Prisoner Self-Help

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Archive for the tag “trauma in prisoners”

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

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.

Prisoners and Psychological Trauma

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

UK Trauma Group

Combat Stress (UK)

The Long Boat Home – directory of UK therapists offering reduced-cost treatment to ex-servicemen and women

National Center for PTSD (US)

Iraq Vets Stress Project (US)

David Baldwin’s Trauma Pages

Medical Foundation for the Care of Victims of Torture

Gift From Within – International organisations for victims of trauma and victimisation

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