneself
Sensation-seeking
To generate exhilaration or excitement
therefore their urge to use DSH might be a product of their mental illness. But it has to
be noticed that they were aware about the manipulative eects of their behaviour. Sim-
ilarly 24% of self-mutilators in an inpatient sample selected the reason longing for care
and attention (Herpertz,1995) but personality disorders were diagnosed in 87% of the
self-mutilators,the most common was BPD with 48%. However,if the Diagnostic and
Statistical Manual of Mental Disorders (DSM) criterion of self-mutilation (DSM-III-R
diagnostic criterion No. 5 for BPD) was not considered for diagnosis,only 28% of the
sample were diagnosed with BPD (Herpertz,Sass and Favazza,1997). In Osuch,Noll
and Putnam (1999) six motivations for DSH in psychiatric inpatients were examined
and reasons related to interpersonal-inuence only gained moderate empirical support.
In a study about adolescent inpatients' usage of DSH modest support was gained for
reasons belonging to the category inuencing others and magical control,which also
refers to attempts to control,protect or hurt others but with the dierence that the
self-injurer is not aware about these functions. Personality disorders were diagnosed
in most participants but their reliability is uncertain because no structured clinical
interview instrument was used (Kumar,Pepe and Steer,2004). Nock and Prinstein
(2004) found that the reasons to get attention and to get help were endorsed by
14% of the interviewed adolescent inpatients,whereas to get other people to act dif-
ferently or change was chosen by 12%. The sample was not screened for personality
disorders. In a sample of in- and outpatients,which were not diagnosed by structured
diagnostic interviews,45% of the participants selected the reason stop hurt by others,
40% chose get attention,ask for help and 16% endorsed get therapist's attention
9

Table 2: Methods and results from empirical studies on the functions of DSH. Modied
after Klonsky, 2007.
Study
no
f
self-injuries
% Female
Sample
typ
e
a
Metho
ds
b
Functions
studied
and
supp
orted
c
Briere
and
Gil
(1998)
93
96
In-
and
Outpatien
t
R
,P
AD,
AR
,IB,
II,
SP
Bro
wn
et
al.
(2002)
75
100
Outpatien
t
BPD
R
AD
,AR
,II
,SP
Herp
ertz
(1995)
54
87Inpatien
t
R
AD,
AR
,I
I,
SP
Jones
et
al.
(1979)
39
56
General
and
psyc
hiatric
hospital
P
AR
,I
I
Kumar
et
al.
(2004)
50
62
Inpatien
t
R
AR
,I
I,
SP
,SS
La
ye-Gindh
u
and
Sc
honert-Reic
hl
(2005)
64
75
Non-clinical
R,
P
AD,
AR
,AS,
II,
SP
,S
S
Nixon
et
al.
(2002)
42
86
In-
and
Outpatien
t
R
AR
,AS,
II,
SP
,S
S
No
ck
and
Prinstein
(2004)
108
70
Inpatien
t
R
AD,
AR
,I
I,
SP
Osuc
h
et
al.
(1999)
75
85
Inpatien
t
R
AR
,I
I,
SP
,SS
Shearer
(1994)
41
100
Inpatien
t
BPD
R
AD,
AR
,AS,
IB,
II,
SP
,
SS
a
BPD
indicates
that
all
participan
ts
had
been
diagnosed
with
borderline
personalit
y
disorder.
b
This
column
indicates
the
metho
ds
used
to
study
functions.
R
=
self-rep
ort
of
reasons;
P
=
self-rep
ort
of
phenomenology
.
c
AD
=
an
ti-disso
ciation,
AR
=
aect-regulation,
AS
=
an
ti-suicide,
IB
=
in
terp
ersonal
boundaries,
II
=
in
terp
ersonal-inuence,
SP
=
self-punishmen
t,
SS
=
sensation-seeking.
The
presence
of
an
abbreviation
for
a
function
indicates
that
the
function
w
as
examined
by
a
particular
study
.
If
a
function
receiv
ed
strong
empirical
supp
ort
in
a
particular
study
(e.g.,
that
items
relev
an
t
to
a
particular
function
w
ere
endorsed
by
more
than
half
the
sample
or
more
often
than
items
related
to
other
functions),
its
abbreviation
is
bolded.
If
a
function
receiv
ed
mo
dest
empirical
supp
ort
in
a
particular
study
(e.g.,
items
relev
an
t
to
a
particular
function
w
ere
endorsed
by
bet
w
een
5
and
49%
of
the
sample,
or
that
it
is
possible
but
not
certain
that
the
items
endorsed
supp
ort
a
particular
function),
its
abbreviation
is
enlisted.
10

