Wednesday, March 01, 2017

"Can't shout, can't scream - I hurt myself to get pain out..."

(See also, appearance on BBC World Service's The Why Factor episode about self-harm - broadcast on June 5, 2017: www.bbc.co.uk/programmes/p0548s5t)

"Sink a few too many pints and the world sings and swigs with you.
Puff your way through a pack of Marlboro Lights and a gang of fellow smokers will seldom be far away.
But stub one of those cigarettes out on your arm, or slice a razorblade across your flesh, and you do it alone. The world turns away very quickly.
Four types of self-harm, four ways of coping with pressure – but while half might invite mild disapproval, the other two inspire a blend of revulsion, anger, shock and frustration..."

Ping an elastic band repeatedly around your wrist and a colleague might raise an eyebrow.
Fill a cup at a fountain and dash the cold water in your face and they could then raise both.
But produce a razor and scythe it across that wrist, or repeatedly thump yourself in the face, and any unfortunate witnesses might well raise alarm - and more.

Today is the fifth annual Self-Injury Awareness Day, to highlight concerns - and indeed misconceptions - about the estimated one in 200 who harm themselves, or one in five women and one in seven men, or 13 per cent of those aged between 11 and 16, depending on different studies.
And to encourage those in need towards help - and encourage those who can offer so, to do so.
If only such alternative actions and distractions suggested above and by some counsellors, when feeling any urge to self-harm, were the entire answer.
And yet here at least, they can prove just enough of a coping mechanism in times of rising anguish at home or work - with apologies to colleagues taken aback by such behaviour.


This piece, not the Sylvia Plath extract pictured here, is being written almost 21 years to the day since a first cut - the deepest, in hindsight in some senses, albeit possibly also the shallowest.
That is (or was), repeated shreds to the face with a slim kitchen knife more often used for chopping canapes - at the time wielded in curiosity and hatred for the pathetic excuse for a person seen in the mirror.
These far older, if not necessarily wiser, days see the wounds that followed as no longer fat angry red welts, instead griddles of faint yet remaining white lines down each arm.
Appreciated somehow, at least, as visible reminders - embarrassing often, but borne with a tentatively-increasing (if still self-conscious) nonchalance.
But the guidance offered as to alternative actions, as reflected above, keeps in mind. 

Not that all counsellors’ suggestions should be taken as gospel.
Why, one posed an unanswerable quandary: ‘Have you ever committed suicide before?’
It is tricky, mind, to try to be wry about such a grisly issue.
A sympathetic mother was taken slapstickily aback when told her son was off to the cinema to see a film called Eraser - the mishearing for ‘razor’ more bleakly entertaining here than the workaday Schwarzenegger supposed ‘thriller’ itself.
A rare A&E visit, on a dull Sunday afternoon, to give at least a look over an arm-slice that had gone too far also elicited - after insisting everyone else waiting there go first - a resigned smile when admonished by the doctor: ‘Don’t do that again, okay?’
For some, self-harm can indeed be a precursor - that is, one of the precursors - towards suicide, as suggested by a May 2016 study in The Lancet showing 54 per cent of young people who took their own lives between January 2014 and April 2015 had harmed themselves in the preceding week.
For others, however, it acts as the very opposite - not as a prompt towards death but an action *against* tipping towards that lethal point.
Above all, the concern for and from many - whether medics or sufferers - is that self-injury is not simply dismissed as attention-seeking.
And if it helps, then let it help. 
Not that it ought to be no cause for concern. Of course it should. 

Yet charities such as MIND are among those encouraging a more open-minded approach, while blogger ‘Wedge’ set up his helpful LifeSigns website at the turn of the century after finding too little online - only to discover plenty of people keen to discuss their experiences and usefully engage with others.
The practice is too often not only seen as exhibitionist but also one for youngsters - and indeed the majority do appear to begin harming themselves either in pre-teen or teenage years.
A 2014 study found a 70 per cent surge in ten-to-14-year-old’s requiring A&E treatment for hurting themselves over the previous two years - while another found nine out of ten self-harmers start in childhood or teenage years.
A new poll published today by charities YoungMinds, The Mix and selfharmUK suggests one in four young men aged between 16 and 24 have deliberately harmed themselves.
Inflicting pain on oneself can come to feel like a controllable outlet for a tumult of emotions trapped inside, whether depression or stress, failure or frustration, despair, grief or flashbacks to past trauma - or self-loathing. Lashing out in a way that, theoretically at least, hurts no one else. 
Silent screams.
Understandable concern from some, however, can also come up against similarly predictable confusion from others - turning away in disgust or turning on a self-harmer with accusation and abuse.
Continuing stigma only adds insult to injury, especially at a time when already over-strained and under-resourced mental healthcare services suffer increasing austerity pressure - cut in real terms by 20 per cent since 2012.
One in ten depression patients referred by GPs to the NHS’s Improving Access to Psychological Therapies programme wait a year simply for assessment and one in six attempt suicide while on the list.

