A recent study of 14 000 armed forces personnel in the UK returning from Afghanistan and Iraq Over suggests that 20% of the young servicemen under 30 had gone on to commit a violent offence after coming home, compared with 6.7% of young men outside the military, with PTSD and alcohol being major factors.
Read the full article on the BBC website http://www.bbc.co.uk/news/health-21790348
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:
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.
by Michael Mallows
Hurt – Hate – Hope – Healing – Wholeness
Inevitably, the elements overlap and intertwine, and no matter how hard we’ve worked, or how far we’ve come, it is always possible to relapse, which doesn’t necessarily mean that we have to start over!
Hurt is the pain we carry, like a burdensome thing, as a result (or so we tell ourselves) of our past; all the betrayals and abuse, the rejection and ridicule, the physical assaults, all psychological as well as psychic blows. And the shadow of the past might be very long indeed because it probably echoes not only our own childhood, but that of our parents and grand-parents, and beyond.
Hate is usually externalised in our contempt and disdain for others. We talk to or about the bosses or bullies who have caused us distress. We build walls against people who are different, we treat children with disrespect, we betray the partner we cheat on. Blaming them (or our past) is a smoke screen for the deeper hurt and the greatest hate – that we are out of love with who we think we are, as evidenced by the countless ways in which we treat ourselves unkindly or even dangerously! In short, when ever we treat others in ways that demean or degrade them, we reveal how we really feel about our selves!
Hope by definition, hope is wishful thinking; if we have it already, hope is redundant! We hope for something that does not yet exist. When we focus on what’s wrong with other people, hoping they will change so that we will feel better about ourselves, we are not paying attention to our own faults and failings. This is hardly surprising if we don’t really like ourselves very much, which is evident in the way we deny and delude ourselves that the problem is caused by other people – past or present – and we are only the effect. If we have nor resolved, let alone recognised how our sense of self is riddled with feelings of inadequacy, hurt and hate, then hope is already contaminated.
Healing will only truly start when we recognise our meanness of spirit – to self and others, when we acknowledge our spiteful thoughts and gossip, when we admit our narrow minded prejudices, when we take responsibility for our vindictive acts and attitudes.And we can heal deeper wounds if, in the moment that we hurt the most, when we believe, and others agree, that we would be perfectly justified in retaliating, in seeking revenge, in hitting out with words or actions, in getting our own back by making others suffer, if, in that moment we choose not to seek vengeance or retribution.In that fleeting moment, even though we are hurting, if we go against the habit of hurting back, we have transcended the terrible weight of personal and collective history.We have chosen to act from a wellspring of love (even though we might still feel hateful), and to create a little and yet a vast space into which we and others might choose to grow.
Wholeness requires that we include rather than exclude other people, even if they are not as we would wish them to be. We treat them as we would like to be treated and would treat ourselves if we were filled with self-validating self-esteem. In this place, we become exemplars of the way we’d like to world to be. We stand as the possibility of love where, all too easily and all too often, we have previously been willing to hit out, to hurt, to hate, ‘just to teach them a lesson’! The lesson they learn when we pass on our hurt and hate is hopelessness in a bleak world because what we do is what we teach. And everything we do says who we think we are! If the above does not apply to you, you might anyway find it a useful frame of reference when you listen not only to what people tell you, but what they don’t say.
Michael Mallows is a psychotherapist, supervisor, trainer, consultant, author and expert on adoption. He is developer of SET (Social Effectiveness Training) and CRAFTY Listening.
by Deanne Jade www.eating-disorders.org.uk
If you had an eating problem before going to prison, the stresses of prison life could potentially make it worse. Research suggests that female prisoners are twice as likely to have an eating disorder as women in the general population – it has been estimated that up to 5% of women in prisons have obvious severe eating disorders, and it is suggested that up to 25% may be at risk, less severely affected or hiding their problems; in my recent visit to one prison I found that the prevalence of bulimia was 70%! There is very little information on eating disorders in male prisoners available at the moment, but it does not mean that men are not affected – they are less likely to seek help so true figures of men suffering with eating disorders are not known; it is likely that men with alcohol problems could be more prone to develop eating problems.