and feel control over others(Briere and Gil, 1998). In Nixon, Cloutier and Aggarwal
(2002) only 10% of the questioned adolescent in- and outpatients endorsed get care
or attention from others and again the sample was not diagnosed for personality dis-
orders. Jones et al. (1979) found that 45% of the undiagnosed self-injurers from the
casualty department of a general hospital had given some consideration about the eect
of their act to others, possibly as a conscious way to manipulate their social situation,
whereas the participants from a psychiatric hospital were omitted from this question.
In a non-clinical and therefore undiagnosed sample of high school students 41% of the
participants endorsed I wanted to be noticed, 30% selected I wanted other people
to see how desperate I was and 21% chose I wanted to shock people (Laye-Gindhu
and Schonert-Reichl, 2005). Although most of these studies only gain modest support
for interpersonal-inuence as a function of DSH, they provide enough evidence to val-
idate that it can indeed serve as a manipulative act whether or not some researchers
completely refuse this function or even label it as a myth (Jeery and Warm, 2002).
It is strikingthat the majority of participants in all studies presented so far is fe-
male which may result from the presumption that DSH is predominantly a behaviour
that occurs in women (Suyemoto, 1998). Therefore most research was conducted with
mostly or exclusively female participants. However, recent studies investigating DSH
behaviour revealed comparable prevalence rates of DSH amongmen and women in clin-
ical samples (Kumar, Pepe and Steer, 2004) as well as in non-clinical samples (Klonsky,
2011; Heath et al., 2008; Hilt et al., 2008). Although most of these samples were not
large enough to allow generalisation it is assumed that some features of DSH, including
the prevalence of DSH and the history of attempted suicides, do not dier between men
and women (Andover et al., 2010). Even though most of the evidence that DSH can be
used strategically to inuence other persons was gained in studies with mostly female
participants, this ndingis thus also valid for men.
This is insofar important as prison inmates are not equally distributed between the
sexes. For example in 2002 there were 1,309 male inmates per 100,000 men in the USA,
compared to 113 female inmates per 100,000 women (Harrison and Karberg, 2002).
As most prisoners are male, Gambetta's hypothesis of DSH as a strategic device to
deter other prisoners from attackingwould mostly apply to men wherefore research
about DSH mostly conducted on women could pose a problem. As already shown
the prevalence of DSH is equal between both sexes but there might be core gender
dierences between the functions of DSH (Andover, Pepper and Gibb, 2007). Claes,
Vandereycken and Vertommen (2007) found that in a sample of psychiatric inpatients
men scored on average higher on the functions to get attention from others and to
11

