The Flickering Candle of Self Harm

A wounded heart often leads to a wounded body, and the power of emotional disturbance from constant pressures in life has  highlighted  this  problem  that is more often than not, secretive,  unreported and little known about in general.  Self  harm,  or self destruction can take a number of forms and a broad range of different behaviours  that display  the lack of coping skills and  a

deep emotional distress that is out of control. The Royal College of Psychiatrists  defines  self harm as an “intentional act of self poisoning or self injury irrespective of the motivation or degree of suicidal intent”.  Deliberate self harm is one of the strongest predictors of suicide and those who self harm  increases the likelihood of ending their life by their own hand by between 50 and 100 fold above the rest of the population,  over a twelve month period.  Even though people who self harm live to tell the tale, there is much confusion among researchers and the medical profession as to the diverse guises and the rainbow of issues that incorporate the destruction of self harm.

Consultant Psychiatrist at Cork University, Dr. Eugene Cassidy states that the need has never been greater to develop a response to patients who engage in self harm.  According to the National Registry of Self Harm there was an increase of 96% in the rates of self harm presenting at emergency departments among men between 2007 and 2010 and 35% increase  in  women  presenting  in  Cork alone. A notable increase has been observed since the economic downturn with a 20%  increase  in male self harm.   Disquieting figures  show that for self harm there was a 23%  increase in the figures shown for South Tipperary and 117% increase in Cork.  

It is interesting to note that  in Limerick City,  an area long associated with high levels of self harm,  a significant decrease has been noted since the initiative  between  the  National Suicide Research Foundation and the Suicide Prevention Office in Limerick .  They have  put in place a multi-level programme which consists of workshops for depression and suicidal behaviour.  Included in the programme are GP’s, social workers, counsellors, gardai, teachers, priests and the media, coinciding  with a public awareness campaign on depression and suicidal behaviour intervention  with people who engage in self harm.   If this has worked in Limerick should it not be replicated  and  promoted across the country?

The  most recent figures show that 12,000 patients presented  at emergency departments  in 2011. “This is a significant problem”, Dr. Cassidy has said,  “and  as self  harm is  the single biggest risk factor for future completion of suicide,  is an alarming figure”  According to statistics from the Registry of presenting patients at emergency departments, 17%  who  were  waiting   for  a doctor or a psychiatrist left  the emergency department without  getting appropriate treatment.  The risk of repeated self harm is much higher in those who leave without being assessed so this should be an area for immediate consideration and concern.  Dr. Cassidy   advises   that  patients  who  are obviously in emotional and physical pain should not be left  sit for long periods without been seen urgently,  as that escalates the feelings of being unsupported and a burden on the system.   

Robust data  gathered  shows that in the period between 2003 and 2009  that  71,119 people presented with self harm  at  hospital emergency departments throughout Ireland.   A  revealing study done on attitudes of medical personnel state  that doctors and nurses sometimes see people who self harm as time wasters and lack understanding in respect of self harm  and feel it is associated with mental illness.   88.4% had stated they heard negative comments towards people who present with self harm.   Not an ideal attitude to handle such sensitive issues. Dr. Cassidy also said “ that staff were not trained in the understanding of  this  escalating  health  problem”.  This is now being addressed in Cork University Hospital, where the data on Suicide  in Ireland is collated and stored.  

Unanswered research questions abound and studies are relatively  new,  but anecdotal evidence that those who present at emergency departments are only a small fraction of the overall numbers who self harm.  Most people self harm in private and it has a huge impact on their day to day living and the difficult task of keeping it a secret adds further pressure to an individual.  The burden of secrecy and trying to hide their scars and bruises is hard to carry  and when people do not confide,  even to family  members,  and  it  only  comes  to  light when somebody notices a damaged body or strange behaviours,  the shame and stigma adds to further pain.  It can affect everything from what they  wear,( like  covering arms etc.)  what sports they play,  to  damaging  close relationships with others and has a huge and destructive impact on life.  Young people self harm to cope with their problems and feelings and find it a way of dealing with intense emotional pain.  That soon creates even bigger and more serious problems because it can set up an addictive pattern of behaviour from which it is difficult to break free.

What is self harm?

Self destructive behaviour is a widely used term that conceptualises certain kinds of disturbing  behaviour and self inflicted harm,  that a person  cause  to  themselves.  Self harm is identified as behaviour that includes the following;    when somebody intentionally hurts their own body, attempts of suicide by hanging or strangulation, cutting with blades, glass, knives, scissors etc., burning with cigarettes or others, hitting and mutilating body parts, such as punching, scratching the skin until it bleeds,  causing sores and scarring,  inhaling or sniffing harmful products, hurt their bodies internally by inserting objects,  pulling out hair and eyelashes, scalding the skin, excessive piercing , swallowing things not edible, or inflicting diverse  injuries on themselves.   Banging your head or fists off a wall, off the ground, hitting the body with a stone or a brick or putting your head through a glass door is always the sign of out of control frustration and deep emotional pain.  Drug misuse, drinking chemicals, driving dangerously, and risk  taking  are  also  considered self destructive actions. The most common method used by both males and females who presented at Hospital Emergency was drug overdose  of  tranquillisers, paracetamol  and antidepressants products.  Self cutting was the second most common method of self harm and more associated with males.    