There are broadly speaking three types of eating disorder: Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder. An eating disorder is not an illness like measles. It is not something that you either HAVE or DON’T HAVE. Most women and many men are concerned with what they eat and how they look, and many people do strange things to control their weight.
People with an unhappy relationship with food do not necessarily fit neatly into the three main categories of eating disorder. Some people have features of all these problems and some people start with one disorder and then evolve into the other.
The Three Dimensions Of Eating Problems
Whether or not you have an eating disorder depends upon how you are functioning in three significant dimensions.
Thoughts
Feelings
Behaviour
Where behaviour is concerned, many people lose sight of what is normal. They are so used to doing these things, they don’t remember what it was like to enjoy food and look forward to eating. Some people who behave dangerously with food are in denial about how serious their problems really are. But some people who have a serious eating disorder think they have no right to seek help because they aren’t “bad enough”.
What Kind of Eating Problem Do I Have?
If you…
…you are probably suffering from BINGE EATING/COMPULSIVE EATING
If in addition to the above you are…
…you are probably suffering from BULIMIA
If you are…
…you are probably suffering from a form of ANOREXIA.
Eating disorders are extremely distressing and can be damaging to heath, and anorexia can be life threatening. If you recognise yourself in the above descriptions, please seek support. Expert psychological help in relation to eating disorders may be hard to access while in prison, but do speak to a member of staff you can trust who may be able to investigate what’s available for you.
Sources of information and support
National Centre for Eating Disorders www.eating-disorders.org.uk
Beat www.b-eat.co.uk – the leading UK eating disorders charity offering informaiton resources and support
First Steps Derbyshire www.firststepsderby.co.uk – UK charty which has a prison outreach project
Deanne Jade is a psychologist and one of the first eating disorder specialists in the UK; she has over 30 years of experience as therapist and trains practitioners in working with issues such as binge eating disorder, bulimia, anorexia, and obesity. She is the Director of the National Centre for Eating Disorders www.eating-disorders.org.uk
by Andy Hunt www.practicalwellbeing.co.uk
Writing thoughts and feelings about trauma or crises for as little as 15 minutes a day for as few as four or five days has been shown to be correlated with:
How to do the writing ritual
Write honestly and openly about your deepest feelings and thoughts about the situation you are in or went through. Try to make sure you keep these writings private (though of course in prison it may be difficult or impossible to do so) or you may find yourself unconsciously censoring what you write and diluting the effects of the writing . Consider destroying what you wrote after it is complete, again for the same reason.
Write for a relatively short time, say 15 minutes. This writing is often draining or emotionally difficult. Limiting the time makes it both a bit more tolerable and more likely that you will do it. Write for only four or five days. This time limit seemed to work very well in the experiments that were done. They are not carved in granite, however, and if you find you need more time, you can take it. One of the points of this limit of a few days is again to contain the experience so it doesn’t take over your life.
Try to find both a private time and place to write, ideally when you are less likely be interrupted (though again this may be challenging in prison setting). Don’t worry about grammar or spelling or getting it right. Just write. During the writing days, try to use the same time each day or evening to write. It’s not crucial, but it can sometime give your unconscious mind some structure and preparation time if it knows exactly when the writing will take place. This can also help contain the emotions and intrusive thinking that may occur.
Ignore these guidelines if you discover something else works better for you. Everyone is unique.
Sources
Opening Up: The Healing Power of Expressing Emotions, James Pennebaker, NY: Guilford, 1990.
The Writing Cure: How Expressive Writing Promotes Health and Emotional Well-Being, eds. Stephen J. Lepore and Joshua M. Smyth, APA: Washington, DC, 2002.
Bill O’Hanlon, M.S., Possibilities, 551 Cordova Rd., #715 Santa Fe, NM – PossiBill@aol.com, www.brieftherapy.com
Andy Hunt is a therapist, advanced practitioner and trainer of EFT (Emotional Freedom Techniques) and master practitioner and trainer of NLP (Neuro Linguistic Programming). His website is www.practicalwellbeing.co.uk
by Masha Bennett www.practicalhappiness.co.uk
Psychological trauma occurs when a person experiences a traumatic event, which usually involves a threat (or perceived threat) of death or serious injury to themselves or others. The common emotions the individual may feel in these circumstances involve fear, helplessness, shock or horror.
