Saturday, 9 January 2021

14 THOUGHTS FOR 140 DAYS FREE OF SELF-HARM

"Every accomplishment starts with the with decisionn to try"

John F Kennedy


Today marks the one hundred and fortieth day since I last self-harmed, and I wanted to mark the occasion with a little (or big, we’ll see how much I end up rambling…) blog post:

 

1.    When I started to self-harm

I think that this thought was quite obviously going to feature in here somewhere! I mean, you don’t reach a milestone like this and not remember when it all started. I first self-harmed when I was fifteen years old, I had just been assaulted by a stranger and someone I trusted and respected offered his support… then he began using it as a cover to abuse me.

In my teenage mind, I had so many thoughts and reasons not to report the abuse that I felt completely overwhelmed and desperate for some relief. I think my initial thought process behind self-harming was that it might make me less attractive to my abuser. That maybe he’d be ‘put off’ by the cuts and then the scars. So, I began using a pin from a noticeboard to scratch at my arms and legs. The scratches were enough to draw blood but also enough that I could excuse them as cat scratches to anyone who might see them and ask questions.

My initial intention of damaging my appearance became a lot deeper and more intense; I started to believe that only I should have the power to hurt my body and thought that self-harming would prove this, and that it would leave me feeling more in control. I could take charge of how much or how little, pain I was experiencing.

 

2.    How much it escalated

Over the years of my mental illness, I’ve almost been forced into becoming more insightful with my response behaviours and the motivations for them. This has meant that I have some knowledge on just how my self-harm escalated from scratches to cuts severe enough that I’ve required surgery.

I think that the main cause of the escalation was that my mind had seemed to adjust to the level the self-harm started at and it – almost – inevitably, felt as though it stopped being effective or sufficient enough to cope with my ongoing struggle. Whilst the abuse had physically finished, the mental and emotional impact it had was still going strong and that meant I still experienced the need to find a coping strategy for my thoughts, feelings and memories.

For the two years immediately after the abuse, I didn’t self-harm in that way again. Instead, I misused alcohol to block out the memories and restricted my diet to punish myself for all the reasons why I believed I had deserved the abuse. Working so hard to avoid what had happened to me, made my mental health vulnerable and now that I think about it, I’m not surprised that I started to hallucinate and that those voices told me to kill myself.

From my first suicide attempt, I think that my original method of self-harm escalated as a direct result of me being sectioned under the 1983 Mental Health Act. Being in a psychiatric hospital meant that I was robbed of so many of my unsafe coping skills and in desperation I found new, different ways to self-harm. Ways that were – if there was a scale – more dangerous than those I used when I had my freedom in the community!

Another reason the self-harm escalated, was when there was a problem with my medication and the pharmacy failed to issue my anti-psychotic drug, which meant that the hallucinations came back. I felt as though I’d learnt that the previous gravity of my self-harm had never been ‘good enough’ to silence the voices, so I felt convinced that I had to go one step further… Any my cuts that were once deemed to be ‘superficial’ ended up warranting plastic surgery after I severed the branches of my Radial Nerve.

 

3.    The most helpful Dialectical Behaviour Therapy (DBT) skills for battling self-harm

After being admitted to a specialist psychiatric hospital over 100 miles away from home, I started to engage in the recommended treatment for those diagnosed with Borderline Personality Disorder (BPD), individual and group DBT sessions. In the Therapy, there are four parts: Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness. Each part has a set of skills to arm someone with in order to battle the symptoms that are the diagnostic criteria of BPD.

The first of the four skills I found the most useful for battling thoughts to self-harm, was from the Emotional Regulation part and is labelled as ‘PLEASE’ and listed to be used for reducing a person’s vulnerability. Each letter of the word stands for a different quality of life that could impact how vulnerable – and potentially therefore unsafe – you are. ‘P’ and ‘L’ come from ‘physical illness’ and pointing out the affect that being physically poorly can have on your mental health. The ‘E’ relates to ‘eating’ and illustrates the benefits that a healthy diet can have on the state of your mental health. ‘A’ stands for ‘altering drugs’ and is used to highlight the importance of only taking your prescribed medication, not using unprescribed and sometimes illegal drugs that could alter your mental state. The ‘S’ is to raise awareness of the fact that ‘sleep’ can really influence the vulnerability of your mental health, with most people needing a good quality sleep in order to ‘function.’ Finally, the ‘E’ is for ‘exercise’ and is there to encourage you to engage in healthy exercises and routines in order to stay healthy and on ‘top form!’

