The Journal (Newcastle, UK)
July 5, 2000

Prejudiced views on self-mutilation

I WOULD like to say how offended and saddened I was by an article in The Journal about the death of a school pupil in Carlisle in which Richey Edwards was described as a “freak” because he self- mutilated.

Having had first hand experience of a family member cutting themselves, I would like to point out that it is a form of mental illness, often caused by depression. It is prejudiced views like those in this article that lead to the cruel and unnecessary comments that people with this problem often have to endure, and this in turn often makes their depression worse. I just wonder if an article describing someone in a similar way with another, more publicised mental illness such as anorexia, [which is after all, another form of self-mutilation] would ever have been printed.

I send my greatest sympathy to the girl’s family, who have lost someone who they loved.

L KILLICK [16]


The Guardian (London)
July 12, 2000

Behind Closed Doors: Why are So Many Asian Women Driven to Suicide and Self-Harm? Chris Arnot meets a brave survivor who knows the pain of isolation, low self-esteem and sexual abuse.

Bobbie was 13 when she discovered that the man she thought was her brother was really her father, and the woman she thought was her mother was really her grandmother. It didn’t stop there. The woman in a frame on the wall was not, as she had been told, an aunt who lived far away in India. She was her real mother. What’s more, she had committed suicide when Bobbie was a baby.

Confused? Not half as much as Bobbie was when these brutal facts of her life were blurted out, in the heat of a family argument, by another “brother,” who turned out to be an uncle. It was a devastating catalogue of deception to pile on to the shoulders of a budding adolescent—albeit one who was hardly innocent of the cruel complexities of an adult world. She had been sexually abused from the age of five by the man she had thought was her father but who was, of course, her grandfather. Thirty years on from learning the truth about her mother, Bobbie is curled up on the sofa in her council house, talking with remarkable composure about her life as a victim and survivor of almost unimaginable emotional turmoil. “Mine is an unusually intense and ugly story,” she says, “but I’m still here to tell it.” This is despite four suicide attempts, despite savage beatings by men and despite her own apparent need to hurt herself physically, sometimes banging her head against a wall until it bled.

She started self-harming in her teens. “At first I would go into the toilet to pinch and scratch myself so that the pain on the outside would temporarily shift the focus from the pain inside,” she says. Her real name is Kusum Wason. She was born in Nairobi, to Indian parents, 43 years ago. The family moved to London when she was 11. Bobbie is the name she took on during her time as a “flirtatious” dancer, and it stuck. It’s what she chooses to be called in a television documentary for the East series, to be shown next Monday on BBC2. Two other, younger women are also featured. All three are self-harmers. All three are Asian.

Statistics show that Asian women are three times more likely than their white counterparts to attempt suicide. And when the Newham Asian Women’s Project, in east London, analysed those attending its counseling and mental health support groups, it found that three out of five were inflicting physical pain upon themselves. Some cut themselves with razors or knives. Others would scald themselves with irons or pummel walls with their fists.

The project’s patron is the actress, writer, and comedienne Meera Syal, who says she was pleased to be asked to present the TV documentary. “I’m becoming more and more concerned about Asian women and what’s happening to us in this country,” she says. “It’s shocking that the incidences are so high in such a specific group at a time when the same group is being applauded for its achievements in education.”

So why is it happening? The reasons put forward by Anjum Mouj, chair of the Newham project, are “domestic violence, neglect and sexual abuse in childhood.” But those factors could apply to any number of women from all backgrounds. Over and above these wellsprings of discontent are other factors to which Asian women are particularly vulnerable.

One is racism. A young woman called Humerah tells Syal how, when she was 14, she would be alone in the house during school holidays. “The National Front people used to ring up and give me delightful messages.” She goes on to say: “I just thought I’d try out what the razor was really like because I just felt so numb, so alone and pretty desperate... It just made me feel something, and that was important.”

Isolation is another factor, sometimes coupled with an identity crisis. Sita was separated from her brothers and sisters at 13, after her mother had a mental breakdown, and sent to live with white foster parents. “The message they were giving me was that it was wrong to be Asian... I still don’t know who I am,” she says as the camera closes in on her face and her big eyes glisten with imminent tears.

There is one other factor which makes Asian women prone to low self-esteem and, consequently, at higher risk of self-harming: they were born female in a community where it is still common for male offspring to be valued more highly.

Bobbie knows all about that, and tells me what it has meant for her. “Girls are not looked upon favourably in our culture,” she says. “Once I found out about my mother, I was told that she killed herself because of me. The rest of my family regarded me as a jinx.”

Until comparatively recently, her life has been like the improbable plot of a harrowing melodrama. At 17, she had two children, and a mother-in-law who insisted on keeping them from her. Bobbie was shown the door. She had short spells of homelessness and alcohol abuse, drifting from one violent relationship to another.

Her current partner, Navid, has proved to be a rarity in her chaotic life: a kind man. And she appears to be blossoming as a result. The mental legacy will always be there, but she now confines any self-harming to poking at her ears, occasionally and surreptitiously. She knows that banging her head against a wall would alarm the three children who still live at home. “My kids provide my energy source,” she says, proudly.

Certainly, she seems to exude an inner strength which is now being put to wider use. She is active in the local tenants’ association and wants to stand as a Labour councilor in the next elections. Meanwhile, she’s working as a counselor for the Southall Black Sisters, trying to help other women who are harming themselves. “I know what they’re going through because I’ve been there myself,” she says. She knows what it’s like to be abused, rejected and so angry inside that physical pain seems like the only diversion from mental torture.

“I’m still angry with my family and my community,” she says. “I used to be angry with my mother for not being there for me. Now I just feel sad for her. When I help a young girl to give up suicidal feelings, I find myself talking to my mother afterwards. ‘There you go, mum,’ I say. ‘One more for you. Your death wasn’t in vain’.”


Today’s School Psychologist
July 14, 2000

Educators: Add questions about injurious behavior to checklist

Self-injury—cutting, burning and other types of mutilation—is more common and happens more frequently than most people think, Minnesota psychologist Kathleen J. Papatola says.

Educators discuss other forms of self-destructive behavior—like alcohol or drug abuse—on a regular basis, but self-injury is a topic that’s often overlooked. And that’s because educators aren’t aware how widespread the problem is or they aren’t asking the right questions, she says. School psychologists can teach other members of the education team to be on the lookout for self-injury.

“When I see suspicious marks on a student I assume they’re self-injuring. So the question becomes, ‘How long have you been hurting yourself?’ not ‘Are you hurting yourself?’” Papatola says. “Educators need to put (self-injury) on their roster of questions. Be aware of it and ask about it.”

How does self-injury get started?

There’s a continuum for self-injury, Papatola says. At the very basic level it may be a coping mechanism. It may relieve tension or help kids get attention, albeit in an unhealthy way. At its worst, the victim feels she can’t stop the behavior and may wind up in the hospital.

“It’s kind of like marijuana,” Papatola says. “Not all kids that try marijuana end up drug addicts but some do. For some self-injury just relieves tension but for others, it becomes how they cope with life.”

Psychologist Wendy Lader, clinical director of the Self-Abuse Finally Ends Alternatives Program at McNeil Hospital near Chicago—the only program in the country dedicated to treating people that self-injure—works with the hard-core victims of self-injury, women who have been in and out of treatment for years.

Lader, who also authored the book Bodily Harm, told Papatola, about a 37-year-old female self-injury patient who injected urine into her ears and under her skin, scraped skin off her arms then rubbed the wounds with feces until they became infected.

What you can do to help

The best thing school psychologists can do is educate their colleagues on self-injury and its warning signs. And don’t be afraid to intervene if you suspect a student is self-injuring.

But be aware that there are two schools of thought on self-injury, Papatola says. One holds that it’s an addictive behavior. Papatola thinks this is dangerous.

“Most clinicians wouldn’t consider self-injury an addiction. That puts the burden on the self-injurer and thins options for intervention,” she says.

Papatola considers self-injury an impulse disorder. And, through treatment, victims can learn to channel dysfunction in healthier ways.

