The document summarizes research on self-harm, especially cutting, among young people. It finds that cutting has become more social and connected to peer groups online and offline. Cutting releases biochemical rewards in the brain and serves as a coping mechanism for overwhelming emotions. To address this issue, the document proposes creating an empowering graphic novel based on real stories of those struggling with self-harm. The graphic novel aims to help young people find alternative coping strategies and reduce stigma around self-harm.

1. Young People &
Self-Harm
Team Health DX
Lee Chapman, Nathan M. To, Candice Yee
Primary Contact:
Nathan M. To, CCC PhD
Research Consultant | Producer
nathan.to@ronininstitute.org

2. THE CHALLENGE

3. How might we create empowering spaces
for young people engaging in self-harm, and
enable them to find help?

4. (INSPIRATION PHASE)
HERE’S WHAT
WE KNOW
1

5. SELF-HARM
IS REAL.
SELF-HARM
IS DANGEROUS
SELF-HARM
IS COMMON

6. 1 in 5 females + 1 in 7 males
every YEAR
U.S. stats on self-harm injuries: http://www.healthyplace.com/abuse/self-injury/self-injury-
self-harm-statistics-and-facts/
engage in SELF-INJURY

7. That’s...
1 in 4 hospitalizations
among youth age 10 to 17
2013-2014 Canadian statistics on intentional self-harm injuries:
Canadian Institute for Health Information (CIHI): http://www.cihi.ca/web/resource/en/info_child_harm_en.pdf
See also: http://www.cbc.ca/news/health/self-harm-behind-1-in-4-youth-injury-hospitalizations-1.2839395
http://healthymindscanada.ca/self-harm/
1, 324 hospitalizations (in 2009-2010)
2,500 hospitalizations (in 2013-2014)

8. Self-harm describes a
range of behaviours,
including:
➜ Cutting your own flesh
➜ Severely scratching your
skin
➜ Burning or scalding
yourself
➜ Punching things or
throwing your body against
walls and hard objects
➜ Hitting yourself or
banging your head
➜ sticking objects into skin
➜ intentionally preventing
wounds from healing
➜ swallowing poison, toxic
substances or
inappropriate objects

9. Our proposal focuses on...

10. CUTTING

11. WHAT WE LEARNED
(themes)

12. CUTTING
IS
SOCIAL

13. Cutting behaviour
is SOCIAL:
ONLINE +
COMMUNITIES
➜ Tumblr
➜ Instagram
PEER GROUPS
➜ Peer Pressure
➜ Cut to “fit in”
Past research
suggested self-harm
occurs in physical
isolation.
THIS HAS
CHANGED.

14. CUTTING
HAS
BIOCHEMICAL
ASPECTS

15. CUTTING
IS A
COPING
STRATEGY

16. KEY INSIGHTS

17. Young people see
their cuts as
battle scars,
a source of pride
among those who
cut.
(INSIGHT THEME 1)

18. Young people cut
to make
connections
with others.

19. There is a tight-knit
group online of
young people who self-
harm.
Some are recovering,
many are still active.

20. Cutting can involve
Peer Pressure
e.g. in an effort to fit in with a social
group, young people may experiment
with cutting when they see their
friends doing it

21. Cutting can be addictive.
Young people who cut
cannot help themselves.

22. Cutting triggers a
biochemical reaction in
the brain.
(INSIGHT THEME 2)

23. Serotonin, Dopamine &
Endorphins interact…
Cutting feels Soothing.
Factoids:
These are brain
neurotransmitters.
Sometimes called the
“happy chemicals”.
Serotonin: mood related.
associated with feelings of
pride & significance. Low
amounts mean higher
impulsivity
Dopamine: associated with
the good feeling of
achieving rewards.
Addictive.
Endorphins: brings
euphoric feelings that mask
pain. e.g. runner’s high
Sources: http://goo.gl/dqfApq
http://goo.gl/vJ5aRV
http://goo.gl/mNp0fJ

24. even Rewarding.
so People who cut get
some hormone-rush and
feel soothed from
cutting.

25. The “soothing”
experienced by those
who cut differs with each
individual.

26. Cutting can be
experienced
differently:
as numbing or
feeling more alive.

27. Thus, cutting can feel
rewarding,
reinforcing
& addictive
for those in emotional pain.

28. Young people cut
to cope with
overwhelming
emotions.
(INSIGHT THEME 3)

29. A goal of cutting is
to deal with
emotional pain.
e.g. Sadness, depression, anger,
trauma, bad memories

30. Thus,
Cutting is a way to
help with emotional
regulation

31. “We can’t just take away
someone’s coping strategy
without replacing it with
something else”

32. They need support to find
alternate ways of
coping / emotional
regulation
Can’t just tell those who cut
to stop.

33. “Telling young people to go ‘COLD TURKEY’ will not work.”