The second DBT skill I’ve found useful in connection with self-harm, has been from the ‘Distress Tolerance’ part of the Therapy programme. It’s named ‘Using Pros and Cons’ and is very simply about listing the benefits and the negative consequences to you engaging in a particular behaviour, reaction, or activity. The aim in doing this skill is obviously for you to end up with a list of reasons why you should and shouldn’t do something, and for the positive, most healthy and safe side, to outweigh the other. I thought this skill wouldn’t be helpful where it concerned self-harm because I always believed that hurting myself wasn’t really a ‘decision’ or an ‘option.’ I refused to accept that I would ‘choose’ to self-harm. But writing the pros and cons to it really provided me with the time to think through this – almost – automatic response to any sort of hardship. It gave me the opportunity to realise that actually, all my very valid reasons not to self-harm, really did outweigh any benefits I believed it might have.

The final two DBT skills that have helped me battle my self-harm, are also from the Distress Tolerance module. They are the acts of distraction and self-soothing. Each one has its own little mnemonic, but I’ve learnt that the important part of these two skills – the part that really makes them become helpful – has been to expand on your own definition of each one. I mean, for self-soothe DBT recommends doing something that engages your five senses (taste, smell, see, hear, and touch), and initially, I thought that self-soothe was all about having a bath or getting cosy with a candle, blanket, and comfy clothes. Yet, learning DBT, I’ve found that even things like listening to relaxing music, eating something delicious, looking at something calming, can also be very valid method of self-soothing. 

Finally, distraction, which I think this has always been my favourite skill! The DBT module lists a mnemonic that I still don’t fully understand; ACCEPTS! Before DBT, I would have thought distraction was a very simple and straightforward coping mechanism and that it meant devoting your time and attention to something in particular – preferably something that is the alternative to an unhealthy or unsafe behaviour that you would otherwise be engaged in. In learning this skill, I was immediately very aware that there was a fine line between distraction and avoidance, and it’s so important that you learn where that line in and are conscious of edging toward it.

 

4.    Physical & emotional pain

Over the years, I’ve been in hospital for many different reasons that have often involved me being in some sort of pain. The traditional question – which must be somewhat mandatory – is “on a scale of 1 – 10 how bad is the pain?” And it’s something that made me think about whether it should be used in a mental health situation too.

I think that using a scale like that, can sometimes help the person to put their pain in perspective and it might end up leaving a person thinking ‘actually, I’ve come through a lot worse.’ Of course, the danger of doing that is the fact that everyone has a different pain threshold and where a headache might be a number 4 for some people, it could be a 1 for others. That possibility shouldn’t change the way the individual’s pain is viewed; it shouldn’t leave you thinking ‘I don’t think I’d be crying if this was me.’ It shouldn’t become a comparison tool, just a method of better understanding how a person is feeling.

Another danger to scaling pain (emotional or physical) is that if a person is in tears, screaming, shaking… whatever, it can become a bit insulting for someone to then ask how bad your pain is. I’ve often screamed “obviously a ten!” at Doctors and Nurses who’ve asked me to scale the pain. However, the other day, I dislocated my shoulder for the fifth time, and the Paramedic actually said, “I’m going to assume your pain is at a ten!” And I said “actually, no. I’ve experienced worse.”

Finally, how do you assess different kinds of pain using the same scale? I mean, a pain in your tummy, or a sprained ankle, can be a completely different type of pain to a broken bone. Since the fourth time I dislocated my shoulder, I’ve been left with three types of pain: firstly, the very obvious bone-y pain. Secondly, the pain from the muscles and ligaments that have all been stretched in the wrong direction. Thirdly, when my shoulder was put back into place, my Auxiliary Nerve was damaged, so I’ve also been left with nerve pain down the outside of my arm. They each feel completely different – one is sharp, one is a dull ache, one is throbbing… so how could I make a comparison to determine which is ‘worse?’

