Self-harm – the stigma and the upset
This month we’re looking at a particularly difficult and painful topic – Self-harm. We know and understand that this can be distressing and fully understand why this month you may want to give the blog a miss.
Our aim in this blog is simply to give an overview of the topic and signpost those in need to the best place for support. We know that each person has different reasons as to why self-harm is happening and recognise this isn’t the venue or forum to begin to look at the psychology behind it.
Self-harm – what is it?
Self-harm is hurting yourself as a way of dealing or coping with, difficult feelings, painful emotions or overwhelming situations and/or experiences. Self-harm can be outworked in lots of different ways including – scratching/pinching, cutting, hitting/punching objects, burning or hair pulling.
Self-harm may offer some physical respite from the emotional situation being faced, but often the distress remains. Sadly, the act of self-harm can exacerbate existing feelings or add layers of complexity to already overwhelming situations. If you become dependant on it as a coping strategy, as it can take a long time to stop.
Self-harm – why do people do it?
There are no rules people self-harm, it is different for each person. For some, the reasons are understandable – coping strategies, dealing with abuse or traumatic experiences. For others, the reasons are less easily understood and harder to fathom. Sometimes those who self-harm don’t know the reasons why either.
Self-harm can be described as a way of:
Expressing something that is hard to put into words – ‘I don’t have the words to say, but I have the actions to show’
Making invisible thoughts and feelings, visible – ‘This is what I’m feeling inside’
Transferring emotional pain into physical – ‘This hurts me…’
Acting as a release valve for emotions – ‘By doing this, I can cope for just a little bit longer’
Creating a sense of control over a situation that feels out of control – ‘When others do things to me, I can’t do anything about it… but this I can control’
An escape from traumatic experiences – ‘I don’t want to feel these emotions – the pain of self-harm is better than the pain of what I’m feeling’
Creating a fixed point of certainty in an uncertain world – ‘With everything happening around me, and being done to me, I just want to know I can control something in the chaos’
A punishment for behaviours or feelings – ‘I don’t like what I’ve done and I deserve to be punished’
A response to feeling numb or disconnected with what’s happening – ‘if I hurt, at least I feel’
Creating a reason to care for themselves – ‘I’m bleeding and I can do something positive for myself’
Express suicidal thoughts – ‘Maybe it would be better if I wasn’t here any more feeling these things?’
Some people make the argument that self-harm is ‘attention seeking’ and they are only doing it to get a reaction or to cause shock and worry. This attitude and approach can be incredibly harmful, leaving those who’re self-harming feeling judged and even more isolated.
The reality is that for many who self-harm, this is done in private and isn’t publicly known. If someone who is self-harming, is doing it to bring attention to themselves, (there is nothing wrong with this) – in fact it can be them asking you to notice them and for their pain and distress to be seen, acknowledged and taken seriously. This is a good opportunity to begin to put the help and support in place that they need.
Self-harm – who does it?
There are no hard and fast rules about people who self-harm. Imagine you’re at the supermarket. You look around and see lots of different faces, ages, genders, races and classes – any of them could self-harm. There are certain groups who may be more susceptible to it, e.g. young people, those facing financial challenges and members of the LGBTQ+ communities as they all face specific pressures which may lead to an increase in the likelihood of self-harming.
Self-harm – first steps
There are certain stages of self-harm that happen resulting in the actual harm taking place.
Triggers – What’s happening that’s causing the feelings – these could be people, situations, anniversaries, sensations or specific thoughts or feelings. By being aware of these things, there can be a consciousness and deliberateness about the response.
Awareness – What’s happening that is causing the urge to self-harm – feeling sad or angry, disconnecting from situations, repetitive thoughts about self-harming, poor decision making around personal safety, racing pulse or sensation of heaviness. These sensations can be an indication that a self-harm episode is imminent. This is an opportunity to intentionally respond differently…
Distracting – If they’ve been triggered and are aware of the initial signs that they’re going to self-harm, then distractions regarding the next step can be helpful. Remove themselves from challenging situations, creating breathing space or undertaking an activity that’s been proven to be helpful can all be useful. Speaking to someone can also help give a perspective and help to lessen the feelings they’re having.