show others how strong I am. Therefore the prevalence of DSH among prisoners with
a manipulative component tting to Gambetta's hypothesis might be even higher due
to the majority of inmates being male.
Another point to mention is that the majority of the presented studies analysed
the functions of DSH in clinical populations, which typically show serious psychopathy
and this might lead to the assumption that DSH is not only nearly exclusively used
by persons with mental illnesses, but also probably solely used by them in an interper-
sonal way due to their disease. Even if this would be the case Gambetta's hypothesis
could still be applied to prisoners because many studies suggest that around 10-15% of
prisoners have mental disorders (Lamb and Weinberger, 1999, and references therein).
The possible overestimation of the link between DSH and psychiatric disorders, most
prominently BPD, is probably supplementarily reinforced by the fact that DSH is ex-
clusively mentioned as a symptom for BPD in the current DSM-IV-TR. This might
lead to an increased likelihood of a BPD diagnosis if the subject resorts to DSH.
The prevalence of DSH in non-clinical populations is approximately 4% (Briere and
Gil, 1998) and it was shown that self-harmers show substantially more traits of BPD
and other personality disorders (Klonsky, Oltmanns and Turkheimer, 2003). Thus
it might be that the usage of DSH is in general produced by a personality disorder
or a trait of it and possibly this is also the reason of the interpersonal use of DSH.
But nevertheless studies show that at least some of the self-injurers were aware of this
mechanism or simply used it to achieve the desired eects. As said in the beginning and
consistent with Gambetta's prediction, the usage of DSH has to be related to conicts
to assure that interpersonal reasons are involved, but it can still be accompanied by
other motivations which could also simply be the presence of a personality disorder or
one of its traits.
As seen in the presented studies a variety of interpersonal reasons exist, ranging from
the wish for attention or care to shock others or show desperation. These motivations
are classied into social-positive and social-negative reinforcement (Nock and Prinstein,
2004). Social-positive reinforcement means the following presentation of an favourable
stimulus (e.g. attention, help) and social-negative reinforcement results in the removal
of an aversive stimulus (e.g. escape from unpleasant tasks, avoid punishment). In the
case of DSH as a device to deter attackers the reinforcement would be social-negative
because the prisoner would avoid the expected physical harm from assaults.
However, it has to be considered that nearly all results in the research of the func-
tions of DSH are gained from self-reports and there might be a tendency of the ques-
tioned self-harmers to denote their interpersonal use of DSH as intrapersonal due to
12

the better social acceptance of this behaviour as a relief for oneself than as a means to
manipulate others (Nock, 2008). Secondary the design of the self-reports might have
inuenced the results which is a common problem to psychological studies (Schwarz,
1999) and in this case it could be particularly important because most researchers focus
largely on intrapersonal reasons of DSH and downplay the social components of DSH
given that this is a popular folk concept that they do not want to reinforce (Nock,
2008). Additionally the interviewed self-harmers might fear that if they admit using
DSH to manipulate others, the exertion of inuence does not work any more because
the others might now be aware, although anonymity is guaranteed by the researchers,
of their manipulation (Stone and Turkkan, 2000). These considerations may add to the
low numbers of reported cases of DSH with strategic motives but nevertheless these
cases veriably exist and they are linked to conicts.
2.2 Non-suicidality of DSH
The next prerequisite is that the executed acts of DSH have to be non-suicidal because
an intent to die would completely undermine the whole concept of using it as a signal
to deter attackers (Gambetta, 2009). Therefore the more specic term non-suicidal
self-injury (NSSI) which refers to direct and deliberate destruction of body tissue in the
absence of any observable intent to die (Nock, 2010) is more appropriate to describe the
corresponding acts that t to Gambetta's hypothesis. DSH is indeed in the majority
of cases used in the same sense but in contrast to NSSI the denition of DSH as non-
suicidal is not unambiguous. It is, however, important that methods do not count
as having a suicidal intent if they are only fatal in the long run, as for example the
drawing of blood increases the chance to get HIV, especially in the environment of a
prison, which is in long-term deadly but not directly.
NSSI includes forms and functions very similar or even identical to DSH. The most
common forms of NSSI include skin-cutting, banging, hitting, burning and scratching
of skin and the area most probably to be injured are the arms, hands, wrists and
thighs. Although most self-injurers engage in more than one form of NSSI (Klonsky
and Muehlenkamp, 2007b), all forms full the requirement of non-suicidality.
2.3 Display of the non-suicidal self-injuries
To function as a signal the incidents of NSSI have to become known to the target
audience, in this case to the possible assaulters. This is a logical criterion because
otherwise the performed acts of NSSI could not work as a signal if it is not sent to the
13