Of course, NHS staff are well-meaning and invariably encouraging - with some especially useful approaches.
Starting out as a weekly local newspaper reporter also pointed this writer towards the Croydon branch of MIND, who produced an insightful film called Visible Memories which was later distributed nationwide.
Staff at the nearby Royal Bethlem Hospital were happy to talk about Britain’s first specialist inpatient unit for self-harmers, and their eyebrow-raising approach allowing people there to keep blades unconfiscated.
But senior A&E staff have also confessed to feeling impatient at times with people arriving in over-crowded wards with self-inflicted injuries, albeit later reflecting ruefully.
This is all from someone abashed at any of the few occasions when such assistance has been unavoidable.
And also from someone whose self-inflicted pain comes nowhere near the hurt felt when such behaviour has been used against as an aggravated factor, as if not only taunts but injuries then inflicted by others can be justified by awareness of past cuts, punches or kicks you could yourself control.

The moment of self-injuring impact can feel more numb than some.
At the risk of (yet further) dreary self-indulgence, this is from a blog written two years ago about a then-recent depressive relapse:
"Not that it actually really hurts when swiping – the main pain follows in the days ahead, each scar however well-tended tending to sting to every touch.
"But the familiar old necessary rigmarole, of cleansing, dressing and clearing up, barely felt a fulfilling use of an evening.
"Then there came the same old sense of abashment the next day, with potentially ahead the awkwardness whenever exposing arms, say, in changing-rooms or to a new partner’s curious scrutiny."

Actually cutting out cutting - or any other form of self-injury - can only come from within but can of course only be aided by help and above all understanding from others.
The major contributory factor for those who have managed to stop seems to a dawning perception that this is "unhealthy" behaviour, according to a study of more than 14,000 people by New York’s Cornell university in 2015.
This outranked, in its usefulness, such other influences as unwanted attention, scarring, shame or upsetting friends and family.
And yet all can come into the mind’s eye - well, here, at least.
To go back to the top, to revisit the potential responses of others - well, of course horror must feel natural enough.
What could compel someone to take a blade to their own flesh, see those trickling bloody ribbons and keep on doing so?
All the while that, say, necking bottles, incubating nicotine or over-working towards a stressedly premature grave might be shrugged off as somehow more natural instincts.
Perhaps some flippancy in this piece, from someone safely into recovery (while so much older now than those youngsters in today's new survey), can risk edging into facetiousness.
But if self-injury remains for too many an uncomfortable taboo, then all the better to confront it head-on in whatever way feels beneficial.

We all know how tragically Sylvia Plath’s (beautifully productive) life ended, and all her brutally bleakly sweetbitter poems.
But that glancing section of her one novel The Bell Jar, posted above, strikes heartily here, in its plangent desperation and lyricism ("the redness flower from my wrists ... till I sank to sleep under a surf gaudy as poppies ... The blood gathered darkly, like fruit") but also collision with routine and, well, wit.
The black patent leather shoe, the mother coming home and the eleven-thirty bus to Boston.
And yet, and yet: "It was as if what I wanted to kill wasn't in the skin or the thin blue pulse that jumped under my thumb, but somewhere else, deeper, more secret, a whole lot harder to get at."
Of course, alas, she got there in the end.
Not everyone wants to, nor will. Hopefully so.
Anyway. So. After more than 1,500 words, perhaps best to belatedly call: "Cut!"
Whether you do or don’t, here's to getting help. And feeling help.
And that, others elsewhere, help.
A need is not only to keep healing, but also to keep hearing.

Other sources of support include the Samaritans on 08457 909090 or at www.samaritans.org.

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