Some people hurt themselves in an effort to cope with their feelings of inadequacy
By Jodie Pippert
Her boyfriend broke up with her today. So she’ll have another cut on her wrist tomorrow. How did he break his hand? He punched another wall. Did you hear that she’s in the hospital? She cut herself too deep this time. There is a secret illness that plagues an unknown number of Americans each year. This illness, which is more common than many people realize, is called self-mutilation, also known as self-injury. The number of people hurting themselves is almost impossible to estimate, because it is something often done in secret.
It is often not spoken of, but there is help and intervention available for victims of self-mutilation.
One young Topekan, age 17, who asked that her name not be used, said, “Heartache caused me to do it. I do it partly as a reminder to myself not to trust and not to love.”
She cuts herself. She uses anything available—from keys to knives. And she does it on a regular basis.
Family fights, loss of her dog and stress from relationships with guys lead her to try to end her life. That was when she first discovered self-mutilation.
“There was no pain, just a release,” she said.
Along with practicing self-mutilation she also goes on periods of binge eating and extreme exercising.
The act of self-harm is often done in private, making it a shame-filled secret. But experts agree this seemingly bizarre and misunderstood act indeed occurs. There are ways to recognize the signs of this practice and to prevent this destructive behavior from occurring.
“Self-mutilation is the purposeful behavior of hurting yourself with the immediate goal to reduce troublesome symptoms,” said Leigh Alexander, nurse manager for the professional-in-crisis program at Menninger.
Beverly Bryant, program director of the Child and Adolescent Inpatient Psychiatric Unit at Menninger added, “These self-inflicted injuries may range from superficial scratching, to cutting, to the extent of needing stitches.”
According to Armando Favazza, professor of psychiatry at the University of Missouri-Columbia School of Medicine and author of the book Bodies under Siege, self-mutilation may be classified into two major categories: culturally sanctioned and pathological.
“Culturally sanctioned self-mutilation involves religious rituals or coming-of-age practices,” Favazza said.
The pathological self-mutilation may be broken down into four sections:
Culturally sanctioned self-mutilation has been around since the beginning of humankind. The first recorded incident, however, of pathological self-mutilation can be found in the Bible under Mark, chapter 5, verse 5: “And so, unceasingly, night and day, he would cry aloud among the tombs and on the hill-sides and cut himself with stones.”
People practice self-mutilation for a variety of reasons.
Adolescents commonly do it as a way of fitting in or as an expression of their anger. It may just be a way of getting attention or possibly an attempt to punish themselves for something, said Bryant.
She said this problem doesn’t affect only adolescents. In adults, self-mutilation is usually a sign of an underlying disorder such as Post Traumatic Stress Syndrome (PTSD) or a Borderline Personality Disorder. In PTSD patients, the self-mutilation is often a way of grounding themselves from the dissociative feeling that they experience.
In most occurrences, this practice is actually a way for the person to prevent themselves from committing suicide. It’s as if the tension they feel gets released once they see blood, Bryant said.
“Many people who do it are doing it in part to communicate just how much they are suffering; as if they cannot put it into words,” said Dr. Jon Allen, the Helen Malsin Palley chair in mental health research at Menninger.
About 40 percent of people who practice self-mutilation will develop an eating disorder of some kind, and 40 percent of eating disorder cases will become a “cutter” or a “burner,” Favazza said.
“The behavior,” Favazza stated, “provides short term relief from mounting anxiety, depression, and racing thoughts and many other unpleasant symptoms.”
This problem is found more often in women than men—an estimated 60 to 40 percent ratio, Favazza said. Although there is no exact reason why this is, it may be because men have other choices.
“Men have more outlets for expressing their aggression, whereas women don’t have those outlets.” Favazza explained.
A lot of people who suffer from this affliction will deny practicing it because they feel ashamed for their behavior. There are, however, signs and symptoms to look for, such as:
Allen said there have been reports estimating the prevalence of self-harmful behavior ranging from 0.2 percent to 1.4 percent. However, due to a lack of accurate reporting, those statistics may not be precise.
“Things that they (parents) may think will pass may seem like the end to a child,” Bryant said.
If you suspect someone of practicing self-mutilation there are things that you can do to help them. You want to mention it in a supportive way. Ask questions such as “Are you feeling OK?” or “How are things going?” and maybe progress to “Do you ever feel like life isn’t worth living?” Bryant said.
If they do decide to talk about it, be empathetic. Also encourage the person to seek evaluation through a local mental health center or a doctor and get a referral. If you think that they are even acutely suicidal, it is considered a medical emergency and you can call 911 or the police.
Evening News (Edinburgh)
January 12, 2001
Horror at Secret Agonies of 16,000
By Jane Hamilton
DOCTORS’ lack of understanding was blamed today for contributing to 16,000 incidents of self-harm going unreported in the Lothians each year.
The true extent of the problem of people mutilating themselves to cope with distress was revealed for the first time today in a shocking Government-sponsored report.