audience and therefore can never be perceived. Any conscious form of display is hence
a form of active signalling (Gambetta, 2009). However, this is not limited to display
of the results through exposure of the aected areas (e.g. turn up sleeves to present
injured arms), it is also possible through witnessing the process of NSSI itself or by
relying on credible sources to spread news about the act (e.g. cell mates, guards).
The process of signalling alone does not specify the meaning of the sent message;
it only states that a message is sent. Therefore display is evidence for interpersonal
usage of NSSI as for intrapersonal purposes the self-injurers in the majority of cases
resort to NSSI in private (Nock, Prinstein and Sterba, 2009) and mostly hide the traces,
marks or scars. But display does not restrict the motivations in the production of the
signal exclusively to interpersonal motives. It is possible that at rst NSSI is carried
out of intrapersonal reasons and it becomes accidentally known to the audience and
then shows an interpersonal eect whereby the self-harmer learns how to rationally use
NSSI and possibly continues using the behavior, coopting it for interpersonal motives
in addition to the intrapersonal reasons (Gambetta, 2009).
In conclusion any form of deliberate display is directly linked to interpersonal eects
and therefore separates neatly between solely intrapersonal usage of NSSI and interper-
sonal use, which still can be accompanied by intrapersonal motives. In consideration
of the hypothesis to use NSSI as a strategic means to deter attackers the extent of
interpersonal and intrapersonal reasons in production of the signal is not important,
it is only crucial that there are interpersonal motivations involved which are revealed
automatically by conscious display of the committed acts of NSSI. However, the con-
scious display to the possible assaulters does not render the requirement of linkage
to conicts unnecessary as this linkage shows not only that interpersonal reasons are
involved but also restricts them from various interpersonal motives (e.g. cry for help
to prison authorities) to the ones that matter for the hypothesis. More precisely, this
means that the need to deter assaulters arises when there are conicts and hence the
elevated chance of attacks exists.
2.4 Intended message of non-suicidal self-injuries
As already stated before NSSI can signal various messages ranging from attention-
seeking to provocation of revulsion with which the signaller wants to achieve social-
positive or social-negative reinforcement. In case of NSSI as a rational device to deter
attackers the reinforcement is social-negative because an aversive stimulus is removed,
precisely the physical pain and the mental humiliation caused by the assaulters. This
limits the possible messages sent by NSSI according to Gambetta to signals of madness
14

or fearlessness (Gambetta, 2009).
Used as a signal of madness the prisoner appears more threatening and dangerous
due to his demonstration of unpredictability and therefore the perceiver might fear that
the signaller could also hurt him in an episode of lunacy. This anxiety is justied even
if the perceiver is signicantly stronger as the potential insane prisoner might strike
any time and in total irreverence of consequences for his own health which he fairly
presents by harming himself. So the natural defence of being stronger or well-organised
with other prisoners that are ready to perform retaliation does not work against danger
from probably insane prisoners. In total the eect of using NSSI as a signal to show
madness is to indicate the possibility of irrational actions and therewith the generation
of fear by unpredictable acts in general (Schelling, 1980). But if there is an asymmetry
of force, in detail that the possible attacker is accompanied by other prisoners and
thus they form a whole group of assaulters, the signal of madness loses a lot of its
threatening eect. Even if the attackers assume that their victim might be insane and
thus capable of irrational acts of defence or revenge, the chance of being the actual
target is much smaller in a group. Hence the terrifying eect of madness is gone and
this is the main reason why madness is not considered to be a message eective enough
to deter assaulters according to Gambetta.
Another point to mention is that signalling madness is more likely a signal for
prison authorities to relocate the signaller into a mental hospital. In this case the
signal of NSSI is sucient due to the fact that the prisoner might hurt himself severely
or unwittingly kill himself by his next attempt. Additionally it is also mentionable
that many psychologists view NSSI on a continuum with suicide (Zahl and Hawton,
2004; Houston, Hawton and Shepperd, 2001) hence NSSI could be the beginning of a
behaviour that gradually increases in severity and leads ultimately to suicide. Except
for the inicted danger to himself, an insane prisoner could also possibly kill or severely
hurt other prisoners or personnel. These kind of occurrences could lead to serious
political trouble and therefore the jobs of the current prison administration might be at
stake. These coherences are well known and there are documented cases in which the
hope of transfer is highly assumed to be involved in the decision to perform NSSI or
suicide attempts (Haycock, 1989). Furthermore the existence of madness aimed to deter
attackers and of madness to be transferred to an asylum would complicate the whole
hypothesis due to the fact that additional criteria have to be established to distinguish
between them. And as shown before, madness as a signal to avoid being attacked by
a group of assaulters is probably ineective and therefore it is supposed for simplicity
that all such signals are in this case directed to prison authorities.
15

