Self-harm among SA adolescents is emerging as a far more widespread problem than previously understood, with new research showing alarmingly high rates among school-aged children. Experts say the behaviour is often a response to unprocessed trauma, loss and emotional distress, rather than a desire to die, but warn it is a strong predictor of later suicide risk in a country where mental health services for young people remain severely limited. The tattoos on Zandile Simelane’s arms tell a story that most people can’t read.
Hidden beneath the delicate blue ink of flowers and butterflies, small white scars rise, remnants of the time when cutting herself seemed like the only way to express how much she was hurting. “I didn’t want to die,” the now 31-year-oldtold Bhekisisa’stelevision programme, Health Beat, about her teenage self. “I just needed someone to help me through the pain.
A part of me was just screaming – screaming internally to say ‘What is going on? I don’t know what type of help I need, but help me.’” For Simelane, the pain began in the years after her mother died, when she was a young teen. Her mother, she says, was her whole world and home was her safe place – infused with her mother’s energy, it was welcoming, filled with warmth and bursting with life.
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After her funeral, Simelane’s life changed completely. She moved in with her father and her stepmother, with whom she didn’t have much of a relationship. It wasn’t long before she was sent off to boarding school in Durban.
“I’m caught smoking behind the hostel. I’m coming to school drunk,” she recalls. One day, angry and desperate, she pierced her own ear.
Soon, she started cutting herself. “Maybe if I cut myself, something will happen,” she remembers thinking. Maybe the pain on the outside would finally match the pain inside.
Maybe blood would say what she could not. Maybe someone would notice. Eventually, they did.
A roommate saw that something wasn’t right with Simelane and spoke to a teacher. Soon she was in a psychologist’s office, and not long after, a hospital bed. Her father arrived from Eswatini in less than two days.
Her pain, she says, was finally heard. And the relief poured out. For some teens, emotional pain manifests as self-harm – including cutting, burning, hitting, biting, scratching and picking at skin.
It’s a coping mechanismpsychiatrist Danella Eliasovoften sees in her practice near Hillbrow. “A kid who is cutting themselves or hurting themselves is a distressed kid,” Eliasov told Health Beat. “They’re feeling emotional pain, and they’re expressing it almost as physical pain because they’re struggling to express it in words.” “Self-harm is hurting yourself without the intention to die. You just want to almost hurt yourself… because you’re desperate and don’t know what else to do.”
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