With only about 4000 incidents reported annually, researchers believe the problem is four times greater than was previously thought.
Young people are most at risk of falling into the destructive habit. But the study, carried out by mental health group Penumbra, shows a growing number are failing to seek medical help because of lack of understanding and the stigma attached to the problem. Shocking
The report also criticises the lack of services and information available to people aged between 16 and 21.
Most young people affected by the phenomenon felt there were little or no services geared towards helping and supporting them. Some existing services were also criticised for being judgmental and stigmatising the very people they are there to help.
Among the problems highlighted in the report, which will be launched today at a conference in Edinburgh attended by Deputy Health Minister Malcolm Chisholm, are:
Mr. Chisholm, concerned about the details of the research, stressed: “Mental Health is one of three clinical priorities in Scotland and we are determined that the Health Service will meet the full range of mental health needs.”
The minister added: “This is an important piece of research that highlights some of those needs and should be studied with great care.
“It is essential to work with and listen to young people to ensure the services shape in such a way that effectively meets their needs.”
Patrick Little, Penumbra’s Scottish development manager for young people, said: “The report clearly says there needs to be more training for GPs and professionals in the care field.”
Mr. Little stressed there are thousands of young people who mutilate themselves, but keep it secret because of the stigma and lack of understanding.
Dr. Ian McKee, who recently carried out research into suicide, self-harm and deprivation at his Wester Hailes surgery in Edinburgh, said the low hopes and expectations of many young people led them into self-harm.
He said: “It’s shocking. We have the figures that prove people living in areas of deprivation are more likely to self-harm. Society is failing young people who feel they have nothing to look forward to in life.”
Dr. McKee felt very strongly that high unemployment, little educational opportunities and poverty were all a major factors in cases of self-harm and suicide in young people.
Nicola Sturgeon, the SNP’s health spokesperson, said: “It’s alarming. There are many reasons why people self-harm and more research is needed into the causes of it.”
Conservative health spokesperson MSP Mary Scanlon said the report needed to be “a catalyst for understanding and support.”
She added: “We have come a long way, but we have some way to go to meet the needs of mental health and to reduce the stigma and shame surrounding it.”
Of the young people who took part in the research, 85 per cent felt there was a need for a one-to-one service.
Overdosing, using knives and skewers to stab themselves, starvation, and burning themselves were among the habits young people reported.
But admissions about the misuse of sex and playing dangerous games, such as dodging traffic with a reckless disregard to their safety, were also included in the report.
The most common reasons for self mutilating included bullying, sexual and physical abuse, poor image and low self-esteem and mental health problems.
One interviewee said: “If I hadn’t been bullied, sexually and physically abused, and if I had had the emotional support when I needed it, maybe I wouldn’t use self-harm as a way of coping.
“Self-harmers are seen as an embarrassment to society. People are scared of us and can’t talk about us seriously.”
Several recommendations from Penumbra will now be considered by service providers.
January 13, 2001
Tragic Toll That is Wasting So Many Lives
EVERY hour three teenagers in the UK self-harm, and someone who has self-harmed is 100 times more likely to die from suicide than other people, say the Samaritans. They cut or burn themselves or, perhaps, take an overdose as a way of coping with difficult emotions.
Their problems vary but research shows about 65 per cent of those who self-harm are experiencing relationship difficulties.
Among men, almost half also misuse alcohol and about six per cent of women have an eating disorder.
Suicide claimed more than 6,000 lives in 1998 and it is increasing among young men. Since the early 1980s, the number of suicides by men aged 25-34 has doubled. And, in the same period, the number of men aged 15-24 who self-harm has also doubled. Currently, five times as many men under 35 kill themselves as women.
In a joint statement, the Youth Call Centre volunteers said they were “shocked and concerned” when they saw the figures on young suicides and self-harm.
“From our meetings, we felt what was needed was a line offering young people a chance to talk about their problems with their peers in confidence. We’ve carried out research and a questionnaire revealed 75 per cent of the young people we approached believe this line would be of benefit.” They added: “We aim to offer understanding, support and confidentiality for young people who need it. We know it won’t be easy but are willing to persevere. We know we can make a difference.”
The Herald (Glasgow)
January 13, 2001
Woman Says Self-Harm Helped Keep Her Alive
By Raymond Duncan
A young woman yesterday told how she would rather cut herself than go on drink binges or get high on drugs because she felt she was in control when deliberately injuring herself.
“Sarah,” 20, who was forced to drop out of university because of her problems, said self-harm had kept her alive.
“It felt almost safer being in control although I know I am fooling myself. For me it was a way of coping and not taking the final step. I wanted to know if it was painful and whether slashing my wrists was an option. “Hopefully in the next couple of years I will not be self-harming but I will still have the legacy of the scarred arms and have to deal with the prejudice and stigma.”
Sarah, who urged a greater understanding of sufferers and more help for them, was speaking after an Edinburgh conference at which the findings of major new research into self-harm among young people were revealed, exposing a huge hidden problem.