That does not mean that the signal of madness and its eects are completely ineect-
ive but the focus is on another message, namely fearlessness. According to Gambetta
this is the main message in incidents with an asymmetry of force, that means when the
signaller could be easily overpowered by a group of attacking prisoners. Because of the
weakening of madness as the transported message there is no need to look closer at the
assaulters' fear of irrational acts as this is inferior to the eects of demonstrated fear-
lessness. These eects are the indierence or immunity of the victim to physical attacks
and therefore the inability of the attacker to control or humilate him. Furthermore it
demonstrates that the assaulters could not inict worse pain on the signaller than he
already did by himself and hence there is no feeling of power over the signaller. This
might together with indierence diminish the joy and purpose of the assaulters to pick
on the signaller.
The attackers' motive is in this case supposed to be instrumental aggression (i.e.
taking control over others) (Campbell et al., 1999) which is a goal-directed means to
deal with interpersonal conicts. A positive correlation between instrumental beliefs
and physical aggression in prisoners exists evidentially (Archer and Haigh, 1997) and
self-reports of bullies in prison reveal that asserting power is indeed a reason for their
behaviour (Ireland and Archer, 1996). But if the instrumental aims of the assaulters
are most likely not satised due to the demonstration of fearlessness and hence lack of
control, there might be a chance that the attackers do not engage in physical violence
against the signaller. This renders fearlessness suitable for the idea of deterring attackers
by displaying it via resorting to acts of NSSI.
2.5 Characteristics of fearless non-suicidal self-injuries
As already mentioned NSSI meant for signalling can transport dierent messages. In
order to send the intended message of fearlessness the signaller has to choose a form
of signalling that does not allow its interpretation as another message. More precisely,
this means that the prisoner has to make sure the receivers do not misconceive the use
of NSSI as a form of despair due to intrapersonal problems or as a cry for help to the
authorities. Both of these concepts would most likely increase the happening of attacks
and therefore result in the opposite eect. It seems that the prevalence of assaults
is especially high among vulnerable prisoners (Ireland, 2000), including inmates with
odd behaviour or a history of psychological care (Blaauw, Winkel and Kerkhof, 2001)
which both mostly applies to prisoners resorting to NSSI. As in many studies shown and
generally accepted NSSI can manifest poor coping skills and high psychological distress
(Cole-King et al., 2011; Williams and Hasking, 2010) and hence weakness, especially in
16

a prison where the rates of self-harmers are higher than in the outside world (Morgan
and Hawton, 2004). Therefore the need for distinction between the dierent meanings
is especiallyimportant.
To restrict the denotation to fearlessness while using a signal that demonstrates
in the majorityof cases nearlythe opposite, namelydespair and vulnerability, it is
therefore necessaryto increase and enhance the signal massively. This cannot be done
bya more regular usage of NSSI as this might be dicult to perceive bythe possible
assaulters due to the fact that there is verylimited freedom in choice of where to spend
your time in prisons. Additionally a more frequent use of NSSI could also strongly
increase the perception of the signaller's weakness.
Fearlessness can be signalled byresorting to NSSI in private and then showing the
injuries or relying on others to spread the news. In this case it is essential to modulate
the signal in terms of expressiveness, namelyto enhance the act of NSSI itself. This
can be done bychoosing more painful methods (e.g. a deep cut to the bone instead
of supercial skin-cutting). There exist theoreticallya lot of possibilities to upgrade
nearlyall forms of NSSI in a seriouslypainful and far-reaching way. Another method
to demonstrate fearlessness might be the performance of NSSI in front of the audience
without anysigns of hesitation, pain or fear of the act itself or its consequences. In
this case the usage of more painful and serious acts might not be necessaryto send
the message of fearlessness because the audience directlysees it and is not relying on
information about the act from other persons (e.g. guards, cell mates) or the physical
evidence of the occurrence of severe NSSI (e.g. wounds, scars). This advantage of rst-
hand experience could therefore probablybe even more eective to signal fearlessness
as the severityof NSSI done in private could also have happened accidentallywhile the
prisoner wanted to perform a less serious act.
Consequentlythat means that prisoners who use NSSI as a signal to deter assault-
ers are theoreticallyexpected to use at least one of these distinctive enhancing features
to clarifythe message of their signal as fearlessness. As alreadydiscussed evidence
of acts of NSSI with a manipulative component in fact exists but there was no closer
look at the methods of NSSI and the severityof the resulting injuries. Furthermore
the presented studies indeed searched for dierent motivations but not to which extent
a certain motive is the reason of an act of NSSI and therefore how the combination
and extent of motivations to self-harm shape the outcome. In fact this would be a
veryinteresting insight into the mechanism and occurrences of NSSI but most likely
impossible to achieve because self-harmers are supposedlynot able to name all of the
reasons and their individual extent that lead to a particular incident of NSSI. Unfortu-
17