For more information, contact Kathleen Papatola at 75764.226@compuserv.com


The Age (Melbourne)
July 26, 2000

Getting Out of Harm’s Way

Interviewer: Self-Harm, thank you for agreeing to talk to us today. You certainly are mysterious to many and we understand that we’re not going to be able to learn all there is to know about you today. This interview simply aims to help us begin to understand you.

Self-Harm: You’re welcome, but you know that the answers that I give you today may not be the same tomorrow.

Interviewer: First of all, Self-Harm, are you known by any other names?

Self-Harm: Well, yes. Self-Mutilation, Self-Injury, Slashing, Cutting, Burning, Severe Picking, Head-banging ... just to name a few.

WHEN we meet, the scars that Naomi Anthony, Tania Raquel and Lee Tatchell have inflicted on themselves are not obvious—nor is the pain that others have inflicted on them. They’re all in long shirts and trousers, but it’s winter and we’re in a freezing Carlton terrace set up as a counseling suite, so that’s not unusual. I don’t notice the slight scarred roughness about Lee’s hands and face until she points it out.

The three, who met in a self-help group two years ago, have joined the group’s facilitators, Micaela Cronin and Sue Mitchell, to write a book.

Inside Out, Outside In, Wounding While Healing is a collage of health information combined with the poetry, pictures and recollections of Naomi, Lee and Tania. It’s so powerful that it comes with a health warning. Those who tend towards self-harm are advised to read the last chapter first, to read in small chunks, to use the help of a support person—and not to read it just before bed.

But in the opening chapter, where they interview Self-Harm, the character comes across as strangely seductive. Self-Harm describes itself as strong enough to confront intense pain, anger, stress and grief. Sometimes euphoric, like an orgasm. Close. A release. A way to regain control over your body, to stop panic. A way to feel real. A way to show you’re alive. A way to express overwhelming feelings. Something that makes other coping mechanisms seem trivial. Available. Effective. Constant.

But there’s a catch: Self-Harm confesses to making people feel embarrassed, ashamed, isolated, alienated, and rotten.

The women’s drawings tell that story: woman naked splodged with blood, woman caged, woman buried alive, woman’s face in fragments, woman sitting on a floor sobbing in a corner, woman writing on a mirror in blood. One stark line drawing stays with me: a naked woman, her face obscured by a dark rectangle, her breasts and stomach slashed by brown lines, which grow more frenzied between her belly button and her thighs. Is this what is hidden beneath the long clothes?

Interviewer: Who or what supports your existence in the world?

Self-Harm: Many things. Child abuse for one...Being hurt by someone you love can mean that pain is associated with comfort; it’s very confusing. I help with that ...isolation, secrecy, shame, denial, ignorance, blame, fear—they also support my existence. They say things that encourage me, egg me along.

Childhood experience, “the not-so-missing link” to self-harm, according to the book, is the great unspoken topic when we meet. Sue, protectively, steps in quickly to quash a request that Naomi, Lee and Tania tell their stories from the start. They talk, at length, about the pain they feel, but not its source.

Their writing is more revealing. “FREE MY SOUL,” Tania demands of “you f---ed up, freaky, child-beating, raping, torturing/ ARSEHOLE! ARSEHOLE! ARSEHOLE!” in one poem.

Elsewhere, she is reflective and analytical. “Self-harm is an expression to me, reminding me I am real, when all else around me seems not to be. (I feel) release when the blood flows, reality when I feel it actually being done, horror when I realise it was me that did it to myself,” she writes. “I vowed to break the cycle of emotional, physical and sexual abuse, yet here I am continuing the emotional and physical side of the abuse, to myself. It’s the need to control.”

Naomi describes how almost anything can trigger a sort of flashback, an intense physical memory. “That’s where the cutting comes in. The blades are my friend and foe all rolled into one. There is a part of me that associates the pain of being raped with comfort and closeness. So I cut—deep inside myself ... to somehow comfort myself. And I cut to escape these feelings that grip my body. I want to cut myself free from these body memories; attack and slice those parts of my body which feel these things. I want to cut away the feeling of those hands upon my breasts, the flesh upon my stomach, the hardness inside me.”

Lee says that as a toddler she twirled her hair around her finger until she was half-bald. As a child she started banging her head against walls “before I discovered scissors, tweezers, and blades.”

She says no one really noticed her self-harm until, when she was 15, she started cutting her arms, which others misinterpreted as suicide attempts. Her relationship with her family broke down when she was 20 and she was, for a time, homeless.

Lee seems like a bit of a joker sometimes. She takes a seductive personal-ad tone at one point when talking about herself: “I’m 25, I’m single. I’m looking for—just kidding.” Later, she comments: “I’m a Scorpio. I sting myself all the time.”

And she muses on the thoughts of her cat, Stanley, “who sneaks up when I do things I shouldn’t be doing ... I will say, ‘Stanley, don’t claw my arms and make me bleed.’ And he will say, But you do it!”’

Interviewer: So tell me, what impact do you have on a person’s life?

Self-Harm: I have a huge impact. I leave them with scars, leave them with the shame of the scars ... When other people see the scars or see my behavior, they are repulsed, shocked, angry, hurt, and they treat that person differently as well.

Interviewer: Do you want to say anything else about your relationship with the families and friends of those who use you?

Self-Harm: People are very afraid of me, I terrify people...This fear and lack of understanding also penetrates all the so-called helping professions.

Interviewer: So what would you like to say to those people who are frightened by you?

Self-Harm: Your fear and misunderstanding keeps me strong.

“I have had lots of friends who have just walked,” says Lee. “It’s just too much to deal with. They think you don’t like yourself or, She’s just a freak.”

Tania lost a job when she was hospitalised from self-harm in 1994 and has not worked full-time since.

Being publicly identified is a scary prospect. A fourth group participant pulled out of writing the book.

The group are determined, however, to improve public and professional understanding of the phenomenon. They are indignant about people who think what they do is about attention-seeking or trying to commit suicide.

“It’s the opposite of a suicide attempt. Self-harming can lead to death if it is vicious enough, but that’s not what’s behind it,” says Tania, 29, adding that the will to live is strong. Self-harmers are survivors who have lived through the most horrendous things.

Professionals who try to punish self-harmers or force them to agree to stop are on the wrong path, the group says. So are well-meaning counselors who suggest relief measures that just don’t fill the need, like a cup of tea or a hot bath. Micaela says a common approach, that of getting a person to agree to a contract” not to self-harm, is flawed—it can take away a patient’s only coping technique and assumes they can control the urge.

Caring professionals, such as doctors, also often incorrectly assume kindness will reward self-harm and, indirectly, make the person more likely to hurt themselves again, she says. A medical worker who attended the book launch the week before our interview had confessed that she was not allowed to be kind to people in such cases. It wasn’t standard procedure.

Naomi, who started self-harming at 18 after moving to Melbourne from the country, says one doctor stitched her wounds without anaesthetic, telling her she could take a bit more pain since she had inflicted so much on herself. “That makes me feel more ashamed and want to do it again.”

Does she feel regret after she self-harms? “Sometimes. It’s sometimes just another scar to add to the collection ... It’s part of the pain underneath. I feel very much like it’s a part of who I am. I wouldn’t choose it, but I didn’t choose the abuse either and that’s shaped who I am.”

Scars are trying to express that pain. “In a way I wouldn’t want to erase them. It’s been part of my journey,” says Naomi, now 24.

Interviewer: So isolation, shame, secrecy are your friends; who are your enemies? Who doesn’t support you?

Self-Harm: The opposite of those things—people who will actually listen and hear and tolerate. Tolerance. Also, new coping strategies—when people start to nurture themselves or do nice things to their body or nice things for themselves instead of using me, they’re on about everything that I oppose.

Can self-harm be cured? No one in this group seems to have an answer, but they have found alternative coping mechanisms. The group’s focus was on controlling self-harm, as a symptom of pain, rather than curing it as an illness.