The study, carried out by the Scottish mental health charity Penumbra, said self-harm was not “a horrific prank or phase” or simply attention seeking or a cry for help.
Around 4000 people are admitted to hospitals in Edinburgh and the Lothians annually with self-harming injuries, about a quarter of the figure for Scotland. Statistics indicate that between 40% and 60% of people who kill themselves have previously self-harmed.
The findings of the £15,000 study, funded mainly by the Edinburgh Social Inclusion Partnership, showed much dissatisfaction among young people about national agencies’ support.
Some existing services were viewed as “judgmental” and stigmatising of those who self-harmed.
Eve-Marie Haydock, author of the research document “No Harm in Listening,” said the perception that self-harm was “a female phenomenon” could now be challenged with rates among young men higher than previously believed.
She said traditionally females chose passive methods such as eating disorders or overdoses while males selected non-passive ways like self-strangulation.
Now males were opting for passive methods like indulging in dangerous sexual behaviour and destructive sexual relationships.
Sarah said later that people did not self-harm lightly. “I don’t know anyone who has said they think it’s cool.”
She said she began self-harming because she hated herself and blamed herself for everything that went wrong in her family.
She had been encouraged to go to a Penumbra conference where for the first time she found there were other sufferers. “I was not a freak of nature and it was a huge relief.”
She had been bullied at school and been “desperately unhappy and alone,” unable to get on with her peer group.
Her GP and her school were the first to know about her problem. “They wanted to help but didn’t know who to contact.”
The self-harm phenomenon was highlighted last year by Shirley Manson, the Scottish rock singer, who told how she carried a penknife in her Doc Martens in case she felt the urge.
Yesterday, Sarah said she did not believe the disclosure by Manson, lead singer with the band Garbage, and other high-profile figures would encourage people to self-harm.
“I was pleased that people who had got their lives together had said they had done that. It gives sufferers hope.”
Malcolm Chisholm, deputy minister for health and community care, who addressed yesterday’s conference, said the Scottish Executive was considering the possibility of developing a helpline for people suffering from low mood and depression, similar to helplines being run in three areas of England.
“Such an initiative will have relevance to self-harmers and potential suicides as well as to people who are depressed.”
Fort Worth Star Telegram
January 22, 2001
Suffering in silence; Pressures of youth can lead to self-mutilation, experts
By Jennifer Radcliffe
Tricia Jeter knows that razor blades cannot solve her problems anymore.
She didn’t use them to try to kill herself, she said. There was just something about cutting her skin and watching the blood.
A relief. A sense of control. A way to dull the pain inside.
“It’s the satisfaction of knowing it will hurt, and you can control it,” said Tricia, 15. “Even though it hurt, it was just a relief.” Afterward, Tricia would resume her everyday life, which includes a boyfriend and a supportive family. She hangs out with friends, takes dance classes and dreams about being a doctor in the Air Force.
Tricia, a freshman at Carroll Junior High School in Southlake, is one of thousands of teen-agers who hide scars from self-inflicted cuts under jeans and long-sleeve shirts.
Self-mutilation, self-injury or cutting leads as many as one in 250 people to repeatedly hurt themselves.
Self-injury typically begins in adolescence, when youngsters often struggle with low self-esteem and have problems expressing feelings. Freshmen, who face many new pressures, may be particularly vulnerable, psychology experts say.
Tricia told her mother in November that she was cutting herself. She is now seeing a psychologist.
She fits the profile of a self-injurer.
They are usually young women with good backgrounds, perfectionists who have a difficult time talking about feelings, said Karen Conterio, administrative director of Self Abuse Finally Ends, a 15-year-old program in Illinois that treats self-injurers.
Almost 90 percent of self-injurers say they are discouraged from expressing emotions, according to Conterio’s research. Almost 50 percent report past physical or sexual abuse.
Most have low self-esteem, she said.
These conditions, coupled with hormone changes, make adolescents especially susceptible to self-injury, she said.
“There is a real sense of being out of control. This is a way to attack the body to regain control,” said Conterio, who co-wrote Bodily Harm: The Breakthrough Healing Program for Self-Injurers.
Tricia said she was not abused, but her family life was strained. She grew up with an alcoholic father and remembers nights when he would pass out on the floor, she said.
Her parents divorced about five years ago. For a while, it was just Tricia, her two sisters and their mother. Tricia is close to her sisters, Whitney, 13, and Katy, 19.
In 1998, Tricia’s mother remarried. Having a stepfather was a big adjustment. Tricia said she has never been close to him or to her mother, who stay busy with their jobs.
Tricia, like other freshmen, also has problems with self-image. She said she has never felt as pretty as other girls at school. About two years ago, she went on a severe diet and lost about 20 pounds.
Last year, when Katy moved out to live with her boyfriend, Tricia said she felt abandoned.
“I felt everything was going to pieces,” she said.
