If anyone ever comes across someone who is self-harming it can be very shocking. Whether it is a colleague, a client at work, a family member or friend, it can be very hard to know what to say or do to help that person. Very often we choose to do nothing.
It is our lack of understanding about this subject that often leads us to clam up and ignore it. Sometimes we can be so shocked and worried that we beg the person to stop or perhaps we might resort to using punishing tactics or bargains.
There is often an image that those who self-harm are very disturbed or mentally ill. In most Muslim cultures self-harm is not talked about or understood. The person may be treated in punishing ways by family as they know no other way of dealing with the issue.
We often assume that this person is suicidal, especially those who self-harm through taking too many prescription or over the counter drugs. This often means that the self-harmer will keep their harming secretive for a very long time before they ask for help.It also means that people who are approached by the person are at a loss as to how to help them. Even many professionals lack the training and knowledge to help clients or patients that self-harm. Families often panic when they realise their loved one is self-harming. As Muslims we need to help support someone when we find out they are hurting themself. It is our duty to tackle the issue head on.
Some facts about self-harm
• The UK has the highest rates of self-harm in Europe (NICE 2002)
• Approximately 25,000 young people are admitted to hospital after self-harming every year.
- This figure could be much higher because:
- Many cases are written off by hospital staff as being suicide attempts
- Many self-harmers pretend it was an accident or they were attacked.
- 1 in 10 people have self-harmed at some point in their teens (Samaritans)
- Young females are the highest risk group
- Self-harm is most common in young people, mostly starting at age 12.
- There are growing numbers of primary school children self-harming with the earliest reported cases at age 4.
- The number of recorded incidents is 2-3 times higher in women. However men are more likely to hide their self-harming or pretend they have been in a fight or attacked.
- Self harm is more likely to occur when a person is in an isolated environment, whether that be the home, prison or mental health hospital.
Why do people self harm?
Everyone self-harms for their own reasons however there are some factors that increase persons potential to self-harm.
• Having a family history of self-harm or suicide
• Drug use
• Low self-esteem
• Social isolation
• Bullying or abuse
• Sexual abuse in early life
• Early trauma
The main over-arching reason people self-harm is to try and cope with emotional distress.
Self-harm is often identified as a way of disassociating from past traumatic experience. And can become a coping mechanism for ongoing emotional pain in the present.
Self-harm and suicide
People who have been in hospital due to self-harm are 100 times more likely to commit suicide the following year
50% of the 4000 people who die by suicide each year have self-harmed.
Emergency services often misinterpret a persons self-harm as an attempt for suicide or a cry for help. The best thing to do is to ask them outright.
“There is no hazy line. If I’m suicidal, I want to die. I have lost all hope. When I’m self-harming, I want to relieve emotional pain and keep on living. Suicide is a permanent exit. Self-harm helps me get through the moment.” (Quoted from Department of Health women’s mental health strategy)
Suicide is a final end to ones life. Self-harm is a coping strategy to stay alive. The best way to find out if someone wanted to commit suicide is to ASK THEM!
How we can relate to self-harm?
When we find out someone is self-harming it can be very shocking. We often associate this behaviour with those people who are very ‘disturbed’ such as some extreme cases of psychiatric patients. Though in reality, there are far more people self-harming than we realise. We cannot understand why people might hurt themselves. But perhaps there have been times when we have self-harmed without realising that this is what we were doing.
Looking at self-harm as a continuum
Self harm can is literally behaving in ways that are destructive to the self. This may start with something that does not seem alarming at first, like skipping a meal or driving to fast when we are angry. When we look at those actions we might recognise elements of our selves in this and can somewhat understand why some people harm themselves in stressful situations. Very often we make a decision that we know is not the right one for us yet we do it anyway. This only makes us feel worse about ourselves and can lead us to further self-defeating behaviour. However, it can develop into more striking actions such as punching a wall, headbutting, hair pulling until eventually people begin to self injure such as cutting or burning the skin. Also staying in harmful relationships or leading promiscuous lives are also examples of self harm as it often stems from feelings of low self esteem and lack of worth.
Self harm and addiction
When the body had been injured in any way the brain releases various neuro-chemicals including endogenous opiates and serotonin. These are similar to heroin. This causes the body to feel a sense of calmness and wellbeing especially in difficult situations. In this way self-harming can produce the same effect as illicit drugs. It is the feeling that is produced as a result of the harm that the person ‘craves’ rather than the actual act of harming in itself.
Self-harm offers temporary relief from emotional pain. By focussing on physical pain the person no longer thinks of their personal problems and experiences the release of the opiates.
Craving: The person has an expectation that the feeling they will get from harming will be better than it actually is. This is because their memories of harming are laced with dopamine. They imagine the feeling of what it was like and an urge or a need to carry out the act of harming occurs. This is often known as ‘euphoric recall’ in the arena of addiction. When a person is prevented from harming this feeling can become very intense until they are able to carry it out.
Why do people self-harm?
Maslow’s Hierarchy of Needs
Research shows that those who self-harm often do so in situations where their basic needs as a human being are not being met. This is often why many people self-harm when they have lost something or someone, experienced some trauma or been isolated or housed in a secluded or enclosed environment (e.g. prison, hospital, hostels etc).
Growing numbers of refugees to Britain are self-harming especially among young males. These men have been through war, bereavement, low self-esteem, loss of homes etc and come to a country where they cannot speak the language. They have lost their sense of belonging and inner peace. They have lost most of their basic human needs and perhaps this explains why so many asylum seekers resort to self-harming.