Recently, since the injuries to my EPL Tendon, Radial and Auxiliary Nerves, and my AC Joint, I’ve told my GP that I’m just grateful that my mental health is doing so well because otherwise, I’d be concerned that the physical pain would have a detrimental impact on it. I think that at this point, it’s common knowledge that your physical health can affect your mental health. And whilst I said that my mental health is better, that doesn’t mean my injuries haven’t impacted it. I’ve often cried purely out of frustration that the pain I’m in is stopping me from doing activities I enjoy, and which are actually useful for my mental health! Fortunately, I have an amazing GP who makes a huge effort to understand my pain and how it impacts my life.

 

5.    The encouragement factor

In the specialist psychiatric hospital, I really saw a different side to self-harm. In other hospitalisations, I always kept to myself and rarely made friends with anyone on the wards, but from the beginning of my admission to the specialist hospital, I was told that the typical admission lasts 12 -18 months. That meant I felt compelled to bond with the other inpatients and to build relationships with them in order to make my admission that little bit more tolerable!

Getting to know the other girls, I really felt a sense of comradery and support; but it became apparent that I was the only person on the ward to view that support as encouraging one another to stay safe. I was in my hospital room when there was a very stern knock on the door and without waiting for me to invite the person in (as is the rule), staff barged in and told me to get into the communal sitting room immediately so that they could search my room.

When I got to the room, all the other girls were there, and I realised that it wasn’t just me having their room searched. No one talked until the Ward Manager came in and told us all that from the recent increase in self-harm on the ward, staff had realised that all of the injuries appeared similar and had come to the conclusion that those who’d self-harmed had used the same item as one another. They weren’t sure what it was until a search in one of the rooms turned up a very sharp object. The staff told us no one could go back to their room until whoever had brought the sharp onto the ward admitted to it.

As soon as the staff left, the sitting room exploded into arguments! Each girl who’d used the sharp obviously knew who had given them it, but no one seemed to know who had actually brought it onto the ward in the first place. There were big suspicions though, and I ended up shouting at the girl everyone suspected and told her that we were all paying the price for what she’d done and if she actually cared about any of us, she would admit to it. She finally confessed to the staff and we were back in our bedrooms by the end of the day.

A long time later – just before I was discharged from the hospital – one of the girls asked me what had changed. What had been the catalyst for my change in attitude and the improvement in my mental health. I told her that going AWOL, attempting suicide, ending up on life support, and then being transferred to the Psychiatric Intensive Care Unit (PICU) above our ward, had really scared me straight. It had been the turning point where I had finally realised that if I didn’t start engaging with staff and attending therapy sessions, this was going to be my life. And I didn’t want that. Not long after telling the girl this, she had gone AWOL whilst on leave from the hospital and attempted suicide. I remember crying in a Reflection (the sessions at the end of the day where everyone had to gather together and talk about their day) and saying it was my fault she’d done that; that I’d encouraged her to do it. Everyone reassured me though, that what she had done after our conversation was on her. It was her responsibility to have twisted my words into advice, or to have used them as hope that things can get better.

Whilst I won’t lie and say that I got absolutely no benefits from self-harming – obviously I did or I wouldn’t have continued to do it! – I would never encourage someone to use it as a coping mechanism. I’ve seen how dangerous it can be and have learnt that there are better, more effective coping skills to use as alternatives.

 

6.    A message to services (the Police, NHS staff, Paramedics etc)

There’s a few things that I’d like Services to know about self-harm and about helping and supporting someone who is doing it:

ü  Don’t ‘remind’ every person of the impact their self-harm could be having on their family and friends – they’re probably already fully aware of that

ü  Don’t judge a person to be weak for turning to self-harm as a coping mechanism

ü  Try to always ensure that the person keeps their dignity in whatever your response may have to be

ü  Assuming that a person hasn’t sought help or support prior to self-harming can be patronising – maybe the support they got wasn’t ‘good enough’

ü  Don’t let any pressures with time or funding impact your response to the person – they know you’re busy and most likely already believe they aren’t deserving of your time

 

7.    Social media influences

Being a blogger with such a large audience, I think that it would be incredibly easy to assume that this aspect of self-harm would be discussed in this post.

