Topoi (2022) 41:383–394

https://doi.org/10.1007/s11245-022-09796-z

The Enacted Ethics of Self‑injury

Zsuzsanna Chappell1 

Accepted: 22 January 2022 / Published online: 11 February 2022

© The Author(s), under exclusive licence to Springer Nature B.V. 2022

Abstract
Enactivism has much to offer to moral, social and political philosophy through giving a new perspective on existing ethical
problems and improving our understanding of morally ambiguous behaviours. I illustrate this through the case of self-injury,
a common problematic behaviour which has so far received little philosophical attention. My aim in this paper has been to
use ideas from enactivism in order to explore self-injury without assuming a priori that it is morally or socially wrong under
all circumstances, seeking to establish a less implicitly value-laden analysis. Enactivism can help us in making this behaviour
more intelligible and contextualising it through examining the relations of individual embodied action and social practices
with the help of enactivist theories of habits and affordances.

Keywords  Applied ethics · Enactivism · Reason · Self-injury

1 Introduction “out of character”. At times it is almost as if we have to

work around a black box of irrationality, which impedes our
Enactivist theories are already proving useful in areas such progress at every turn. Cognitive philosophy can help us in
as philosophy of emotion (Colombetti 2014), philosophy unlocking this black box. Furthermore, we want to unlock
of joint action (Gallagher 2020), skilled action (Cappuccio our black box in a relatively value neutral way. While we
et al. 2020; Rucińska 2021), philosophy of music (Krueger may acknowledge that no theory is able to achieve complete
2014; Schiavio et al. 2017), philosophy of psychiatry (de value neutrality, we can strive to reduce inherent biases.
Haan 2020; Glas 2020; Nielsen 2021) and bioethics (Sve- Myopia, akrasia, forgetfulness, addiction are all negatively
naeus 2021). A key questions is whether this usefulness can loaded terms; they are not just a puzzle to solve, their nega-
be extended to areas of philosophy that fall under the label of tive consequences are usually implicit in the language we
value theory, namely moral, social and political philosophy use. They impede rationality, particularly understood as
and aesthetics. The aim of this essay is to explore the poten- the instrumental rationality of adopting suitable means for
tial enactivism has for contributing to the field of applied achieving our ends. I believe that enactivism could offer us
ethics. As such, it is written from the perspective of applied a relatively less value-laden alternative for explaining such
ethics carried out in the analytic tradition looking for poten- seemingly irrational behaviour.
tialities in enactivism, rather than the other way around. The ethical implications of enactivist theories have
Rather than focusing on enactivism’s implications on already provided interesting insights. An explicit discus-
meta-ethics, the structure of our ethical theorising itself, in sion between enactivism and ethics was initiated by Colom-
this paper I want to draw out another way in which enactiv- betti and Torrance (2009) over ten years ago. Van Grunsven
ist theories can have a significant impact on this area of (2018) started an important enactivist engagement with
philosophy. Many ethical puzzles owe their existence to the topic of agency and responsibility. Enactivist bases of
the fact that we are not perfectly rational, ideal agents. We the joint action required by morality, law and politics are
are forgetful, myopic, akratic, experience addictions, emo- discussed by di Paolo et al. (2018) and Gallagher (2020).
tions which cannot be rationalised, and are prone to acting Enactivism has lead thinkers towards feminist theories of
care ethics (Urban 2016; Van Grunsven 2018, Loaiza 2019),
which examine the links of justice to interpersonal, embod-
* Zsuzsanna Chappell
zsuzsanna.chappell@gmail.com
ied relations. Urban argues that theories of care ethics are
closest to a “genuinely relational phenomenological ethics”
1
Independent Scholar, London, UK

13
Vol.:(0123456789)
 Z. Chappell
384

(2016, p. 172). Enactivist theories of skilled action also mir- form.1 Yet while this environment forms us and constrains
ror the process of virtue acquisition which is foregrounded our choices, it also offers us possibilities for action, and we
by virtue ethicists (Annas 2008; DeSouza 2013). can shape our environment in line with our values. Thus
In order to examine how enactivism could explain ini- we are not mere passive experiencers receiving values from
tially unintelligible behaviours in a relatively value-neutral our environment. “The organism is the centre of activity
way, I will discuss the social and moral norms around delib- in the world” (de Jaegher and Di Paolo 2007, p. 487): an
erate self-injury as a case study. This topic has been rela- autonomous agent not limited to responding to environmen-
tively neglected in ethics, even though it is similar to issues tal stimuli and satisfying internal demands.
discussed in greater detail, such as suicide (Cholbi 2011),
Organisms do not passively receive information from
addiction (Pickard 2020) and eating disorders (Giordano
their environments, which they then translate into
2019). Given their link to the philosophy of psychia-
internal representations whose significant value is to
try, where enactivism is already proving to be influential
be added later. Natural cognitive systems are simply
(e.g. de Haan 2020; Nielsen 2021), these issues are a good
not in the business of accessing their world in order to
starting point for the interaction of enactivism with value
build accurate pictures of it. They actively participate
theory. I turned to enactivism myself when, working on
in the generation of meaning in what matters to them;
the ethics of self-harm, I needed a way of thinking through
they enact a world. (de Jaegher and di Paolo 2007, p.
some of the problems evidenced by the behaviour. Self-
488, emphasis added)
injury is usually described from the start in normatively
laden terms as dysregulated or dysfunctional behaviour. Our environment is dynamic rather than static; it is con-
While I believe that self-injury is undoubtedly bad and not stantly changing. Natural forces, non-human animals and
to be encouraged, it is also important to engage with it in a humans all contribute to this ongoing change. Part of the
more value-neutral way in our research, a way that not only challenge for each of us is then to adapt to this world in
focuses on and pathologises individual cognition, but pays flux. For us humans, since we are not only embodied but
attention to the entire body-mind, embedded in a social and also moral animals, one of the criteria of successful adapta-
material environment. tion will be moral2 (e.g. MacIntyre 2009). Not only do we
In Sect. 2 I will provide a brief overview of enactivism. In want to succeed as biological organisms, we also want to
Sect. 3, I will provide a definition of self-injury and illustrate live according to our notions of justice and the good life,
the kinds of ethical problems it poses. In Sects. 4 and 5 I the right and the good. Thus our aims are significantly more
focus on two key concepts from enactivism to see how we complex than that of bacteria pursuing nutrition.
could understand self-injury better: habits and affordances. Applied ethics focuses on particular, problematic real
In Sect. 6 I will briefly discuss the broader implications of world situations. As a result it encompasses the intersection
using enactivism in order to extend the range of mutually of the empirically knowable material world (our world) and
intelligible behaviours. moral-philosophical theories, principles, and ideals (the way
we ought to enact a world). Nearly all areas of applied eth-
ics have a strong embodied component: reproductive ethics,
2 Enactivism the ethics of disability, parenting, food or the environment
are just a few examples. Furthermore, ethics is naturally a
Just as we would expect from a rapidly developing field, relational enterprise. Much of it asks questions about how
there are variations in the ways in which different scholars we ought to treat people, including ourselves. Even when we
use the term ‘enactivism’ (cf Kiverstein and Clark 2009). think and write about individual conceptions of the good life
The roots of enactivist theories lie in ecological psychol- or the ethics of environment, we have to acknowledge that
ogy and cognitive science (Varela 1999), and in classical the way we live our lives, the way we treat our environment
phenomenology, especially the works of Merleau-Ponty (di will always have implications for the people with whom we
Paolo et al. 2018). At first sight, maybe at the point when share our world and for future generations who will inherit
theories of enactivism tell us how bacteria will float up in it from us.
liquid following a sugar gradient, it may be difficult to see Ethical accounts often take up problems that occur when
how ethics would benefit from such theorising, unless we inter-personal sense-making breaks down. As an exam-
are addressing the question of value-formation (or why the ple, we discuss issues of responsibility and agency exactly
bacteria should value pursuing the dissolved nutrients).
Enactivism encourages seeing ourselves, as humans, also
as bounded organisms comprised of both body and mind and 1
  In Hume’s famous terms: ought implies can.
placed into a social and physical environment with which 2
 The extent to which some non-human animals might enact some
we need to interact and which constrains the values we may form of morality is an open question.