Tricia then started hurting herself by scratching her arms until they bled. Usually, she scratched under her sweater, where no one could see.
Soon, Tricia began using razor blades on the inside of her upper arm. She also has burned her wrist with matches.
“You get used to the scratching,” Tricia said. “It’s almost as if you need something else.”
She went to great pains to hide the scars. Sometimes, her mother or her sisters would ask about the marks, but she would make excuses to ease their minds.
Karyn Mally, Tricia’s mother, said she was shocked when she found out that her daughter had been hurting herself for a year.
“I thought we had a good relationship, but I guess she just didn’t want to tell me,” Mally said. “I should have known what was going on. I should have been more compassionate.”
‘A coping method’
Self-injurers are grasping for a way to cope with painful emotions, experts say. By hurting themselves, they lower the intensity of their rage, loneliness or disappointment to tolerable levels.
Endorphins, which the body releases when it is injured, are also believed to help relieve the chemical imbalances that most self-injurers suffer from, experts say. The chemical changes, which last about two hours, may explain why teens report feeling calm and relieved after they hurt themselves.
“I just felt like I had taken like a load, a burden, off me,” Tricia said.
Stephen Levenkron, a New York psychotherapist who wrote Cutting: Understanding and Overcoming Self-Mutilation, said self-injurers tend to lose sight of reality.
Many self-mutilators enter a trancelike state and claim that they cannot feel the pain, he said.
Courtney S., a junior in the magnet science academy at Lyndon Baines Johnson High School in Austin, said she had a similar feeling before she would cut herself.
“Usually, the reasons why I did it is because I felt like I was in a dream, like I wasn’t really there,” she said.
“It’s just a feeling that you can’t really explain. It’s like all you want to do is sleep because the nightmares you have were better than your life,” she said.
“I cut myself because I want to live. It’s just a coping method,” she said.
Levenkron said teens rationalize cutting.
“The kids don’t represent themselves accurately,” he said. “They’re not calling it pain anymore. They’re calling it intensity.”
The dramatic gestures are not teen-age rebellion or botched suicide attempts. In most cases, self-injurers have deeper problems, such as depression, anxiety or post-traumatic stress disorder, said Lindy Garnette, director of child and family mental health services for the National Mental Health Association.
“Often there is a mental health issue, but often it’s an undiagnosed problem,” she said.
Unless underlying problems are treated, self-injurers will hurt themselves for years, experts say. The episodes, which usually worsen, can result in permanent body damage or accidental suicide.
A Northwest High School freshman, who asked that her name not be used, said she knew that if she did not stop cutting, she might accidentally kill herself.
“I was thinking I would end up doing it too deep and end up almost killing myself, but I didn’t want to kill myself,” she said.
The student said she was terrified to tell her parents that she had been hurting herself for four years.
“It’s just really sad because you feel you have so much pressure to try to please everybody so you can’t act out like other kids do when they have problems,” she said.
She said she has not cut herself since she had an emotional talk with her mother three months ago.
“As soon as you admit it, it just gets easier,” she said.
Other teens say they struggled to stop cutting.
“I can stop doing the behaviors, but I haven’t found a way to stop wanting to do it,” said C.J. Dahlgren, 19, of El Paso, who cut and burned herself throughout high school.
Dahlgren’s first cut was a self-punishment after her grandfather’s death. She felt guilty, she said, because she had not talked to him in two years. Eventually, she cut herself any time she argued with her mother, got a speeding ticket or received a low grade.
“Most of the time when people start this, it’s because they feel they’re out of control,” said Dahlgren, who has had skin grafts to cover some scars on her arms. “What they have to realize is that this is going to control them and their lives.”
‘A way to heal’
With medication and therapy, most self-injurers can recover, experts say.
“What parents and friends have to face is the old-fashioned word heartbreak—that someone they love is mentally ill,” said Levenkron, who has treated 50 cutters in 25 years.
As part of Tricia’s therapy, her psychologist has instructed her to draw on her arms with a red pen when she feels like cutting. She has used the approach at least three times.
Other self-injurers are advised to replace cutting or burning with lesser pain, such as holding ice. Healthy coping techniques such as talking, writing or drawing are also recommended.
Recovery requires tremendous work by patients as well as their family and friends, Levenkron said.
Tricia’s mother says she takes extra steps to nurture and protect her daughter. She often checks on her, as she did when Tricia was a baby, she said.
“I find myself now going upstairs to make sure she’s OK,” she said. “I’m not comfortable yet, so I try to gear my life and days around her to make sure she’s not alone.”
Belfast News Letter
January 31, 2001
Female Times—Better Health: Crisis Card for Victims of Self-Harm
MORE than 60 per cent of people who try to commit suicide have a history of self harm.
New crisis cards issued by North & West Belfast Health & Social Services Trust could help reduce this misery. The Someone to Talk to Someone to Listen card is a unique source of information for those who are in despair or who have deliberately self harmed.