I first became aware of this aspect came with the Cut for Bieber trend on Twitter in 2013, when seeing the pop star taking drugs left a lot of young people convinced that self-harming would both help them to cope, and motivate him to stop what he was doing. It scared me that self-harm could become a ‘trend’ and that it could be a coping mechanism that people could so quickly resort to using.

I’ve personally experienced two instances of social media becoming a negative platform; the first was when I was in my teens and some girls started bullying me at school and then it progressed to private messages on social media. It was hard to deal with because it made me feel as though I couldn’t even escape the bullying by being at home in my own bedroom. It felt as though the bullies were everywhere. My second experience was when I received a couple of horrible comments on my blog posts and they knocked my confidence so much that they became one of two reasons why I stopped blogging for a few months in 2014. It was really off-putting to be doing my best to always write openly and honestly, yet to still face backlash for that. I didn’t want to change how I blogged, so I thought not blogging at all was the best outcome.

Obviously, I came to realise that ending I’m NOT Disordered would mean the bullies had ‘won’ and I’d been defeated by their spiteful remarks from the cowardly position of being behind a keyboard! I’m so that I realised this and found that no matter how many horrible comments I got, they were worth it to receive more than twice as many positive comments from people who felt helped and support by my blog’s content.

I completely understand that there’s a whole lot more, deeper unsafe aspects to social media, but I’m also of the opinion that you get what you search for. If you want to search for photos of self-harm or motivators to restrict your diet, then you’ll find them. In the same way as if you were to search for support groups or healthy advice, you’d find that content too. Granted, sometimes the negative things can be thrown in your face on social media, it’s all about learning to cope with that.

 

8.    Stereotypical comments around self-harm

“Have you tried having a nice, long bath?”

“We’ve got actually poorly people to be looking after who didn’t bring it upon themselves.”

“What about snapping an elastic band against your wrist?”

“Think of how your parents must be feeling!”

“If you’re beginning to disassociate, you could submerge your face in cold water.”

“Just take your medication and try to get some sleep.”

“Did you even try to talk to someone before you did it?”

“So, you weren’t trying to kill yourself?”

 

9.    UK help lines & the importance of having a support system

NSPCC: 0808 800 500

Mind: 0300 123 3393

Samaritans: 116 123

Men’s Advice Line – Respect: 0808 801 0327

From the very beginning of my mental health deterioration, I’ve been aware of how helpful it is to have a support system, and that your system can have so many different purposes. I mean, I feel that I have one which is my friends and family, another that has all of the professionals, and a last one of anyone and everyone involved with I’m NOT Disordered. Each system not only has different people in, but they also have a different impact on my mental health and, in turn, my self-harm.

The system with my friends and family (and definitely my pets!) provide me with a more loving and reassuring support which comforts me and promotes feelings of being cared for. The thought that there are people out there who love me and – in my pets’ case – rely upon me, is a helpful notion when I’m having thoughts to self-harm. I’ve been incredibly lucky to have not lost any friends through my mental illness – I mean, that’s the way it should be, but I’m very aware that for a lot of people it isn’t always the case. Going into the specialist psychiatric hospital I was terrified I’d lose all my friends because it was over 100 miles away from everyone and I was warned that the hospital was for long-term admissions. However, the thought of all the people I loved and who loved me, motivated me to try really hard to recover and be discharged as quickly as possible because I hated being so far away from them.

The system with the professionals is obviously much more boundaried and formal and has changed a lot over the years as professionals (mainly Community Psychiatric Nurses and Psychiatrists) have come and gone. When I was at my most poorly, I always took their departures personally and believed it was my own fault – even when on one occasion she had to go on maternity leave! It made me very reluctant to engage with anyone because I worried that as soon as I did, they would leave, and I’d be back to square one with a new professional. But being in the specialist psychiatric hospital for over two and a half years, I learnt a lot about relationships in general and it really helped me to build bonds with some of the staff (particularly my Key Nurse and one of the Psychiatrists). From doing this, I discovered the benefits I would experience in opening up to the professionals.

