What is self-harm?
Often because we only think of the extremes in terms of self-harm, be it:
· Suicide attempts.
We miss the tell-tale signs of other forms of self-harm –
· not washing
· not brushing teeth
· living in jogging bottoms
· under-eating and wearing baggy tops
· or binge-eating then making themselves sick.
What is Suicidal Ideation and Self-harm?
Suicidal feelings and self-harming behaviour have to be considered as part of the same continuum as suicide is the ultimate in self-harm, also people who self-harm may also suffer from suicidal ideation.
Suicidal feelings or suicidal ideation is the notion of wanting to die and to ‘give up’ with life, as it seems meaningless. This can be further exacerbated due to social isolation. This existential crisis comes from an extreme sense of hopelessness and depression. This could occur due to a recent trauma, severe depression, or remembering past trauma due to a trigger.
Below is an explanation of self-harm and how it manifests, all of which or individually can lead to suicidal ideation.
Suicidal feelings can be overwhelming and seem insurmountable especially if it is not easy to talk to family about the feelings. Nevertheless, it is vital to talk to people who understand to reduce the isolation and to normalise the emotions to prevent an attempted suicide. Organisations such as the Samaritans (https://www.samaritans.org) are available at all times of the day and night, also it is extremely important to work with a therapist to help deal with the feelings and to come to some understanding about how to reduce and manage the suicidal feeling and ideation.
Addictive behaviours are also self-harming – some of which are socially acceptable and sanctioned behaviour and may not be considered ‘self-harming’ such as binge-drinking, excessive smoking, or over-exercising. It only gets seen as self-harming when the person can no longer function without the drink or exercising at socially unacceptable times.
Family & Friends
Family members and friends repeatedly get exasperated and tend to be brusque with someone who may be demonstrating this kind of behaviour. On many occasions these are signs of an existential crisis and possible anxiety or depression, self-loathing, lack of self-love and also feeling out of control of their lives, particularly when it comes to eating disorders and suicide attempts. Nobody chooses to fall into this place. Sometimes the person has disconnected from their body and becomes super-logical about everything because they are trying to shut out the physical and emotional sensations and pain. But when this becomes too much they have to have a release and will self-harm.
All of the above are a cry for help. It is important to seek the help prior to it becoming a crisis situation – often with psychological pain it is difficult to articulate until it becomes an emergency or the person may be in denial that anything is wrong at all. https://www.mentalhealth.org.uk/publications/truth-about-self-harm
Sometimes a crisis can occur due to a traumatic event or the person has an allergic reaction to drugs (both legitimate and illegal ones) – as we are all unique these can affect us all in different ways because our biological chemical make-up reacts differently to what we put into our bodies. This can potentially lead to a brain chemical imbalance leading to psychotic behaviours and effectively a personality change.
What is happening in the brain?
Anyone who is self-harming has had a brain chemical imbalance as their stress levels will be extremely high and this leads to a shut-down in brain pathways as a means of coping, so they will not be able to access happy thoughts or memories leading to what seem like illogical behaviours and changes in personality. To the person it makes perfect sense to deal with psychological and emotional pain by self-harming.
What are the changes in behaviour and thinking to look out for?
Often the person will not even realise their thinking and behaviour has changed, they can become any combination of the following:
· quiet and secretive
· aggressive and uncaring
· and others.
What is an existential crisis?
Uncharacteristic behaviour is part of a breakdown or an existential crisis, which does not mean the person will always be like that. They have to be supported through to another place, I call it ‘no woman’s/man’s land’. It is a place where the certainties of self/life have dissolved away into a wasteland, and it is a waiting game to allow the next self/life to come into being. Each moment of each day feels like a drag through treacle. In this transition stage there can be a lot of blame, anger, self-hate, guilt and ultimately pain.
This does not mean the person climbs into bed and hides under the duvet – far from. To help build compassion for self the person needs to do things that will be nurturing and enabling by not self-sabotaging and feeding a negative self-concept.
Who can help?
Since nobody, other than ourselves can change our thinking, it is important to find someone who understands and is willing to help the person to explore the pain and change from that space to another where there is happiness. Seeking help from experienced professionals is essential, as they are trained to listen, can sit with and hear another person’s suffering, but also know how to look after themselves. Often family and friends can’t bear to see someone they love suffer and therefore can be abrupt and give advice such as ‘You’ve been like this for ages – just snap out of it!’
An existential crisis manifests as despair or hopelessness and leaves the person asking ultimate questions such as ‘What’s the point of life?’ As they try to deal with these thoughts and feelings they resort to something physical, like cutting themselves, to alleviate the pain.
When someone is dealing with thoughts such as ‘life isn’t worth living’, ‘I wish I were dead’ or ‘death would mean no more of this pain’ they are having suicidal ideation; when there is a plan there may be suicide attempts.
Underlying feelings about suicide
There are many reasons why someone becomes suicidal – underlying it all there is heartache, for example where the person feels their heart is broken and shattered into a million shards of glass and they no longer know who they are. They cannot go back to a place of feeling whole and losing themselves leaves them in the place I call ‘no woman’s/man’s land’ above.
Why don’t loved ones understand?
Frequently when working with suicidal clients I ask ‘what does it feel like?’ They are surprised because usually they don’t get asked this as the people they know are often grieving for the person they used to be and get angry because they cannot fathom the change and because the person they love is no longer available to them.
Talking normalises feelings
When clients are unsure what to answer, I prompt with ‘Describe what your unique experience is – sometimes people say they feel like they are constantly falling backwards, or feeling as though they are drowning or as if they are really small and there is a huge dark looming figure above them, or they feel they are locked in a cell deep underground.’ This reassures clients because they realise that their pain can be openly discussed without having to hold back, and also that they will not be judged or told to ‘snap out of it’. This normalises their experience when they realise others have also experienced something similar and they are not going ‘mad’. Clients soon realise they do not have to protect me from their thinking or feeling, unlike family and friends who cannot bear to see them struggling.
By starting to articulate their experience, this frees them to be completely open up and name the pain; by being trusted and listened to with an open heart, they learn to trust themselves and allow the enormity of what they have been through to start to sink in and allow themselves to not just live in their heads, but start to allow the emotions and pain some space.
Working with a therapist can take a few months if not years. And clients give themselves a hard time when they fall back into a despair again – this is quite normal. The process of coming back from an existential crisis is not linear, it is cyclical – there will be successes and relapses. Nevertheless, over times the client finds creative solutions to manage their life. https://www.mind.org.uk/information-support/helping-someone-else/supporting-someone-who-feels-suicidal/talking-about-suicidal-feelings/#.W2gxjC2ZMWo
Kala Patel MA, Counsellor and Psychotherapist MBACP, PGCE (Oxon)