For Lee, it’s been art, doing to a picture or a piece of clay what she has the urge to do to herself. The book’s cover artwork is an example of this: four images of a sad-eyed naked women covered in splodges and streaks of blood. She has been aided by the Centre for Creative Ministries in St Kilda and has a key to a church where, in its loft, she can draw. Lee sees art not only as therapy but as a career and has had three exhibitions. “People seem to appreciate it and want to buy it.”

In a poem in the “Transformations” chapter of the book, she addresses other sufferers, reminding them they are not alone: “... I have been there/And I’m living on/ Always trying/ Always fighting strong.”

Naomi takes refuge in physical activity. At first, it was obsessive. She would sometimes do four aerobics classes in a row. Now it’s more likely to be a run or dancing to loud music. Her psychiatrist is also helpful.

The desire to self-harm—sparked by times when she does not feel believed or heard or understood—can be transferred to other activities. She’s studying an arts degree, majoring in English and history, and is involved in drama and writing activities. She is also a part-time youth worker, which she intends to keep doing after graduation.

And, with the others, she hopes to get funding to help train more health professionals about self-harm. Already they have trained several hundred people, sometimes ending up with the whole room in tears.

“It no longer has to be blades piercing my skin/or bricks pounding my back—for me to feel my body./ My body doesn’t have to be being tortured and attacked for me to feel alive,” Naomi writes. Sometimes it is just the sun on my face, a hand on my arm,/ the ground beneath me—and I can feel... It can be beautiful,/ it can feel good.”

Tania is working on a program that teaches teenage girls about issues such as self-harm, domestic violence and sexual abuse. “It’s difficult but rewarding. You are talking about yourself to a group of people who don’t know you ... (saying) ‘I’m giving you all of me.’ So if people don’t want to accept it then that is not really my loss, it’s theirs.”

She is also a member of the Women’s Circus. When she’s feeling vulnerable, she goes for the highest swing, called the cloud swing.

“I swing as high as I can to feel safer...I’m up high, out of reach of everything around me. I have to be in my body to swing as high as I do,” she says.


Evening News (Edinburgh)
July 26, 2000

Bid To Uncover Reasons Behind Self-Mutilation

YOUNG people who harm themselves are being urged to contact an Edinburgh charity to help it research the problem.

Mental health charity Penumbra wants to speak to young people who self-harm, their family and friends, or agencies who have worked with them. The research is aimed at informing agencies about the type of services they want and how they can be helped. It also wants to try to break down the myths that surround self-harm, which can involve people cutting or burning their own bodies.

Penumbra believes that teenagers and young adults often resort to self-harm as a way of coping with stress and problems in their personal lives, but the issue was hidden and stigmatised in Scotland.

It has found that the problem was most acute among teenage girls, although it can affect people of all ages and social classes.

Self-harming can take many forms, including eating glass, drinking bleach and the most common, cutting or burning the body.

Each year about 3000 people are admitted to Edinburgh Royal Infirmary with self-inflicted injuries.

Celebrities with a history of self-mutilation include Shirley Manson, the Edinburgh-born lead singer with the rock group Garbage, and Hollywood actresses Christina Ricci and Angelina Jolie.

About 70 per cent of cases involved females, although research suggested the gap between the number of male cases was narrowing.

Penumbra spokeswoman Eve-Marie Haydock said anyone taking part in the research would have their information treated confidentially and anonymously. The project wants to focus on people aged 16 to 21. Further information is available on 0131-475 2380.


The Journal (Newcastle, UK)
November 25, 2000

Extra help is on the way for patients at risk of self-harm

MENTAL health chiefs in Northumberland have been given the go-ahead to appoint a specialist consultant to improve services to people at risk of harming themselves.

The new nurse consultant will target those who deliberately injure themselves by taking drug overdoses or carrying out other acts of self-harm. He or she will also improve links between Wansbeck General Hospital’s accident and emergency department, GP surgeries and mental health services and help meet Government-ordered targets to reduce deaths from suicide.

Nationally it is estimated that deliberate self-harm accounts for more than 100,000 hospital admissions a year in England and Wales. Up to 25% of suicides have been to hospital after self-harm in the previous year.

A staff nurse working in the Wansbeck Hospital accident and emergency department will come across more than one patient per shift with deliberately self-inflicted injuries.

Northumberland Mental Health Trust director of nursing Adrian Childs said: “These patients need specialist help and the nurses who care for them also need support.”


Green Bay Press-Gazette
September 19, 2000

Celebrity lends voice to help teens
By Heather Stur

The message: Issues such as self-injury must be discussed openly. The voice: Lisa Simpson.

Yeardley Smith—voice of the saxophone-playing daughter on the Fox animated series “The Simpsons”—spent about an hour Monday afternoon at the Brown County Central Library chatting with local teens and some adults about issues such as eating disorders and self-injury. “It’s interesting to find out that people who are famous like her have problems like everyone else,” said Green Bay resident Max Morein, 11.

The discussion was partly a promotion of “Can You See My Pain?,” a documentary about self-injury produced by Northeastern Wisconsin In-School Telecommunications and the Cooperative Educational Services Agency 7.

Smith, 36, is a member of the board of directors of The Diana, Princess of Wales Memorial Fund, which donated $40,000 to the group for the project. The organization helps finance projects aimed at “teens at risk,” president Kathryn Wittneben said.

In a presentation that was more a conversation than a speech, Smith talked with audience members about her 18-year struggle with bulimia. Self-injury and bulimia may be different acts, but what drives a person to engage in either is the same, she said.

“My teen years weren’t my happiest years,” Smith told the audience. “I didn’t feel like I fit in anywhere.”

Green Bay resident Erica Grossman, 17, said self-injury is prevalent among high school students but is not discussed.

“People find it very disturbing, so you really don’t talk about it,” Grossman said.

“It’s almost as though eating disorders have become socially acceptable,” said 18-year-old Blake Fleischman.

As for how Lisa Simpson would deal with a friend who injured him or herself, Smith said Lisa would be strong and supportive.

“I think she’d show enormous compassion,” Smith said.


Derby Evening Telegraph
September 8, 2000

A Most Private Kind of Hell

latest figures have revealed that nearly 1,700 people in southern Derbyshire have ended up needing medical attention after trying to harm themselves. This is a slight decrease on last year but is part of a steady upward trend in the past 10 years. Health Reporter Joanna Snicker investigates what drives people to put themselves in danger in this way and asks what is being done to stop it.

JAYNE Harpham lived the saddest of lives. By the age of 26, she had a string of attempts at self-harm to her name. Suffocation bids, slashings, even an attempt to jump from a bridge, pepper her history. Few people would have been aware of her existence until her attempts finally came to fruition.

She was discovered with a plastic bag on her head, the handles tied tightly around her neck suffocating her, in May this year. Her inquest was reported in this newspaper on August 31 and thousands read about a woman who until then would have been known only to the staff of the mental institutions where she had spent most of her life.

Jayne Harpham had a personality disorder coupled with a depression-related mental illness which resulted in many attempts at self-harm.

The post-mortem examination showed that she died from oxygen starvation of the brain. There was nothing else wrong with her, no signs of heart disease or tumour. She was a healthy young woman who had her whole life in front of her.

The cause of her death was her own mind.

Southern Derbyshire Mental Health NHS Trust, which manages mental health in this region, has just released its latest figures on deliberate self-harm.

What they show is that Jayne Harpham’s story is part of a bigger problem locally and nationally.

Last year there were 1,671 incidents of self-harm needing medical attention at Derbyshire Royal Infirmary, which is slightly down on last year’s rate of 1,769 but a significant increase on the 1990 figure of 979.

And these figures only tell part of the story because they refer to people who end up in hospital. There are estimated to be many more who will never be known to the authorities.

However, Government targets are concentrated on suicides, stipulating that the number of deaths should be reduced by a fifth in 2010.

But suicides figures are small compared to the number of self-harmers. In 1998, there were 51 deaths from suicide and undetermined deaths in Southern Derbyshire.

Under Government targets, this would mean reducing the number to around 41 within the next 10 years.