13
The Enacted Ethics of Self‑injury 385

because we are not always sure when agents are responsible 3 Self‑harm as Self‑injury
for their actions and when they are not. We need to work out
how to best make sense of the actions of others in order to Most would place self-harm on the side of morally, rather
be able to apply moral terms such as responsibility to those than culturally prohibited behaviours. Thus they would say
actions. Of course, intra-personal (within person) sense- that it is always wrong, rather than that it is wrong within
making can also break down, which is what makes akrasia or the context of their society’s culture. The basis of this belief
weakness of the will such enduring puzzles. In these cases, is relatively little explored. The first question of ethics to
we do not understand our own actions. Enactivism could ask here is: on what grounds can we interfere with the self-
serve an explanatory function where current explanations directed behaviour of others? If self-harm is not morally
are weak or fail by explaining these issues better in a way wrong, then (apart from social customs, which may be unjust
that does not prejudge their moral evaluation. or unfair) its wrongness may be grounded in the badness of
Concepts such as affordances and habits, which I will the action or its consequences: it is wrong to treat ourselves
discuss in more details in later sections of this paper, can in a way that feels and looks quite this bad. We are usually
be incorporated into larger frameworks that study enaction careful to avoid harm and injury. We tend to think that there
within a social and cultural setting. One example of this is are very few reasons that trump preserving bodily integ-
the skilled intentionality framework (Rietveld and Kiver- rity. These reasons are usually about avoiding even greater
stein 2014; van Dijk and Rietveld 2017). These philosophers injury either in another, for example when someone risks
argue that skilled individuals have learnt to respond appro- being hit by a bullet to save someone else, or in ourselves, as
priately to the sociomaterial practices they are part of, the when someone cuts off a foot to free themselves from being
cultural world which they inhabit. So far, such theories have trapped under a boulder.3
for the most part assumed that following social rules and This leads us to a second ethical question: what consti-
norms of behaviours is uncomplicated from a morally nor- tutes a good relationship with our embodied selves? A big
mative perspective (Rietveld and Kiverstein 2014; Mojica part of the puzzle is why self-harm should be regarded as so
and Gastelum Vargas 2021). Thus, adhering to such norms much worse than other things we do which are bad for our
is seen as largely beneficial for individual agents (Mojica bodies, but from which we do derive some kind of benefit
and Gastelum Vargas 2021) and serves to enable a flourish- or satisfaction, such as eating too much unhealthy food or
ing life. smoking cigarettes. Yet to most, unlike these kinds of dam-
Yet, the assumption of skilled intentionality simply con- aging behaviours, self-harm appears as particularly difficult
sisting of following socially normative behaviour needs to to understand or even unimaginable, making it imperative
be problematised when we are dealing with morally ambigu- that any good theory of self-harm should make the phenom-
ous behaviour or in pluralistic societies where communi- enon more comprehensible. Not understanding self-injury
ties with different sociomaterial cultures live side-by-side. can lead us to assume a priori that something that is bad is
In these cases, the question is exactly what constitutes a also wrong, thus apportioning blame even before consider-
skilled response. When there is disagreement about what ing the relevant facts.
that response should be, mutual sense-making can even The most familiar form of self-harm is deliberate self-
break down when one group does not even try to make sense injury. While its notoriety has waxed and waned over time
of the meaning of actions when those meanings are not read- (Chaney 2019), discussions about and depictions of self-
ily available to them (Schutte 1998). Enactivism can be a injury have become a familiar element of contemporary
useful tool for analysing the way in which meanings can be Western culture over recent decades (Steggals 2015; Bros-
thus lost between people. sard 2018). Self-injury is usually defined as intentional tis-
This becomes apparent when we consider the problem sue damage. Cutting, hitting, bruising, hair pulling, biting,
of self-injury. Agents who self-injure are usually seen as taking a non-fatal overdose of medication, burning, swal-
impulsive and compromised in their agency. While this may lowing objects or otherwise inserting them into the body are
be true, this ignores the fact that self-injury takes place in the all common examples of self-injury. Among these cutting is
context of distress, mostly caused by social factors outside currently the most commonly reported (Chandler 2016) and
the agent’s direct control. Not only is self-harm related to self-poisoning is not included under all definitions.
agents’ social situation, but it can be seen as both provided Thinking superficially, we may believe that someone who
and prohibited by the same social discourse. It is a case little self-injures does so for the sake of the injury,—the overall
explored in the ethical literature (exceptions include Pick-
ard 2015; Kong 2019), and it is difficult to interpret within
existing frameworks. Thus it is exactly the kind of ethical 3
  There may be other acceptable reasons in other (sub)cultures, for
problem which would benefit from an enactivist approach. example linked to religious rituals where injuries contribute to reli-
gious ecstasy or insight.

