Every now and then you do a piece that catches you in the throat. This piece stemmed from an interview with a blogger who was tackling some intensely personal stuff on his blog about his own self-harm, which he has now ditched as he has stopped harming. Result.
John cuts himself. He takes a razor blade, draws its edge slowly across his upper arm until it parts the skin and glides smoothly, steely into the soft flesh beneath. He says that when he sees the blood, it feels good; it feels like the sting of sunburn and a release of pressure. When his feelings get confused and his thoughts are clouded, he seeks solace in pain. The pain focuses him, it’s a pure sensation, a reminder that he can feel; that he does have emotions and everything is alright again. It’s like hitting the ‘reset’ button. Refreshed, John patches the cut with a plaster, rolls down his sleeve and goes to sleep.
This is deliberate self-harm, and John is no fictitious character. He’s one of thousands of self-harmers in Ireland, who cut, burn or otherwise harm themselves to find relief from the paradoxical pain of emotional numbness. It’s neither a suicide attempt nor a cry for help, it’s a way of managing overwhelming emotions, and it’s the only way self-harmers see fit to do so.
By cutting himself and letting blood flow, John opens an emotional pressure valve. “The cutting makes you feel, you feel the pain, you see the blood and it’s like everything goes back to normal then because you’ve just released what was there, what was building up inside you through pain, through bleeding, through cutting.”
In 2003, nearly 10,000 people in Ireland presented to hospital with injuries caused by deliberate self-harm. It is thought that half that number again may be harming but not seeking medical attention. John’s story adds credence to that. He has been cutting himself since the age of seven, but has only gone to hospital on a handful of occasions, when the cutting drew an unusual amount of blood and he got scared that he had caused himself severe damage.
“I can remember the first day I did it,” John says. “I can’t remember what was going through my head, I just remember going up the stairs to the bathroom and locking the door. I remember opening up the cabinet and seeing the razor blades there and taking them out. And I started just to make one cut, then made a series of cuts.”
Soon, John found the cutting was becoming a familiar way of finding release. “I just found it did me good back then, it was helping me, helping me get through things I didn’t understand at the time, and then it became something I did on a regular basis.”
The emotional ‘numbness’ is hard for him to explain. “Your emotions get very confused, you become devoid of emotion and it just causes numbness. The only way I can describe it is as a lack of emotions, you can’t feel anything. Your head goes like cotton wool and you get very frustrated and confused. The only way you can get through these emotions is by cutting yourself.”
The calm that the cutting brings is a purely psychological reaction for some. Professor Kevin Malone of St Vincent’s Hospital in Dublin explains that self harmers tend to experience ‘intolerable levels of anxiety’ and that the harming provides a ‘transient release of tension.’ It also represents a desire to take control over their own body, often as a reaction to trauma during childhood. Another theory regarding repetitive harming is that it is a form of natural addiction. The pain from cutting triggers a release of endorphins which unblocks a wave of the body’s natural pleasure chemical, dopamine. This gives the same ‘high’ people experience when running long-distance or getting tattoos. Like any high, it can become addictive.
Self-harm’s habitual nature is what distinguishes it from another common term, parasuicide. Parasuicide is a once-off, uncharacteristic act, often a cry for help. Acts of parasuicide are more typically chemical overdoses, often using large amounts of mild tranquilisers or paracetamol, and these acts represent a large chunk of current self-harm figures. Cutting ranks as the second most frequent method of self-harm, accounting for 20 per cent of hospital admissions.
Regular self-harmers, on the other hand, treasure the privacy of their actions and will go to great lengths to hide it from others. Those who do confide in someone about their problem will often defend themselves by saying they have no intention of committing suicide, and want no-one to know about what they do, a fact Professor Malone disputes. Prof. Malone is an expert in suicidal behaviour, and is anxious to point out that there remains a link between deliberate self-harm and suicide. “There’s a notion that they’re ‘just’ self-harmers. Most self-harmers don’t end up dying from suicide but there are a small number who will.” He explains further, saying that people who self-harm are in a very conflicted position. “At one level there’s a huge amount of pain and they do want to keep it hidden. at another level, they’re frantic for help. Hiding it can only last so long.”
Paul O’Hare from Samaritans says that people who harm themselves are “horrified that they do it, they’re disgusted with themselves. They’re mortally embarrassed that anyone would find out. Because of the stigma attached, guys are better at hiding it, as they are with their emotions.” John, for example, has been harming since the age of 7, but has yet to broach the subject from his mother, from whom he has hidden his cutting. “Family-wise, I kept it hidden from them for quite a long time,” he says. “It’s only in later life that it’s become more of an issue that they’ve come to know more about it. My sister would know and I’d talk to her quite a lot about it.”
Outside of a circle of close friends or family, the fear of being stigmatized or tagged as an attention-seeker prevents self-harmers talking openly about their behaviour. Instead, many look for advice from anonymous online support groups. Survivors of self-harm and specialists in the field share advice through web for and bulletin boards. Concerned relatives and current harmers form virtual communities to discuss how best to cope with family members who harm, their own harming and all peripheral issues.
When John began cutting himself, he felt totally alone. Ireland in the 1980s wasn’t a place to be admitting to such behaviour, and he believed his form of self-abuse to be peculiar to him. Then, on a trip to New York, he saw a young girl with unmistakable scars on her arms. “With harming there’s a pattern, it’s a pattern of cuts, its ten or twenty straight cuts, all the same length, all the same width.” Seeing the cuts on her arm made him realize he wasn’t the only person putting a knife to their own skin.
He also looked to internet communities for support and in the last year has started his own weblog site at http://iselfharm.blogspot.com. On it, he documents his struggle with self-harm in depth, shares experiences and tries to direct other harmers to places they might find help. It’s also a source of comfort for him at times. “It has been therapy for me, being able to put everything down on paper.” Regular readers also chip in with messages of support and encouragement. The site has attracted several thousand hits and is the first of its kind in this country.