Delaying – There is no easy solution to the challenge of self-harm – no quick and easy fix – no cold turkey approach that will break the back of the problem. Self-harm is often a quick response to feeling overwhelmed and it can provide a quick and effective release. In delaying this response, those who self-harm experience two things – firstly they can begin to understand what they’re feeling – admittedly painful and difficult – and secondly, they can allow those initial urges to pass and may ultimately take either a different approach or self-harm to a lesser extent.
Self-harm – friends and family
Finding out someone you know or care about is self-harming can be traumatic and painful. Your reaction to their sharing can have an impact on whether they continue to be open and honest with you or not. It can be hard to work out what steps to take and what approaches will work best for them. It is also important to remember that self-harm is usually someone’s way of managing painful or difficult emotions – in the majority (though not exclusively) these are different to suicidal feelings or ideation.
There can be approaches that help:
Non-judgemental – ‘Thank you for telling me, I understand how hard this must have been’
Supportive – ‘If there is anything you need, please let me know. I’m here for you…’
Remember there is more to them than just the self-harming – ‘Tell me about your day…’
Empathy and understanding – ‘I know that life can be really challenging, do you want to talk about it?’
Allow them control – ‘What would you like to do next – how can I help you, help you?’
Offer to help find support – ‘Do you think it’d be helpful if I looked at some options that may be helpful for you?’
Remind them of their positive qualities/strengths – ‘I loved that painting you did or I‘m really thankful for how you helped …. through that situation. It was incredibly kind…’
Be honest – ‘I know this is hard and scary, because I’m feeling that too’
And approaches that aren’t so helpful!:
Trying to force change – ‘Right, I’m sending you to a convent!’
Acting or communicating in a way that takes away control – ‘Right we’re going to keep you locked away from your friends and anything or anyone that could be an influence on you’
Ignoring or overly focusing on injuries – ‘Oh, you’ve done that again vs Oh, you’ve done that again!!!!’
Attention Seeking – ‘Again, if you wanted my attention you should have just asked… you always do this… what do you want from me?’
The best analogy here is the aircraft oxygen mask. If there is an emergency, oxygen masks fall from the ceiling and your instructed to put the mask on and breath. In that emergency, passengers are given a clear instruction. Before you attempt to help anyone else, ensure your oxygen mask is on and working first. You can’t help anyone else if you’ve passed out or are dying having inhaled toxic fumes.
The same is true here. You can’t support anyone else if you’re not getting the help and support you need first. Take care of yourself! Caring for someone else - Mind is a great site for advice.
Self-harm – getting help
If you find out or know someone is self-harming, there are different ways you can approach this. Before you go full-on ‘fix it mode’, it’s important that you find out a bit more about the topic – there are lots of helpful online resources listed below.
In the first instance, if a young person (or adult) you’re with has self-harmed and you are worried about their life being at risk, you must take them to the hospital to get them the help and treatment needed.
You can contact your GP and discuss options with them.
Talking therapies may be effective in treating the root causes of self-harm and beginning to address the behaviours themselves
There are also small groups available to support around this key mental health issue.
Self-harm – final thoughts
At east to west we’re proud of the work our team do at St. Peter’s Hospital supporting young people (and their families) who’ve been admitted having self-harmed or attempted suicide. Over the years we’ve found that by taking the time to build relationship and simply chatting with the young person as an individual (rather than a patient or self-harmer etc…) has a profound impact on them. At some level they crave the human interaction and engagement that looks beyond what they’ve done and rather focuses on them – by name. For some, they know the reasons why they are there, for others, their actions are a result of desperation or exasperation. What we bring is hope – hope in the darkness and despair, hope in the horrible reality of their experience and hope that there may be a way through how they are feeling to a better place and brighter future.
And this is the key – hope.
We have to hope that their situation will get better, they will learn alternate coping strategies and in time, end self-harming. And we can be part of that, by holding that hope, even when they can’t. It isn’t easy and there’ll be bumps along the way, but keep going and keep hoping.
Self-harm – support resources
The majority of this document is based on www.mind.org.uk and their advice for parents/young people.
Next month – July: Time to say goodbye – moving on from one year to another
If you want to hear more or have topics/themes you’d like us to discuss, please don’t hesitate to get in contact at email@example.com