13
 Z. Chappell
386

experience of it,—rather than for the relief it brings. Yet States had self-harmed. Despite the common stereotype,
self-harm, as it is currently defined, is not primarily about self-injurious behaviours are not limited to adolescent girls,
masochism or enjoying getting injured. Even people who do even though it appears that the majority of those who report
not enjoy getting injured may find purpose in self-harm (Sut- self-injuring are young and female (Sutton 2007).
ton 2007). While self-harm is a very heterogenous behav- Reasons provided for self-harm are diverse, though they
iour, as people can have different motives for, explanations appear to stem from experiences of distress. The most com-
and methods of self-injury, the recent empirical literature mon motivation cited in the empirical research literature is
does reveal a broad picture of contemporary practices of emotional regulation or a “pathological soothing mecha-
self-harm (e.g. Brossard 2018; Chandler 2016; Sutton 2007; nism”5 (Herman 2015, p. 109): coping with emotions that
Steggals 2015). Much of the time, self-injuring seems to seem unbearably intense or trying to jolt the self out of the
resemble taking over-the-counter or prescription medicine numbness of emotional dissociation (Pickard 2015, Rossi
against pain, more than it resembles taking illegal drugs Monti et al. 2019). Other reasons include self-punishment,
for the high they cause.4 While taking paracetamol for a re-enacting trauma or responding to loss of control. Not all
mild headache is an indifferent experience in itself, I do not reasons for self-harm, however, are negative, even within
enjoy taking a stronger prescription pill for my migraine as it this context of distress. Testimonies from those who self-
makes me feel drowsy and foggy. I would not take either just harm show that it is also seen as a way of taking control,
for their own sakes, as they are not beneficial for my body enacting agency, whether it is through experiencing pain on
all things considered, without the presence of pain. Equally, one’s own terms or creating permanent reminders and shap-
self-injury is usually not beneficial in itself. Of course, just ing the body through scars (Chandler 2016).6 For some, it is
as someone can become addicted to pain killers, one can also the self-care administered when looking after their injuries
become addicted to self-injury. One may also take painkill- that has the greatest significance. For others, the body mir-
ers compulsively, or not realise that what they are eating roring the state of the mind holds an aesthetic significance.
are painkillers, rather than candy. Equally, someone could Many of those who self-injure report that they do so exactly
develop a compulsion to injure themselves, or they might in order to counter suicidal ideation (Motz 2010), even if on
drink poison in the mistaken belief that it is medicine. These rare occasions they might in fact put themselves into dan-
are, however, cases of addiction, compulsion, mistaken gerous situations where it is no longer clear, even in the
belief or delusion, cases which a basic analysis of self-injury mind of the agent, whether the intention was to self-harm
needs to explicitly exclude. But neither is harm or injury or to attempt suicide (Brooke and Horn 2010). It is likely
an unwanted side-effect of self-harm. The smoker smokes that those who self-harm will turn to culturally sanctioned
because they are addicted to nicotine, enjoys smoking or interpretations when they seek to explain their behaviour to
wants to fit into their peer group, and is only incidentally themselves and others (Steggals 2015). Thus there may be a
damaging their lungs in the process. The adrenaline junky gap between the intentionality of the agent enacting the self-
may engage in risky extreme sports and the risk of injury injury and the same agent explaining the self-injury later
is part of the thrill, but their aim is not to get injured, so to themselves and others. There is still a need for empiri-
that they can repeat the experience. By contrast, the person cal research that unpacks how these behaviours are enacted,
who self-harms would be focused on injuring their lung or as current evidence from individual testimonies does not
actively risking injury through extreme sports and any other yet provide a full explanation for them. As self-injury is
benefit, such as actually enjoying extreme sports, would be such a heterogeneous behaviour both in terms of motivation
at most a secondary consideration. and method, it is also difficult to generalise from specific
Self-harm as self-injury can point towards numerous examples.
psychiatric disorders, including depression, anxiety and One way of approaching this problem is through adopt-
personality disorders, but while it is usually an expression ing the enactive model of agency developed by Gallagher
of mental distress, it is not always a sign of mental disorder (2020), who differentiates between three different levels of
(Sutton 2007) and can easily go undetected by others. Its agency, following the model developed by Pacherie (2008).
prevalence in Western societies is high, although difficult to The first type is distal intentionality (D-intentions): planned
estimate given its hidden nature. A meta-analysis by Mue- action agents resolve themselves on in advance. Someone
hlenkamp et al. (2012) put the prevalence rates at 16.1% or
18% among adolescents studied between 2005 and 2011.
Klonsky (2011) found that 5.9% of adults in the United
5
 Once again, this raises the question what makes this soothing
mechanism particularly pathological, compared to say eating a tub of
ice cream.
4 6
  Of course someone might also later on come to consume drugs in  More empirical research is needed in order to establish how this
order to avoid withdrawal symptoms. plays out in practice, without which we can only speculate.

13
The Enacted Ethics of Self‑injury 387

may decide to stop self-harming, or they may plan for self- how they talk about it to vulnerable others, it is difficult to
harm in a ritualistic fashion, for example through purchasing show that self-injury is harmful to others, rather than simply
a supply of clean blades and bandages. In the moment when offensive.
the urge to harm oneself appears, such deliberations may This does not mean that self-injury is something we
become less important, as in the moment, habitual proximal- should acquiesce in, let alone promote, just as we want to
intentionality (P-intentionality) and basic motor intention- reduce other self-damaging behaviours such as drug addic-
ality (M-intentionality) take centre stage, over-riding more tion, smoking or a poor diet. But we need to be more aware
careful deliberative impulses. P-intentions do not necessarily of the social circumstances that may lead to both self-injury
inherit the action plan of D-intentions. This type of inten- and its condemnation, and the individual distress it origi-
tions serve to anchor intentions to specific situations. Thus nates in. Ultimately, what needs to be eliminated is the
they respond to the current situation as the agents perceives underlying pain and distress, instead of simply focusing on
it to be, which may over-ride previous D-intentions. In the erasing a behaviour that society strongly disapproves of.
case of self-injury this could mean the immediate distress Viewing such behaviour through the enactivist lens may
and accompanying urge to harm oneself may over-ride ear- also help us change what aspects of self-injury we pay atten-
lier plans to abstain and habitual action is initiated instead tion to. This allows us to develop a picture of self-injury that
and carried out through basic M-intention. Retrospectively, is not focused only on a pathological behaviour, but takes a
these may be turned into a more coherent narrative of emo- broader view of it as an embodied activity embedded in cul-
tional management or mismanagement reflecting cultural ture (Clarke & Whittaker 1998). This mirrors the approach
practices of sense-making. of the skilled intentionality framework in locating actions
Despite its badness, self-harm is arguably not morally within a landscape of sociomaterial practices (van Dijk and
wrong. Duties towards oneself against self-injury and sui- Rietveld 2017). In fact, this paper has grown out of my own
cide that are grounded in respecting one’s own humanity difficulties in thinking self-injury in a relatively formal way,
and dignity (Kant 1797/1996, Pickard 2015) can be difficult while discussing the ethical issues surrounding it.
to establish (e.g. Muñoz 2020). Any duty with which I bind In Sects. 3 and 4 I will examine the way in which two
myself can equally be over-ridden by my right to deal with important enactivist concepts—habits and affordances—can
my body as I will. If an agent is in severe, acute distress and make self-injury less mysterious and unintelligible. The
they are unable to respond to this in any other meaning- habitual nature of self-injury simultaneously captures some
ful manner, then refraining from self-injury may even be of our deepest concerns about the behaviour, while also
more harmful and damaging to autonomy and dignity as it pointing to why it is so difficult to change self-harm behav-
leaves them in continued distress. This could put self-injury iours. Thus, the concept of habits helps us to dig deeper in
in line with other ways of damaging our bodily integrity that understanding the implications of the individualist aspects
are acceptable because we are trying to avoid greater harm of self-harm we are currently focused on. Affordances, on
or injury. This may be particularly the case for those who the other hand help us change the focus of our attention
say that self-injury helps them to manage suicidal ideation. and move it away from the individual in distress to how our
Requiring people to stop self-injuring without examining environment solicits quick and dirty distress management
the meaning of the practice may lead people towards more through self-injury.
damaging alternatives such as over-eating or excessive diet-
ing (Brossard 2018) as they will still need to deal with their
distress in some way and there are no guarantees that this 4 Individual Habitual Action
will be a healthier one.
Moral considerations towards others, through an appeal Our everyday ambivalence about habits is displayed by the
to the harm principle, are also problematic as a basis for fact that we think of them both as mindless, as when we are
establishing that self-injury is wrong. In the large majority brewing morning coffee, and as something for which people
of cases those who self-injure deny that they do so in order can be held responsible, as in addiction and self-injury. Self-
to communicate with others, which is borne out by the fact injury is not only engagement with our surroundings and
that self-injury tends to be carefully (although not always our bodies, but it is habitual engagement. It is rarely a one-
successfully) hidden7 (Brossard 2018). As long as those who off action and instead becomes part of a regular repertoire
self-injure take reasonable precautions in how they appear in of skilled action aimed at dealing with distress. Sometimes
front of potential witnesses and bystanders and are careful of this distress may even be quite mild, such as the discomfort
caused by boredom (Brossard 2018). Thus self-injury can be
7 likened to other forms of habitual skilled performance which
  This should be differentiated from communicating about one’s self-
injury, for example in an online support group or in therapy. The aim can be performed without deliberation (Ramírez-Vizcaya
of the act itself is most often not communicative or manipulative. and Froese 2019). It is this habitual character which often