Approaches to self harm
This approach focuses on immediate abstinence. The aim is to try and stop the person from harming in any way.
If the person is institutionalised, such as prison, hospital, psychiatric care etc, the staff will be informed of removing any items that could potentially lead to the person self-harming, such as shoelaces, sharp items and even less obvious items such as paper. In some extreme cases they may be given a room with only a mattress in with no sheets.
Techniques used by counsellors or therapists in the outpatient setting are through the promotion of abstinence and trying to get the self-harmer to stop the behaviour.
Cold-turkey can often lead to distressing and uncontrollable cravings to self-harm. Very often the expectation of what it would be like to self-harm is completely unrealistic, due to the dopamine-laced memories.
This approach has been criticised that it can make the persons will to self-harm even stronger. Research has proved that this is not the best way of working with people who self harm and that harm minimisation has had much better results in the long-term.
Harm minimisation approach
According to the Women’s mental Health: Into the Mainstream the aims of the harm minimisation approach are as follows:
• Adopt a non-judgemental approach in order to understand the reasons why the person is self-harming using active listening skills
• Working with the person to find more positive means of coping and expressing their feelings.
• Provide a means by which the person can address the core issues and underlying problems that led them to self-harm.
• Advising and supporting the person to address their injuries e.g. providing them with their own first aid box (except in life-threatening situations and where hospital treatment is needed).
• Empower the person as much as possible – make an agreement as to when it will be necessary to intervene with their injuries.
• Provide an arena whereby individuals can maintain as much dignity and control as possible.
Quotes from people who have self-harmed and professionals
“The most important thing is not to tell people to stop, but to listen to them, find out what they need to stop and help them find ways of achieving that. This way people heal in their own time. Telling people to stop makes them more secretive, more dangerous, and more dishonest about it. People need not feel threatened by people that are ultimately trying to help.” (Truth Hurts, Mental Health Foundation)
“People say that we only self-harm to get attention. Well then give us the attention. We want someone to talk to and open up to. If you ignore the problem it won’t go away”.
“I would become so angry that I would rather hurt myself, than someone else.”
“It was better for me to hurt myself than let someone else hurt me”.
“As I would cut myself, all my tension would seep away”.
Sometimes people find it hard to think of their own ways to cope with the urge to self-harm. The best way is to allow them to feel empowered as much as possible by allowing them to select their own methods without having to directly suggest them to them out loud.
Learning new coping mechanisms
While the person is attempting to come to terms with the past and make positive changes for the present and future they will need to learn new ways of handling things.
Self-harm is a way to cope with life and difficult emotions as we have already discussed. Therefore it is imperative to help the person find new ways of coping with stress, anxiety, difficulties etc.
Coping strategies may include:
When having an urge to use, it can be useful to delay harming. Initially starting for 15 minutes perhaps working up to an hour or more and eventually delaying until the next day and so on.
It is important not to feel too ashamed of oneself if they succumb to the urge. The idea is to try and keep delaying until the length of time between harming lengthens.
Urges come in peaks and waves. Imagine by delaying the urge, it usually wears off and passes.
Guided imagery/breathing exercises:
There are many useful imagery c.d’s available. Or one can go to ones own special place. This can help reduce stress, avert the mind and relax the body and regulate breathing.
Writing a journal or unsent letters:
Writing down our feelings can be a very therapeutic tool in trying to understand ourselves and our emotions. It may help us to achieve some release and allow time for urges to pass. Unsent letters can be particularly useful when feeling strong emotions for another person in a case that might cause more harm if we said these things to them face to face. It can also gain some closure for those people from our past who we are no longer able to communicate with in present times, especially those who may have become deceased.
Not everyone is able to put their emotions into words. Art therapy can be a useful way of expressing feelings and gathering a greater sense of self. Art in itself can be very calming and stress-relieving a is a great way of distracting oneself when feeling the urge to self-harm.
This is a very huge and vast topic and is a course within itself. Examples of modern organised philosophies include yoga and Tai Chi. However even going for a walk, and looking at beautiful scenery can be therapeutic and relieve anxiety and tension.
Establishing Balance and Harmony
In order to achieve a healthy recovery from any addiction including self-harm we must establish a routine that encompasses a sense of balance in our lives.
It is recommended that we excersise at least three times a week and this can include walking. Exercise produces the feel good factor because the brain releases serotonin.
The acronym SMART has a number of slightly different variations, which can be used to provide a more comprehensive definition for goal setting:
S – Specific, significant, stretching
M – Measurable, meaningful, motivational
A – Agreed upon, attainable, achievable, acceptable, action-oriented
R – Realistic, relevant, reasonable, rewarding, results-oriented
T – time-based, timely, tangible, trackable
This provides a broader definition that will help you to be successful in both your business and personal life.
When you next run a project take a moment to consider whether your goals are SMART goals.
• Well defined
• Clear to anyone that has a basic knowledge of the project
• Know if the goal is obtainable and how far away completion is
• Know when it has been achieved
• Agreement with all the stakeholders what the goals should be
• Within the availability of resources, knowledge and time
• Enough time to achieve the goal
• Not too much time, which can affect project performance
Once the goal has been established and set. We need to work with the person to help them to believe that it is possible.
Lynne Ali-Northcott MSc (Addiction Counsellor)