Friday, 31 May 2013

Some thoughts on self harm

I've had many conversations with people over the years about self harm. I've discussed it with friends, family, doctor's, nurses and therapists. I've discussed it with a line manager at work and I've even discussed it with a stranger on the train once, after they noticed the scars on my arms. So, I thought I'd take the time to share some of my thoughts based on my experiences both of self harming and of talking about it.

Firstly, I would like to make it really clear that self harm is not a failed suicide attempt, nor is it necessarily an indication that someone is contemplating suicide. People self harm for a whole variety of reasons, often the same person engages in self harming behaviour for different reasons at different times. I know that I've harmed myself in different ways, at different times for a variety of different reasons.

Sometimes it's been a way to cope with overwhelming emotion or racing thoughts that seem beyond my control. At other times I've self harmed simply in order to feel something, to prove to myself that I still could. Then there have been the times I've dissociated so heavily I can't remember what I've done or why. There is very little more upsetting than 'coming round' somewhere to find yourself with clearly self inflicted injuries and no idea why they are there. Finally, I've self harmed when the suicidal thoughts became too much to deal with, when I was truly afraid I would give in and act on them. Somehow, hurting myself seems to hold those thoughts at bay, reduce them for a time. I have quite literally hurt myself in order to keep living. For me, self harm is often the direct opposite of an attempt on my life.

Something which comes up often when talking about self harm is the idea that it is wrong, a maladaptive behaviour which is only ever harmful. I am not entirely sure this is true. Certainly, it looks like an unhealthy behaviour. I would accept that a mentally healthy person doesn't engage in self harming behaviours. Where I would argue is that it is automatically maladaptive. There are times when I have tried very hard to engage in more 'healthy' behaviours to control my thoughts and emotions, to get back to a place where I can fight them again. There are times those techniques - many developed in conjunction with a therapist - haven't worked. At that point, I would argue that harming myself is in fact a valid response. Particularly if the only remaining alternative is suicide.

For me, suicidal behaviour can be a compulsion which I find it very hard to fight. There are times it hasn't been, times where it has seemed like the best way out. On those occasions, as soon as any other alternative has been found the desire to take my life has ceased. There are other times though where that isn't the case. Where the compulsion is so strong there simply isn't time to think. Times where the compulsion is so powerful I can't simply sit and wait for the feeling to pass. On those occasions, self harm can help alleviate the compulsion. It's almost like by giving in a little, the urge is lessened to the point I can fight it once more. To the point I am able to put into practice the techniques and tools I've been given to keep myself safe. There have also been times where suicide seemed like the best option and I wasn't in the position to seek advice or help in finding another.

I am thinking now about when I was much younger and being abused by my father. I was too young to move out, running away hadn't worked and I had nobody to talk to. No where I could go for help and advice. At ten years old, I didn't even have the language to talk about what was going on even if I had found someone to talk to. By thirteen, when I made the first attempt on my life I had the language but my depression had deepened to the point that things liked talking to people seemed entirely beyond me. In situations like this, where any form of help or support seem impossible suicide can seem like a frighteningly welcome idea. At times like these, self harm provided a temporary relief from such thoughts and feelings. Temporary, but accessible as often as I needed it. It allowed me to maintain a degree of functionality, it allowed me to continue living until I reached a point that alternatives became available.

I am writing this now as someone who hasn't hurt herself on purpose for three years. It's the longest I've ever managed and I'm pleased to report that I have developed many other ways of fighting suicidal urges, of dealing with racing or intrusive thoughts and emotions so strong I struggle to cope with them. I still remember very strongly being that other, younger girl however. The one who turned so often to self harm because she didn't yet have tools to handle things any other way, or found herself in situations where those tools didn't work. I can say with a hundred per cent certainty that my life is better without self harm, but also that I wouldn't be here to realise that if I hadn't had this tool at my disposal.

I guess I want three things from this post. Firstly, to address the assumptions which can be made about self harm - it's not a suicide attempt, and whilst it can be connected to suicidal ideation or thoughts that's not necessarily the case. Secondly, some understanding that self harm serves a purpose, it can work, albeit temporarily and that for each person, each time they self harm the reasons can be different. Finally, I want anyone who reads this and identifies as a self harmer, there is hope that one day in the future you won't need that particular tool any more.

So, if you are reading this and know somebody who self harms, please try not to assume you understand and please don't judge. Anybody who self harms would be happy to find a safer, healthier way of dealing with things but there will be times this really is the best option they have available. Understand and accept that and you'll find helping them reach a place where it's no longer necessary will be easier for everyone involved.

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