13
 Z. Chappell
388

causes the greatest worry to others. Even when it functions Remedying self-harm is not as simple as exchanging one
as intended—relieving distress,—self-injury remains a sub- habitual action for another. Some habitual actions suggested
optimal behaviour according to most measures and bad for as alternatives to self-injury may in themselves be cultur-
us in itself. A good analogy when we are arguing against ally acceptable forms of self-harm, such as snapping rubber
self-injury would be to say that drinking sugary drinks may bands, pinching oneself or holding ice cubes (Sutton 2007).
alleviate thirst as well as water, but we consider water a Other, more socially acceptable forms of self-harm may still
healthier alternative. be an unhealthy choices; for example eating to the point of
Habits can be seen as non-intellectual short-cuts that sim- discomfort.
plify regular tasks. They can also be counter-productive to Any habitual, skilful action is developed over time and
our stated goals and intentions (Miyahara and Robertson then repeatedly enacted and re-enacted. Action becomes eas-
2021). Yet, mindlessness does not fully capture how we ier over time and acquires fluidity. As they are automatic and
think about habits, as we also tend to link habit to character quickly responsive, habits can be deployed without reflec-
(Annas 2008; Maiese 2021). A virtuous person cultivates tive, conscious thought, but need not be blind and rigid,
virtuous behaviour, and if we think that self-injury is a vice, given that they respond to specific situations. Habitual action
then it is not only an unpleasant habit, but a sign that we are may be “intelligent and flexible while involving no deliber-
not able to deal with our problems “the right way” (Chan- ate action control and no explicit representation of the action
dler 2016), we are not sufficiently skilled at choosing the goals” (Cappuccio et al. 2020 p. 610). When in a situation
normatively correct response to our situation from the rep- which someone finds extremely distressing, these habitual
ertoire of responses made available to us by our social and actions can over-ride more conscious decision-making pro-
material environment (Rietveld and Kiverstein 2014). Thus cesses. Indeed, the pressing nature of the distressing stimu-
there is something lacking in our character; we are lacking lus and the urge to alleviate distress that goes with it will
as persons. This clearly invites normative judgment. Even reduce an agent’s ability to formulate and carry out alterna-
if habits are mindless day-to-day, agentic control is present tive actions. Thus self-injury will be considerably advan-
at the point of cultivating habits, rather than at the point of taged over other distress-management strategies that do not
enacting them. Linking disgusting habits to a lack of char- provide relief as quickly and as seamlessly. The higher the
acter may help to explain stigmatisation as well as concerns cost of alternative strategies in terms of loss of fluidity and
about “epidemics” and contagion. skilfulness (that is, slower, more stumbling action) the lower
As well as a sign of poor character, self-injury is also the chance that the alternative strategy will prevail.
seen as an urge, as a complete failure of self-control, negat- Through acquiring fluidity, an action also increases the
ing responsibility, especially if we have “caught” it from sense it makes. It is not only that self-injury is practically
someone else. Yet when patients say, and psychologists write somewhat easier to carry out. It also acquires meaning for
that self-injury is compulsive, they usually mean that the agents as it is repeated over time, through a sedimentation
urge to self-injure is very hard to resist, rather than that it of past actions, emotions and situations. By contrast, other
is impossible to do so. Neither is self-injury an addiction in actions, such as holding an ice cube, will feel alien. They
the sense that it causes withdrawal symptoms. This comes may even hold meanings which negate any affective ben-
through clearly in an account by Rita Binns, who stopped efits: a mother who regularly puts the hairbands that her
self-harming because she was concerned about the impact daughter would otherwise lose on her wrist may very well
of A&E attendance during the coronavirus pandemic (Binns develop associations which make snapping a rubber band
2020), and in accounts of people refraining from self-harm on her wrist infeasible as an innocuous, socially skilful form
in front of others and especially in front of children (Pickard of self-harm. This last example also illustrates that habits
2015). These agents are in fact responding skilfully to the are usually situated among a network of habits (Ramírez-
sociomaterial practices that they are part of (van Dijk and Vizcaya and Froese 2019), which give meaning to each other
Rietveld 2017). This is reflected in definitions of self-injury reflexively. The moment of self-injury often does not stand
as “deliberate”. It encompasses cases where agents are not on its own, but is part of a network of behaviours. Someone
either globally or locally unable to make rational decisions, purchasing razor blades or bandages at the chemist’s shop
are not coerced, are not under the influence of psychotropic could do this as part of a mundane shopping trip for house-
drugs or suffering from psychotic delusions, and are aware hold basics, or they may be stocking up their self-harm kit.
of the consequences of their actions. Many of those who Equally, someone who does not keep such a kit but uses
self-injure will plan the action in advance, keeping a self- readily available household objects expresses something
injury kit including blades or bandages. Others plan self- about their particular way of using self-injury as less for-
injury and possible need for hospital attendance around their malised and more contingent.
working hours (Brossard 2018). It is only when someone finds a strategy for alleviat-
ing distress that is genuinely meaningful within this wider