Several UK sites deal specifically with self-harm, and provide detailed information for family and friends of suspected harmers. The UK has the highest rate of self-harm in Europe. Four people in every 1,000 self-harm in the UK, double the estimates for Ireland. Here, just under two per 1,000 people cause themselves deliberate harm, but numbers are on the increase. Half of all recorded episodes are by those aged under 30, and the peak rates in Ireland are found in girls aged 15-19.
The National Suicide Research Foundation estimates that one in every 150 girls in this age group presents to hospital as a result of self-harm at some stage. Although women are traditionally more likely to harm themselves, the gender gap is narrowing, and particularly in the midland and eastern areas, young males are catching up fast. Close to one in 250 males aged 18-34 harmed themselves in 2003, a rather alarming number.
Men are more likely to cut themselves than women, and are also more likely to involve alcohol in an episode of self-harm. John agrees. “If I go out and drink I would self-harm more aggressively than if I wasn’t to drink,” he says. “I was having just two or three pints of beer and I’d have total blackouts, I’d wake up in the morning and I wouldn’t remember getting home. I would have harmed and I wouldn’t remember any of it.” It can be even more destructive harming, too. “I find that sometimes when I get out of control, I don’t care, I’ll cut anywhere on my body,” he says. “I’ll never cut my face but I’ll cut my legs, arms, stomach or chest.” His last episode was particularly traumatic, and came at the end of a night out drinking.
Ireland is very poorly served when it comes to this growing problem. There are a few scattered research groups in Ireland, but they exist without much co-ordination, and there is, as yet, no dedicated group dealing with the problem. There are options, however, for Irish self-harmers who wish to talk to someone anonymously. Most experts recommend going to see a local GP, but as self-harm tends to be a very secretive habit, people prefer the anonymity of helplines or online groups.
Childline and the Samaritans both run helplines for people looking for someone to talk to. Samaritans are taking an increasingly pro-active role in dealing with the problem, and have been educating their staff on how to respond to people struggling with a self-harm problem. John has been helping them with this, recording a two-part video detailing his struggle and the reasons behind it. As a self-harmer, he felt isolated by the lack of resources in Ireland for people going through the same turmoil, and felt compelled to do something about it. Through his input online and in the video, he hopes that others will find support and have an easier time than he did. “I’d like to think that’s the sort of direction that things are going for me, that I could get involved and help other people. Obviously I’ve got a long way to go myself, but I feel some good has to come out of this.”
The video was an instant success, and after its first showing, staff responded immediately, thanking John for brave contributions and wishing him well. “When someone has the confidence to confide in someone about it,” says Samaritans spokesperson, Paul O’Hare, “the response given to that is crucial to their recovery. If they’re labeled as bad, mad or stupid, they’re less likely to open up.” O’Hare feels this is a product of our societal aversion to open discussion of emotions. “In Ireland we’re very good at having conversations but bad at talking about how we feel.” Samaritans are also aware of how important anonymity is, and to that end have gone further than providing a helpline. “Younger people tend to feel happier putting their feelings down in words rather than talking on the phone,” he says, and now Samaritans can be reached by email, allowing even greater anonymity.
“We’re really only beginning to deal with what society thinks of this,” says O’Hare, adding that we’re now much better at talking about suicide than we were ten years ago. As with suicide, the number of young males harming themselves is on the increase, and O’Hare insists that behaviours like these must be viewed as part of one continuum rather than in isolation.
Through lengthy and ongoing therapy, John believes he has gained more control over his self-harm habit in the last few months, but lost control in others. “I think I’ve a better handle on the harming than I have had in a long time, but there’s still a lot going on in my head. I do get tempted some times, I do have bad days.” On his blog, he says: “I have given up a lot of control in the last while, around when I started to get help, writing the blog and being very open about harming. Sometimes I think I did too much too quick, I was on such a quest to ‘get better’ that I started to convince myself that I was better and the lines got blurred. At the end of the day, I am the only one who can control my destiny. I am going to get myself together and become who I want to be in my own time and my own way.”
An anonymous comment on John’s blog shows how self-harmers often feel a sense of isolation as a result of what they do:
“John, I am currently battling a war with self-harm. It all began about a year and a half ago. I had heard about people who cut themselves as a form of release, and one day I tried it for myself. I had never felt anything like it. It was exhilarating and magical. It turned my life around, and I felt completely different. Everything I hated was suddenly insignificant because I had a way to deal with it all. Before long I became a slave to self-harm. All day I fantasized about it, and it continuously weighed in my mind. When I wasn’t doing it, I was thinking about it. I was self-indulgent and completely mortified. I am currently still dealing with all of it, and cannot stop on my own. I don’t think I can ever stop. But there is always hope. For the record, the amount that I love self injury, is equal to the amount I hate it. We’re friends, but we are worst enemies. It is a complete paradox. I hope that someday I will be able to overcome all this and help others who are in the same position I was once in. Anyway, I simply decided to post this so that you know I can relate to you and many others out there. Take care.”
Where to go for help
Samaritans run a 24/7 helpline for anyone who wants to talk anonymously about their problems or those of a loved one. Call them in confidence on 1850 60 90 90, or email them firstname.lastname@example.org. Their website (www.samaritans.org) has some useful information on self-harm
Childline answered nearly 180,000 anonymous calls from children and parents in 2004, and introduced a new texting service in April of this year. Call them on 1800 666 666 or text on 50101
www.nshn.co.uk – National Self Harm Network (UK)
http://iselfharm.blogspot.com – John’s self-harm journal
www.theblackdog.net – Site for men suffering from depression