Traumatic experiences could include: road traffic accident, natural disaster, rape, assault, robbery, childhood abuse, combat situations, domestic violence, terrorist attack, torture, diagnosis of a terminal illness, traumatic bereavement and others.
Some people can feel traumatised following events that do not directly threaten life but are nevertheless shocking and deeply upsetting, for example, being made redundant, finding out that their partner is having an affair, having their home re-possessed, losing a beloved pet, being bullied, humiliated, criticised or blamed. Whist these events may not satisfy the “official criteria” for trauma, it is important to acknowledge that they could have a profound and lasting effect on our lives and that sometimes we may need help to deal with these “mini-traumas” – especially if we experience a number of these in our lifetime.
In the context of criminal justice, being arrested, charged, put on trial, incarcerated are potentially traumatic experiences that could exacerbate any existing trauma-related condition. Prisoner’s family members can be left traumatised directly or indirectly. Many prison staff are affected by incidents such as suicide attempts, assaults and other events that are not an uncommon part of prison life.
Post-traumatic Stress Disorder (PTSD) is diagnosed if the person who has experienced the traumatic event, continues to suffer the following symptoms after a month or longer after the event:
(a) Intrusive thoughts, flashbacks or nightmares, where the traumatic event is re-experienced; sometimes re-enacting the traumatic situation.
(b) Avoidance of people, situations or things that might bring on their intrusive symptoms (this may include self-medicating with alcohol or drugs in order to numb the feelings)
(c) Hyperarousal – physiological signs of increased emotional arousal, hypervigilance (constantly looking out for danger), increased anxiety or irritability, increased startle response.
An article by Claudia Baker, PTSD and Criminal Behaviour, quotes figures from research (presumably conducted in the US), indicating that among incarcerated populations PTSD has been found in approximately 48% of females and 30% of male prisoners, which does not surprise me (in fact I am guessing that these figures may be under-estimated). On the other hand, a review of literature by UK psychologists Goff et al. in 2007 quotes figures of between 4 and 21% PTSD in prison population – which to me seems to be an unrealistically low estimate, though the authors do acknowledge that women are disproportionately affected.
If my own experience of working with prisoners and hearing their life stories is represetnative, a very significant proportion of them have suffered not just a single traumatic event, but multiple, often chronic trauma, typically going back to childhood, and whilst it is important to acknowledge that traumatic experiences in themselves would not necessarily lead all sufferers to break the law, Claudia Baker’s article gives some examples of circumstances when trauma can be directly or indirectly linked to a criminal offence.
Effective treatment for trauma and post-traumatic stress is rarely available in prisons, and incarceration itself will often exacerbate the distressing symptoms. Current research evidence favours treatments such as CBT (Cognitive Behaviour Therapy) and EMDR (Eye Movement Desensitisation & Reprocessing), and evidence is also building up supporting the use of approaches such as EFT (Emotional Freedom Techniques), creative therapies (art, music, sandplay, writing, drama therapy), body-oriented psychotherapies (e.g. Sensorimotor therapy, Somatic Experiencing) and certain forms of hypnotherapy. In my clinical experience, each individual is unique and requires a unique approach, with no single technique or therapy being a solution for all.
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.
Some sources of information and support
Combat Stress (UK)
The Long Boat Home – directory of UK therapists offering reduced-cost treatment to ex-servicemen and women
Medical Foundation for the Care of Victims of Torture
Gift From Within – International organisations for victims of trauma and victimisation
by Masha Bennett www.practicalhappiness.co.uk
On the international Women’s Day 8th March, I have been reading some sobering facts and statistics about women in prisons. A few years ago I managed a drug rehabilitation unit at Her Majesty’s Prison Styal in Cheshire, and the repeated mention of this prison in the press was especially poignant for me.
The Guardian article from which I borrowed some of the above information, detals some truly harrowing examples of the level of distress and mental health issues that many of women prisoners are experiencing.
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 websites are www.practicalhappiness.co.uk and www.eft4addictions.co.uk.
References
Women Prisoners – Facts & Figures
Women’s Prisons in desperate need of reform, says former governor. The Guardian, 11 February 2012
Prisoner Self-Help 