seeking help

The mere possibility

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Warning: This post might be triggering for those affected by suicidal thoughts.

I’m not suicidal as I’m writing this, but I’ve thought about it a lot.

Conversations with mental health professionals after the event play out again, and again, and again in my head. There is one thing in common, in every one when asked some version of “Why didn’t you call before you did something?”, my response (should I choose to say it) would be “That I didn’t think you’d take me seriously”.

I’ve never experienced this myself, because I’ve never interacted with an NHS crisis service before the event, as I have no confidence in my own ability to tell if I’m about to hurt myself, so taking the risk of having someone else tell me the same thing deters me. Unfortunately I also know people who have spoken to crisis services before acting and been told that they wouldn’t be seeking help if they were really suicidal.

This is the tricky bit. I know when an incident is on the horizon. However when I’m stuck in the middle of one I feel incapable of reaching for help until it has resolved to the point I’m in need of A&E, minor injury, or I no longer plan to do anything, and just want to tell someone so it isn’t a secret or burden to hold forever.

I don’t know how to get away from the fear of being judged by a professional. There are amazing people who work in mental health services, where I have felt safe and not judged, but just the knowledge it is a “luck of the draw” whether I get a professional I can talk to or not is enough to make it really hard to initiate.

The fear of being judged permeates assessments by professionals, depending on the professional I’ll disclose different parts of my story, all of it true, just focussed on the stuff they already know, or sometimes (when with a more difficult professional) can’t do anything to make the situation any worse. I see all professionals on a spectrum from “perfect” to “awful”, so my stories go on the spectrum as well. The closer to “perfect”, the more of my story you get, and the more you get, the more I believe you can help.

Intrusive thoughts are restricted so tightly I’ve only initially disclosed them when already in significant distress as a last resort for finding help. On the plus side, the existence of them was written in my notes, so more professionals became aware, and eventually I could talk about them with my normal psychiatrist. I probably would have been comfortable discussing them anyway with the people I talked to, but having their mere existence in my notes gave me a starting point, and they started the conversation so I felt confident it wasn’t “attention seeking” behaviour.

And that brings me onto another part of a fear of being judged. A fear of being seen as “attention seeking”. I haven’t had this said to me, maybe because of the lack of attention I seek to avert an incident, only afterwards when there is a concrete physical ailment to treat.

The best I can do is honestly briefing a professional how I’ve been, not how I think I’m going to be. The past seems set in stone, I can’t alter my current behaviour to make my past more attention seeking. Discussing the future on the other hand (especially when my “choice” to self-harm is emphasised…).

If you can reach for help before something happens, then that is great, don’t feel bad about doing so, unlike me…

Motivation for self-harm, and alternatives

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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 forgetting 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

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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!