It contains telephone numbers of a range of statutory, voluntary and community organisations who offer support or services to individuals in need. The organisations include the Samaritans, the Homeless Advice Centre, the Drugs Helpline and Cruse Bereavement Care.
Social workers from the Trust have observed that the number of patients admitted to local hospitals with deliberate self-harm has increased. Many of them will have tried to harm themselves more than once.
The Crisis Card was launched this week and Richard Black, the Trust’s Chief Executive said it was their responsibility as health and social care professionals to work together to improve and develop their responses to vulnerable individuals.
The card will be given to individuals leaving hospital and will be available in Accident and Emergency Departments, GP Surgeries and from statutory and community organisations throughout north and west Belfast.
The Orlando Sentinel
March 2, 2001
Self-Injury on the Rise; Disorder Helps the Depressed Cope with Runaway Emotions
By Pragati Patel, Colonial High
The world today can be a difficult thing to deal with. For young adults it can be especially tough. Most of us are well-adjusted human beings, able to cope with everyday drama and emotion.
However, some people aren’t able to deal with these everyday emotions and seek an alternate way to relieve their distress. One of the most common, yet least recognized, diseases affecting young Americans today is self-injury. Although not as widely recognized as several other disorders, self-injury is prevalent in society today. In recent years awareness of the disease has grown. It wouldn’t be unusual to turn on the radio and hear a song with lyrics relating to self-injury, or to see one of your favorite shows dedicate an episode to this disorder.
Self-injury is also known as self-inflicted violence, self-harm, self-mutilation, and SI. Generally, self-injury is used to alter a mood or state of mind by inflicting physical harm serious enough to cause tissue damage.
The most common methods of self-injury are cutting or burning the skin. Other forms of injury include hitting your body to cause bruises, hitting yourself with a heavy object, picking at your skin until it bleeds, biting yourself, or pulling your hair out. Tissue damage is indicated by a mark that lasts more than a few minutes or an abrasion that draws blood.
Self-injury is often linked to depression and is used as a coping mechanism. Often it is mistaken as a failed suicide attempt. Studies have suggested that people who self-injure are easily overwhelmed emotionally, consequently causing the activity to become addictive.
Self-injury works in bringing the injurer’s psychological and physiological tension and arousal back to a bearable baseline almost immediately. Dr. Sharon Farber, author of When the Body is the Target: Self-Harm, Pain, and Traumatic Attachments, said that self-injury is “an individual’s attempt to solve emotional problems to make himself or herself feel better.”
A junior at Colonial High School, who has overcome an experience with self-injury, said that “it took my mind off the emotional pain I was feeling and made me focus on a different kind of pain.”
Eventually, the negative consequences add up, and it is no longer the safe and easy way to cope with emotion.
Many people who self-injure are unable to remember when they first got the idea of hurting themselves, or when they actually began to self-injure.
“In my experience with self-injurers, I have found that they are usually trying to gain control of something in their lives, said Sharon Jones, an English teacher at Colonial High School. “They use cutting as a bulimic or anorexic would use food.”
In abusive homes, many self-injurers were punished for expressing certain feelings or voicing emotions. Along with this, many self-injurers did not have a role model who effectively displayed the proper behavior for coping.
Self-injury is often combined with feelings or guilt, helplessness, rejection, self-hatred, anger, failure, and loneliness. This disorder can also be found in conjunction with a history of substance abuse, eating disorders, or physical abuse.
It is important to understand that self-injurious behavior does not categorize a person as psychotic, suicidal, or mentally disturbed. Self-injury is simply a way for an emotionally overwhelmed person to cope.
Help is available for those who seek it. Many believe that self-help is an effective way to deal with self-injury. However, in many cases clinical help is also needed.
Good Morning America
March 14, 2001
Cutting, A Physical Response To Emotional Pain
Anchor: Charles Gibson
Reporter: Ann Pleshette Murphy
CHARLES GIBSON, co-host: Up to three million Americans have a problem that they don’t want you to know about. It’s an intensely, private, self-destructive impulse born of a pain that they can’t express any other way. They injure themselves, mutilating their bodies in an effort to make their emotional pain physical. And for nine out of 10 of them, it starts when they’re teens, a response to pain from something as commonplace as school stress or as devastating as death or divorce of their parents. In today’s AMERICAN FAMILY, our parenting contributor Ann Pleshette Murphy looks at what they call ‘cutting.’
Ms. LISA BAYENS: The pain brings me smiles, but it also makes me weep. The blood brings me confidence, but it also stirs up fear. The blade brings me power, but it also creates a demon.
ANN PLESHETTE MURPHY reporting:
(VO) That demon was an overwhelming urge to mutilate her own body, to cut herself on her arms and stomach, usually with a razor. Sadly, self-injury is far from unusual. Afraid to let their feelings out, troubled kids turn their anger on themselves. It was a problem that plagued Lisa Bayens for eight long years.