Mental health workers are generally skeptical about using suicide as an indicator of health, but agree that it is difficult to judge success in this area.

These latest figures have been compiled by the “deliberate self-harm team.” It is made up of people who are experienced in a range of disciplines such as nursing and social work.

They are called in when a patient arrives at Derbyshire Royal Infirmary’s Accident and Emergency having harmed themselves. They also help people who are judged to be distressed.

The team says that the slight decrease in the number of self-harmers is a just a blip in an otherwise dramatic rise over the past 10 years.

They are not optimistic about stopping people harming themselves but have some hope about reducing suicide rates.

One of the members, Sheran Jones, says: “Developments such as catalytic converters in cars and restricting prescription drugs will make a difference to suicide because people will not succeed so much in killing themselves. But to stop people wanting to hurt themselves is a deeper problem.”

So why do people feel the need to self-harm and how can they be stopped?

“The key message is that self-harm problems are multi-factoral,” says Dr Andy Clayton, head of psychiatry at the trust.

“There are a range of issues, social, economic and relationship issues coupled with how people are able to cope that need to be tackled by society as a whole, not just mental health agencies.”

The report on self-harm shows some interesting trends, such as the fact that the number of female self-harmers outstrips males.

But the number of male harmers has also increased significantly in the past 10 years. In 1999, there were around 400 male self-harmers whereas last year there were 821. This also contrasts with the Southern Derbyshire suicide figures where 13 were women in 1998 and 38 were male.

Dr Clayton said that much of this disparity was due to the change in men’s traditional role in the past few years.

He said: “Ten years ago men knew what they were meant to be—macho, beer-swilling, with a good chance of finding a job. There was a lot of manual labour and, in many cases, it was a job for life.

“Nowadays men do not know what they should be, soft or macho. It’s all to do with stability. If we feel internally stable, we know who we are, so when we face crisis we have that stability.

“If we don’t have control and stability then we are more vulnerable.”

The team are adamant that these attempts at self-harm are not a call for help. They say that most are irrational and not deliberate and the majority are alcohol related.

So what can be done? The self-harm team hopes that they will not be needed so much in the future but that means hoping that society can provide the solutions.

Jayne Harpham’s case shows the problems health professionals have in caring for people bent on self-harm.

She had been a sectioned patient at the psychiatric unit of Derby City General Hospital, which is run by Southern Derbyshire Mental Health Trust, for a year and was being observed every 15 minutes on the day she died.

Those 15 minutes were not long enough in her case. It just took a few minutes for her to die by her own hand.

But how can you infiltrate people’s lives enough to stop them taking their own lives when society dictates that everyone should have freedom to do what they like?

It is a particularly pertinent question with more people with mental illnesses, which surely makes them vulnerable to suicide, now expected to live in the community with the closure of hospitals such as Derby’s only psychiatric hospital, Kingsway, in March 2002.

The report shows that 72 per cent of deliberate self-harm patients have done it before and 77 per cent had a recorded psychiatric history.

However, Dr Clayton says that only a third are under the care of mental health services and of these, many will commit self -harm because of other problems and because of the mental illness.

Mental health managers also say that despite Kingsway’s closure, the intensive care unit and acute hospitals unit will continue.

They also point to the success of projects to help people live in the community.

One place which is trying to bridge the gap is a mental health home called Trevayler, in Burton Road.

Run by the charity 2 Care, it caters for people aged 18 to 65 who have suffered from mental illness and are in need of care and support in a rehabilitative environment.

Manager Mark Goldsborough, who is a qualified psychiatric nurse, said that he believes that this form of care for the mentally ill will help prevent suicides.

In his home, which is classed as providing “therapeutic” residential care, there are 23 beds and around 15 people are discharged into the community every year, 13 of whom will have settled and do not need re -hospitalisation.

During their stay, they cook and clean and draw up rotas to carry out tasks.

Mr. Goldsborough says that this kind of unit has shown success in dealing with the prevention of self-harm or suicide.

He said: “It’s more likely to be successful and make a person less likely to kill themselves if there is this kind of support.”

“It is essential that we ensure that people do not fall through the gaps, when they leave hospital. It is important that they have an extensive and intricate care plan.”

But whether these initiatives and targets will work could depend on far more than health plans.

Keith Waters, another member of the deliberate self-harm team, says that problems with relationships are often the crux of acts of self-harm.

“What we have noticed more than anything else is that relationships are often the cause of these acts.

“These are people who have quarreled or split up with their partner or there may be financial problems and often alcohol is involved.”

It seems that whatever support people are given to deal with their mental health problems, this simply cannot replace a good job, home and relationship, for it is often these factors which lie at the root of many people’s attempts at harming themselves.

REPORT RESULTS

THE annual report on deliberate self-harm revealed the main features of self-harmers.

It showed that, during 1999, there were 1,671 cases of people attending Derbyshire Royal Infirmary who were seen by a member of the “deliberate self-harm” team.

Of these, 685 were male, 986 female and 433 attendances were repeat acts.

People in their 20s are more likely to self-harm with 475 aged 20 to 29 compared to 222 aged 40 to 49 in 1999.

The most common method was overdosing, the second self-laceration. Alcohol was involved in 64 per cent of cases.

Southern Derbyshire mental health trust medical director Dr Andy Clayton said people should not be ashamed of seeking help. “The number of people who self-harm is huge—everybody will have a friend, acquaintance or family member who will have self-harmed.”

The first point of contact is your GP but there are also voluntary organisations such as the Samaritans on 0345 909090 or the Bristol Crisis Service for Women on 0117 925 1119.

You can also write to the National Self-Harm Network, PO Box 16190, London NW1 3WW.


The Daily Telegraph
September 16, 2000

A Life of Torment
By Penny Valentine and Vicki Wickham

Dusty Springfield was one of the finest female singers of the 20th century. This first of three extracts from her biography reveals that behind her hauntingly beautiful voice lay a tormented woman who battled drug addiction, a fierce self-loathing, and a habit of self-mutilation†

The New York ambulance screeched to a halt and the paramedics raced up the steps to the apartment on the fourth floor. She answered the door in her pink tracksuit. Later they wondered how this pretty woman with the breathy English accent had even managed to pull the door open, so bad were the cuts to her arms.

At Bellevue Hospital they took her to the psychiatric wing and booked Dusty Springfield in under her real name, Mary O’Brien. It was 1985 and it was her second visit to the hospital with self-inflicted wounds, but it was a scene that had already been played out countless times at other hospitals.

When she lived in California, the dashes were so frequent she joked of knowing the paramedics by their first names. Each time, the bloody wounds that confronted the doctors were self-made—carved by a woman driven by inner torment.

The moments of crisis usually happened at night. Dusty always had trouble sleeping. Four hours was her usual tally and friends were used to her phoning them at one or two in the morning to talk.

She could not bear the loneliness of the dark or the unnamed terrors that seemed to overwhelm her. If there was no one to comfort her, she would take a blade and cut herself, then ring for an ambulance so she could be taken to safety.

In New York that year, Dusty appeared her usual self, smiling and joking. It was all image. Underneath, she was deeply depressed and broke. At 46 she was trying to make a comeback and had borrowed money to make demonstration records.

She had been calling her manager, Vicki Wickham, endlessly. But if Vicki offered her work, Dusty would find excuses not to do it. It was as though she was in the grip of a terrible lethargy. The anti-depressant pills only made her more anxious.

Vicki went to see Dusty in Bellevue, where she had “sectioned” herself, volunteering to be locked up in a mental ward to save her own life. She was in a communal area behind locked doors, shuffling around in a hospital gown. Her pretty face was bloated by hospital medication that left her dazed and slow.

For the first week she had been in a straitjacket, which she later took home as a trophy. Bodily contact was forbidden and Vicki could only talk to her. No, Dusty did not want to come out. They were “looking after” her. She found the ward a haven from the harshness of real life.

It had not always been like this. In the 1960s she had been acclaimed as one of the greatest women singers in the world, with 16 hit singles to her name. Stars such as Annie Lennox, Elvis Costello and Elton John adored and admired her. So, what had gone so terribly wrong?