34. Emotional pain is made
worse when young
people
shame & blame
themselves for cutting

35. More support & public
understanding is needed.
Stigmatizing those who
cut reinforces
the shaming cycle.

36. (IDEATION PHASE)
HOW MIGHT WE...
2

37. How might we reward
young people differently--
so that they feel the same
amount of pride without
harming themselves?

38. How might we help break
the cycle of
biochemical reward &
reinforcement
in people who cut?

39. How might we direct people
to alternate ways of coping
when they are overwhelmed
and feel compelled to cut?

40. we came up with a lot of exciting,
innovative ideas…

41. here’s one of them...

42. a GRAPHIC NOVEL

43. It will create an engaging,
visual and emotionally
stimulating way
of reaching young
persons engaging in self-
harm.

44. They are “cool”,
accessible & also
relatively less expensive to
produce
(e.g. compared to our more tech-focused solutions)

45. Distribution can involve
local libraries, schools,
community centres, &
both independent &
mainstream book outlets

46. Graphic novels can be
accessed
regardless of whether
young people self-harm or
not.

47. This wide appeal prevents
young people from seeing
themselves as a
“problem”.

48. “The person is not the problem.
The problem is the problem.”
-Michael White, Narrative Psychotherapist

49. Thus, this wide appeal
helps reduce the
stigma of persons
engaging self-harm,
preventing cycles of self-
shame.

50. PHASE
PROTOTYPE
3

51. A graphic novel:
...adapted from Real Stories
...based on actual experiences
of real people who have struggled
with self-harm in the past or
present.

52. Developed in collaboration with:
...writers who have close knowledge
of self-harm issues.
...clinical professionals, social
science researchers, educators &
other key experts on self-harm.

53. F . M. L .

54. FML is real and raw
FML is the sentiment driving despair
and hopelessness, and the
compulsion to self-harm
fml can and will be turned on its
head, showing our audience that
there is redemption and hope

55. FML the graphic novel
a seven part series
each part, a stand-alone piece, is anchored
on a unique character
each part explores the lives and struggles
of each character
all the characters share one thing in
common - a history of self harm and a way
out of their own personal hell

56. The world
contemporary suburban
wasteland where teen girls
deal with a lethal
combination of ennui and
abuse

57. ● Amy’s story opens with
blood and gore, and a
paramedic rescue - then the
story takes us back to how
she got here. and the
redemption that saves her.
● amy comes from a middle
class suburban household
● her dad is irish, her mom is
chinese jamaican
● she is bullied constantly by
other kids who don’t get her
mix.
● she becomes socially
anxious and depressed. she
becomes reclusive,
retreating in a world of
online games and anime
● she starts to hurt herself,
first with a pin prick. but it
doesn’t stop there.
Amy, 15 - Mixed and weird
C
H
A
R
A
C
T
E
R
1

58. Graphic Novel Cover

59. Information included for
people who need help
Brief Cover Page
If you are, or know anyone who
currently engages in self-harm, please
urge them to call:
1-800-Alt-Cut

61. EVALUATION
4

62. People said...

63. "It's cool. I don't cut, but this will help me understand why
other people in my school do it. And maybe I can pass this
along to them." - teenage girl

64. “Many people enjoy reading graphic novels and they can speak to people in different ways. This
mode also caters to those of varying degrees of reading abilities so can target a wider audience. In
this way the message can be delivered which is better than a flyer or only textual format that might
overwhelm people...it will also help those who are creating the graphic novel to cope and reflect on
what happened in their lives and bring meaning to their experience; thereby, serving multiple
people.”
-Dr. D.M. Law, Assistant Professor, WLU
Youth & Children’s Studies & Psychology

65. In future iterations...

66. We will tell different
stories
about characters
that...

67. ...may not fit a stereotypical
teen subculture.
We will tell their unique,
personal story.

68. We will also tell
inclusive stories...

69. ....stories that embrace
cultural diversity & sexual
diversity.

70. Unique backgrounds.
Unique contexts.

71. Shared struggles.
Shared emotions.

72. and
Different definitions
of three, powerful letters.

73. F . M. L .

74. what Does it
really
stand for?

75. Thanks!
Team Health DX
Members:
Lee Chapman, Nathan M. To, Candice Yee
For more details or collaborations, please contact
us. Look forward to hearing from you.
Primary Contact:
Nathan To, CCC PhD
Research Consultant/Counsellor
nathan.to@ronininstitute.org

76. ACKNOWLEDGMENTS
This presentation was originally created for the
IDEO/Acumen “Human-Centred Design” course on
NovoEd.
➜ Presentation template by SlidesCarnival
➜ Photographs by Death to the Stock Photo
(license)

77. CREDITS
Special thanks to all the people who made and
released these awesome resources for free:
➜ Presentation template by SlidesCarnival
➜ Photographs by Death to the Stock Photo
(license)