Ms. BAYENS: I remember it like yesterday. I was 12 years old. I felt so much anger inside, and I was so upset that I wanted to have my feelings be expressed, and I couldn’t just discuss them with somebody. So I felt like I had to put a--a mark on my body. And then once I did that, I felt so relieved afterwards that I continued the behavior every time I was sad or angry, upset, depressed. As it progressed, I would have to hurt myself more. My arms were raw, my stomach was raw. I could not—I could not bleed as much as I wanted to bleed, so then I realized that I needed help.
MURPHY: (VO) Lisa turned to the SAFE Alternatives Program in Berwyn, Illinois. The only program of its kind, SAFE, which stands for Self-abuse Finally Ends, is run by Dr. Wendy Lader and Karen Conterio, authors of Bodily Harm. Patients, mostly girls in their late teens, move in voluntarily for a month and learn how to ignore self-destructive urges.
Unidentified Woman #1: Why do you go there to the worst thing?
Dr. WENDY LADER (Clinical Director, SAFE): Our program puts the responsibility squarely with the client. For her to be empowered, or him, to recognize that they do have control, that this is a choice.
MURPHY: (VO) What’s radical about this approach is its simplicity. Patients must sign a no-harm contract, promising not to hurt themselves during their 30-day stay.
Unidentified Woman #2: I wasn’t communicating that I was angry.
MURPHY: (VO) They participate in group therapy and receive medication to combat depression. Most important, they are taught to reach for a pen, not a knife, when their feelings overwhelm them.
Unidentified Woman #3: The jump is so frightening between where I am and where I want to be.
Unidentified Woman #4: I like and care for the person I am.
Unidentified Woman #5: It doesn’t happen all at once, you become.
MURPHY: (VO) Experts say that self-mutilation is rooted in low self-esteem and an inability to express difficult emotions. In addition to writing, Lisa expressed her pain through art.
Ms. BAYENS: I really like to draw. Before and during the hospital, it was dark. It was a lot of anger. You could look at a piece, and you could say, ‘She is angry.’
MURPHY: (VO) That anger was brought on by a neighbor who sexually abused Lisa for years, starting when she was only 5. She kept this terrible secret from the two people she loved most, her parents.
Ms. BAYENS: And I did not want them to know about the past sexual abuse, so I could not bring the self-injury up to them. And I did not want to hurt them.
MURPHY: But you were hurting so much, right?
Ms. BAYENS: Yeah. But I would rather hurt inside and not have them hurt because I would sacrifice myself for them, so I would rather them not hurt.
Come on, you better come here! (Calls dog)
MURPHY: (VO) Lisa’s been free from self-mutilation for over a year, and given SAFE’s 75 percent success rate, her future is hopeful.
Dr. LADER: We really believe that once they face their fears directly that they can live a normal life, not just without self-injury, but actually be happy and live a healthy and productive life.
GIBSON: Ann Pleshette Murphy is here. This young woman, Lisa, had been sexually abused. What’s the correlation between sexual abuse and cutting?
MURPHY: It’s about 50 percent. About 50 percent of them have experienced either physical or sexual abuse. But that’s just half, the other half have not.
GIBSON: Wh—what I think everyone—immediately comes to mind is the—the physical pain...
GIBSON: ...that you’re causing yourself, and yet, as she wrote, she said it made me feel good.
MURPHY: Yeah. Well, the—we have to understand that they are in enormous psychological pain, so this is a way of controlling these overwhelming emotions. It really cuts through the chaos. A lot of them describe it that way. Plus, there are natural opiates in the body, and so they may experience a kind of physical relief that’s now being studied in, you know, brain research.
GIBSON: Yeah, I heard about a cutter once who was afraid to get shots...
MURPHY: Yeah. It is...
GIBSON: ...but she still cut herself. It’s—it’s so strange.
MURPHY: It is hard to understand because we try to avoid pain, but it’s not painful, it’s a big relief for all of them.
GIBSON: Warning signs.
MURPHY: Which is why they come back to it.
GIBSON: Warning signs.
MURPHY: Well, it’s very hard because this is something that is, you know—they conceal it. She—you know, Lisa wore long sleeves. She never changed in the gym with the other girls. If parents see unexplained bruises, if a girl says, ‘Oh, I cut myself shaving,’ but it’s—it’s really odd and this keeps happening, don’t ignore it. You know, the most important thing is to get a child to a therapist who knows how to deal with this kind of problem.
GIBSON: This SAFE program, you said, only one of its kind, very small, so what do you do?
MURPHY: Well, as they say, get them some help. There are lots of books out there. SAFE has a wonderful Web site with a lot of information which also connects girls to one another, which is a very important first step. But most important, you know, don’t get angry and don’t—don’t get panicked. There are ways to treat this. It is not a suicide attempt. It is a sort of morbid form of self-help.
GIBSON: All right. Tha—or—or begging for so...
GIBSON: ...begging for help...
MURPHY: Begging for help.
GIBSON: ...from someone else.
