self-harm

What is real right now?

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Trigger Warning: this post discusses thoughts of suicide and self harm

Definitely real (at 23:49)

  • I’m anxious
  • I’m awake

Possibly imagined (as of 23:53)

  • I’m too anxious to sleep
  • I felt suicidal
  • That the red card (meltdown/crisis indicator) I put on my ward room door earlier was justified

What I think, on my anxiety level

I’m feeling lost in my mind. I feel that my anxieties about the impact the Covid-19 are real, but I don’t know if they’re any worse than everyone else’s.

For (high anxiety)

  • I inflicted pain on myself
  • Cut skin on my arms with my teeth (not that effective though).
  • Had suicide present as a real option to resolve a problem.
  • Being unable to go for a long walk removed an significant coping strategy

Against (normal anxiety)

  • When talking to my care coordinator earlier we got disconnected, and she didn’t ring back, presumably because she felt I was repeating the same anxieties as on the last call to them 2 days ago.
  • Ward staff waited 3 hours to respond to my crisis indicator (suggesting that they thought my feelings would be transient)

What I think, of crisis response

That it appears the ward staff have decided the best course of action in the event I am anxious is to ignore it, hoping that it dissipates. If it doesn’t, then offer me PRN and suggestions of coping strategies I’ve already exhausted, before finishing with that I need to talk to them so they can help, despite the indicator showing that means that I feel unable to talk.

For (me)

  • Leave any anxious person alone long enough (say 4 hours) and the anxiety will fade, even if it’s unpleasant for the anxious person.
  • They did ignore my red indicator, and remarked that I should have gone to the office (I did, but froze and turned back – too anxious to wait).
  • I was so anxious that relaxing made me cry (crying was suppressed as I was frozen up)

Against (me)

  • I did eventually fall asleep, however briefly 4 hours later, so maybe and crisis wasn’t a “real crisis” (remark by nurse on duty)
  • I seem to have upset every staff member I’ve come in contact with today

What I think, of me being alive

If I’m dead I can’t spread the Covid-19 disease, so why not end it all? I’ve got an untested plan for killing myself on the ward, but haven’t used it as if I get caught before completion I probably won’t get another chance.

For (do it)

  • If I’m dead, I really can’t infect anyone else (at least not in a way that’s my fault)
  • The staff used PPE (gloves, surgical mask and flimsy plastic apron) when dispensing medication this evening, suggesting that I am a real contamination threat.
  • The staff don’t know I felt suicidal earlier, so they can’t mitigate what they don’t know about. I don’t even want to tell them after how dismissive they’ve been of the anxiety.

Against (don’t do it)

  • Everyone else will still be alive and infecting each other.
  • Everyone is a threat, not just me, I’m just lost in trying to comprehend how big (or not) of a threat I am compared to everyone else.

What I think, of remaining on the ward

I can see the perks, food, reasonable clean facilities, and I won’t be left with an escalating mess in my room, but the loss of freedom is a big deal, I really want to go for long walks to deal with anxiety.

Don’t need a for/against. I’ve already done it in my thoughts.

Conclusion

I’m losing confidence in my ability to assess my anxiety level, with the reactions of staff, and the general population’s anxiety level impacting my assessment.

It’s a training issue…

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Met a a CPN (community psychiatric nurse) (lets call him Mark, not his real name) on Tuesday for an assessment. He had training in handling difficult behaviour.

It’s not what you think, his training focussed on understanding why someone would do something, and how to work with them.

So his first response to me self-harming is why did it happen, not how to deter or stop it. Although how to avoid it happening does come later, and the procedure is based on understanding the person.

He did understand that a lot of staff didn’t really want to focus on the triggers, just avoiding the problem of self-harm, especially when they are the triggers. Obviously 99% of staff don’t have the behavioural training, I really wish they did.

Oh, and as a double-plus I found out that my current social worker definitely subscribes to the same view as Mark, I’d suspected that beforehand though, as her behaviour towards me indicated that.

This gives me a bit of hope that the CMHT might be able to help me.

P.S. I’m an unusual case for Mark, usually he’s called in to deal with aggressive/uncooperative behaviour, that isn’t me, but he was still the best option. For me it was that stuff triggered me to self-harm, but most staff had (some?) trouble figuring out how to help and reduce incidents.

P.P.S I’m not sure just giving all staff behavioural training would work, as some have been on the job for long enough that their mindset that “the patient is always the one at fault, not the system they’re in, and definitely not any staff”. I’m not sure what would be required to fix that, other than making sure that new staff don’t develop the mindset so that eventually it’ll disappear as staff retire.

Almost, but not quite 😁

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So tonight I almost burnt myself, but pulled back at the last minute.

Unfortunately I did spent more than 75 minutes procuring the means to burn myself, and I cut (superficially) earlier.

I’m gonna call this this a victory. I still have the means, but I haven’t used them.

What got me distracted? Had a new phone which had all the wrong ringtones, so I had to copy them from my old phone onto the new one, and pick the right ones. It was a mundane task, but having my new phone just the way I like it made me feel better (the old phone probably stopped charging because the charging port had too much water/cleaning damage).

I did call the local crisis team as well, just had a quick chat with them about what I would be doing tomorrow and later in the evening, when they asked for details, not much time spent on the self-harm. Not sure how helpful it was, but I didn’t harm myself afterwards, so it can’t have been all bad…

I don’t know about tomorrow, or the day after, but for tonight, I’m good.

P.S. Was assessed by the occupational therapist on the local CMHT on Tuesday. She was really nice, and somehow made me feel safe describing a lot of the rituals that I go through as part of my OCD. Guess the confidence is a psychology staff thing, only seems to really exist around them. Just to be clear, safety exists with other staff, but psychology staff get to the “safe zone” a lot faster somehow (ie. not after lots and lots of meetings).

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.