13
The Enacted Ethics of Self‑injury 389

context of behaviours can that strategy start to replace self- chew toy (it affords chewability), while it would appear to
injury. Problematically, these can involve not just healthier me primarily as something to write with (it affords grip-
forms of self-soothing, but even more damaging behaviours pability for the purposes of writing; it is a special kind of
such as over-eating, excessive dieting or over-exercising grippability that presupposes that I hold the pencil with a
(Brossard 2018). This could, in our initial approach to man- tripod grip). By saying “appears to me as” I am already
aging self-injury, weigh in favour of ethical theories of harm indicating a process of sense-making: what is salient to me
reduction rather than outright prohibition: keeping in place is not primarily that the pencil is grippable, but that it offers
safer ways of self-injuring until the underlying distress is me a potentiality for writing.8
addressed or new meaningful forms of distress management We can learn new ways of using our environment through
are created, and also appreciating the value that such a prac- experimentation or through information provided by others
tice as a whole has for the agent. Thus behaviours like self- and thus broaden the range of affordances available to us.
injury remain ambiguous. While not morally wrong, their Children will start by making simple marks with a pencil,
possible right-making features are not easily generalisable, then move on to communicating through drawing objects
and others may require to perform imaginative work in order and then writing, once they first learnt the relevant social
to enable them to recognise theses in the first place. system of symbols (Rietveld and Kiverstein 2014).9 Simi-
This brief discussion of self-injury as habitual action may larly, we can also lose affordances. Arthritis may stop some-
already help us in clarifying some of our existing worries one from playing the piano; the piano (as an object) will no
about self-injury and some of the reasons why it is a dif- longer afford them the possibility of making music. Gain-
ficult behaviour to change. Still, focusing on self-injury as ing and losing affordances may be of particular relevance to
individual, habitual action maintains and only expands on ethical issues, as it is in the case of self-injury. Many objects
existing explanations. Yet I believe that enactivism can offer afford more than one possibility for use. A knife (which is
us even greater explanatory power and new ways of think- grippable) can be used to cut up food, open a package, pry
ing about self-injury, by turning our attention to the way in a lid lose, butcher an animal or self-injure. If I do not have
which both our material and social worlds offer up the option food to cut up, a package to open, a lid to loosen or an ani-
of self-harm to distressed agents. For this, I now turn to the mal to butcher, the knife does not at that time afford me
concept of affordances. the relevant action, as I lack the necessary combination of
material objects in my environment. As a city-dweller, using
a knife to butcher an animal is not an affordance I would
5 Environment and Affordances consider knives to hold in the regular course of things.10
Similarly, for most of us, knives as material objects do not
In Sect. 3, I defined self-injury as intentional tissue damage immediately present the opportunity for self-injury, as we
to one’s body carried out in order to cope with a distressing are not in the state of distress which self-injury can address.
situation. We can reformulate this in the following way: self- Our environment may not only afford self-injury, we may
injury is the agent’s use of objects in their material environ- perceive it as actively soliciting it (Siegel 2014), just as we
ment to damage their bodies with the expectation that this perceive a ringing phone not just an opportunity, but as an
will help them cope with a distressing situation. This allows invitation or even a demand to answer it. Thus for many who
me us to locate self-injury among the practices made avail- self-injure, just seeing a knife might bring forth thoughts
able to us by our environment. of further injury. As Rietveld and Kiverstein (2014) put it:
Enactivism has adopted the concept of affordances from
We suggest that is our current abilities and concerns
ecological psychology to capture the opportunities for action
that make it the case that we are solicited by one affor-
offered to agents by the world around them (Rietveld and
dance rather than another. Moreover, once we have
Kiverstein 2014; Krueger 2014; Colombetti and Krueger
available the notion of a solicitation, we can also rec-
2015; McClelland 2020). While there is more than one con-
ception of affordances available, here I focus on the version
developed by Rietveld and Kiverstein (2014) as it is a com- 8
  This is consistent of McClelland’s (2020) definition of affordances
ponent of the framework of skilled intentionality introduced as “AFFORDANCE: x affords φ-ing for S iff x offers an opportunity
in Sect. 2 and helps me to position self-injury within a land- for S to φ.” (p. 403): a pencil affords writing for me iff the pencil
scape of interrelated socio-material practices. offers an opportunity for me to write.
9
At a simple level, a pencil is grippable for me and chew-   Even this is an oversimplification. Since I started writing this paper,
able for my dog. This does not get us very far, as gripping my daughter had started to play at writing by producing squiggles
which were only intelligible to her. Then she moved on to writing rec-
and chewing are not the level of actions we are primarily ognisable characters from the Latin alphabet.
interested in. Thus we can go on to say that a pencil (piece of 10
  Although the affordance is still inherent in the object even if it is
soft graphite wrapped in wood) might offer my dog a good not available to the agent (Rietveld and Kiverstein 2014).

13
 Z. Chappell
390

ognize how sometimes the world can motivate us to by accident, they are provided with a ready-made model
act in certain ways. When we experience a particular of how to self-injure, primarily through cutting (Brossard
tendency to act in a certain way, this is because we 2018). Self-injury is positioned as a viable method for our
have been solicited by one of the many possibilities for urges towards managing our distress through its portrayal
action available in our situation. (p. 342) in entertainment, the media and public discourse (Steggals
2015). Given this cultural context, enactivism can help us
How do people come to realise that objects in their environ-
to re-frame self-injury as an affordance embedded within a
ment afford action that reduces distress through self-injury?
cultural system, a skilled socio-material practice.
Brossard (2018) argues that they do so either by accident or
Also relevant here is Hacking’s work (1998) on environ-
through a cultural learning process. Someone might realise
mental niches that allow transient mental health epidemics
that refusing to let an injury heal and making it worse is an
to develop, such as an outbreak of supposedly hysterical
outlet for certain kinds of feelings. Nowadays, when self-
fugues in the late nineteenth century or multiple personal-
injury is commonly discussed in the public sphere, people
ity disorder in the twentieth century. Hacking argues that
are much more likely to learn about the concept through
such patterns of disordered behaviour emerge when there is
cultural transmission, but will adapt the actual form their
a framework of diagnosis in the mental health system within
self-injury takes to their own circumstances. In everyday
which the behaviour will neatly fit, the behaviour becomes
discourse this is often simplistically presented as vulner-
easily observable, it is situated in an ambiguous position
able people starting to self-injure or being encouraged to
between virtue and vice and it provides release which is “not
continue self-injuring through being led astray by depictions
available elsewhere in the culture within it thrives” (p. 2).
of the act, most likely on social media. However, this story
When we assess it against these criteria, self-harm fits neatly
is much too simple.
in contemporary understandings of emotional regulation and
We can observe self-injurious acts among captive animals
even trauma. The internet has made self-injury much more
who have no options to escape either loneliness or undesir-
visible and has given a means for people to connect online
able cage-mates, lack adequate mental stimulation and are
to discuss it. It is situated within a broader acceptance of
not offered alternative ways for distress management (Breun-
body modification, whether in the form of tattoos or botox,
ing 2013). This implies that our environment affords oppor-
and it also rebels against the pressure to present an air-
tunities for distress management through self-injury in itself,
brushed, picture-perfect body. Finally, it does appear to offer
without any cultural baggage attached or learning required.
release to those practicing it. These elements do not make
In a classic anthropology paper Mauss (1973) notes that
self-injury unique to our society, but they could explain its
while common behaviours such as sleeping, walking, eating
relative prominence. Hacking discusses the case of hysteri-
or swimming are carried out in all societies, their particular
cal fugeurs, mostly men who took to the road and travelled
execution will vary according to social constraints. Simi-
long distances in France at the end of the nineteenth century,
larly, Elias et al. (2000), in his masterful study of Western
often claiming little memory of or control over their behav-
manners since medieval times, argues that common actions
iour. People have wandered off from home before and since,
differ widely over time as cultures change; while in medieval
and have started new lives, but their behaviour did not have
England standing on one leg may have been considered nor-
the same social and cultural significance it had during that
mal, it would be seen as outlandish now, even though we do
specific historical time and place.
continue to stand frequently. Thus while self-injury may be
Through its sociocultural meaning self-injury has retained
present even in non-human animals, as members of various
its significance as a coping mechanism, but has also acquired
cultures humans will assign different significance to it and
additional meaning as a dangerous, deviant epidemic. In
might enact the behaviour in culturally specific ways.
this cultural context, self-injury is presented fundamentally
While self-injury seems to exist as a constant over time,
ambiguously, as it is simultaneously forbidden as repugnant,
various socially recognised outbreaks and epidemics over
habitual, contagious, and advertised as something to turn
time have manifested differently (Chaney 2019). Thus,
to at times of psychological distress. To adapt an argument
between the two world wars, there was a spate of cases of
Seaber (2016) makes about the depiction of eating disorders:
“needle girls”, who self-harmed through inserting sewing
while someone not in distress, afraid of injuries or with a
needles in various ways into their bodies. Meanwhile, hos-
low pain threshold might see self-injury as pre-reflexively
pital and asylum records from nineteenth century England
wrong for themselves and repugnant for others, someone
show that head banging, self-biting, self-scratching, hair
with a different outlook and needs may re-interpret cau-
pulling were common behaviours among patients, with-
tionary warnings as useful guidelines or even aspirational
out attracting any special attention from physicians or the
instructions. The second person can come to see affordances
wider culture. In our early twenty-first century society peo-
for self-injury in their environment (a knife becomes a pos-
ple do not need to discover the relief offered by self-injury
sible tool for managing emotions), while the first person

