Self Harm

I found this article here: http://www.mcmanweb.com/article-118.htm
This article first appeared on Suite101.com - Mental Illness in Families and Society, the author is Amy Hillgren Peterson. She wrote a book called Elusive Butterfly about her life with bipolar disorder. This hits close to home. I'll write more about it later.
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In my travels on the web and as a volunteer who answers emails for Mental Health Sanctuary, I have come across an increasing number of people, mostly women, who self-harm. It is estimated that up to 3 million Americans injure themselves, double 1997's figure. I believe it is the increased knowledge of mental disorders, including personality disorders, and their origins that have caused more people to come forward and seek help for their self-injurious behavior.

Shelly, a young woman from Alabama, writes, "When I would cut, I would feel relieved, and when the blood was flowing it was like my pain was being released, it was like it was the way my body 'cried'. I often cut in situations that it would then be possible for me to get attention from others around me in. This I have come to know was my need to be nurtured. It was also about my need to control others and my environment when I was so out of control myself. I did not even know that what I was choosing to do in cutting was a) a choice and b) a result of my feeling vulnerable and out of control."

Much has been written about borderline personality disorder, and the traumas that lead up to it. Cutting often begins in adolescence. In the past, the typical "cutter" has come from an abusive or neglectful home, or has lost a parent at a young age, or has been raped or sexually abused.

Shelly began cutting herself in college. "Firstly, I began to cut as a means of soothing my aggravated feelings for which there was no connected feeling and virtually no conscious understanding for years. I began to cut around the age of 17, when I left home and was in College. I was living in a dorm and was extremely stressed and unable to cope with all of the people I lived in close quarters with.

"I cut, usually with razor blades and there were times where I would break glass and basically gouge myself with it. Many times the latter efforts required stitches.

"When I would cut I would be so stressed, so agitated, and feel so overwhelmed and helpless, though for years the only 'feeling' I could identify was ANGER, I knew I was angry and that I was very agitated.

"I didn't know that I was as detached from my feelings and indeed myself as it turns out I now know I was.

"I was not able to cry. I was not particularly into journaling. I would not talk to people about my problems. If I was forced to talk to anyone I would lie about stuff. Half the time I wasn't sure what was real and what wasn't. I had no idea how to be personally responsible for myself, my feelings, my pain or how to meet any of my own needs. I used people and I hurt people and I hurt myself."

Shelly gave up self-injury on her own. She writes, "I thought about what I should do to feel better. I was feeling very impulsive and having many many impulses to 'act out' majorly. But, I kept crying. Finally I was sitting there talking to myself and what I ended up saying that was the precursor to much change was, 'Why do you want to hurt yourself some more, again, YOU HURT ENOUGH ALREADY' And with those words I got up and composed myself, got on my bike and made sure I made it home safely. This in retrospect was me beginning to get in touch with all of my pain and grief, looking inward instead of reflecting all that was going on inside outward to the world around me.

"I believe that we all live so much closer to the awareness of what we need and what we need to do for ourselves then we often realize. The answers were inside of me, and they are likely inside of you right now too. Remember, if we want to achieve different results, we have to make new, different, healthier choices.

"I did not ever cut after that day again. The night I just described was a fall night in 1988, and I was 31 years old. It was a very big beginning."

A treatment program for self-injury, thought to be the only specialized, inpatient program of its kind, is Self Abuse Finally Ends (SAFE) in Berwyn, Illinois. There is no coddling. The program rejects common notions about how self-injurers should be handled -- with restraints, sedatives, and constant supervision.

In an article appearing in the February, 2001 issue of JANE magazine, cofounder Karen Conterio says, "We don't what patients to find the child within. We want them to find the adult and move on."

Self-injury scares family members. A growing number of teens who are still minors are placed out-of-home by parents who are afraid of them, who do not understand the behavior, and who issue an ultimatum to stop the self-injury or not come home.

Rather than share shocking, grisly tales of their self-injury, SAFE Alternatives therapists believe such talk incites and glorifies self-injury and prohibits such conversations.

I have received numerous emails from young women whose self-injury relates to their untreated or undertreated bipolar disorder.

"I was desperately depressed," Caroline writes, "but my thoughts were racing such that I couldn't keep up. I had just been hospitalized for depression and my meds were changed. I don't know what happened but I went for a walk in the cold and snow. I stopped behind a bridge where I could think. I took a pocket knife out of my pocket and started running it up and down my leg, outside my jeans. I slowly moved it so the sharpest point of the blade was against my calf. As I moved it in slowly and the blood started rushing down to my shoes, I started to feel relief. I twisted it slowly, and unexpectedly it slipped and I stabbed myself up to the hilt."

Terrified, Caroline threw the pocket knife into the creek below and started walking, no limping, toward the hospital several blocks away. By the time she got there, her temperature had dropped to 94.8 and she had paled from the loss of blood.

"I don't think I will do that again," she says, "I will call a therapist, write in a journal, something...but it scares me that I got so much relief from the cut and the bleeding."

While Conterio from SAFE Alternatives says, "we think that self-injury is not a disease, it's a choice," most mental health professionals see it as a symptom of borderline personality disorder, depression, or another mental illness and struggle to treat it effectively. Didactic dialogue therapy, at the edge of treatment for borderline personality disorder, has been used with some success. Also, developing and using self-calming activities helped Shelly stop self-harming.

She writes, "Coming to understand myself, developing my own identity and coming to accept myself for who and what I am has helped me not only stop all self-harming behaviours but it has also helped me to be able to relate and better connect in a healthy way to others without devaluing them, without putting them on a pedestal and without seeing them in a black or white, good or bad way. When you can accept yourself, you will be kinder to yourself, you will learn to love yourself and you will then be able to accept others for who they are...You do not have to self-harm to survive. "

With balance between better coping skills and choices, and treatment for the underlying mental health disorders, there is hope for the millions of people who self-injure.