Trusting professionals

Lately I’ve been experiencing a large number of thoughts around self-harm. This has started my thinking about who do I trust to tell about them. The answer is, very few people, and just two professionals.

Trusting professionals is the subject of this post.

When I’m in crisis I’m advised to call the local CRHT (crisis resolution and home treatment) team. I don’t, ever. I am too terrified that I’ll call and be accused of threatening to self-harm. I don’t trust the CRHT to help me, and I have too many friends who have been dismissed by the CRHT as not at risk.

Comments made about me by professionals express that I’m too high functioning to need continued access to support, with the same arguments for removing me from the ward now being used to justify discharge from the CMHT (community mental health team). The reasoning being, that they don’t appear to do anything for me.

Then there is the incredibly common expression by psychriatric staff “it’s your choice to [self-harm/kill yourself/…]”. It doesn’t help, at all, it just works as a way to absolve the staff member of any responsibility to help you. This isn’t personal, it is just how they always respond, with the idea being that this will provide you with the willpower to not hurt yourself. It does not consider the case where you actually want to hurt yourself as it doesn’t feel like there is another option – they don’t explicitly provide another option. This also gives the staff grounds to disregard whatever you do to yourself as “your choice”, “your responsibility” and ignore the emotions and distress that led to the action. When seeing a psychologist this doesn’t happen, they understand that this method is extremely unhelpful and acknowledge your distress. Unfortunately staff are trained that reacting to your distress or expressed thoughts is a bad idea on the grounds that it encourages you to express yourself that way for attention. I’ve found it really doesn’t matter how little attention they issue, it doesn’t put me off self-harming, as the goal is internal and for me only, how they react isn’t relevant.

From my point of view that means I might as well self-harm without telling them, then they can’t accuse me of being attention seeking or say anything at all; at that point all that’s left to do is patch up and prevent any serious damage and send me out into the real world again (as stated by my care plan).

The staff reaction isn’t all bad. When I encounter A&E staff who are trained in treating physical problems I have found them sympathetic, supportive and worried. In a way I’m lucky, my diagnosis is OCD. If it was BPD there is a significant chance it might be the other way around.

Onto my two professionals, a psychiatrist, with whom my time is coming to a close. I did get more than the maximum allocated 20 sessions, which I am glad of – just 20 wouldn’t have been enough. The other is a social worker who has helped me navigate the benefits system and access a psychiatrist when necessary.

However I am going to lose both of them shortly, as I haven’t had any serious incidents since September (barring attempting to burn myself earlier this week). As such I am no longer view as appropriate for the CMHT to follow me.

The part that puzzles me is the remark that “my crisis plan will remain in place, with some follow up by CRHT”. It feels like it won’t matter how bad I get, I will not ever be brought back onto CMHT support. I do not like that. It feels that if I’m going to be at risk of hurting myself, I should still be on the CMHT, not the treat any phsyical problems, then discharge ASAP from A&E plan.

I have to admit this post isn’t the most cheerful, and is very busy expressing how I feel. That last paragraph is only expressed here, hasn’t been said anywhere else, and I wish it was, hopefully I’ll find a moment with a trusted professional to express that…

I don’t find it easy to trust staff, as there are way too many of them and they all react differently, trust only comes with extended positive interactions, which are rare.

Sorry I haven’t edited the post, it was too anxiety provoking to go back through it.

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Motivation for self-harm, and alternatives

Trigger Warning: This post discusses self-harm, and references feeling suicidal.

This post’s focus is the often invisible self-harm that happens without people noticing it, normally. I explore the causes of myself having self-harmed in the past.

See here for help on minimising the harm you do to yourself. Some techniques I’ve found useful are snapping an elastic band against yourself, punching a pillow or sofa or running. Distracting yourself is a good option as it lets the emotions dissipate so you don’t end up harming yourself (see this post). I often count from 1-8 again and again when feeling anxious.

Should you ever want to kill yourself call someone you trust, a service like Samaritans 116 123, your local CRHT (if you have the number), or just 999. If you don’t live in the UK the numbers you have access to will be different.

Punishment

Self-punishment is a way of trying to cope with some “crime” you feel has been committed by you. It only emphasises the “crime”, and the goal is to make you feel worse as the punishment.

The crime could be an unwanted intrusive thought, or something like fogetting a chore. The action can be tiny, with no-one else aware of it, but to you it feels significant. A rational response would be to acknowledge that it happened, and move on, which is what you have to do in the end.

As the least extreme example (and not in the self-harm category) you could say not watch a series you like on Netflix, or make yourself go to bed early. This just emphasises that you were unhappy with the action, but, as I’ve found, isn’t any good at preventing it in future, as I just obsess over the mistake more.

At the other end of the spectrum you could feel you deserve to die for the action, and take some steps to do that.

Inbetween the two extremes are superficial cuts (where the cut draws blood, but doesn’t need treatment), serious cuts (which need treatment or leave very nasty scars), and burning. Any self-harm can leave a mark.

The main effect of the self-harm is it’s shock value as I find I am now well and truly distracted as I’ve done something worse that the original problem!

