Self Harm, why it happens and patterns

Deliberately inflicting pain or injury by cutting oneself or some other form of self-mutilation seems incomprehensible to many people. But it’s a common, typically secretive, experience for about 8% of adolescents and young adults according to recent research conducted by Lifeline.

People who intentionally harm themselves aren’t always easy to identify or categorise and recent research indicates they are equally likely to be male as female.

Some known predisposing factors include severe intellectual disability, acute psychosis, a childhood history of physical or sexual abuse, and personality disorders.

For these people, the impetus to self-harm includes:

  • difficulty managing frustration or anger,
  • compelling hallucinations or delusions (in the case of those with acute psychosis),
  • difficulty managing the symptoms of trauma such as intense emotional states, and
  • the self-blame and self-loathing that often follows from abuse.
  • Often, alcohol or other substances may reduce inhibition and facilitate self-harming.

People who have suicidal thoughts may also harm themselves. But while both acts lie on the continuum of self-destructive behaviour, it’s not a simple linear progression from one to the other.

Despite self-harm being one of the major risk factors of attempted or completed suicide, a large proportion of people who self-harm have no desire to die whatsoever. Some may even have very strident views against suicide.

Why self-harm?

Research into self-harm suggests a variety of motivations, triggers and circumstances of those who deliberately injure themselves.

  • Common explanations include self-harm being a way:
  • to release tension or frustration, or express anger,
  • to substitute emotional for physical pain,
  • to be able to “feel something” when feeling emotionally disconnected (or dissociated), or sometimes
  • to induce dissociation to avoid aversive emotion as is common in the case of abuse or trauma.

For some people who harm themselves, being able to feel physical pain or see one’s own blood can be comforting – a way of self-validation or being able to feel more “real”.

Self harm comes in many forms for various people but mine manifested itself in deep cutting episodes. When dissociation occurred I would never remember cutting, how I did it; where; with what nor what damage I had caused. I would return from my surreal state, totally unaware of what I had done, rejoin the family, completely oblivious to the incident. No pain was experienced until sometime later and it was then that awareness of what I had done dawned. I might stand in the shower and with the deliberate precision of an artist target the wrist and press the razor sharp blade against my skin and watch with dispassion as the first the bubble of blood begin to form as the skin begins to separate. That’s the first cut. Dissociation is complete and then all that is desired is the visibility of the veins and muscles. The second cut follows easily follow directly into the same track as the first and so it goes until muscle is revealed and blood is beautifully flowing freely and with it all the guilt, pain and grief of the past. The death of the children, Aisling, my baby. The blood running down our legs. The blood liquifing down the shower well or bathroom floor represents each lost child. It is my atonement. Try as I might I can never reach the artery. I have dug and dug and never reached it. I have failed. Then the predictable trips to the Emergency Department for stitching, downplaying the event to avoid admission to the psychiatric ward or assessment by the psychiatric team.  Avoidance of admission to even the private clinic paramount. Containment destroys the chance of suicide, my chronic, ever present goal. It is the just payment for what I allowed to happen. Just payment for the children I allowed to die, allowed to be raped and allowed myself to be raped.

The men and my Mother’s job is complete. I own the guilt for what happened over those eighteen years. She so often said she should kill me. She first  held me up against the wall, feet off the ground to her face height and said “You know one day I will kill you”. I was about four when she lifted me up by the throat and said that. She tells me that now.  Now it is my job to complete the task for her. Let her rest in peace. Her needs are all that matter. I dissociate almost daily and she tells me to kill myself and finish the job for her. To stash medication. “Don’t take that dose, slip it into your pocket when he’s not looking and hide it”, she would say or “Go get a blade now while he’s distracted and slit your wrists. Finish yourself off”. Other times it would be just me wanting to punish myself for letting the men near me and the only way to do that was by cutting so while Andy was out of the room I would go into the bathroom and start taking apart a razor blade. Once I started I would dissociate and go into a trance and commence cutting feeling no pain whatsoever and just become mesmerised by the deepening wound and ever increasing blood flow. The banging on the door would be distant, from another time. I would not hear it. Not recognise the voice. I would just keep cutting until satisfied I had caused enough damage to redeem myself for my sins only then would I come back to the present and hear Andy’s imploring at the bathroom door. I open the door to reveal a blood mess in the bathroom. Othere times he is unaware I have cut and I just cover the wound with my sleeve, clean up the mess, hit the blade for future use and come out of the bathroom calmly. Only maybe an hour later when the blood soaks through the garment or flows down my arm is it apparent what I have done. She’s had a victory once again.  She and the men. The past blends into the present.

