An Honest Account of Self-Injury (TW)

It’s something I’ve been struggling with for over ten years now. Self-injury is possibly the biggest mental health taboo we face; it is something that is hard to talk about and hard to define.

I first hurt myself intentionally when I was 13. I still have faint scars on my wrist from using a safety pin to scrape the skin. Over the years I ‘progressed’ (so the wrong word…) to using scissors, then craft knifes. For me, it is a ritual behaviour that I know I can trust to make me feel better – for a little while at least.

The pattern for me in the past has been to make a few shallow-ish cuts. It was all about the ritual; it was almost a mindfulness exercise in focus and being present. I think that’s why I’ve found it hard to stop. It was always a way to escape unruly emotions and anxieties – and I always fought the urge for as long as possible before giving in.

My latest self-harm has been different. Instead of riding out the urges I acted impulsively; I didn’t turn to any healthy coping skills before acting on the need to injure. Different also, in that I used a kitchen knife. Very out of the ordinary for me. I wound up at the minor injuries unit needing to be glued – the first time in my history that I’ve sought professional treatment for a self-harm wound.

I wish I knew what was going through my mind when I did it. Maybe that would hold some answers for me. In truth, I didn’t even feel it – seriously depersonalised in the act. It is quite scary to think how bad it could have been.

It is hard to explain the motives behind self-injurious behaviour; partly because it’s not the same for everyone. For some it is about dealing with physical pain to lessen emotional pain. For some it is about taking control. It could be due to depression, or mania, or psychosis, or personality disorder. Myriad reasons and myriad methods combine to make it a tricky topic to talk about.

I would love to say there’s a magic reply to use when someone is self-harming. There are a lot of methods out there to help lessen the need to hurt oneself. The Butterfly Project is a nice one; instead of hurting, the person draws a butterfly onto their skin. There’s a tumblr page for the project where people can share their butterflies. Other ideas include snapping an elastic band against the skin, or holding an ice cube. One of my psychiatric nurses told me about one of her service users who froze the knife in water; the idea was that by the time she’d managed to defrost it and get to the knife, the urge had passed.

One of my coping strategies is ‘Just one more song’; I put on a playlist and tell myself that I have to listen to one song before I act. Once that song is over, I tell myself again ‘just one more song’ and listen to the next track. And so it continues until the playlist is finished and I realise that I don’t feel the urge quite so badly. It usually works; it certainly lessens the emotional distress of being in such a bad head-space.

I am hoping that this last incident isn’t going to set a precedent for a new type of self-harm for me. I think my awareness of how dangerously I acted is giving me some protection from repeating the behaviour. The truth is, I wish I could be rid of the need to do it; until I ‘get over’ it I’ll just have to keep trying to use other coping skills.

An Honest Account of Self-Injury (TW)

The Disaster I Like To Call ‘Friday’ (trigger warning)

I’ve debated writing this all weekend, but I have come to the realisation that I would be a hopeless advocate of mental health transparency if I hide aspects of what having mental illness entails in my life.

In the days running up to crisis day I’d been scoring 8s and 9s on the mood tracker app. Thankfully I had diazepam and zopiclone at home, so I was managing it reasonably well (note to self – speak to pdoc about an alternative to the less-than-effective Valium). It was unpleasant, uncomfortable and on Friday it became uncontrollable.

I should mention also that I’ve been having hours unaccounted for, which is pretty scary in itself. It is mostly down to needing to use zopiclone during the day to bring the edge off the high mood; it can cause retrograde amnesia if you don’t sleep after taking it.

On Friday I hurt myself. I don’t entirely recall why, or what the motivation was; the first I was aware of it was when I knew I needed to call 111 for some help. I’d not taken a zopiclone that morning, but had had a few mg of diazepam. The lovely person on the other end of the line called a paramedic car for me and off we went to the hospital.