Dusty began life as Mary Isobel Catherine Bernadette O’Brien, the younger of the two children of Gerard and Kay O’Brien, in London in 1939, a few months before World War II. Her father was a tax accountant and, on the surface, the O’Briens were a model, middle-class, churchgoing family. Mary and her brother, Dion (he later changed his name to Tom), attended respectable Catholic schools. But beneath the surface was turmoil.

The family’s chaotic meal times would occasionally be punctuated by fits of over-exuberance in which her parents would hurl food around the room. It was a strange habit that Dusty took into adult life. She loved the sound of breaking glass and disintegrating crockery and would explode into orgies of destruction whenever boredom or drunkenness got the better of her.

Her parents were at odds with each other. While Kay, Irish-born and from a family of journalists, was fun-loving and sparky, her husband was a solitary, quiet man and something of an intellectual. They would have ferocious rows while Dusty cowered at the top of the stairs, listening. It was in her childhood that Dusty also learned lessons in self-loathing and she grew up thinking of herself as nondescript. At her convent school, she was not a star pupil. She was plump, mousy-haired, had a square face and wore glasses. Her sense of humour seemed her only saving grace, making her popular with others but less so with the nuns.

Her parents, wrapped up in their problems and emotions, had no time for her. She would put her hands on the boiler until they burned—the only way she could make anyone in the house take notice of her.

This was the first instance of the self-mutilation that would recur later in her life. Whenever the pressure grew too great, the adult Dusty would slash her arms and legs with a savagery borne of utter hopelessness. She admitted: “When they see blood, it’s the only time they listen to you.”

It was a compulsion that horrified her friends and lovers, but which seemed to less sympathetic observers merely a violent form of attention-seekingÖ


Scottish Daily Record
September 28, 2000

What Makes a Normal Young Girl Slash Her Arms and Batter Her Knees with a Hammer?; Karen Went to Hell and Back and Now Helps Other Sufferers
By Maria Croce

KAREN HOUGH has a fresh face and a smile which radiates a new-found contentment.

This new, confident Karen is a refreshing contrast to the girl who was once so filled with self-loathing that she subjected her fragile body to years of abuse.

As she moved into adulthood, her self-harm intensified from stabbing her arteries to smashing her knees with a hammer.

Once she even broke her wrists by slamming them off a table. She pulls up her sleeve to reveal a series of pale white scars which run the length of her arm and shoulder.

She said: “Although sometimes I feel I wasted years of my life, I don’t try to hide my scars. I wear short sleeves. I don’t regret anything because I’m a better person for it. Because of what I’ve been through I can help others. At least now I can help stop others going through the same thing.”

Self-harming is now in the past for Karen, 24. She is a youth worker and plans to return to university.

She has also just launched a support group, called Apollo, to help others who are harming themselves.

Karen’s past actions may seem unusual, but according to a recent report by the Samaritans, three young people every hour in Britain harm themselves. Even celebrities have admitted self-mutilation in the past. They include Edinburgh-born Shirley Manson, of rock group Garbage, and Hollywood actresses Christina Ricci and Angelina Jolie.

Princess Diana was said to have harmed herself and so did Richey Edwards, of rock band Manic Street Preachers.

The Samaritans say almost half the population knows someone who has self-harmed—but many do not know how to help them.

Karen is glad to be alive. She came close to bleeding to death after she stabbed an artery in her arm in 1996.

Luckily, a stranger in the street came to her aid and she was rushed to hospital.

She said: “I didn’t want to die. I realised I’d gone too far. I vowed never to cut myself again. Looking back, I don’t know how I could have done that to myself. It was like a different life.”

Karen was seven when she began to hurt herself. She was a bright, music-loving youngster who grew up in a middle class home. But she decided to fall over on purpose to hurt herself.

She said: “I think it started off as a way of looking for attention. I got days off school with a sore leg.”

But over the next few years, Karen’s motives for self-harm changed dramatically. She said: “I can’t remember exactly when it happened, but I made the mind connection that if I was bad I should be punished. If I did something I thought was bad, I would hurt myself.”

At the age of 10, she had an operation to remove her appendix. At home, she picked at the scar with a needle. Other times she would slam her wrist on a table or hammer her knee.

She said: “A lot of self-harmers say they don’t feel pain, but I felt everything. I wanted to punish myself. If someone was in an angry mood, I would feel responsible—even if it had nothing to do with me. I felt everything was my fault. But I don’t blame anybody else for what I did. You’re responsible for your own actions.” Karen’s friends and family thought she was accident-prone and didn’t realise she was hurting herself.

She said: “I would tell people I’d fallen, so nobody realised what was really happening.”

Karen believes she was hurting herself as a way of dealing with the pressures of life.

She added: “Some people will go home from a stressful day at work and have a glass of wine—my way of coping was to harm myself.”

Karen went to university after school. But before turning 19, she told her GP she was hurting herself. So she dropped out to deal with her problems.

Although she was referred to therapists and psychiatrists, Karen felt the system at that point was not geared up to help her. And she then started to hurt herself more openly.

Karen said: “Because my self-harm was out in the open, I started cutting myself with the craft knife I’d used for my art class. I was very mixed up.”

But after her brush with death, Karen decided something had to be done.

She said: “I realised I was the only one who could get myself sorted.”

So, with the help of a psychotherapist, Karen beat the problem.

She said: “I now feel like I’ve finally grown up. When I look back to when I was self-harming, I think I was being very childish. But I wouldn’t say that’s the case with all self-harmers. Now I like the person I am and I love my job and I felt great setting up Apollo. I’d like to give people hope that they can stop self- harming and get their life back on track.”

Karen is writing a book about her experiences and has plans to develop her support group.

The group gives self-harmers the chance to talk to others in a similar situation. But they need extra funding as well as trained counselors.

Dr. Prem Misra, Glasgow-based consultant psychiatrist, says people harm themselves for various reasons.

He said: “Some people may be driven to hurt themselves as a reaction to pressure and stressful circumstances. They may not experience much pain. But they need psychiatric help.”

Eve-Marie Haydock, of Edinburgh-based mental health charity Penumbra, said many people harm themselves to get a feeling of control.

She said: “Self-harmers do not hurt themselves to die. They may self-harm to release pressure, to try to exercise control over their lives as a coping mechanism. We need to generate more information so self-harm can be better understood and destigmatised.”


Chatelaine
October 1, 2000

Aching for affection; Self-injury as the new anorexia
By Liza Finlay

Meet Kirsten—a lawyer who graduated at the top of her class—and a woman who fights emotional demons by hurting herself. Liza Finlay examines the condition some experts are calling “the new anorexia.”

The air in the kitchen was thick with tension. Kirsten and her mother weren’t arguing: they were “discussing” her mother’s dating tactics. Points and counterpoints volleyed back and forth with increasing speed and ferocity Finally, Kirsten’s frustration bubbled over. “I was trying to tell her how I felt but she didn’t want to hear. She wouldn’t listen and I couldn’t find a way to communicate, so I took the last resort.” The last resort for Kirsten, then age 31, was to brutally punch herself in the face.

It was her mother who screamed. “She got on the phone to my husband,” says Kirsten now, three years later. “She kept saying, ‘Get over here, get over here. You’ve got to control her.’ But I didn’t need to be controlled. I needed to be heard. I was trying so hard to tell her how I felt. But my honest truth wasn’t the truth she wanted to hear. It had been that way forever. I had all of this pent up anger that hadn’t been expressed.”

In fact, the anger Kirsten so violently expressed that day had been building since childhood—an anger that throughout her adulthood sought expression in the non-verbal language of self-harm. By the time she reached her 30s, Kirsten had repeatedly punched, pinched and scratched herself “My goal was to create a bruise,” says Kirsten. “I wanted to show the world that I didn’t have any value for myself I had so much negative energy bottled up inside me. Instead of lashing out, I would take it out on myself.”