Not all cutting episodes are as a result of dissociation but are deliberate attempts made in a meticulous, calculating manner to end a flashback, just to relieve consuming guilt or to kill myself    I would abide my time and wait for Andrew to be out of the house for just the few minutes it would take to carry out the act and get the relief.  His ever vigilant supervision was exhaustive and steady never wavering but someone intent on self harm or suicide will find a way.  Hidden blades from stolen razor blades careful dissected to remove the blade out of the cradle of the safety razor would be drawn across the skin on the forearm. Deep, pressured.  One cut, then two then maybe three until the skin separation was complete. The underlying fatty tissue exposed. At first no blood would flow so no relief was felt. Then, ah yes then, the blood would flow and the deliverance would come.  For the time at present, distraction and diversion were complete and the flashback would stop or not come. The aura had been defeated.  Mother, oh Mother dear you have got what you wanted too.  My body mutilated once more. If suicide was the necessity the cutting would just continue until veins and muscle tissue became exposed.  The tendons appeared and these are remarkably harder to sever and by then by time would have elapsed and Andrew would have found me bleeding heavily and I would be saved once again with extreme anger on my part.  There was no gratitude ever expressed. I was not grateful or relieved. I was just frustrated that yet another attempt had failed. After years of cutting my lower arms are a two year old’s  picture drawing – lines of ugly red keloid red scars and tissue.  Stitching varies wildly in casualty, so some wounds are a work of art, neat and tidy, while others carried out by uncaring doctors who think self harm is attention seeking and give clumsy, rough large stitches which scar badly.  Mental Health training in Emergency  varies wildly and you encounter understanding and appropriate respectful treatment and consultation and relevant history taken.   Correct assessments made and time spent to allow you to recover from the trauma self inflicted though none-the-less valid. You are bandaged and taken into a  private care room not sent back out into the public waiting room. Careful evaluation of current professionals are consulted whose care of you is considered rather than a knee jerk reaction of admission to hospital which can just serve to exacerbate the trauma.  However, there are a breed of doctors and nurses who have no understanding of Mental Health and no evaluation takes place. You are triaged and sent back into the waiting room still in flashback, bleeding through the bandage for all to see, visibly upset. You wait sometimes three hours for further assistance and when you receive it you are not asked what precipitated the cutting but are merely stitched up, not even given prophylactic antibiotics or letter for GP explaining situation and sent home. Your partner is offered no support. Sometimes you are not sent home but the Mental Health Team is called and you are admitted to the nearest Mental Health Unit which may not even have a bed for the night. All that can be hoped for is that the Private Clinic will have a bed available the next day if I have not been Scheduled under the Mental Health Act. If I have been Scheduled under the Mental Health Act there is awful process of interview with a Psychiatrist, a total stranger, to have the Schedule lifted. You say as little as possible and learn quickly what to say to get it removed.  It does not take long to learn to play the system.   Hopefully I go home if just a cutting but if an overdose or other suicide attempt transfer to the care of the Clinic where I am well known and receive excellent care and see my own Psychiatrist.  Not ideal but better than the Public System.  It is crucial that the public system exists and we must have one but it has a long way to go before it caters to the needs of those experiencing Complex PTSD.  Much needed Government funds must urgently be invested in developing a system that caters for the range of differing Mental Health conditions and separates the varying clients of deviating conditions so that these conditions are not exacerbated and clients do not become institutionalised.  The private system is not perfect either but through private health funds individuals needs are better catered for.  The tragedy is that it is only the relatively few that can afford private health an indictment on our society.

With Complex PTSD comes the scourge of dissociation and Dissociation Identity Disorder which in my case is my Mother and versions of my younger abused self all resulting in my telling myself that I have no right to live and am to blame for the abuse that happened to me. It is through intensive EMDR and Psychotherapy that I am slowly coming to terms with my past and coming through the maze of my trauma. It is a slow healing process with one step forwards, two steps back. The Mental Health system is a lumbering beast to navigate your way through but I have finally found a Clinic that can cater to my needs so when suicidality is high I have a safe place for my family to know I can take a break from the planning at least and they can have respite from constantly watching over me. It also gives my Psychotherapist a chance to do more intensive EMDR which is such effective therapy in my case. It significantly lessens the intensity of the flashbacks and reduces them in time from traumatic experiences to unpleasant but tolerable memories filed away. All therapy is to be remembered as an ongoing process. A continuum of hard work with a trusted and valued professional.

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