bleedingouthepain

The Long Road Back from Bleeding
One Cut Can Calm While Another Can Kill
By: Tricia McCarter-Joseph

After signing a no-cutting contract with her psychologist, *Gabrielle began feeling resentful and eventually began cutting herself again. She was still depressed and missed her blades, which the contract said she couldn't use. "In the [therapy] sessions…I would not say anything of real significance…," said Gabrielle. "I was making no progress and I felt too depressed to care about the contract anymore…"

When the tension became unbearable, Gabrielle used a butcher knife on her arm to relieve the stress. Although her parents found out and took her to a mental hospital, she never stopped craving hurting herself; strangely it was the one thing that made her life manageable.

Katy was severely depressed for years and didn't even know it. "This began around the age of five, and… worsened up to the age of 10," Katy explained of her diagnosis. "At that age, I was clinically depressed. However, my depression was not recognized by my family, my doctor, or myself."

A medical student who had access to scalpels and needles, she would use these instruments on herself to cope with her depression. Katy also suffered from anorexia nervosa, an eating disorder where the person is obsessed with being thin. Sometimes she cycled up to 50 miles a day. "As I neared the end of my PhD, I was so severely depressed that I self-harmed…several times a day," she said.

The National Mental Health Association (NMHA) defines self-injurious behavior as the deliberate, repetitive, impulsive, non-lethal harming of one's self. It is characterized by cutting, scratching, punching, burning and other forms of bodily harm. NMHA maintains that habitual self-injurers make up one percent of the population, with higher proportions of females than males.

These women have been self-harmers since they were teenagers, beginning at 14 and 15-years-old respectively. Gabrielle, a twenty-one-year-old college student, likes listening to Pink Floyd and is hooked on Harry Potter books. Katy, 29, comes from a middle class family in Britain where her father worked for IBM and her mother was a teacher. Many may find it unconscionable to physically abuse one's self. Others mistakenly believe that people who self-injure are seeking attention, but in actuality they are voicing their pain the only way they know how.

"I was bullied very badly at school," Katy said. "I was unable to voice my pain, and instead cut myself and wore it secretly as a comforting sign that I had expressed my feelings."

Dr. Wendy Lader, Clinical Director of S.A.F.E. Alternatives (Self Abuse Finally Ends), a nationally recognized program for self-harmers, agrees. "Self-injurers will injure in places on their bodies that others can't see," Lader explained. "They will often make excuses…rather than display their injuries in an exhibitionist fashion."

However, self-injury isn't a condition unto itself. In fact it isn't even a disease. Rather it is an indication of something much larger. "Self-harm is a symptom of several different disorders, [for example] Borderline Personality Disorder… but [it] is not classified as a specific disorder itself," said Matthew K. Nock, Assistant Professor at Harvard University, and a 10-year clinical researcher of self-harm.

"It makes me feel secure that I self-injure…"

Katy first hurt herself with a razor blade, lightly scratching her arm and hand "about 30 times." She has overdosed on several occasions, and once "had to be resuscitated by a doctor and ambulance staff." Katy has also cut herself so many times, that at least once she has visited an emergency room with cuts that were severely bleeding.

Katy said: "I deposited a pool of blood beneath me on the waiting room floor. Waiting patients were concerned and asked me what I had done. I felt if I told the truth they'd be [horrified]. I lied and said I had accidentally put my hand through a window."

However, due to her medical background, she later learned how to properly dress and stitch herself without having to go to the hospital, and avoided having to lie to others who asked her about her condition. She claims it is one of the reasons why her scars have healed so well.

Gabrielle's experience is similar. "When I was 15…I began… pinching myself and digging my nails into my skin," she said. In 2001 she attempted suicide more than once. At one point she overdosed "and [passed] blood afterwards. It hurt but it didn't kill me."

Does the end justify the means?

So how does this kind of self-destructive behavior help the underlying problem? "Control. I like being in control of myself," Gabrielle answered. "Security. It makes me feel secure that I self-injure, like a blanket a child carries for comfort." She explained that hurting herself calms her, and helps her to keep stressful situations under control. Sometimes after cutting she is so tranquil that she can go to sleep. When her parents took her to the mental hospital, Gabrielle was so distraught, that to compose herself, she went into the bathroom and punched herself in the face. Ironically no one at the hospital noticed her bruised cheek.

Katy herself says that after seeing many psychiatrists, she was finally diagnosed with clinical depression. "I didn't even know what depression was as a kid," she said. "I thought it was normal to sleep two hours a night, hate myself, and think about death and suicide all the time."

Experts say it is important to understand that self-harm is more of a coping strategy and generally not suicide; although some do attempt it when their pain becomes unbearable. For many self-harmers it is a method of relieving emotional stress or tension that they cannot express otherwise. Aside from the fact that many self-injurers may suffer from a mental or psychological disorder, such as depression, an eating disorder, or even substance abuse, self-injury doesn't cause the underlying disorder. Instead in dealing with whatever condition they may have, self-harm helps them to keep stressful feelings at bay.

In some cases, suppression of feelings may play a role with some self-harmers who may have been taught to stifle emotional or physical pain. Gabrielle had a similar experience with her father. "I remember crying and my grandmother holding me. My father later told me to never do that again. I wasn't supposed to cry, especially in front of my grandmother."