Kirsten is afflicted with what the psychiatric community calls “self-harming behaviour” or “self-mutilation.” This can mean anything from scratching to cutting, punching, burning and even poisoning oneself. It’s nearly impossible to accurately determine the number of self-mutilators in Canada as the behaviour is symptomatic of so many other conditions, particularly eating disorders (some have dubbed it “the new anorexia”). It is safe to say, however, that Kirsten is one of thousands of Canadians, mostly young women, who inflict injuries on themselves as a way of controlling seemingly uncontrollable anxiety. If there is a line where self-hate becomes self-harm, women like Kirsten teeter on it precariously. They live with an inner anguish that makes their reality an emotional dungeon. Escape is elusive and often mapped out with bruises and cuts. It’s only recently that researchers have begun to be able to read this map.

Kirsten was 10 when her parents separated. It was not amicable and while, to the outside world, the mother and young daughter appeared to be recovering well and happily moving on, according to Kirsten it was all a performance of Oscar-winning calibre. “I learned about performing from my mother,” she says. “No one would know how insecure and vulnerable she was.”

No one, except Kirsten, who became her mother’s confidante, was privy to her inner fears and demons. “She would be seeing two men at the same time and telling me all about it. I don’t think it was good for a 12-year-old to know about her mother’s intimate life. I decided to grow up then and there and take all of her troubles on myself. I was an adult in child’s clothing. I didn’t know how to deal with her.”

She felt angry. But rather than communicate her feelings, Kirsten tried to solve her mother’s problems instead. A classic pleaser was born. At 12, Kirsten began what was to become a 20-year struggle with anorexia nervosa, starving to punish herself for what she perceived as her inability to resolve both her mother’s and her own problems, and as a bid for attention and care.

“I’d virtually stop eating, sometimes for eight days at a stretch, to get everyone’s attention. I think that was where the idea to self-harm really came from. As an adult, at times when starving myself wasn’t enough, I’d punch and scratch.” She beat herself until bruises marked her limbs.

While popular culture casts self-harm as an adolescent disorder, Kirsten was in her late 20s when she first turned to injuring herself. “I had used every trick in the book by that time,” she says, citing her eating disorder and excessive drinking. “None of them had worked. I still had all of these feelings that I couldn’t get out. So, I started to hurt myself.”

Most experts agree that at its core, self-harm is about coping—a way of speaking the unspeakable. Steven Levenkron, author of Cutting: Understanding and Overcoming Self-Mutilation (Penguin), describes it as a language used when words can’t be found. For many self-injurers, emotional wounds are an intangible enemy—they can’t be seen and they are difficult to control. Self-harm brings the battle from the head to the hands, transforming the pain into something more easily managed. The breaking of skin becomes a way of staving off a breaking of the spirit.

In the past 10 years, newer research even suggests that biology may play a role. There is some evidence to suggest that low serotonin function may be a factor in impulsive self-injuring, a theory that bodes well for drug therapies such as Prozac, which regulate serotonin levels to ward off the depressed states that may act as catalysts to harmful behaviour. Other studies have looked at the link between pain and the increased production of natural opiates such as endorphins. A cycle may be formed in which, paradoxically, habitual self-harmers hurt themselves to experience relief.

Susan Engels, who is co-ordinator of the Women Recovering From Abuse Program (WRAP) at Sunnybrook & Women’s College Health Sciences Centre in Toronto, has worked for more than a decade with severe self-harmers. She estimates that nearly 90 per cent of the women in her program—designed for women recovering from physical, emotional and sexual abuse—harm themselves in some manner. While not all self-injurers have been abused, a high percentage have. Similarly a significant number of anorexics and bulimics in WRAP self-harm. What all self-injurers share is an overwhelming sense of self-loathing.

“Women who harm themselves all make three automatic assumptions,” says Engels. “They are: I am a bad person, the world is a hostile place and I have no control over my world.” Paradoxically, gaining control over that world is why many self-harm. Engels calls the infliction of wounds a re-enactment of a previous trauma, with self-injurers going through it over and over until they gain some sort of elusive psychic mastery over the pain that plagues them.

But if the self-abuse is a re-enactment of a painful memory, it is also an opportunity to rewrite the script, to put the self-harmer in the driver’s seat with a degree of control she didn’t have before. The start and stop of the abuse is strictly controlled by the harmer herself and that may give some sense of power. “They’re controlling the pain in their life and not someone else,” says Engels. “They could not stop the abuse. They can stop this.”

Pain, however, isn’t the only emotion self-injurers seek to control. Sadly, happiness can be a frightening feeling for many. Unable to make sense of it and afraid to allow themselves to become too accustomed to it, they will inflict pain instead, an emotion they are more at home with.

In 1987, Kirsten, then 22, met her soon-to-be husband at the busy Toronto law firm where she was articling and he practised. After graduation, she accepted a position at another firm. While they both worked excruciatingly long hours, Kirsten’s mate was on the fast track, and though he was loving and supportive, his extended absences left Kirsten feeling neglected.

When the couple did spend time together, Kirsten struggled with feelings of being misunderstood and unheard—much the way she felt with her mother. She resorted to self-harm as a means of expressing her frustration and pain.

“I never took the plunge to find out what sort of resistance I’d meet if I said what I really wanted to say. I was afraid to tell my husband I wanted to spend more time with him because he wouldn’t listen. I was afraid I wouldn’t be loved. That was too big a risk.”

She’s foggy about the number of times she ended up in the emergency room between 1994 and 1995, receiving intravenous electrolytes after protracted periods of starvation and drinking. “There were so many calls to 911 and so many trips and each time I remember thinking, ‘This will get him home from the office.’”

Kirsten, like so many other self-harmers, suffered a frustrating double whammy—an inability to express her pain and anger compounded by crippling doubt about her right to have such feelings in the first place. Right hook, left jab. The boxing match between scalded heart and scolding head can last for years, and as injuries accumulate, many self-harmers become almost numb to the pain. The self-injury, ironically, becomes a way to awaken the senses, an attempt to feel alive -- to feel something, to feel anything.

To someone watching that behaviour, it can look like anything but trying to feel alive; in fact, it can look like a suicide attempt. But that’s not necessarily what self-harmers are doing, says Dr. Paul Links, who holds the Arthur Sommer Rotenberg Chair in suicide studies at the University of Toronto and St. Michael’s Hospital: generally, individual episodes of self-harm are not suicide attempts. But Dr. Links is quick to point out that those who self-harm are twice as likely as the general population to commit suicide, making successful therapeutic intervention an urgent need.

But therapy has been frustratingly inadequate for both sufferers and clinicians. While the tide now appears to be turning, in the past, many self-injurers were treated like the lepers of the emotional disorder colony, threatened with expulsion from hospital programs if their self-harming behaviour persisted. “It’s a little like saying that if you show the symptoms of your illness you won’t be helped,” says WRAP’s Engels. “It doesn’t make any sense. There used to be a real stigma attached to self-harm, largely because no one really understood it.”

The therapeutic community is now opening its doors to self-injurers with talking therapies to try to root out the issues underlying the behaviour and those favouring the behavioural approach to get women like Kirsten to replace harmful coping mechanisms with more healthful ones. At WRAP, Engels creates exercises that give women alternative means of expressing their emotions. She has also created the Living in Our Bodies workshop to reconnect self-mutilators with their bodies in a healthy manner. Participants paint their visions of their bodies and are retaught how to feed and nourish themselves, both physically and emotionally. Many keep diaries that document their growing awareness of their shape, their skin, their limbs and the thoughts they’ve shared with others in the group. “Women who self-harm often cope by removing themselves from their bodies,” says Engels. “They dissociate to such an extent that their bodies become a disconnected object that can be repeatedly harmed. There is a need to establish a connection between this object of hatred and the self”

Self-harm is a habit that is formed over a lifetime. “Breaking the habit is necessarily a long struggle,” says Engels. “I tell the women in our program not to expect to feel better right away. It takes time.”