I have just realised I’m writing this like a newspaper report, and that’s not the point of my blog. I want to be clear over the emotional rollercoaster I’ve been on for the last couple of weeks. It has been awful, mentally draining, even physically draining and yet I have been restless nonetheless. My mind has not caught a break, and what’s awful about it is that a break from thinking is exactly what I need.

What is awful is that I don’t understand the reason behind hurting myself. Normally I ‘ride the urge’ for a while; I resist and resist until the need passes and I’m quite good at turning to healthy coping strategies such as mindfulness practice and mindless television. I’ve not been that manic since I first for unwell, and I thought I was over it – I guess having had such a long period of only having mixed or hypomanic moods made me forget how dangerous a true manic mood can be.

I’m speaking to my CPN tomorrow and hoping that she’ll have some bright ideas for managing this; although I’m also hopeful that the crest of the wave has broken. I am planning to be back to work on Tuesday too. Fingers crossed!

The Disaster I Like To Call ‘Friday’ (trigger warning)

Spotlight on Self-Harm (trigger warning)

Self harm is a growing problem worldwide. Statistics here in the UK suggest as many as 13% of 11 to 16 year olds purposefully hurt themselves, but it’s not just a problem that adolescents face. It can be a life-long battle for many.

I started to hurt myself by cutting my arm aged 13. At first I used safety pins to scratch my wrist; small half-centimetre scars that have now faded with time. Over time I progressed to using scissors and the self injury became a ritual I used to cope with the pressures of teenage life. At the time I told myself it was temporary, just a stop-gap to last only as long as it took me to grow up and learn to deal with the world.

I want to use this post to talk a little about the problems with self-harm I’ve faced as an adult. I stopped my teenage self-harm aged 17, and managed to stay away from it until I got unwell aged 22.

People tend to associate self injurious behaviours with depression. For me, I’ve found that I struggle more with it when I am manic or psychotic (or both, as they normally come hand-in-hand for me). My mind turns to it when I cannot cope with the high, wild level of mood and I’m looking for ways to calm myself down. I have learned great coping skills over the years but they are not always the first thing I turn to when I am ‘in the moment’. In adulthood I know I ‘should’ know better, but my insight when I am unwell isn’t always great.

As an adult, I’ve found that the extent to which I hurt myself is greater. I no longer use blunted blades for example – and so the resulting injuries are far worse. I also find that I can do more damage when I’m manic than when I’m depressed. When I am in a low mood, I feel the pain more. When I am in a dysphoric state I don’t feel it, and it’s hard to recognise when it has gone too far. It is also a control thing for me; a way of getting my head clear and bringing myself down to a normal level of functioning.

It is hard to talk about self-harm in public. Writing this feels like I am baring an aspect of my soul to the world and it’s not entirely comfortable. But it is a topic that is increasingly important to focus on. It is not something we should be sweeping under the mat.

There are so many great ways to cope with the urge to self-harm. The Butterfly Project is one such way; the idea is that instead of hurting themselves, the person copes with the urge by drawing a butterfly on their skin. Other ideas that I’ve tried in the past and had some success with include the ice method (whereby you hold an ice cube in the hand) and the elastic band one (you ping an elastic band against the skin). The only issue I have found with these moderation methods is that it’s not always the pain I’m craving – sometimes it is the damage I want to cause that makes me need to act on the urges. I’m still working out how to mitigate those situations; I would appreciate advice if anyone has it!

This piece has so far mostly focussed on cutting as a form of self-injury. There are many more forms; overdoses without the intention of suicide, punching walls and burning oneself are examples. Substance abuse can also be seen as a form of self-harm. As many as 30% of those with bipolar also abuse drugs or alcohol, compared with around 4% of the non-bipolar population.

Self-harm is a conversation many people are now getting involved in. The key to overcoming it is to learn healthy coping skills. If you are struggling with self-harm, you will be doing a great thing to look after yourself if you seek out help from your GP or a therapist.

Spotlight on Self-Harm (trigger warning)