13
The Enacted Ethics of Self‑injury 391

will not learn to do so. This explains why simply becom- others give to our actions and our bodies will then escape us,
ing aware of self-injury, for example through social media, be out of our hands. In turn these others may fail to see the
does not necessarily socialise someone into self-injury. The original meaning in our behaviour, and instead make sense
skilled use of affordances means that the agent understands of it according to their own interpretations, foreclosing the
that self-injury is to be used to deal with distress, just as possibility of genuine interpersonal sense-making.
on a more mundane level a skilled agent understands that If self-injury is a fundamentally embodied action, reac-
we stand on a chair to change a light bulb but not to eat our tions to it of disgust, revulsion and repugnance are also fun-
dinner. damentally embodied. To a large extent, these are visceral
Through its simultaneous prohibition and promotion the reactions to sights which are the indication of danger: rot-
act of self-injury acquires layers of meaning: not only is it ting food, injuries, putrefaction all signal that something can
a way of dealing with distress, it is a particularly culturally go badly wrong for us here. But as Mary Douglas (1966)
charged way of doing so. This is not inherent in the material has shown, we can learn to extend disgust to culturally con-
object but it is inseparably added to the affordance it offers structed sources of dangerous impurity. Under our current
once the agent is aware of it through being immersed in the cultural conception of psychological and physical health,
relevant cultural context and its landscape of affordances.11 self-injury is a form of bodily, psychological and cultural
Someone self-injuring once they have learned the cultural impurity; it is unhygienic.
significance of their behaviour will be performing a different While instinctive revulsion at the sight of wounds and
action from someone who does not know that there are other injuries is a common human response, here it acquires an
people who also self-injure, or that it is a largely forbidden added dimension through the fact that the injury is self-
action. inflicted. Psychologists report feeling physically threatened
A point worth considering is that self-injury reveals a at the sight of self-injury wounds (Motz 2010). Becoming
way in which our own bodies afford actions just as other aware of the self-injury of others reveals to us that this is a
material objects around us do.12 After all, at its most simple, possible way of coping with difficulties which we too may
self-injury requires no other object, as it can be carried out adopt, but which we may recoil from. Increasingly, self-
through scratching, hitting, biting or hair-pulling. This is injury is seen as contagious (Chaney 2019), maybe because
the body used as a dual instrument: a tool for causing and disgust often inspires fears of contagion (Ahmed 2004).
an object for receiving pain. To this extent it highlights a Images of self-injury or even the sight of old self-harm
disturbing duality of our bodies and the attitudes we can scars are seen as potential triggers that will cause others
take towards them. to hurt themselves. This, of course, can add to the distress
By creating scars, and so on, we create further affor- of those who have already self-injured, as now their bodies
dances—something through which our bodies and distress themselves suddenly appear as sites and sights of contagion
can be contemplated at one remove (see McClelland 2020 (Chaney 2019).
for a theory of mental affordances). Visible marks and inju- This is implied in the cycle of self-injury commonly
ries may allow us to express and display distress. It may accepted in the literature (e.g. Sutton 2007). The cycle, as
allow us to take back control, as self-injury is often carried commonly described, starts with distress that becomes seem-
out in situations where someone has little control over their ingly unbearable and generates an intense urge demanding a
lives or their emotions. By marking our bodies—whether response. Agents respond to this urge by self-injuring, which
with a new haircut, tattoos or self-injury scars—we signal a provides relief, whether through the pain of the injury itself
form of ownership over it and mark its individuality. Even and other related sensory aspects such as the sight of blood,
if self-injury is carried out as a primarily secret behaviour, or through the self-care administered afterwards. The tem-
scars can communicate past experience of distress even after porary respite that follows is eventually replaced by guilt
long periods of time. And even as we are discovering and over the self-injurious behaviour and shame about having
creating potentialities our own body can afford, we will have to hide its consequences. Finally, the individual’s level of
an effect on others. The meaning and interpretation these distress rises again, now encompassing both the initial dis-
tressing situation and the added negative affect resulting
from self-harm.
11
 Why some people are more susceptible to turning to self-harm The basic narrative focuses on the individual cogni-
than others is something that still needs to be established through tion,—both thoughts and emotions,—and ignores both the
empirical research. embodied meaning of self-injury and the extent to which all
12
  Husserl (2012) and Merleu-Ponty (1968) also discuss the tensions aspects of this cycle are socially embedded. Self-harm is an
inherent in our bodies acting simultaneously as subjects and objects affordance fostered by society that on the one hand allows
of our conscious experience through the image of our hands touching
each other, where the gap between touching and being touched can agents to remain in distressing situations and on the other
never be quite bridged. hand both legitimates and prohibits self-injury as a method

13
 Z. Chappell
392

of emotional self-regulation. All stages of the cycle could as stigmatising it. It reminds us that our environment pro-
also be characterised through participatory sense-making. vides us multiple ways of interacting with our bodies and
Agents make sense of their distress through the ready-pro- under the specific circumstances an agent faces (often a
vided affordance of self-injury, and the real or internalised choice between two bad option, such as continuing distress
and expected reaction of disgust from others further fuels or self-injury), what is bad for us is not necessarily wrong
that distress. This serves to obscure rather than reveal some as well. Thus enactivism can shift our focus of what is
of the aspects of self-injury that are relevant for its ethical salient about a behaviour.
assessment. My worry is that the use of reactive attitudes Enactivism is here useful in two ways. Firstly, new per-
such as blame to disrupt self-injury only contributes to fur- spectives can help us in determining how we should judge
ther strengthening the hold of this behaviour in the lives of this problematic behaviour, for example by helping us under-
distressed people. Social norms themselves could be affor- stand how self-injury becomes an affordance provided not
dances: norms afford us the opportunity to blame others just by our material but also our social environment. This
or to pressure people to desist from further self-harm. Yet allows us to recognise the way in which our culture shapes
this blame causes exactly the kind of distress that leads to the possibilities we see in our material environment and
repeated self-harm. the contribution of our society to problematic behaviour,
If we take this thought further, we can argue that human without neglecting the importance of individual enaction.
bodies are fundamentally social bodies. Even when they are Secondly, it directs us to aspects of self-injury which are still
on their own, in an empty flat or locked into a bathroom, a under-explored, making us demand deeper explanations of
person is enmeshed in sociality. Affordances for action and how the uses and benefits of the practice reported by per-
emotion flow as much from the outside as they are enacted sons who self-injure are generated and experienced. Thus
from inside a person’s body-mind. By being normatively while the ethics around self-injury may need re-evaluating,
social bodies, we are also ethical bodies. Interpreting our- we simultaneously need more empirical research to do so
selves as ethical bodies opens up (at least) two possible successfully, notwithstanding the excellent qualitative stud-
explanations about self-injury. On the one hand, our bodies ies cited in this paper.
are bound by social convention, but they are also pushed Does this single case offer any indication of how enactiv-
by social forces against those conventions. I take this to be ism can become a theory of sense-making particularly use-
the idea behind the argument by Scanlon and Adlam (2009) ful for ethical theorising? According to one influential view,
that self-injury is never deliberately chosen or voluntary, moral philosophy can be conceptualised as the study of how
but is rather violence against the self that society pushes we should treat other people (Ronald Dworkin, quoted in
someone into. On the other hand, self-injury can also be Appiah 2006, p. 17). By contrast, Juergen Habermas differ-
read as a deliberate resistance using the invitation for relief entiates between ethics and morality, and conceptualises ethi-
most immediately available—an affordance inherent in our cal theories as the motivational bridge between abstract moral
bodies—to pressures which are either caused by, or not satis- judgment and action (Habermas 2018). For Habermas, moral
factorily resolved by our sociality. Instead of obscuring it, an discourse aims at the impartial evaluation of action conflict,
enactivist analysis helps us to reveal this complex landscape, whereas ethical discourse is grounded in the lifeworld of the
thus enabling us to develop better ethical theories. individual, including their culture, and can accommodate ego-
centric and ethnocentric demands (Habermas 1996). A general
rule, such as the Kantian categorical imperative might indicate
6 Discussion that lying is morally wrong, but our culture and the position
we occupy in society can lead us to believe that under certain
My aim in this paper has been to use ideas from enac- circumstances lying is ethically permissible. Thus, it might
tivism in order to explore self-injury without assuming be acceptable for a stigmatised individual to lie about their
a priori that it is morally or socially wrong under all cir- identity, as an act of passing, so as not to be excluded from
cumstances, seeking to establish a less implicitly value- the social and material goods that should be available to all.
laden analysis. Looking at self-injury through the lens Equally, while self-injury is for the most part inappropriate, it
of habits can confirm us in the normative judgment that can become culturally suggested appropriate behaviour under
those who self-injure choose actions from their environ- certain circumstances of agential distress.
ment in the “wrong” way, even if it goes some way in This conceptualisation of the distinction between morality
understanding why it is so difficult to change from self- and ethics is useful here, as it helps us to identify a potential
injury to other modes of distress management. Looking role for enactivism in ethics: it elucidates the way agents make
at self-injury through the lens of affordances complicates sense of, and respond to the situation they are in. The ques-
this picture considerably by showing how cultural factors tion is whether applying a basically enactivist framework to
make self-injury more widely available at the same time our thinking about self-injury achieves anything other than

