While the psychiatric therapeutic community is focused on individual diagnostic tools to understand deliberate self harm, self-destructive behaviour among young persons in Western society is increasing to a level where it arguably must be regarded as a cultural rather than an individual problem. While psychiatry adheres to its expert role, trying to find explanations for the individual behaviour in past life experiences and subsequent personality formation, the world outside of the therapy room is changing. In this outside world, on the Internet deliberate self harm is not described as a pathological behaviour that needs to be corrected, but as a powerful tool to cope with present life stressors, a way to form an identity and even as a way of staying alive. Against a background of present trends in society and how these influence identity formation, these narratives give important clues for finding new approaches to the experiences and life strategies of young persons living in modern society. In encounters with young persons whose self-harming behaviour has become intimately woven into the fabric of life, the keys to opening up different perspectives and find other ways to cope probably can not be found without accrediting the strength and determination in the present behaviour and closely and attentively pay attention to her own understanding of her situation, her own strengths and her own abilities.