GIBSON: Thanks very much, Ann Pleshette Murphy.
MURPHY: Thank you.
GIBSON: You can learn more about treatments for cutting on our Web site, abcnews.com. When we come back, what you don’t know may cost you. How phone companies are now raising the price of information. We’ll be back. Stay with us.
UK Newsquest Regional Press—This is Wiltshire
March 15, 2001
Help before it is too late
DOCTORS and health care workers from west Wiltshire have been learning how to help people whose depression has led to self-harm.
A one-day workshop at Cumberwell Park Golf Club, Bradford on Avon, last week gave an up-to-date overview of the assessment and management of depression and self-harm in the area.
Each year about 1,200 people attend the Royal United Hospital accident and emergency department after harming themselves. Of these, 90 per cent have taken an overdose. National evidence shows one per cent of all of these will commit suicide within 12 months of attending.
The workshop, which was attended by around 70 GPs and other primary health care professionals, was to improve understanding about the different roles of primary and acute care given at the Royal United Hospital and to underline the importance of maintaining consistency during care.
Consultant mental health nurse Anthony Harrison, who, with a partner runs a mental health liaison team, said: “Following an episode of self-harm a person admitted to accident and emergency will receive care and medical treatment in order to stabilise their condition.”
Anyone who is depressed or suicidal and wishes to talk to someone in confidence should contact their GP, a member of their primary health care team, or the Samaritans any time on 08457 909090.
New Moon Network—For Adults Who Care About Girls
Video: Can You See My Pain?
Concise, descriptive review of a 30-minute video concerning the issue of self-injury among adolescent girls
Produced by Northeastern Wisconsin In-School Telecommunications, University of Wisconsin-Green Bay
This 30-minute video and its accompanying guidebook explore the behaviors, causes, and treatment strategies surrounding self-injury (which is when people, often girls, intentionally burn, cut, or otherwise injure themselves). Self-injury is reaching epidemic proportions, yet few of us really understand who does it or what drives them to this destructive act. In the video, viewers hear from several girls and women who have self-injured, as well as from Karen Conterio and Dr. Wendy Lader, co-founders of the SAFE (Self Abuse Finally Ends) Alternatives Program, located in Chicago. To order the video, contact Kristel Hawley at 800-633-7445 or firstname.lastname@example.org. For more information on SAFE, see its Web site at www.safe-alternatives.com.
Subscriptions-New Moon-A Magazine for Girls and their Dreams: $29/yr New Moon Network-For Adults Who Care About Girls:$25/yr HUES-Hear Us Emerging Sisters:$19.99/6 issues. New Moon Publishing, P.O. Box 3587 Duluth, MN 55803-3587
Aberdeen Press and Journal
April 20, 2001
Why Self-Harm is More Than Just a Cry for Help
By Nicola Barry
IN THE evenings, Lorraine sits at home in front of the fire in a comfortable armchair, a small table at her side. She has no interesting book to read, no comforting glass of wine, no flickering TV screen.
Instead, on the table beside her is a piece of glass with a jagged edge. It is part of a self-harm kit Lorraine keeps in her handbag for use in times of despair. She talks about her habit matter-of-factly—as if it were the concern of somebody else.
Every so often, when she is alone at home, Lorraine will take the glass and pierce the soft skin of her upper arm until it cracks and bleeds.
Lorraine watches the blood oozing and—despite the agonising pain—does nothing to make it stop.
On the contrary, the sight of the blood seeping out brings her a temporary respite from the gnawing anxiety that is her everyday life.
The purplish scars on Lorraine’s arms speak for themselves. They cause her continuing pain and discomfort. Her veins are in such a state the medics struggle before they can draw any blood at all.
Again and again, she will return to inflict more wounds to the same infected scar.
The behaviour may not be as unusual as you might like to think.
In Scotland, the numbers of young people who harm themselves intentionally is thought to be as high as those who abuse alcohol and drugs.
Some use sharp glass, others knives, compass points, or tin lids to cut themselves. Others prefer to burn themselves with smouldering cigarette ends.
People self-harm for different reasons. The act is always an indication of an underlying problem; a build-up of negative emotion. It is never a prank, never a phase one goes through, never a mere cry for help. It is done to cleanse and create release—especially by youngsters who have been abused.
At 29, Lorraine is a young woman with a sense of humour, which is immediately evident in her choice of e-mail address: nuttytart-dot, etc, and madasafish-dot, etc.
Lorraine was not abused, however. She hails from a stable family in the Central Belt. Her father pushed her relentlessly to succeed and she felt she could never live up to his expectations. Lorraine began what she now refers to as “superficial scratching” of her arms when she was just eight years old.
An operation on her right arm led her to graduate to using a compass to pierce the wound, and later, a piece of rough glass.
Despite having a good degree in politics and international relations from Aberdeen University, Lorraine’s self-esteem is still at rock bottom. She suffers from depression, as well as an eating disorder.