My final support system is probably fairly unique to me being a blogger. I’d like to think of myself as loyal to the organisations and individuals I’ve collaborated with on I’m NOT Disordered, and this tends to mean building a relationship with individuals from an organisation’s media team. Over my eight years of blogging, I’ve collaborated with numerous organisations – which have varied from Cats Protection to the British Transport Police – and have found myself extremely appreciative of them. I’ve taken their agreement to collaborate as a sign of them having faith in I’m NOT Disordered and believing it is worthy of associating their name and reputation with my little blog!

 

10. Why blogging helps me

From starting to blog eight years ago, I have always found it beneficial for my mental health and therefore, helpful in me fighting thoughts to self-harm. I mean, that’s sort of obvious because why would I have continued to blog for so long if I wasn’t benefiting in any way?! I started to blog with the hope that allowing me the opportunity to write about my thoughts, feelings, and experiences, would give me the time to process everything and that in having that time, it would mean I was less likely to do something impulsive like self-harm or attempt suicide.

Another way I’m NOT Disordered has been helpful in so far as my self-harm is that I’ve received so much feedback from readers telling me how helpful my content was for them. How comforting it was to hear that someone else was going through the same thing or something similar as they were. And the fact that I had come through those things was reassuring and provided them with a level of hope that they too, could overcome these challenges. The knowledge that I might be helping others through my blog, really encourages me to feel as though I had a level of purpose; that I had a reason to be alive and to stay safe.

 

11. Self-harm stigma

As with most aspects of mental health, there’s a stigma around self-harm and a lot of judgment around those who engage in the unsafe coping mechanism. I think one particular belief people on the outside hold is that self-harm is an attention seeking behaviour because they struggle to understand what purpose it has if it isn’t a suicide attempt. I mean, what’s the end goal to self-harm?

This was definitely a stigmatised view that I experienced from others when I hadn’t yet learnt how to explain my own motivations for self-harming. I struggled to help people to understand the power that the hallucinations had over me and why they had an impact on whether or not I self-harmed. The ironic thing was, once I’d finally learnt how to put things into words, I had to battle all the memories of the occasions when I had felt mistreated, the less willing I was to help them to understand so that they would treat me better. But the way I look at it, I shouldn’t have had to learn how to put it into words in order to experience less stigma and discrimination. That attitude shouldn’t have been there in the first place. I shouldn’t have needed to change it.

 

12. My favourite items to distract from self-harm

Book: Fantastic Beast and Where to Find Them: The Original Screenplay by J K Rowling

Series: Pretty Little Liars on Amazon Prime Video UK

Movie: The Greatest Showman

Activity: Adult Colouring Book – Creatopia

Game: The Sims Freeplay

 

13. The general aftermath of self-harm

Of course, ‘self-harm’ covers such a huge range of behaviours, so the aftermaths can be so varied that I debated even writing this part! For me, the aftermath tends to involve a trip to Accident and Emergency (A&E) – sometimes in an Ambulance, stitches or sometimes surgery, and then scars.

Mostly, the aftermaths leave me thinking ‘was it even worth it?!’ I mean, I was getting a few minutes relief from silencing the hallucinations and calming my thoughts and feelings, yet in return I had to go through hours in a waiting room, the possibility of a discrimination in the response of professionals, pain… Yet, the next time I was close to self-harming, all I could think about was those minutes of relief.

 

14. My messages to anyone struggling with self-harm

There’s a few things I would want someone who is struggling with self-harm to know:

ü  Always seek medical attention where necessary – even when you’re reluctant to

ü  Take time to self-soothe – your body deserves a rest and some kind attention

ü  If you’re struggling to put things into words, try writing them down

ü  Don’t take an ignorant person’s judgement of you, shape your view of yourself

ü  It doesn’t make you ‘weak’ to allow others to help and support you

ü  Take the advice you would give to someone you cared about

ü  The achievement of not self-harming feels so much better than any relief from doing it

There’s hope