Skin, Silence, and Signals: Understanding Adolescence, Self-Harm, and the Challenges of Our Times
“We all live with two bodies—the one we’re born with, and the one we have to learn to live in.”
— Didier Anzieu, psychoanalystWhat Does the Skin Tell Us?
For many adolescents who self-harm, the skin becomes more than a biological surface—it turns into a site where unspeakable inner experiences are expressed. Rather than being just a symptom of impulsivity or “attention-seeking,” self-harm often reflects profound emotional distress and a search for containment when words fail.
In psychoanalytic thinking, this act can be understood as a desperate attempt to make something internal feel external and manageable. The cut marks can function as visual punctuation where language is absent—a way of anchoring the self in the face of psychic fragmentation.
Didier Anzieu’s concept of the Skin Ego reminds us that the skin can be experienced as a psychological boundary. When this boundary is felt to be ruptured or absent, the body may be called upon to bear what the mind cannot.
Growing Up in a World That Feels Intrusive
Adolescents today navigate a landscape shaped by constant connectivity, social surveillance, and algorithmic attention. The digital environment can blur boundaries between self and other, between inside and outside, making it harder to establish a stable internal space.
In such a climate, feelings of intrusion or paranoia may arise—not as mere symptoms of pathology, but as reflections of lived realities. Adolescents might internalize the sense of being watched, evaluated, or misunderstood. This can intensify their difficulty in symbolizing emotions or feeling safe in their own psychic space.
Psychoanalysts and clinicians recognize these responses as deeply entwined with the socio-political environment. Psychic survival strategies—like withdrawal, numbness, or self-injury—often emerge when adolescents cannot locate a secure sense of self within a turbulent external world.
The Therapeutic Encounter: Containing What Cannot Be Spoken
In working with adolescents who self-harm, psychoanalytic therapy offers a unique space: one where silence is respected, emotional states can be symbolized, and overwhelming affects can be slowly thought about rather than acted out.
Therapists may encounter powerful countertransference reactions, including urges to withdraw or dissociate in response to the patient’s pain. Recognizing these reactions is part of the therapeutic process and can help build a shared capacity to bear what once felt unbearable.
Symbolically, the therapist offers a kind of “second skin”—a containing presence that can tolerate the emotional turbulence without collapse or retaliation. Over time, this presence may help restore the adolescent’s own capacity to think and feel, without resorting to harm.
Speaking About What Hurts—And Why It’s So Difficult
Talking about self-harm—both inside and outside the consulting room—is difficult. The subject is often met with fear, judgment, or silence. Yet, naming what is painful, even imperfectly, can be a first step toward healing.
In a world marked by crisis—climate anxiety, geopolitical instability, and technological surveillance—adolescents may struggle to feel held or heard. Psychoanalysis offers a quiet but radical space for rebuilding psychic boundaries and fostering resilience through symbolic thought.
Final Reflections
Therapy does not offer quick fixes. But it can offer time, attention, and a steady presence—all of which are vital when emotional wounds are too raw to be named.
For those who self-harm, the body has become a canvas of survival. In psychoanalysis, this survival is not pathologized, but explored and honored, with the hope that eventually, words may begin to take the place of wounds.
Recommended Reading
Anzieu, D. (1989). The Skin Ego
Blass, H. (2025). Cutting and Survival in Adolescents. Presented at the IPA Congress
Nick, S. (2025). Adolescents and Psychic Space. IPA Congress
Klein, M. (1946). Notes on Some Schizoid Mechanisms
Fonagy, P., & Target, M. (2003). Psychoanalytic Theories: Perspectives from Developmental Psychopathology
Zuboff, S. (2019). The Age of Surveillance Capitalism