13
The Enacted Ethics of Self‑injury 393

tinkering at the margins. I believe that even in such a short Brook S, Horn N (2010) The meaning of self-injury and overdosing
space, turning to enactivism has allowed me to show that it amongst women fulfilling the diagnostic criteria for ‘borderline
personality disorder.’ Psychol Psychother Theory Res Pract
can facilitate a greater understanding of the conflicts that those 83:113–128. https://​doi.​org/​10.​1348/​14760​8309X​468211
who self-injure are caught up in, both on the social level where Brossard B (2018) Why do we hurt ourselves? Understanding self-harm
there is a scarcity of appropriate support and affordances for in social life. Indiana University Press, Bloomington
self-help, and on the level of basic enaction where different Brunning L, McKeever N (2021) Asexuality. J Appl Philos 38:497–
517. https://​doi.​org/​10.​1111/​japp.​12472
motivations can clash without a satisfactory resolution. Con- Cappuccio ML, Miyahara K, Ilundáin-Agurruza J (2020) Wax on, wax
sidering self-injury as a meaningful, skilled habitual action off! Habits, sport skills, and motor intentionality. Topoi 40:609–
points towards a need for not only top-down cognitive thera- 622. https://​doi.​org/​10.​1007/​s11245-​020-​09720-3
pies, but also bottom-up embodied solutions. As a result, we Chandler A (2016) Self-injury, medicine and society: authentic bodies.
Palgrave Macmillan, London
can no longer view self-injury as something wholly undesir- Chaney S (2019) Psyche on the skin: a history of self-harm. Reaktion
able, or as something that individuals can be made responsible Books, London
for overcoming solely through willpower. Instead, it can be Cholbi M (2011) Suicide: the philosophical dimensions. Broadview
seen as part of the dynamics of an individual responding to Press, Peterborough
Clarke L, Whittaker M (1998) Self-mutilation: culture, contexts and
and overcoming challenges raised by the environment with nursing responses. J Clin Nurs 7:129–137
the help of affordances provided by that same environment. At Colombetti G (2014) The feeling body: affective science meets the
this stage, we are back to the more familiar questions of ethics, enactive mind. MIT Press, Cambridge
as we can now ask what a just social environment would look Colombetti G, Krueger J (2015) Scaffoldings of the affective mind.
Philos Psychol 28:1157–1176. https://​doi.​org/​10.​1080/​09515​089.​
like, where no one was needed to reduce distress through self- 2014.​976334
injury, where our responses to distress,—even if manifested Colombetti G, Torrance S (2009) Emotion and ethics: an inter-(en)
through problematic behaviour,—are not stigmatising and active approach. Phenomenol Cogn Sci 8:505–526. https://​doi.​
where better forms of distress management are just as easily org/​10.​1007/​s11097-​009-​9137-3
de Haan S (2020) An enactive approach to psychiatry. Philos Psy-
available if needed. chiatry Psychol 27:3–25. https://​doi.​org/​10.​1353/​ppp.​2020.​0001
New approaches to any subject of philosophical enquiry De Jaegher H, Di Paolo E (2007) Participatory sense-making. Phenom
are never without risk. We could use an enactivist framework Cogn Sci 6:485–507. https://​doi.​org/​10.​1007/​s11097-​007-​9076-9
to take such risks and explore novel problems and novel DeSouza N (2013) Pre-reflective ethical know-how. Ethic Theory Moral
Pract 16:279–294. https://​doi.​org/​10.​1007/​s10677-​012-​9333-z
viewpoints. If we do this, we will not aim to replace or rep- Di Paolo EA, Cuffari EC, De Jaegher H (2018) Linguistic bodies: the
licate our existing ethical understanding, but instead enrich continuity between life and language. MIT, Cambridge
it and supplement it with new insights. The risk is that it is Douglas M (1966) Purity and danger an analysis of concept of pollution
much easier to make theoretical missteps, make arguments and taboo. Routledge, London
Elias N, Dunning E, Goudsblom J, Mennell S (2000) The civilizing
that go off the rails, or what is at times even worse: arrive process: sociogenetic and psychogenetic investigations. Blackwell,
at conclusions which are in hindsight obvious, which offer Oxford
no new revelations either in the outcome or the process of Gallagher S (2020) Action and interaction. Oxford University Press,
reasoning. Failed experiments can inspire others to try again New York
Giordano S (2019) Anorexia nervosa: a case for exceptionalism in
where we have failed, boring experiments can kill off a new ethical decision making. Philos Psychiatry Psychol 26:315–331.
branch of enquiry too soon. https://​doi.​org/​10.​1353/​ppp.​2019.​0047
Glas G (2020) An enactive approach to anxiety and anxiety disorders.
Acknowledgements  I would like to thank the editor and three anony- Philos Psychiatry Psychol 27:35–50. https://​doi.​org/​10.​1353/​ppp.​
mous reviewers for helping me to improve this paper through their 2020.​0005
thoughtful advice. Habermas J (1996) Between facts and norms: contributions to a dis-
course theory of law and democracy. MIT, Cambridge
Habermas J (2018) Philosophical introductions: five approaches to
communicative reason. Polity, Cambridge
References Hacking I (1998) Mad travelers: reflections on the reality of transient
mental illnesses. University Press of Virginia, Charlottesville
Ahmed S (2004) The cultural politics of emotion. Routledge, New York Heidegger M (1953) Being and time. State University of New York
Annas J (2008) The phenomenology of virtue. Phenom Cogn Sci 7:21– Press, Albany
34. https://​doi.​org/​10.​1007/​s11097-​007-​9068-9 Herman JL (2015) Trauma and recovery, 2015th edn. Basic Books,
Appiah KA (2006) The politics of identity. Daedalus 135:15–22 New York
Binns R (2020) The NHS and self-harm—a gap in care. In: Recovery Husserl E (2012) Ideas: general introduction to pure phenomenology.
in the bin. https://​recov​eryin​thebin.​org/​2020/​06/​10/​the-​nhs-​and-​ Routledge, London
self-​harm-a-​gap-​in-​care/. Accessed 2 Dec 2020 Kant I (1797) The metaphysics of morals. Cambridge University Press,
Breuning LG 2013) Self-harm in animals: what we can learn from it. Cambridge
In: Psychology Today. http://​www.​psych​ology​today.​com/​blog/​ Kiverstein J, Clark A (2009) Introduction: mind embodied, embedded,
your-​neuro​chemi​cal-​self/​201305/​self-​harm-​in-​anima​ls-​what-​we-​ enacted: one church or many? Topoi 28:1–7. https://​doi.​org/​10.​
can-​learn-​it. Accessed 2 Nov 2020 1007/​s11245-​008-​9041-4