“If I can’t achieve at 100%, then I have failed,” she said.
“I have made my parents ill over the last few years by pushing them away. I know I have hurt them, but I can’t help myself.”
The feeling of isolation among people who self-harm is immense—mainly because society insists on mocking that which it fails to understand.
Wendy, a young woman who burns herself with cigarette ends, said the act of self-harm left its perpetrators feeling utterly excluded.
“It places you in a minority,” Wendy said.
“People always stare at my arms then make a snap judgment about what they have seen. They don’t realise that I am a vulnerable person; that I feel I am not successful enough, not slim enough, not fit enough and not earning enough. Try living with that level of self-loathing day in, day out.
“I hate it when people say I am just attention-seeking. I ask you ...if I wanted to attract attention, I would take my clothes off and run down Union Street.”
After almost 10 years of helping self-harmers, Pat Little, Scottish development manager with the charity Penumbra, stands out as a pioneer among those searching for a solution to this problem, which is rapidly reaching epidemic proportions among the young.
Many incidents go unreported since those who cause themselves injury often know how to dress their own wounds and keep them hidden from family, professionals, and friends.
Pat, who has just completed some research into self-harm among young people in Edinburgh, knows that some self-harmers have been sexually abused in the past. Many have been sacrificed by their families—by which I mean that their abuser is still at home in the bosom of the family while the wronged child has been forced to run away and manage alone.
“Cutting may relieve the pressure of all that,” Pat said. “The person’s body sometimes represents the abuser and the bleeding gets rid of all their pent-up bad feelings. Physically, the pain may be intolerable, but emotionally, it is still a huge release. Sexually abused young people have this internal conflict. They may hate themselves and want to inflict the maximum damage on their bodies. The fact is that the rest of their life may be out of control, but here is something they can control all by themselves—how many times they cut and how far they go. The trouble is, this activity becomes addictive.”
In Edinburgh, a support group is being set up by Penumbra for young people who self-harm. Pat Little would like to see this extended to other parts of Scotland.
Pat is disturbed by the common response of hospital casualty staff to those who self-mutilate.
More often than not, the self-harmer who presents at casualty will have to contend with a barrage of prejudice and ill feeling.
He or she is likely to be labeled “manipulative,” “attention-seeking,” or “hysterical.” Wounds will be dismissed as “self-inflicted” and therefore “not serious.” Self-harmers often hear comments such as: “Don’t waste time stitching up the wound, he’ll only open it up again.”
Pat Little says there have been incidences in Scotland of self -harmers being stitched up in hospital without anaesthetic.
“Doctors and nurses often try, unnecessarily, to psychiatrise the problem,” Pat said. “Consequently, they often say the wrong things, often reinforcing the young person’s belief that they deserve to be punished. Mostly, self-harmers are seen as time-wasters rather than people with mental health problems. It’s a sort of ‘that’ll teach you’ attitude.”
The National Self-Harm Network in London, an organisation which encourages people to record incidences where they are refused treatment or insulted, has issued advice to accident and emergency staff.
The pamphlet says: “Of all the pressures on A&E departments, someone who self-harms must seem like the last straw. Yet staff venting their frustration on us leads to more self-injury and to an even greater sense of desperation. Poor self-esteem is often accompanied by an acute aware$ -ness of the feelings of others. A nurse or doctor may only show minor irritation, but we can interpret that as barely concealed hostility.”
The unpardonable truth is that sympathetic intervention by staff “in the know” —that is, A&E—is almost unheard of.
In Lothian, about 4,000 people are admitted to the area’s hospitals every year with self-harming injuries. A high proportion of these are young people.
Borders General Hospital, which covers a relatively small area, sees about 500 every year.
Here in the Northeast, the picture is not so clear. Grampian Primary Care Trust keep records, but not specific statistics. Highland Health Board does keep statistics on the numbers who deliberately self-harm.
The Press and Journal fully intends checking those out in future.
While self-harm has little to do with attempted suicide, many young people who have taken an overdose say they did so in response to social problems—such as difficulties with housing, school, unemployment, debt, health or relationships. Self-mutilation may be their only way of letting the world know how bad they actually feel.
One in 20 calls to Childline involves some sort of suicide attempt or an incident of self-harm.
The Scottish Executive is currently working on a framework for suicide prevention. Pat Little is on the planning group. Research indicates that 40-60% of people who commit suicide have previously self-harmed.
“Many of them do not end up in hospital anyway,” Pat Little said. “If they do, it may be their seventh or eighth attempt. They may make a mistake and cut too deeply.”
Pat says there is a serious lack of services and scant information for people who self-harm.
“At Penumbra, we say self-harmers urgently need non -judgmental and unconditional support to get them to consider alternatives—that is, learning the necessary life skills to deal with their problems. Young people do it because of what they have been through and not to get attention. In fact, it is a coping mechanism as well as a punishment. It is not a means of ending one’s life. On the contrary, it sometimes actually keeps people alive.”