Kirsten has precision down pat. Her shoulder-length blond hair is cut in straight lines with few escaping strays. Her equally blunt manner allows for no nonsense. Sitting on the crowded patio of a busy downtown Toronto coffee shop, she angles her chair so that the sun’s rays hit her squarely in the face. One senses that there is little that is arbitrary about her—a reason she picked this cafe, this table and that particular chair. Not surprisingly, she chooses her words equally carefully.

The art of verbal communication, at least on the issues of emotions and desires, is something Kirsten has only recently mastered. “I just couldn’t learn how to express my anger or make myself understood.” Making herself understood verbally was one leg of the journey toward recovery. “About two years ago, I was in the car with my husband,” she says. “I felt trapped in my inability to communicate and trapped in the vehicle. We were having this discussion and I just couldn’t make myself understood. I told him I was feeling like I wanted to hurt myself and he told me he couldn’t do anything about that. In that moment I realized that I wasn’t hurting anyone but myself I realized I had gone through life trying to say what others wanted to hear and do what others wanted me to do. I graduated from law school on the dean’s list. I went to work at a top firm. I was practising law and hating every minute of it. It was just another way of doing the most well-received thing. But I was lying to myself—again.”

Kirsten has spent the past four years working with a therapist who has helped her acknowledge her “inner truth.” She hasn’t practised the career she detests during that time and has no intention of returning to the profession. Instead, she spends her days doing volunteer work for people in recovery from addiction, substance abuse and eating disorders and, word by word, working to master the fine art of verbal communication and a host of other healthier coping strategies.

One of those strategies is to take time outs. “I feel like a little kid some times, but it really works,” says Kirsten, who hasn’t harmed herself for two years. “If I sense that I can’t get the feelings out or I’m not being heard, I get out of the situation. I walk the dog. When I get back I inevitably feel more assured about how to communicate and my husband or mother or whoever feels better about receiving.”

Ultimately, though, self-harm ends when self-worth begins. For Kirsten, it was a milestone earmarked by an acceptance of her feelings and, importantly, her right to have them. “I don’t hit myself anymore because I’m starting to like myself,” she says. “I’m adamant about communicating my feelings in a healthy way.”


Nottingham Evening Post
October 14, 2000

City first for kids’ ‘supernurse’ post; Role helps young who self-harm
By Catriona Cummings

THE first “supernurse” in the country to work with children who harm themselves has been appointed in Nottingham.

Marie Armstrong, 35, will become a “nurse consultant” for child and adolescent mental health services.

She will work from the Queen’s Medical Centre, with youngsters who deliberately hurt themselves. Last year, the Government announced the GBP 27,000 to GBP 42,000-a-year posts to remove the “glass ceiling” which can hamper nurses’ careers.

It means they can become managers, earn more money, and still care for patients.

Mother-of-one Mrs. Armstrong, who starts her new job later this month, will head a five-strong team, including a social worker and a psychologist.

They will work with young people admitted to the QMC and Nottingham City Hospital.

Mrs. Armstrong said: “The team will assess adolescents who may have deliberately hurt themselves and decide what further help may be necessary. It helps young people and their families develop techniques of dealing with their problems, reducing the risk of self harm.”

These may include therapy, storing medicines safely, and linking with other agencies such as schools and social services.

Every year, 150 youngsters under the age of 16 are referred to the QMC after harming themselves, including taking overdoses.

The new role at Nottingham Healthcare NHS Trust is being funded by the Government. Currently, the highest-grade nurses earn up to GBP 24,000. To progress further, they would have to become managers.

Dr. Paul Cawthron, clinical director of child and adolescent mental health services at the QMC, said: “We are very pleased to have been successful in this development bid. Marie will work as consultant for the deliberate self-harm team, improving the services provided to young people admitted to the QMC and City Hospital.

“The team will give greater follow-up support to patients and their families, reducing the demand on other out-patient teams.”

Mrs. Armstrong currently works as a primary care liaison nurse at the Thorneywood Unit in Porchester Road.

She has worked with children who harm themselves for 14 years.

She is studying for a masters degree in systemic psychology, looking at how relationships can influence people’s lives.

Earlier this year, the Post revealed Nottingham City Hospital was aiming to recruit a nurse consultant in diabetic services.

In January, Health Secretary Alan Milburn announced there would be 14 top-grade nurses appointed in the Trent Region, which covers Notts.


Windsor Star
October 26, 2000

Self-Injury
By Monique Polak

It started when Laura was 16. “I began breaking the skin on my face. I’d dig my nails into my skin ’til it bled. I’m not sure why I did it, but it became a habit,” said Laura. Soon, Laura was using her fists to hit her own arms; by the time she was in second-year CeGEP, she was using a small Swiss Army knife to break the skin on her right forearm.

“At first, I always did it at night before I went to bed. I don’t know what gave me the idea. The first time I did it, I was at my wits’ end. I was incredibly depressed and I hadn’t told anybody about my problems. They were bottled up inside me. Sometimes, I’d make horizontal cuts across my entire forearm. It stung incredibly. It was so painful that, in a weird way, it felt good.” Laura, now 21 and a second-year student at McGill University (her name and details about her life have been changed to protect her identity), is not alone.

Self-mutilation has always been around—consider the 13th-century clerics who flagellated themselves as a penance—but the practice seems finally to be coming out of the closet, drawing the attention not only of therapists, but also of parents, teachers and the media. Even the entertainment industry seems to have caught on to the phenomenon. The film 28 Days makes reference to self-mutilation and Fight Club deals in more depth with the urge to injure oneself.

“It’s where bulimia was 20 years ago,” said Tracy Alderman, author of The Scarred Soul: Understanding and Ending Self-Inflicted Violence.

“Any time someone does something injurious to their bodies, especially something so visible as cutting or burning and when there’s blood and guts, people get freaked out.”

According to a recent study published in the American Journal of Orthopsychiatry, four per cent of the general population engages in self-mutilation, acts that most often involve cutting and burning. Most self-mutilators use razor blades, scissors, sharp knives or smoldering cigarettes to injure themselves. Their preferred sites are the wrists, arms and inner thighs—likely because these are the most accessible parts of their bodies. Researchers have found that self-mutilation is as common in males as in females and that its onset tends to occur at adolescence.

Alderman, reached by telephone in her San Diego office, is wary of the term “self-mutilation,” preferring “self-injury.”

“People can injure themselves without mutilating themselves,” she said. “They can hit themselves without permanently changing the body’s appearance. I just don’t like the term self-mutilation. It sounds too harsh.”

Alderman specializes in treating patients who injure themselves. She and the psychologist with whom she shares an office treat about 30 patients every week.

In addition, Alderman consults with hundreds of parents and therapists annually and receives an average of 20 e-mail inquiries every week, both from individuals who injure themselves and from people who worry about them. “I think more kids may be doing it. We’re certainly hearing more about it,” she said.

Brian Greenfield, a child psychiatrist and director of the crisis intervention follow-up team at the Montreal Children’s Hospital, reported that, on average, each month he encounters another child who self-injures. These cases do not include children who attempt suicide, he noted.

Like other professionals who treat self-injurers, Greenfield is seldom shocked by what he sees, though he admits he was taken aback by the sight of a teenage girl whose arms were covered in cigarette burns, many of which were purulent.

Evelyn Rodinos, a psychologist in the counseling and development department at Concordia University who previously worked as a therapist in the local high school system, estimates that in 11 years of practice, she has treated about 30 self-injurers—nearly all women. “The number seems to be increasing, but I’m not sure whether that’s because there’s a greater prevalence or because counseling has become more user-friendly,” she said.

Researchers have found a strong correlation between self-injury and childhood abuse. “There seems to be a link between self-directed aggression such as self-mutilation and abuse of various kinds—sexual, physical and emotional. Emotional abuse includes the parents’ unwillingness or inability to listen to the child,” said Greenfield.

Laura fits this bill. Deeply ashamed of how she was hurting herself, she was initially unwilling to talk about it—even to her closest friends.

“I was cutting myself every single day, sometimes twice a day. I kept thinking, ‘What’s wrong with me?’ and I didn’t know what to do. Eventually, I told a friend who knew of a therapist I went to see,” Laura said.