13
 Z. Chappell
394

Klonsky ED (2011) Non-suicidal self-injury in United States adults: Rossi Monti M, D’Agostino A (2019) Dysphoria in borderline persons.
prevalence, sociodemographics, topography and functions. Psy- In: Stanghellini G, Broome M, Raballo A et al (eds) The Oxford
chol Med 41:1981–1986. https://​doi.​org/​10.​1017/​S0033​29171​ handbook of phenomenological psychopathology. Oxford Univer-
00024​97 sity Press, pp 826–838
Kong C (2019) Nurture before responsibility: self-in-relation compe- Rucińska Z (2021) Enactive planning in rock climbing: recalibration,
tence and self-harm. Philos Psychiatry Psychol 26:1–18. https://​ visualization and nested affordances. Synthese. https://d​ oi.o​ rg/1​ 0.​
doi.​org/​10.​1353/​ppp.​2019.​0000 1007/​s11229-​021-​03025-7
Krueger J (2014) Affordances and the musically extended mind. Front Scanlon C, Adlam J (2009) Why do you treat me this way?”: reciprocal
Psychol. https://​doi.​org/​10.​3389/​fpsyg.​2013.​01003 violence and the mythology of ‘deliberate self harm. In: Motz A
Loaiza JM (2019) From enactive concern to care in social life: towards (ed) Managing self-harm, 1st edn. Routledge, London
an enactive anthropology of caring. Adapt Behav 27:17–30. Schiavio A, van der Schyff D, Cespedes-Guevara J, Reybrouck M
https://​doi.​org/​10.​1177/​10597​12318​800673 (2017) Enacting musical emotions. Sense-making, dynamic sys-
MacIntyre AC (2009) Dependent rational animals: why human beings tems, and the embodied mind. Phenomenol Cogn Sci 16:785–809.
need the virtues. Duckworth, London https://​doi.​org/​10.​1007/​s11097-​016-​9477-8
Maiese M (2021) Autonomy, enactivism, and psychopathy. Philos Schutte O (1998) Cultural alterity: cross-cultural communication and
Explor. https://​doi.​org/​10.​1080/​13869​795.​2021.​19376​80 feminist theory in north-south contexts. Hypatia 13:53–72. https://​
Mauss M (1973) Techniques of the body. Econ Soc 2:70–88 doi.​org/​10.​1111/j.​1527-​2001.​1998.​tb012​25.x
McClelland T (2020) The mental affordance hypothesis. Mind Seaber E (2016) Reading disorders: pro-eating disorder rhetoric and
129:401–427. https://​doi.​org/​10.​1093/​mind/​fzz036 anorexia life-writing. Lit Med 34:484–508. https://​doi.​org/​10.​
Merleau-Ponty M (1968) The visible and the invisible: followed by 1353/​lm.​2016.​0023
working notes. Northwestern University Press, Evanston Sharma VK, Rango J, Connaughton AJ et al (2015) The current state
Miyahara K, Robertson I (2021) The pragmatic intelligence of habits. of head and neck injuries in extreme sports. Orthop J Sports
Topoi 40:597–608. https://​doi.​org/​10.​1007/​s11245-​020-​09735-w Med 3:2325967114564358. https://​doi.​org/​10.​1177/​23259​67114​
Mojica L, Gastelum Vargas M (2021) The affective and norma- 564358
tive intentionality of skilled performance: a radical embodied Siegel S (2014) Affordances and the contents of perception. In: Bro-
approach. Synthese. https://​doi.​org/​10.​1007/​s11229-​021-​03159-8 gaard B (ed) Does perception have content? Oxford University
Motz A (2010) Self-harm as a sign of hope. Psychoanal Psychother Press, pp 51–75
24:81–92 Steggals P (2015) Making sense of self-harm the cultural meaning and
Muehlenkamp JJ, Claes L, Havertape L, Plener PL (2012) International social context of nonsuicidal self-injury. Palgrave, London
prevalence of adolescent non-suicidal self-injury and deliberate Sutton J (2007) Healing the hurt within: understand self-injury and
self-harm. Child Adolesc Psychiatry Ment Health. https://d​ oi.o​ rg/​ self-harm, and heal the emotional wounds. How To Books, Oxford
10.​1186/​1753-​2000-6-​10 Svenaeus F (2021) Health and illness as enacted phenomena. Topoi.
Muñoz D (2020) The paradox of duties to oneself. Australas J Philos https://​doi.​org/​10.​1007/​s11245-​021-​09747-0
98:691–702. https://​doi.​org/​10.​1080/​00048​402.​2019.​16977​11 Urban P (2016) Foregrounding the relational domain—phenomenol-
Nielsen K (2021) Comparing two enactive perspectives on mental dis- ogy, enactivism and care ethics. Horizon Stud Phenomenol 5:171–
order. Philos Psychiatry Psychol 28:175–185. https://​doi.​org/​10.​ 182. https://​doi.​org/​10.​18199/​2226-​5260-​2016-5-​1-​171-​182
1353/​ppp.​2021.​0028 van Grunsven J (2018) Enactivism, second-person engagement and
Pacherie E (2008) The phenomenology of action: a conceptual frame- personal responsibility. Phenom Cogn Sci 17:131–156. https://​
work. Cognition 107:179–217. https://d​ oi.o​ rg/1​ 0.1​ 016/j.c​ ognit​ ion.​ doi.​org/​10.​1007/​s11097-​017-​9500-8
2007.​09.​003 van Dijk L, Rietveld E (2017) Foregrounding sociomaterial practice
Pickard H (2015) Self-harm as violence: when victim and perpetrator in our understanding of affordances: the skilled intentionality
are one. In: Widdows H, Marway H (eds) Women and violence: framework. Front Psychol 7:1969. https://​doi.​org/​10.​3389/​fpsyg.​
the agency of victims and perpetrators. Palgrave Macmillan, 2016.​01969
London Varela FJ (1999) Ethical know-how: action, wisdom, and cognition.
Pickard H (2020) Addiction and the self. Noûs. https://d​ oi.o​ rg/1​ 0.1​ 111/​ Stanford University Press, Stanford
nous.​12328
Ramírez-Vizcaya S, Froese T (2019) The enactive approach to habits: Publisher's Note Springer Nature remains neutral with regard to
new concepts for the cognitive science of bad habits and addic- jurisdictional claims in published maps and institutional affiliations.
tion. Front Psychol. https://​doi.​org/​10.​3389/​fpsyg.​2019.​00301
Rietveld E, Kiverstein J (2014) A rich landscape of affordances. Ecol
Psychol 26:325–352. https://​doi.​org/​10.​1080/​10407​413.​2014.​
958035

13