How can we create an experience which reduces self-harming behaviour especially in young individuals?
Overview
Self-harm is deliberately injuring oneself. It might be a psychological or psychiatric disorder. Self-harm has become more prevalent in today’s world, with the ever-growing mental health problems. One reason to this could be the growing lesser of human-human interaction.
I wanted to research as to how we could help these people as well as raise awareness in the Indian society ,where mental health is still considered as a taboo.
Secondary research
Self-harm can be of two types- Suicidal and non-suicidal. This means only a small percentage of people, self-harm, with the intention of killing themselves.
Then why would people harm themselves without the intention of doing so? After a deeper look inside, I found out that the self-harming behaviour is the most common in adolescence, (12-24 years of age). I also found out, that 65% of the self-harmers, are women.
The rate of self-harm has been increasing since the 1980’s.
For the full research, click here
Myths about self-harm
Self-harm can be of two types- Suicidal and non-suicidal. This means only a small percentage of people, self-harm, with the intention of killing themselves.
Then why would people harm themselves without the intention of doing so?
The rate of self-harm has been increasing since the 1980’s.
Primary research - Field user research
After I had a basic idea and I had done my research on the net, I decided to interview people going through it. But how do I identify who are possibly self-harming?
Reaching out to a few friends, I found out about a girl, who would be okay to talk about it with me. I had to completely change the way I interview as this subject was so sensitive, and I did not want to push her back into self-harming. I made sure I told her that she will never be quoted anywhere, and even if done so, would be anonymous.
The research strategy I used for this project was qualitative. Getting under the surface of users, was the real aim. How they interact in an everyday life gave me an idea to understand attributes and mind sets of people. Qualitative analysis can give deeper insights for a human centric process.
After I had established some ground basis, I was able to communicate with her as a friend who means well and not just someone who wants to research a subject. My interview style had to be semi-structured, as it had to be a conversation, more than a set of questions.
Interviews are always better, when they stop being interviews and turn into conversations.
Case study 1
I definitely did not want to ask anything out of the comfort zone of the girl. I had made a questionnaire of questions I wanted to be answered, but I had to improvise as we went. There were some really vague answers, and that was when I realised that there is no one cause to self-harm. It can be a series of triggers leading to that point.
(For privacy reasons, the name of the victim will not be revealed, and will be called as P1 for the reasons of this research.)
After a few minutes of casual conversation, I dared to ask her the first question. It was, “When was the first time you harmed yourself? She answered that the first time was when her parents were almost at the verge of getting a divorce, and there were fights in the house every-day. She had seen seniors at school do it. So, the first time she cut herself was with a divider from her stationary box. As soon as she had done it, she felt relieved. But after a moment, the guilt crept in. She tried hiding it from everyone. When asked about her parents, she said she could not confide in them as she thought they do not consider mental health to be an issue.
But the relief at the moment of harming one feels addictive, and you start doing it more often. I got a lot of insights from her, and I realised that the common myths revolving around self-harm, were only myths.
As I listened to her whole story, I realised that people were converting emotional pain to physical, so they could stop feeling numb
Identifying victims and stakeholders
After interviewing one person, I decided to document the people who have gone through this, so we could spread awareness in the society. To my luck, some people came forward, who were willing to talk about their experiences on camera, but with their face hidden.
With the help of a film maker, I decided to interview these people. I also interviewed friends of these victims, but was unable to put it in the documentary, due to privacy reasons.
You can watch the documentary here-
In the interviews for a documentary, I met a girl, who had completely different ideas about self-harm. She did not think of it as a wrong deed. She believed it to be right, as it was better than hurting somebody else. And if self-harm was making herself happy, who is to say it is wrong?
For more details of the user interview, click here.
Case study 2
1. Used to harm herself by overdosing on medication. Has cut herself a few times.
2. Had issues with her body, being called sensitive and not being able to fit in.
3. Psychologist helped her get out of self-harming. Has done a lot of homework and taken medication. She finally feels like she has gotten over the worse.
4. “Probably start with actually listening to them instead of just hearing them out… and I know such people get extremely difficult to deal with, I was extremely difficult to deal with… but, umm… just stick around”
5. First few triggers were due to moving into a new environment.
6. Loved to paint, but does not anymore.
Case study 3
1. Used to think that self-harm is easier than finding another solution.
2. Did not trust her parents or friends in the fear of being misjudged.
3. Tries not to blame anyone for her actions. Clear that there are unresolved childhood issues.
4. Believes that mental health is still considered a taboo in India, and would have helped her if someone could have spoken to her about it openly.