nately this leads to the conclusion that it is impossible to compare acts of NSSI carried
out with strategic motives with incidents without manipulative components. Thus it is
uncertain if enhanced NSSI is indeed applied in the particular case of NSSI as a signal
of fearlessness, whether it is in the form of more serious acts, committed in front of the
audience or by relying on credible sources to spread the news.
However, non-clinical studies about the extent of injuries resulting from NSSI exist
but as mentioned before no correlation can be drawn to motivations as it was not
searched for it. Andover et al. (2010) found that on a scale from 1 (supercial injuries
that only damage the rst layer of skin) to 4 (injuries require multiple stitches and are
potentially disguring or life threatening) the medical injury at most severe episode
was for the participating 29 women on average 1.85 and 1.47 for the participating 19
men. On a similar scale from 1 (low/little) to 4 (very much/severe) Nock et al. (2007)
found that the NSSI severity at worst point was on average 2.27 for the participating
94 adolescents and young adults. This increase in severity compared to the study of
Andover et al. (2010) might be a result of the vague scale that was used. In a study
with 282 students 14.8% of the participants admitted to have performed NSSI that led
to supercial tissue damage (scratching or pinching to the point that bleeding occurs
or marks remain on the skin, intentionally preventing wounds from healing), 30% chose
methods that result in light tissue damage (self-bruising, punching or banging oneself
or other objects, sticking sharp objects into the skin (not including tattooing, body
piercing, or needles used for medication use)) and 55.1% stated that their self-harming
behaviour led to severe tissue damage (cutting or carving the body, burning areas of
the body, breaking bones, dripping acid onto skin, and ingesting caustic substances or
sharp objects) (Whitlock, Muehlenkamp and Eckenrode, 2008). Although the majority
reported the usage of NSSI methods with the potential of severe tissue damage it is not
itemised which method they actually used and therefore it could be that the majority
used the most harmless of the listed methods, namely cutting. This would then t to the
severity results of the previously mentioned studies because cutting might only damage
some layers of skin. Therefore NSSI behaviour that falls into severe tissue damage
according to Whitlock, Muehlenkamp and Eckenrode (2008) might be only a 1-2 on the
scales used by Andover et al. (2010) and Nock et al. (2007). In general that means that
the severity of injuries resulting from NSSI is quite harmless from the medical point of
view and thus enhancing the behaviour by using more painful and severe methods can
theoretically easily be done without very serious or even lethal eects.
Furthermore there is evidence that the desired severity of acts of NSSI might be
even lower as there is a tendency to accidentally self-harm more severely than planned.
18