"The self-harm was ignored or sneered at…"

Despite the potential fatal ramifications of self-injurious behavior, a crash landing can be averted. "Although it is a serious and potentially lethal practice, it is treatable," Wendy Lader said. But before that can happen, people who hurt themselves have to change their thinking. "The most important aspect is for the injurer to realize that self-injury is a choice," She advised. "It is actually a choice to medicate away uncomfortable feelings rather than experience them."

But self-harmers also have another obstacle in dealing with uncaring and unsympathetic medical professionals. Katy complained that she had received extremely bad treatment at accident and emergency departments whenever she sought help for her wounds, "including them trying to turn me away [with] blood pouring everywhere." The problem also extends to psychiatrists as well. "Some are under the impression that it's always done for attention or that it's psychotic," Gabrielle added. "Some doctors punish instead of treat."

Dr. Lader said: "ER doctors are overworked and believe that injurers are taking valuable time and resources from people with 'real' emergencies. They often punish the injurer by stitching them up without any anesthetics. What they don't realize is that once the injurer has calmed down, [the person] does feel pain, so [the physician's] actions create tremendous pain and are cruel."

Katy related a situation where she was forced to speak up for herself when doctors wouldn't give her stitches for three self-inflicted wounds on her arm. After demanding that she be stitched, the doctor jabbed the needle directly into her wounds. "The fact that doctors are busy and don't understand self-harm does not excuse the poor, arrogant, and cruel treatment I received."

Dr. Lader hopes her organization can open some eyes to the mistreatment and misunderstanding, but it's difficult. "We have a section on our website for medical professionals and I lecture all over the country, but I rarely have ER doctors or nurses attend. This doesn't seem to be a top priority for them." However, she adds, "As this behavior becomes more widespread, it will be increasingly difficult for the medical profession to ignore the ramifications associated with self-harming behaviors." Something that both Katy and Gabrielle hope won't take them too long.

Katy said: "I know I was the cause of my injury. So part of me understands their reaction. However, my pain is the same as anyone else's. Yes, I physically caused my own injuries, but let's not forget that it was under the influence of several mental illnesses battling it out loudly in my head at the time."

Family: 'without them I'd be dead'

For the loved ones of people who self-injure, it may be a shocking blow to discover that someone close to them is hurting themselves. Public reaction and family support are crucial in helping a person overcome self-injury. However, it's a very difficult path for many parents to tread. "They did not understand my self-harm and it distressed them greatly," Katy said about her parents' reaction to her behavior.

Dr. Lader strongly believes that family is the first line of defense in helping self-injurers. Located at the Linden Oaks Hospital at Edward, near Chicago, IL, the organization offers treatment programs, medical referrals, and various print and video resources on self-injury. Along with Karen Conterio, they started the first structured inpatient program for self-harmers in 1986.

"The most important step is honest communication," Lader advised. "Don't walk on egg shells." However, they must be cautious that they themselves deal with feelings that may prevent them from helping their child or loved one.

Lader explained: "Family members should attempt to check their own intense emotional reactions, such as rage or hysteria, to their loved one's behavior. Instead, they should work to communicate thoughts and feelings in a direct, non-judgmental manner. If they have a hard time doing this, I would recommend getting their own emotional support to deal with these often difficult issues."

For some, the initial reaction is denial, which Lader says doesn't help. "Self-injury is a serious behavior and warrants an evaluation by a professional. Treating it as a [phase] or a fad can end up making matters worse."

For both Katy and Gabrielle their parents have been both inspirations and catalysts, which have put them on the path to recovery. Katy hasn't hurt herself in over a year and for Gabrielle this is the best she's felt in five years. Commenting on her mother, Gabrielle said, "Recently, she said I've been doing well and things have been more relaxed." Katy added, "They are living proof that it is possible to be faced with something totally incomprehensible, and yet support and care for their child."

Additionally the public needs to be a little less judgmental. "To most people, self-harm of any kind is abhorrent," Katy said. However, she eventually found a therapist who helped her through her problems. To her "one human being listening to another human being with unconditional acceptance" saved her life.

Gabrielle has been undergoing biofeedback therapy. "Biofeedback is a treatment that teaches you to…train your brain to relax. You are supposed to get tuned in to signals to your brain and be able to change them," she explained. "Nothing except biofeedback has ever slowed down my self-injurious behavior." She does admit that in the beginning she thought it was a waste of money, but after she started treatment she said she no longer felt depressed.

"Perhaps I have something to offer people."

"I'd like to be a computer programmer," Gabrielle said. "I now feel I'd be happy designing web sites and writing scripts." In 1999 she started a web site about self-harm called Self-Injury: A Struggle. "I felt that while there were great informational resources on self-injury, there were no web sites that completely covered the subject," she said. Her site includes self-harm resources, a section on famous self-injurers, and a message board among other features.

Katy has a doctorate degree in Clinical Medicine from Oxford University. She is in the process of writing a book and volunteers at the National Self Harm Network in London, declaring, "I am set on writing and social work."

For these two young women, they inhabit a world that few of us understand; yet like many of us they are striving to make their lives matter. On the outside they are like everyone else, although on the inside they both have troubled pasts. However, Gabrielle acknowledges that she still has urges, but they are not as strong as in the past.

To the many others who still struggle with self-harm there is always hope. "Despite all the negative feelings they may have, they still have the potential to become content."

Well said.

* Name has been changed to protect the identity of the person.

This article was reprinted with permission from Tricia McCarter-Joseph. Many thanks to Tricia for allowing me to share her important piece here.