A wide range of psychiatric problems such as borderline personality disorder,  depression, bi-polar disorder, schizophrenia, drug and alcohol misuse and other addictions are all associated with self harm.  Low self esteem, anxiety, impulsivity, difficulties at home, school, work, fractious relationships with friends or partners, guilt, poor academic performance, being bullied or the fear of bullying, and the incidence of child abuse, physical or sexual are all factors in self harm.

Young people in their teens, for females between the ages of 15 and 19 and males between the ages of 20 to 24 are more at risk of self harming than the rest of the population and should get help as they are also at a higher risk of suicide.  A survey of young people carried our anonymously, estimated that 10% of girls and 3% of boys in the   age group 15—16  self harmed in the previous year.  They report that they use multiple methods and multiple body locations.  Adolescents and young people who carry out self harm need urgent attention and should be seen by medical personnel.   Anger, which they turn in on themselves and contributes to self harm must be addressed  and  the  feelings  of  self hatred and hurting your body in punishment, are all issues that need urgent diagnosis.   An important aspect of self  harm  is the inability to handle feelings of not being loved, being frustrated, and the ultimate shame and guilt associated with self harm.  Self harm is associated with an individual that do not want to confront  painful  issues and are generally afflicted with depression or deep emotional pain.  Addictions are also an added factor in self harm.

High risk  groups

Rates of self harm are high amongst the prison population as well  as  the homeless, minority groups and those suffering from disadvantage.  Respect, dignity and compassion  and  an understanding of this predicament appears to be lacking in their treatment according to data and research.  In St. Patrick’s Institution where young men are detained, the risk of self harm and para-suicide in the first four days of their incarceration   has been noted by Amnesty International and other concerned groups. In the United Kingdom studies carried out estimate that in the year following self harm the risk of suicide is 30—50 times higher than in the general population,  so an understanding of the deep rooted causes of self harm is paramount for those who care for these groups in our country..

We all have the capacity to self destruct with negative personality traits and can cause oneself irreparable harm or damage either deliberately or inadvertently.  It is the part of the emotional  self  that may have suffered unbearable damage in childhood and remembering is just too painful.  Researchers have found that separation from parents, rejection, disappointments, traumas like abuse, rape,  bereavement, being bullied,  serious illness, disability, or being discriminated against  are all associated causes and damage a person psychologically, which may be associated with self harm at a later stage in life.   People find it difficult  to  understand the  implications that accompany the results of self harm.  It is vitally important to have the person who self harm  speak to someone who can listen and understand their predicament and respond in a caring and non-judgemental way.   A person cannot be isolated from the culmination of frightening emotions that they release by self harm.  Without the help of another person in whom they trust and can share their innermost thoughts and bring life back into control again  it can have devastating consequences.  Many people focus too much on the outer symptoms, which of course are important and need attention, but not enough on the inner  emotions  and  pain  that  is  being  endured  and  difficult  to understand.   Children who  grow  up  experiencing  very  little  unconditional love, respect and affirmation  resulting in  feelings  of emptiness, being unlovable and worthless carry emotional scars that are difficult to heal.  These are all catalysts for human misery and for destructive behaviours in the future to ease their inner pain.

Ways of offering a helping hand.

 Self harm is an isolated and secretive behaviour, whether we discuss it or not  it exists. By ignoring it ,  it compounds and reinforces the shame surrounding the behaviour.  So there are ways to help and bring calm to a person who are in the throes of self harm.  For example:

You can create change by talking in a loving non-judgemental manner.

Retrace the steps leading up to self harm. What events, feelings or upset led up to it.

Offer to seek help, find it and offer to accompany the person there.

Acknowledge how frightening it must be.

Keep negative comments to yourself and convey your respect  but do not intrude.

Don’t be afraid to approach the subject. The individual may be glad to talk.

Encourage them to take a bath or a shower. Give them a cuddly toy to hold.

Massage the hands, neck and feet.       Listen to calming music.

Educate  yourself  on the diverse aspects of self harm, do away with myths and assumptions.

For those who self harm

Speaking to someone about self harm may be hard but extremely important and to be able to trust in those you confide in,  is  essential.  Counsellors, psychologists or psychiatrists that could  help  work  through  the  reasons  for  your  self -harm or an alternative  strategy for alleviating the pain you feel inside.   Someone that makes you feel comfortable  (that might take several people and time)  and that you trust, or confiding in a family member, who may be worried about you already, are all people who can help through difficult times.  A strategy that is also helpful is to write down your thoughts and if possible try and make sense of what you are doing and look at other ways to alleviate your suffering, like exercise, music, singing,  running, jogging,  cycling, playing games or going to a Church to pray or sit in silence.    It is also important that you take care of your wounds and if more serious  go to an emergency department in a hospital where medical care is at hand. Either ways, you are not alone and recovery is possible for everyone.  There are many help lines with a listening ear including the Samaritans,  Childline,  Aware, Console,  etc.   

It is of the utmost importance that you get help as  the  consequences  may be the ending a very precious life because you did not reach out to those you love and care  about.   The candle which is flickering is synonymous with  how  your life is,  if it is not assisted  it will burn out.      

“Have you ever lived my life, have you ever spent one minute in my shoes?  If you haven’t then tell me why you judge me like you do”   (Anonymous)