A cutting cutting from "my back pages"...:
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 not 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.
Perhaps these seem natural enough responses. After all, what could compel someone to deliberately mutilate their own body?
It remains the great taboo of mental health, while other forms of self-abuse such as drinking, smoking, driving too fast or over-working seem more acceptable. Perhaps because they are cleaner, more sociable.
So those who deliberately hurt themselves, an estimated one in 200 - and already torturing themselves with self-loathing and obsessive secrecy - feel even more freakish and isolated.
Especially when they try to get support from health services which often leave them feeling worse, not better.
Croydon MIND is one group leading the battle to break down stigmas which separate self-harmers from the support they need.
Far from averting their eyes, Croydon MIND counsellors are keen to identify self-harm not as a recklessly self-destructive act, but a helpful aid to survival.
The charity has produced a widely-acclaimed film which attempts to confront popular misconceptions about deliberate self-injury.
The video, "Visible Memories", features self-harmers, support workers and hospital staff talking honestly about their experiences.
Too often, self-harmers looking for help from A&E nurses, doctors or counsellors come up against hostility, according to Croydon MIND deputy director Richard Pacitti.
He hopes the 25-minute film, which has sold about 500 copies to individuals and organisations such as Broadmoor hospital, has helped make progress locally.
The Royal Bethlem Hospital, on the Shirley/Beckenham border, is the only hospital in the UK to have a specialist inpatient unit for self-harmers.
And A&E staff at Mayday University Hospital in Croydon have been urged to take a more sympathetic approach to patients attending with self-inflicted injuries.
But Mr Pacitti believes the impetus for more sensitive treatment still comes more from voluntary organisations than from statutory health authorities.
Perhaps the reason for this can be found in the different reactions many people have to deliberate self-harm.
Too often seen as a precursor to suicide, self-injury is in fact more often a safer alternative.
Mr Pacitti said: "Many people don't realise self-harm is a coping mechanism. Hurting yourself is a way of either distracting yourself enough or releasing the feelings that have built up inside.
"Self-harm isn't about trying to kill yourself at all, in fact it's the exact opposite. It's about wanting to stay alive, but developing a technique for doing so."
Staff at the Bethlem adopt a policy aimed at minimising risk, rather than stamping down on self-harm all together.
While other hospitals confiscate all blades and monitor patients sternly, the Bethlem discourages any idea of stifling control.
This stance provokes criticism, claims that staff encourage self-abuse, just as drug therapies which provide sterilised needles are said to condone heroin abuse.
But Mr Pacitti believes such an approach is better than punitive treatment, such as detaining self-harmers under the Mental Health Act or placing them under close observation.
Dr Michael Crowe, consultant psychiatrist with the South London and Maudsley NHS Trust which runs the Bethlem, said: "There's a conflict between ensuring safety and treating people in the way they want to be treated.
"We take a calculated risk of allowing people on the ward with the means of harming themselves. The majority of our patients do reduce the frequency of self-harm while they're here and after they leave.
"But we always tell them this is just one step forward, it's not the end of the road."
Patients spend a maximum of six months on the 40-bed ward, taking part in counselling and activities including art and drama, before receiving aftercare from community support teams.
Clara Manzi, a former patient on Bethlem's crisis recovery unit, said: "If you actually had someone say, 'Take this blade to your own skin and cut it'", I think they'd get the message it's not something you do easily.
"Most psychiatrists would like self-harmers to stop self-harming, but it's not as simple as that. It’s a way of coping. It's been like that for many years."
Angela Smith, whose involvement in a self-help group led to her role in the film, said: "If someone's labelled a self-harmer, they're treated differently. Society sees them as weird, maybe dangerous.
"On one occasion, a member of A&E grabbed hold of me and asked why I was doing this to him - like I was somehow attacking him and doing it to get at him."
Mayday's A&E department sees a daily average of 12 people needing treatment for self-injury or overdoses.
Dr Kambiz Hashemi, who runs the department, admits patience can sometimes wear thin with persistent self-harmers but believes attitudes are improving.
He said: "There may be a doctor or nurse who's had three deaths that day, or has been dealing with heart attacks, and they may not be able to display the sympathy needed.
"I'd be lying if I said that didn't sometimes happen, but we try very hard to maintain a good standard of care, because these patients are vulnerable enough already.
"Unfortunately, what's happening now is we're getting more and more congested and it can be difficult finding a quiet and calm environment to talk with these patients. That's very important."
The immediate priority is to treat the patient's injuries, before carrying out an assessment and pointing the way towards further help in liaison with psychiatric services.
A popular belief is that self-harmers are only trying to draw attention to themselves, but as Mr Pacitti points out, there are many less painful ways of doing so.
And Dr Crowe added: "Self-harm is not attention-seeking or manipulative. In a great majority of cases, it's simply someone feeling bad, with tension rising, and feeling they have to do something to reduce that tension.
"These are people just like anyone else, with the same hopes and dreams. But they have exceptional sensitivity to adverse events which means they take things out on themselves."
Mr Pacitti first became interested in the subject when doing advocacy work for someone who self-harmed.
He said: "It soon became apparent to me that what psychiatric services were doing for this person seemed only to make things worse.
"So many mental health services are centred on eliminating risk. If anyone's indulging in risky behaviour it makes them very problematic. But there are so many risks in life, you shouldn't attempt to get rid of them, but minimise them.
"Many services say, 'We'll give you therapy when you've stopped cutting yourself'. That's like saying, 'We'll help you as soon as you don't need help anymore.'"
Noreen Griffiths, a counsellor for Croydon MIND, has found many patients treated for depression are wary of mentioning they self-harm.
She said: "We're usually well into the counselling programme, often near the end, before they do. It takes a lot of courage. They want to make sure the counsellor won't panic."
Croydon MIND has wanted to set up its own support group for self-harmers and produce new training policies alongside Mayday staff.
But these aims have been stymied by a lack of resources.
The rise of the internet has provided many sufferers with a new outlet for self-expression.
The web offers a variety of sites offering information, advice and forums where self-harmers can share their thoughts.
These heartfelt cries for help can make for disturbing reading - webmasters often use the cautionary caption "TRIGGER" to warn vulnerable readers of more graphic material.
Meanwhile, the few celebrities who have spoken of their own self-harm include Johnny Depp, Drew Barrymore, Christina Ricci and Richey James of the Manic Street Preachers who famously carved "4 REAL" into his arm during a 1991 interview.
Emerging from self-harm can often seem as difficult as being in the full throes of depression.
Scarred arms and legs leave a legacy of shame and concealment, preventing people from enjoying everyday activities such as swimming, sunbathing or wearing T-shirts.
Some sufferers opt for plastic surgery, while the Red Cross offers a scar camouflage service, with firms developing make-up treatments to cover wounds.
But the scarring inside can take a lot longer to heal.
(Originally published in the Croydon Advertiser, January 19, 2001, self-indulgently resurrected as a follow-up, ooh, to this and that
0 comments:
Post a Comment