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Hospitals and prisons are paradigmatic places of confinement and control of bodies. Paradoxically, the prevalence of self-harm is also particularly high there. Clinicians are therefore frequently asked to provide solutions to prevent these acts. How can caregivers and clinicians work with confined subjects without strengthening body control systems and risking increasing the alienation of people who self-harm?Self-harm practices result from multiple factors and can be considered as the product of a power relationship between the individual and the institution. However, far from acknowledging this complexity, the penitentiary institution tries instead to strictly control the meaning of these behaviors by classifying them into two exclusive categories: a “thoughtless” act, testifying to psychological suffering and requiring care; or a “thoughtful” act, testifying to a reprehensible attempt at manipulation. Qualitative research conducted in an adolescent psychiatric ward shows how this type of behavior produces a delegitimizing effect, which is reflected in hospital through a questioning about what it means to be a “caregiver” in a place of confinement. The institution’s ability to accept this questioning at the institutional rather than individual level could then lead to a decrease in self-harm behavior.