5. Thinks of self-harm as a sign of weakness, and is guilty about doing it
6. Usually hides her scars with long t-shirts. Has gotten a lot of tattoos now.
7. Strongly believes that no one except herself can help her.
8. First few triggers were fights with close friends.
9. Avoids doing it now by smoking, or going out on walks.
Observing and analysing
After interviewing these victims, I decided to observe them in their daily life. Most of the day had gone by normally. Sometimes, some incident might trigger them, which we would not even think to be relevant. I observed this to be a case with all the victims who were actively self-harming. I had also observed those people who previously used to self-harm, but have gotten out of it now. They also got triggered due to certain events, but the way of dealing with it was completely different.
Analysing these insights received, I thought it was time to interview psychologists about their view and perspective about this whole thing.
To see the experience map, click here
Interview with the psychologist
1. Depression is the major cause of self-harm. Due to less human interaction nowadays, nobody talks about their problems, which eats you up inside.
2. Anger is another factor affecting young individuals. Anger about oneself is the most common today.
3. After self-harming, they have a guilt of doing something wrong which they cannot seem to accept. Thus, the cycle keeps continuing.
4. Self-harm is just a way to get relief for the time being. This can be channelized in the right way.
5. They tend to feel numb while they are going through problems. Not a lot of people can understand this numbness, which is why they tend to convert that into a physical wound.
6. While thinking of a solution, DBT should be involved in it.
7. The solution must be discreet, so no one will be able to label the victims.
8. Program would consist of a face to face session between patient and therapist. 6–18 sessions
9. Self-harming usually does not stop until the 8th session
10. DBT- Negative patterns are challenged in order to alter unwanted behaviour. It is also used to treat OCD, trauma, anxiety and depression.
Insights
1. Victims cannot stop self-harming until the 8th session, because they are used to seeing blood, and the feeling of pain.- Need, Observation
2. As victims start feeling numb, they need a way to feel the pain. Most common choice of harming themselves is the knife or paper cutter. – Problems, observation
3. Most of the victims do not trust psychologists, as they need an instant solution. DBT and CBT (methods used by psychologists) take time, and the victims do not stick around for that long. – Need, Problem, opportunity
4. Mostly, they feel that self-harming is a sign of weakness, and do not want people to associate them with it. There is an immediate guilt which arises after they have self -harmed. – Observation, problem
5. One of the first few triggers for harming for most of the victims was a fight with a loved one. The anger because of the fight does not have a way to come out, and thus most youngsters tend to harm. This can lead to depression later. – problem, opportunity
6. Self-harm is an instant relief for the victims. It can be channelized by distraction. Victims often do something to distract themselves, successfully avoiding self-harm. – Opportunity, Need.
Design directions
Need a product which will give them a feeling of pain and subsequently reside but will not harm. Eg- Tattoos which fade away with time, Rubber band bracelet.
Using avoidance techniques- Puzzles, writing down your emotions, keeping a journal
An interactive surface which lets you connect to other people who can help.
Finally, after a lot of deliberation, I decided to go ahead with an avoidance technique, which will help victims avoid harming until their eighth session.
This would also include DBT techniques of creating distraction plans.
Art therapy
Art therapy is a form of psychotherapy involving the encouragement of free self-expression through painting, drawing, or modelling, used as a remedial or diagnostic activity. In a world where there is a multitude of ways to communicate and express one’s self, expressive arts therapy is yet another.
I really liked the idea of creating art by destructing. This way victims would not feel guilty about harming as they would be creating something worthwhile. In addition, it would reduce the harm they actually do on themselves.
I decided to go ahead with the idea of making a journal which includes DBT techniques of avoidance. The journal would be handed out by psychologists as well as sold at a very reasonable price.
The idea behind it would be, making the victim distracted by creating art, in turn not making them guilty, and reducing harm. I decided to create activities based on art.
Validation
Expert Review
After completing the initial drafts for book, I asked our psychologist for her opinions. Getting in some fresh perspective, led me to realise some errors and improve upon them before conducting usability tests.
Testing the prototypes
I validated my book with 4 users. I gave people few print outs of the books. These people were not the victims but people who were feeling frustrated or angry. I wanted to test the books before giving them to the victims as I did not want to push them further into harming themselves if there were to be some sensitive topics in the book.
To watch the validation video, click here
Take-aways
What I learnt
This project taught me to empathise with every person in everyday life whether it was for user research or not. I loved creating a solution which involved integrating a physical product into all the UX methods I have learnt till now.
I learnt different therapies use by psychologists and had to help myself to a lot of psychology books.
What more can be done
I would love to take this project forward in terms of manufacturing and setting up a system between psychologists and patients.
Thank you for reading!