This gets out of control for me. As a tolerance develops to the mild self harm, so more extreme self harm is used to get the same shock again. This escalates quickly and is dangerous. I (back when it was a major issue) ended up taking it too far, and ending up in A&E, which persuaded me to stop it for a while, although not forever, the cycle repeated a few times.

It’s not an issue for me at the moment though. After seeing a psychologist I’ve found it easier to accept that I’m OK and that I mess up, but it isn’t such a big deal.

Venting emotion

When suffering a mental illness the distress felt can feel like it is inexpressible. So damaging yourself is viewed as an option.

The type of self-harm used and how extreme it is varies between people. I’ve found I tend to ramp up how severe it it is quickly, as I use it as a last resort to vent, and then next last resort is always worse than the previous one. I do know people self-harm regularly, every day a consistent amount without it getting worse over time.

Hitting something soft or smashing ice cubes is a safe way to vent aggressive emotions as it doesn’t cause any damage.

If you’re unbearably sad cozying up in a blanket is a good way to make yourself feel better.

Obsessing over self-harm

Sometimes I find my mind obsessing over self-harm, and I think about a specific way to hurt myself, again, and again, and again; which gets exhasting to just not hurt myself despite my mind thinking about it. For me, at least, this is part of suffering from OCD; what you obsess over can vary massively between different people with OCD, so some people may not even consider it.

Exhasting to just not hurt myself

Me

After several days of my mind obsessing over it it can feel easiest to just harm myself to get rid of the thoughts. That’s pretty much what happened today when I cut myself, the worst incident in a while.

Conclusion

The thoughts behind the self harm vary a lot, but the results appear the same, and none of it is ideal. Professionals refer to it as a maladaptive behaviour, as opposed to an adaptive, healthy response.

It can feel like you’re cheating by distracting yourself, or minimising the distress by not self-harming. You’re really not, you’re just coping differently in a way that will last and be usable forever.

The real value of distraction

Trigger Warning: Post discusses self-harm and avoidance strategies.

Distraction

When interacting with mental health professionals they often advise you to distract yourself to avoid doing something dangerous.

It can feel like they’re being dismissive “just distract yourself”.

Sometimes distraction really doesn’t work, but most of the time it just buys time. Buying time is valuable though, often the impulse to do something dangerous isn’t strong enough to last a significant amount of time. By distracting myself Igive time for the impulse to fade, and when it does, I’ve “won” – I haven’t hurt myself.

For example, today, I wanted to burn myself. I don’t keep a kettle on hand, which means heating up water to burn myself in a saucepan is going to take a significant amount of time. Today, by the time I’d put water in a saucepan, and started heating it, the impulse faded giving rise to the thought “what on earth am I doing”, at which point I poured the water down the sink and went out.

Usually 20-40 minutes is the estimated time for a normal impulse to last. The problem is when I disassociate, as that can last for hours, or even days. Disassociation is a when I feel disconnected from reality, and it’s as if my mind is still operating, but I’ve lost control. The best analogy I have found is it’s like being in a car, with the brakes broken, accelerator locked down and doors jammed, hurtling towards the edge of a cliff. You can steer to adjust how you fall, but you can’t avoid falling off the cliff.

It’s like being in a car, with the brakes broken, accelerator locked down and doors jammed, hurtling towards the edge of a cliff. You can steer to adjust how you fall, but you can’t avoid falling off the cliff.

Me

There’s very little that can be done to prevent me from hurting myself in that scenario, unless another person realises what is happening and gets in the way. As I’ve discovered that is incredibly unlikely, see below about seeking help.

Similar strategies can work. In this scenario I find myself tricking myself into doing a quite long sequence of steps is needed to be completed before I can do that final action of self-harm.

The steps can include procuring the items I need, decontamination related to my OCD, or tidying up my room/flat under the reasoning that whatever happens I’m left with nothing to clean up, or whoever has to deal with what I’ve left behind isn’t left with much to do if I’m suicidal.

Seeking help, personally

Trying to indicate to someone that I need help when distracting myself is something I find incredibly difficult. When in crisis I can’t justify threating to do something dangerous or preventing myself from doing whatever it is. Hence the most I can justify is giving a minimal indication that something isn’t right. Generally people will have no idea that it indicates a crisis, but if they know me well enough they might or might not realise what it means. So technically I’ve left it up to an unlikely chance whether someone stops me, which as far as I’m concerned at the time isn’t the same as getting someone to stop me.

Part of the difficulty in seeking help is wanting to avoid being viewed as threatening to do a dangerous act. Not really seeking help is, as far as I am concerned at the time, very much not threatening to do something. From my point of view as I’m not actually saying anything about doing something dangerous.

Included in that is that I don’t want to bother anyone if I’m not actually going to hurt myself. Unfortunately by the time I know whether or not I’m going to it’s too late to seek help, as I’ve already done or not done it.

There’s also the fear that I’m not worth the help and support. As far as I can tell that is entirely irrational. At the time though, it’s hard to believe that.

A lot of the time when professionals realise something is very badly wrong, it’s way too late and I’m already need A&E for treatment.

I have requested help before a crisis, but it’s usually a long time before when there isn’t any immediate threat.

That can make helping me difficult, as I’m aware, and make me seem unpredictable. I’m not sure how to break the thought patterns so that seeking help is viewed as a valid option.

If you can seek help, do!