It took several therapy sessions before Laura gathered the courage to disclose that she was cutting herself. Laura’s therapist helped her realize there was a connection between her behaviour and the childhood abuse she’d suffered at the hands of a gymnastics coach.

Laura’s therapist recommended simple behavioural-modification tricks like staying out of her bedroom when the urge to cut herself struck. After three months of therapy, Laura stopped mutilating herself.

“I had one relapse since. I was alone and there was nobody I could find to talk to. The trigger was that a guy I knew—and whom I had trusted—was being sexually aggressive with me. I didn’t know how to deal with him,” she said.

Therapists use a variety of techniques to treat patients who injure themselves. Above all, they stress the need for professionals and others who encounter self-injurers to stay calm and not to panic.

“The drama of the symptom can distract the parent or therapist from actually dealing with the underlying dynamics,” Rodinos said. “You want the problem addressed by people who won’t be seduced by the possible horror.”

When Rodinos works with patients who injure themselves, she focuses on helping them increase their repertoire of coping strategies. She uses behavioural-conditioning techniques to help them minimize the injuries and their frequency.

“I suggest things like cutting only ’til they see the first drop of blood, or waiting 15 minutes, then giving themselves permission to injure themselves—this raises their consciousness that they might have control,” she said. “Keeping a journal of triggering feelings can also make the patient more conscious.”

Experts agree that simply insisting that self-injurers stop hurting themselves is not likely to help. “I tell them, ‘I can’t stop you from doing things to hurt yourself, but clearly what you’re doing shows me you’re in pain and I hope you’ll let me help you relieve the pain,’” Greenfield said.

Alderman believes there is an easy conceptual solution to self-injury—though it’s a solution that takes time and effort. “If somebody feels they’re valued and loved and accepted for who they are and they know how to communicate their thoughts and feelings to others and they have an opportunity to do that, they won’t feel the need to self-injure,” she said.

Asked for what advice she would give to an individual who injures herself, Alderman didn’t need to think twice. “I’d say, ‘Hang in there. It gets better.’”

Of the Web sites dealing with self-injury, Alderman recommends: www.ratatosk.net/psyke/selfinjury/secretshame.html


The Deseret News (Salt Lake City, UT)
November 21, 2000

Self-mutilation is a cry for professional help
By Abigail Van Buren

Dear Abby: This is in response to “Worried Mother, Chandler, Ariz.,” whose daughter is self-mutilating. I had this problem in high school. What wasn’t mentioned in her letter is that cutting, burning, etc., is an addictive behavior. You hit the nail on the head when you said cutting causes physical pain to express deep internal pain, and a mental-health specialist is necessary.

In the meantime, instead of punishing her daughter by grounding her, the mother should try to be very understanding and treat this as an addiction. Anything her daughter could harm herself with should be confiscated—and the girl should be monitored to be sure the behavior is not ongoing. It’s easy to hide. Please inform the mother that even though her daughter is in a lot of pain, she might not be able to verbalize it. It’s best not to prod or force her. Just be there and try to do the best she can. The healing has to come from the daughter. A parent can only help along the way. –Former Cutter in Eugene, Ore.

Dear Former Cutter: Thank you for the valuable input. Read on:

Dear Abby: I am almost 17 and have been cutting off and on since I was 13. When I began, I didn’t realize how addictive the condition is. At one point, I cut at least once a day for several months—and experienced physical withdrawal if I didn’t.

Sadly, my behavior is common for someone suffering from this addiction. Teenage girls seem to be afflicted most often—especially the perfectionist, overachiever types who are also prone to depression and eating disorders.

I have read stories of severely addicted cutters who cut for 30 years or more. I will have scars on my arms, back and stomach for the rest of my life. As you said in your response, Abby, the daughter needs emotional support from her friends. I have been blessed with the most wonderful, caring group of friends who have helped me through my difficult times. I would encourage anyone who is a victim of self-mutilation to seek professional help immediately. –Self-Injurer, Still Struggling

Dear Struggling: Thank you for sharing your personal experience. Read on:

Dear Abby: I have been a cutter for 15 years. People are only recently becoming aware of this problem. I received help when I was younger, and now, as a mother of three, I’m able to control my urges when life gets difficult.

Please inform “Worried Mother” not to punish her child for cutting. Cutters are in need of serious psychological help. They cut because they feel their pain is eating away at them, and cutting is the only way to let it out. Talking and listening to her troubled child is vital. She should not be criticized, and her problems should not be minimized. The smallest thing can feel like an end to her world. –Been There in Las Vegas

Dear Been There—and all of the former cutters who took the time to write: Most people do not understand the dynamics of this problem. Your taking the time to write and educate us is appreciated. According to other letters from former cutters, the problem may stem from clinical depression, bipolar disorder or sexual abuse. And I repeat: It is a cry for help—PROFESSIONAL help.


The Virginian-Pilot (Norfolk, VA)
December 4, 2000

Wannabes’ Desire For Disability Fuels Self-Mutilation
By Alexandria Berger

THE VOICE ON PBS coming from my car radio was soft, feminine and well-enunciated. It spoke with a British accent.

The topic was “wannabes.” But not the kind who want to be rich or famous.

“Wannabes are people who want to be disabled,” the voice said. I pulled over and stopped. I knew about wannabes. But this was the first time I had heard them discussed so openly. “They’ll remove a limb, cut off a digit or mutilate a part of their bodies. I was born without part of my arm and leg. So I decided to travel around the world and meet people who wanted to be just like me,” the voice continued in a low-key lilt.

She recounted the story of George, a wannabe now living disabled in a London flat. So powerful was his instinct to get rid of his limb, he pondered its removal for years. He felt possessed.

Finally, pretending to be a hunter, he ventured into the woods and shot off his leg. Then, seeing the bleeding mass, he reached for his cell phone.

It was out of range.

Luckily, a neighbor who had heard the shot saved his life. His urge satisfied, today George walks with the use of an artificial limb, happy with his loss.

Self-mutilation is no longer a strange phenomenon. It is serious stuff, with Web sites and online chatrooms. Wannabe behavior is most often attributed to psychiatric illness such as borderline personality or compulsive obsessive disorders. In some cases, wannabe behavior is a way to collect disability or insurance benefits.

I had met two wannabes in my travels. Ben Jahoullen was a 38-year-old living in Marrakech, Morocco. He was an expert tour guide who knew where the back-street treasures lurked. But, as he put it, career-wise there was no place for him to go. “I’m trapped,” he told me.

Because of his lower class, Ben would never climb the social ladder, even though he could read and speak five languages. He felt like an outcast.

“Write me and let me know how you are doing,” I said when I left Morocco. After several years, a letter arrived: Ben wrote that he had cut off the four fingers on his left hand and gashed his face, severing a nerve. Although he was visibly disfigured, he felt whole, he wrote, accepted for the first time in his life.

I met Johnny, a dock worker from Dundalk, Md., in 1993 when I was a patient at The Johns Hopkins Medical Institutions. I was at the Muscular Dystrophy Association Clinic hoping for a cure. Good old Johnny was hobbling around on crutches waiting for a prosthesis to be made for his missing foot.

He chose to amputate it on a strapping machine. He said he hadn’t thought about the phantom limb pain—the sensation that his foot was still there. He wanted disability benefits to provide him with a steady income minus layoffs. His claim was being contested under the workman’s compensation system.

A number of cases where limbs have been self-severed then re-attached by plastic surgeons have had legal ramifications. At once, some wish re-attachment of the severed limb, only to want detachment again. Others initially want the limb left off, only to sue because their wishes were granted.

There are no statistics on the number of wannabes, but the existence of Internet sites suggests the numbers are growing. Many wannabes reportedly express this need to disable themselves from childhood, or at puberty, when self-image becomes heightened.

For wannabes, it seems a lifetime theme is, as the children’s song goes, “One finger, one thumb, one arm, one leg, keep moving...and chase your blues away.” Except for them, there is no final refrain.