Coping with Self-harm

by Masha Bennett www.practicalhappiness.co.uk

Among approximately 86,000 prisoners in UK jails in 2011, there were over 24,500 recorded incidents of self harm that year, affecting just under 7,000 prisoners. The good news is that the figures for women self-harming in prison are seemingly going down – with women comprising only 5% of inmates, in previous years they often accounted for almost half of self-harm incidents, and for 2011 it is just over one third of them. (We should bear in mind that these figures refer just to those instances of self harm which were recorded – it is likely that many went unnoticed, as many people who self harm try to hide it – despite the popular belief that they do it for attention.)

A quote from my good colleague and friend Dr Mike Smith of Crazy Diamond: “Self harm is one of the most misunderstood and heartlessly represented  areas of British healthcare…  Traditional psychiatric responses to selfharm are to see it as an illness, a deviancy, attention seeking, hysteria, weak mindedness or suicidal intent. As a selfharmer, or as someone who works with someone who self-harms, it is readily apparent that none of the above models have any roots in reality.”

There are many reasons why someone may self-harm, and it is simplistic to assume that the individual who injures himself is “attention seeking”. Much of self-harm is hidden, and whilst some people may hurt themselves to communicate their distress to others, this is only one of the possible motivations. Self-harm can be a strategy to cope with unbearable emotional/ psychological pain, a way to survive, to release overwhelming emotion, to punish self, to gain some control when feeling out of controls, to re-gain feelings when numb or disassociated, or can have several functions at the same time (and the sufferer is not necessarily aware of these functions).

Image courtesy of David Castillo Dominici / FreeDigitalPhotos.net

Self-harm is commonly associated with the following mental health issues: Post Traumatic Stress Disorder (especially trauma associated with childhood abuse and neglect); Dissociative Identity Disorder (Multiple Personality); Eating Disorders; Substance Dependency; Clinical Depression; Personality Disorders.

However, you may not have a mental health diagnosis but still have the urge to injure yourself. It is a widespread problem, and you may have heard of a few well-known people who have been affected, including Diana Princess of Wales, Kelly Holmes (UK athlete), Bradd Pitt and Angelina Jolie (US actors) and Sia Furler (Australian singer) whose beautiful song “Breathe Me”  refers to her own experience of self-harm – even for celebrities with money, status and freedom, self-injury is a painful, distressing and traumatic issue. Self-harmers who find themselves in jail may find that the urge becomes much worse – and some only start injuring themselves when imprisoned as a way to cope with their distress.

Some forms of self-injury or self-harm are socially acceptable and some are even fashionable in the western society, such as tattooing, piercing, cosmetic surgery, overeating, binge-drinking, dysfunctional relationships. Many professionals mix up self-harm and attempted suicide, whereas there is a big difference between the two. There are a lot of myths and stigma around self-harm, but generally it can be understood is a coping mechanism for emotional and psychological pain, used to soothe and tranquilize unbearable feelings.

Below are some ideas for people who want to cope better with the urges to self-injure, with some possible alternatives and strategies which you could, if you choose to do so, use to prevent yourself from hurting yourself. Depending on the type of emotion/feeling which creates the urge to injure yourself (which could be rage, grief, fear, numbness, feeling out of control etc.) different things may work at different times. Some of these activities may simply act as distracters, others have a soothing and healing effect, some allow to express overwhelming emotions safely, and some others allow to experience a limited degree of physical pain (e.g. when someone who feels numb and injures themselves in order to actually feel something) without actually causing injury.

Of course in a prison the choice of activities you could do easily is likely to be restricted as you may not have access to equipment or space required, and your privacy may be very limited. However I tried to include at least some things that would be possible for most people even in prison. Some of these can be done very quickly, and some will require time and a bit of practice:

• Break some sticks
• Choose a random object and list 30 different uses for it
• Clean your room
• Create a secret code
• Crush an empty plastic bottle
• Do some vigorous exercise
• Draw a picture
• Draw an outline of your own body and colour in the areas where you feel strong feelings
• Draw on the place you want to cut with a red pen
• Draw your own comic
• Go for a walk (if you can)
• Have a rant
• Hit a punchbag/pillow/cushion
• Hum a tune
• Imagine a special box or container where you can hide away your troubles
• Imagine yourself as your favourite superhero and create a story about yourself
• Learn a martial art
• Learn acupressure points for calming down
• Learn grounding techniques
• Learn mind training games and do them in your head
• Learn relaxation techniques
• Look at a tree (touch the bark if you can) and imagine having a conversation with it
• Look at stars
• Look for pictures in the clouds
• Make a wish list
• Make your out-breath longer than your in-breath
• Meditate
• Play a real or imaginary musical instrument
• Play music
• Pray
• Re-arrange your room
• Remember your favourite joke
• Remember the best moment from your favourite comedy
• Rip up a cardboard box
• Rip up an old T-shirt that you don’t need
• Sing an upbeat tune
• Snap your wrist with a rubber band
• Squeeze a stress ball
• Squeeze ice hard (if you can get it)
• Stomp around in heavy shoes
• Take a shower and imagine the water washing away the pain and bad feelings
• Talk to a Listener (in UK, a prisoner trained by Samaritans to counsel other prisoners)
• Talk to a member of staff you can trust
• Tear some old papers you don’t need into shreds
• Throw a pillow at the wall
• Visualise different colours of the rainbow one by one, and notice what effect each colour has on you
• Visualise your favourite place in nature and imagine being there
• Visualise an imaginary Healing Room (where you can have  magical equipment and potions that would make you feel better)
• Watch birds out of the window
• Watch your favourite comedy
• Write a letter
• Write a list of things you are grateful for
• Write a poem or story
• Write a song
• Write down your feelings

An important note for prison staff, carers and professionals – please remember that the self-harm in itself is not the problem, it is a coping mechanism for another problem, so don’t be punitive or force the self-harmer to stop the behaviour (unless of course it poses an immediate and serious risk to their life).
The best you can do is to support them in a non-judgmental way, to help them understand the emotional reasons for self-harming behaviour, and encourage them to seek appropriate support and professional help – if psychotherapy or group therapy is available, consider making a referral, discussing this with the individual.

Masha Bennett is a UKCP registered psychotherapist and a trainer of EFT (Emotional Freedom Techniques). She has worked for a number of years within the criminal justice system, including running a drug rehabilitation programme in a women’s prison, and currently combines work in the UK National Health Service with her private therapy and training practice. Masha teaches EFT, trauma awareness and self-help tools to professionals and general public across 10 countries in Europe, Asia and Middle East. Her website is www.practicalhappiness.co.uk.

References

UK Ministry of Justice – Safety In Custody.

National Self-Injury Awareness Day (2000). Self-injury: Beyond the Myths.

Townsend, M. (2012). Women prisoners: self-harm, suicide attempts and the struggle for survival. The Observer, 11 February 2012.

Sources of information and support

A helpful booklet on Self-Harm published by the UK mental health charity Mind.

National Association for People Abused in Childhood is a UK charity offering support and information for people who suffered any type childhood abuse.

Bristol Crisis Service for Women  is a UK organisation that supports girls and women in distress nation-wide, in particular those who self harm.

Mosaic Minds  is a primarily internet based organization founded by a group of dissociative survivors of childhood trauma and their loved ones.

Survivors UK  is a charity offering help for men who have been sexually abused or raped.

PODS (Positive Outcomes for Dissociative Survivors) is UK organisation providing support, information and training for people suffering with dissociative disorders.