A non-clinical sample of 1776 students with NSSI behaviour revealed that 20% hurt
themselves more seriously than expected and 7.8% of those harmed themselves so badly
that they should have been seen by a medical professional (Whitlock et al., 2011).
This shows that self-harmers may intend less serious injuries than they perform while
resorting to NSSI, meaning that there is theoretically even more potential to enhance
the severity of incidents of NSSI. On the other hand this also increases the severity of
acts of NSSI in general.
However, Stanley et al. (2001) found that self-harmers tend to underestimate the
lethality of suicide attempts and this could possibly also apply to their perception
of NSSI, whereby episodes of NSSI would not be classied as NSSI any more due to
violation of the non-suicidality criterion. Thus acts of NSSI as well as incidents of
enhanced NSSI to demonstrate fearlessness could show lethal characteristics and would
be classied as suicide attempts or even successful suicides. This would again complicate
the identication of cases of enhanced NSSI.
Additionally, it is possible that no evidence for enhancing NSSI to signal fearlessness
has ever been documented because no study so far has ever analysed if there is a correl-
ation between method chosen and motivation to self-harm. As mentioned before it is
nearly impossible to identify the reasons and their extents that lead to a particular act
of NSSI. Furthermore there is also the problem that there seem to be gender dierences
in the choice of methods. Women tend to use signicantly more cutting behaviour
while men report signicantly more burning behaviour (Andover et al., 2010). These
dierences might result from the dierent functions of NSSI between the sexes as male
self-harmers report more often to get attention from others and to show others how
strong I am (Claes, Vandereycken and Vertommen, 2007). Both of these goals can
be achieved easier by using a seemingly more threatening and hence more impressive
method and burning fulls this criterion better than cutting. As these two methods
dier in the perception of their danger, so does most likely the generation of the impres-
sion of fearlessness while using those. It is indeed the case that both methods can harm
self-harmers equally in the medical point of view and it is thus also possible to enhance
both methods equally but the dierence in perception still remains. Consequently the
apparent gender dierences pose another problem in the search for veried cases of
enhanced NSSI to signal fearlessness.
2.6 Uncertainty over a prisoner's toughness
For Gambetta, it follows from the intention of signalling fearlessness by resorting to
NSSI that prisoners who can signal this quality otherwise do not have to engage in
19

NSSI for doing so (Gambetta, 2009). Fearlessness is strongly related to toughness and
this can be conveyed by various means ranging from bragging about committed crimes
to ghting against other prisoners. Considered as signals of toughness are only violent
crimes with the exception of sexual oences, as these types of prisoners are perceived
and treated dierently by their inmates because they generally have a low standing
among prisoners (Akerstrom, 1986) and are not seen as tough even if they used brutal
violence in their felony.
Good indications for a prisoner's toughness are according to Gambetta the criminal
deeds he committed, the length of his current sentence and previous sentences and the
number of times he was in prison before. Indeed prison research supports the idea
that perpetrators have spent more overall time in custody (South and Wood, 2006;
Palmer and Farmer, 2002) and that victims are more likely to be rst-time oenders
(Beck, 1995). It was also shown that pure victims were predicted by a smaller sentence
length and that the sentence length may be a factor in distinguishing pure bullies
from others, but it is assumed that prison-based behaviours are more predictive than
personal, descriptive characteristics (Ireland and Monaghan, 2006).
However, many studies do not replicate some or any of these ndings (Blaauw,
Winkel and Kerkhof, 2001; Power, Dyson and Wozniak, 1997) and to complicate matters
further many prisoners do not belong to the group of either pure bullies or pure victims
but to the category of bully and victim, which is also named aggressive victim (Ireland,
1999). Additionally it is supposed that prisoners not seen as tough by other inmates are
assaulted more often and consequently might also resort more likely to NSSI. Indeed it
was shown that physically weak or vulnerable prisoners are preferred as victims (Ireland
and Archer, 1996) but the assumption that inmates incarcerated for non-violent crimes
are generally seen as weak and therefore bullied more is not supported.
Furthermore it is assumed that the aforementioned types of prisoners resort more
often to suicide out of poor coping (Winkler, 1992) and thus also possibly to NSSI. The
elevated likelihood of committing NSSI was found for rst time prisoners and for young
inmates (Blaauw, Winkel and Kerkhof, 2001; Beck, 1995) and a reason therefore could
be that they most likely do not have such an enormous criminal record to demonstrate
fearlessness with and therefore need other means. The most probable reasons for com-
mitting NSSI are intrapersonal, as coping with the environment of a prison might be
especially dicult for these kind of persons. However, the higher prevalence of NSSI
could also indicate that in total the amount of strategic acts to demonstrate fearlessness
might be higher because of the inability to signal this quality otherwise. As already de-
scribed evidence for manipulative acts of NSSI is scarce, but if in total a higher number
20

Details

Pages
Type of Edition
Erstausgabe
Year
2013
ISBN (PDF)
9783954896615
ISBN (Softcover)
9783954891610
File size
2.8 MB
Language
English
Publication date
2014 (February)
Keywords
deliberate self-harm non-suicidal self-injury signalling theory theoretical biology psychology
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Title: The paradox of self-harm in prison: psychopathy or an evolved coping strategy?
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